Neurology-Online

TBE vaccination

Synonyms

Tick vaccination

introduction

When spring is drawing to a close and the temperatures are slowly rising again, the annual warning notices in magazines and television come punctually with the first rays of sunshine: "Caution, TBE." In many places you can read at the same time that it is best to have TBE -Do vaccination to be on the safe side. But when is a TBE vaccination necessary, how does it work, and what are the risks?

What is TBE?

First of all, TBE refers to early summer meningoencephalitis. The term meningoencephalitis refers to inflammation of the brain. This is potentially life-threatening and represents a neurological emergency. Responsible for this inflammation is the TBE virus, which in Germany is mainly transmitted through the bite of the tick. The virus is found in the tick's saliva.

In high-risk areas, around every hundredth to twentieth tick carries the TBE virus - that means: a tick bite does not necessarily mean a TBE infection. According to the RKI, high-risk areas are the entire federal states of Bavaria and Baden-Württemberg, as well as adjacent areas. Only in the greater Munich area is the risk slightly lower. No uniform tendency can be identified for the rest of Germany; in principle, conurbations with a high proportion of forests and meadows are naturally more affected. A detailed TBE map can be found on the RKI website (Robert Koch Institute).

A vaccination recommendation is made by the STIKO (permanent vaccination commission of the RKI), however, only for the risk areas identified by the RKI and described above. In addition, according to the RKI, TBE vaccination is only necessary for people who have a lot to do in the forest due to work, for example foresters or agricultural workers. The group of people for whom a TBE vaccination is strongly recommended is relatively small.

If you still want a TBE vaccination, this can be carried out by your family doctor. The costs, risks and vaccination in children are discussed below.

Further important information can be found at:

Inflammation in the brain
TBE

procedure

It is important to have the vaccination entered in the vaccination certificate so that there are no mix-ups

The most commonly used vaccine is "Encepur“A triple vaccination. For each of the three vaccinations a dose of the active ingredient "Encepur"A 0.5 ml should be injected into the muscle. When the doctor visits, a dose of 0.5 ml of the vaccine is injected directly. It is an adsorbate vaccine that is injected into a muscle - preferably the upper arm muscle.

With the timing of the TBE vaccination, a distinction must be made which vaccine is used. Both vaccines have in common that they are administered 3 times in total.

The first vaccination dose is not enough, however, so a second vaccination must be given after 1-3 months. The third and final vaccination then takes place 9-12 months after the second vaccination. This vaccination schedule provides basic immunization for 3 years and is recommended for people who need permanent protection. If a vaccination with Encepur is carried out, the 3rd vaccination takes place approx. 9-12 months after the 2nd vaccination. If you are vaccinated with TBE-IMMUN, the 3rd vaccination takes place 5-12 months after the 2nd vaccination.

For people who are planning a trip to a TBE risk area and therefore want to be vaccinated, this vaccination schedule is of course far too inflexible and lengthy. Therefore, a faster vaccination schedule can be carried out: After the first TBE vaccination, on day 0, the second vaccination takes place on the 7th day and the third vaccination on the 21st day. Thus the TBE vaccination is already completed after 3 weeks. Vaccination protection can be expected 14 days after the first vaccination.

The disadvantage of this fast vaccination scheme is that the immunization only lasts for a maximum of 1.5 years and adequate vaccination protection is no longer guaranteed after 12 months.

Is it a dead or live vaccine?

There are two possible vaccines against TBE.

Both TBE vaccinations are dead vaccines. This means that an inactivated TBE virus is injected into the body. This is, so to speak, a dead virus that can no longer multiply. This triggers an immune system reaction in the body of the vaccinated person, although it is not very pronounced. The virus is grown in chicken cells. Despite the fact that it is a dead vaccine, an acute illness should be discussed with the doctor before vaccination.

You might also be interested in: Vaccinations for adults

What to do if you are allergic to egg white?

In the case of a chicken protein allergy, particular attention should be given to which vaccinations are carried out. Both available vaccines against TBE are made with the help of chicken cells. As a rule, the vaccinations only contain traces of chicken protein. These hardly trigger any allergic reactions. However, if a chicken protein allergy is clinically noticeable, i.e. accompanied by pronounced symptoms, the TBE vaccination should only be carried out if it is really necessary. Then the vaccination takes place under close medical supervision.

