by P. Taba, E. Schmutzhard, P. Forsberg, I. Lutsar, U. Ljøstad, Å. Mygland, I. Levchenko, F. Strle and I. Steiner
European Journal of Neurology, in press
Tick-borne encephalitis (TBE) is a vector transmitted viral infections of the central nervous system, with an increasing health burden in Europe. The occurrence of TBE shows a tendency for prolongation of a season and extension to new geographic areas – to North and South Europe, and also in higher altitudes. The total number of TBE cases has shown an increase during recent decades, that might be associated with an occupational exposure, growing migration and travel, and outdoor leisure activities. Also climate changes favourable for ticks, have been attributed as a possible factor for expanding areas, as affecting the pathogen transmission.
With increasing travelling to endemic regions, TBE has become an international problem, and also neurologists in non-endemic areas should be aware of this disease with a significant morbidity. To address the risk for travellers, implementation of risk strategies has been suggested by WHO. Due to these emerging developments, TBE is included into the list of notifiable diseases in the European Union, as having an underestimated risk but available preventive measures.
TBE may cause long term neurological sequelae. There is no specific therapy for TBE but symptomatic treatments are inctroduced, including intensive care interventions in severe cases. Therefore, specific immunization remains the best strategy to prevent the disease. Vaccination against TBE is recommended for people living or travelling in endemic areas with a risk for the exposure of ticks; an example of Austrian prevention strategies has shown that extended TBE vaccination is beneficial in health care and economic prospects.
Still, diagnostic procedures and management of TBE vary through different countries as there are no standards and no previous guidelines, though vaccination recommendations have been published by the WHO and the International Scientific Working Group on TBE (ISW-TBE). The purpose of the Task Force on the diagnosis and management of TBE of the European Academy of Neurology (EAN) was to systematically review relevant publications, and to generate a consensus review to provide recommendations on prevention, diagnosis and clinical management of TBE.
Professor Pille Taba, Professor Erich Schmutzhard and Professor Israel Steiner are in the Management Group of the EAN Scientific Panel on Infectious Diseases.