Vaccines: Tick-Borne Encephalitis

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: Tick-borne encephalitis vaccines contain inactivated viruses. Current vaccines appear to protect against all circulating Western, Far Eastern, and Siberian subtypes of tick-borne encephalitis virus.

2. Indications: Tick-borne encephalitis vaccination is recommended in inhabitants of or visitors to endemic regions (see Tick-Borne Encephalitis). As of October 2020, regions with focal endemicity include Estonia, Latvia, Lithuania, Russia, and Slovenia. Other countries with reported cases include Albania, Austria, Belarus, Bosnia, Bulgaria, China, Croatia, Denmark, Finland, Germany, Greece, Hungary, Italy, Mongolia, Norway, Poland, Republic of Korea, Romania, Serbia, Slovakia, Slovenia, Sweden, Switzerland, Turkey, and Ukraine.

These vaccines are not available in Canada or the United States. Visitors to endemic regions should consult with a physician at their destination of travel if they are performing high-risk activities, including:

1) Forestry work, hunting, farming.

2) Camping in wooded areas, with the highest risk at altitudes <1500 meters.

3. Contraindications include general contraindications for all inactivated vaccines plus a history of a systemic anaphylactic reaction to neomycin, gentamicin, protamine, or egg white.

4. Immunization schedule: The primary vaccination series is 3 doses administered IM in the deltoid muscle at 0, 1 to 3, and 6 to 15 months. After 2 doses, specific antibodies are detectable in 90% of vaccinated individuals. Vaccination should be started in the early winter months to achieve full protection prior to peak tick season. Administer booster doses every 3 to 5 years, depending on vaccine formulation used. The accelerated vaccination schedule is 2 doses 2 weeks apart followed by a third dose after 5 to 12 months (FSME-Immun); or 3 doses on days 0, 7, and 21 followed by a fourth dose after 9 to 12 months (Encepur Adult).

5. Adverse events: Transient erythema at the injection site (≤45%), fever (≤5%).