TBE vaccination and MS

It is speculated that a TBE vaccination can cause multiple sclerosis. However, no direct connection between a TBE vaccination and the occurrence or triggering of MS can be proven. Since the TBE vaccination is a dead vaccine, the immune system is not influenced as much as with live vaccinations. A vaccination against TBE can also be carried out after a detailed examination of the benefits and the associated risks of MS. However, this should be discussed in detail in advance with the doctor treating the multiple sclerosis.

More detailed information about the disease "Multiple sclerosis" you'll find here

Can you vaccinate despite having a cold?

A cold is not automatically an exclusion criterion for a TBE vaccination. However, one should exercise caution in such a situation and always keep close consultation with the vaccinating doctor. If you have a severe cold, your body is weakened and may be over-sensitive to vaccinations. Therefore, if symptoms occur, such as fever or shortness of breath, the vaccination should be postponed if possible. If a fever develops shortly before the vaccination, the doctor should be informed.

Risks

For all age groups, vaccination should only be carried out if you are in good health, otherwise there is a risk of the disease getting worse. Vaccination should be carefully considered in brain-damaged patients or patients undergoing immunosuppressive therapy. Examples include post-transplant condition, HIV infection, and chemotherapy. In individual cases, however, your family doctor can give you precise information as to whether the risk of a TBE vaccination is currently too high.

Every vaccination also carries the risk of an allergic reaction. While this is extremely rare, it can be potentially life-threatening. However, staff and doctors are trained and prepared accordingly for these exceptional cases, so that the risk remains very low.

Side effects

What are the potential side effects of a TBE vaccination?

As with any other vaccination, TBE vaccination can also have side effects in very rare cases. These are usually very harmless and only last a short time. Especially in young patients, such as babies and toddlers, the first TBE vaccination can lead to an increased fever.

Since the purpose of a vaccination is, among other things, to get the immune system "out of reserve" and to familiarize it with the virus, symptoms of illness can occur after the vaccination if the immune status is weak. These range from general malaise and flu-like symptoms to sweating and a fever of around 38 degrees. This is more common, especially after the first vaccination, when the body has not yet got used to the virus. A reaction to the vaccination dose can also fail completely.

In about a third of all vaccinated people there are small changes around the injection site. These include slight redness and swelling caused by the injection of the vaccine into the tissue. This reaction can be perceived as very unpleasant, especially by children. However, it usually goes away by the next day. Occasionally, this can also lead to pain. However, these are usually only weak. In some people who have been vaccinated, the area where they were vaccinated has hardened for a few days and reacts to pressure with slight pain. All of these local side effects usually last a few days and are very harmless.

Occasionally, a TBE vaccination can lead to more general side effects such as fatigue, tiredness and headaches. Occasionally, you may also experience nausea, vomiting, diarrhea, fever, and chills. These too are usually short-lived and not very pronounced.

Serious side effects, such as an allergic or even anaphylactic reaction, are very rare.

Also read: Rash after vaccination

fever

The TBE vaccination can lead to various side effects, which manifest themselves as so-called "general symptoms", i.e. affecting the whole body. These include fever. Some vaccinated people may experience a slight rise in body temperature for a few days, because the body reacts to the foreign substance and has to process it.If there is a sharp rise in temperature, night sweating or even a febrile seizure, a doctor should be consulted.

diarrhea

One of the possible, albeit very rare, side effects is diarrhea. This is one of the general symptoms that affect the whole body, such as nausea or fatigue. Due to the TBE vaccination, the body is temporarily a bit weakened and has to process the vaccine. This can also manifest itself through diarrhea. As a rule, however, this is only short-lived and not very pronounced. A doctor should be contacted if severe diarrhea increases over several days.

nausea

In rare cases, nausea can occur after a TBE vaccination. This usually only occurs in phases, for example for 1-2 hours, and is not very pronounced. The phases of nausea usually occur up to a few days after the TBE vaccination. They are a sign of the natural weakening of the body by the vaccination and do not require any special treatment. However, if the nausea persists for several days and gets worse over time, medical supervision is necessary here as well.

Duration of side effects

The duration of the side effects depends on the symptoms, the immune system and the general physical condition of the vaccinated person. Smaller reactions in the immediate vicinity of the puncture site usually go away after a few days. Depending on the person who was vaccinated, the duration can be as little as one day, but occasionally these side effects can extend to 2-3 days. More general symptoms, such as nausea or fever, are usually of similar duration, but can last for 4-5 days.

What happens after the vaccination?

refreshing

A booster takes place depending on whether a fast or a slow basic vaccination was carried out. While with the fast (3 weeks) Basic immunization the vaccination protection expires after 12-18 months, if this is the case with the slow (12 month) Given immunization for up to 3 years. The frequency of refreshment also depends on the patient's age.

The following applies to the quick vaccination schedule: The first booster should be done after 12-18 months for each age group. From the first booster, a further booster must be carried out every 5 years for the age group 12-49 years and every 3 years for the age group over 49 years in order to maintain the vaccination protection.

For the slow (conventional) The vaccination schedule applies: The first booster should take place after 3 years, regardless of the patient's age. For the following refreshments, the interval in the age group 12-49 years is also 5 years, in the age group 49 and older also 3 years.

It is important to enter the vaccination in the vaccination certificate. as this means that mix-ups and shifts can be ruled out. In the worst case, the year is mixed up and the patient is not vaccinated for a year.

When can you do sports again?

In any case, exercise should be avoided on the day of vaccination. Exercise always puts a strain on the immune system. The body is put under stress through vigorous exercise, which results in the release of the stress hormone cortisol. Cortisol, in turn, inhibits the immune system.

After a vaccination, however, this already has enough to do with dealing with the inoculated virus sample. This is not a good prerequisite for staying healthy.The recommendation not to do sports after a vaccination is not due to the fact that the puncture site could cause pain during sports, but rather that the immune system should be protected. After all, after a vaccination, the body is more susceptible to pathogens that we usually encounter every day and which otherwise do not pose a major problem for us.

As a rule, sport can still be done after a vaccination without the vaccination becoming less effective. However, the body is weakened after the TBE vaccination and should be given some rest to recover after the vaccination. Therefore, after a TBE vaccination, you should not do any sport on the same day. This protects the body and enables it to process the vaccination better.

Sports can be resumed the day after the vaccination, but attention should be paid to any warning signals from the body and, if necessary, exercise should be reduced.

More on this: Can you do sports after a vaccination?

When can I drink alcohol again after the vaccination?

Generally nothing speaks against drinking alcohol after the TBE vaccination, as the effectiveness of the TBE vaccination is not reduced by alcohol. However, alcohol weakens the body, as energy is needed to break down alcohol. Therefore, it does not make sense to weaken the body if it is already weakened by the TBE vaccination. If the alcohol consumption is only a beer or a glass of wine, this is quite harmless, but heavy alcohol consumption shortly after the TBE vaccination should be avoided.

costs

If you decide to have a TBE vaccination, it depends on your health insurance company and your place of residence whether the costs for the vaccination are covered. Almost all health insurance companies pay for the vaccination if the place of residence is in a designated TBE risk area. In addition, some health insurance companies cover the costs if a trip to a risk area is pending. For more information, the doctor should be asked in advance and the responsible health insurance company should be contacted in order to clarify the amount of the costs and their possible coverage.

The cost of a TBE vaccination is around 3 times € 40 per patient. Basic immunization costs just under € 120 per person plus costs for the vaccination itself - should the health insurance not cover the vaccination. The cost of a TBE vaccination, however, depends on the vaccine and possible costs for the doctor who carries out the vaccination. For this reason, additional costs may apply. You should therefore expect an average price of around 60 euros for each individual vaccination appointment.

Who bears the costs?

The costs of the TBE vaccination are not covered by all health insurance companies. For example, it depends on whether the health insurance company classifies the TBE vaccination as a protective vaccination or not. If it is classified as a vaccination, the costs of all people who live in a TBE risk area or count as a risk group due to their occupation are covered. Some health insurance companies also cover the costs of the TBE vaccination regardless of these factors.

Another possible criterion is the TBE vaccination as a travel vaccination before a stay in a risk area abroad. If anything is unclear, you should contact your health insurance company before the vaccination.

TBE vaccination for babies and pregnant women

Childhood vaccination

Children can develop a fever, especially after the first vaccination

The vaccination recommendations for childhood differ at least in German-speaking countries. While Switzerland recommends TBE vaccination for children from the age of six, Austria recommends vaccination from the age of two. In Germany there is no clear regulation, but a recommendation from the RKI, which advises cautious use of vaccinations in preschool age.

In children of this age, the side effects of the vaccination outweigh the actual benefits. In addition, TBE infection is much milder in childhood than in adults. For example, no severe course of TBE infection has been found in children and adolescents under 16 years of age in the last almost 20 years.

Regardless of this, there are vaccines for children and babies from the first year of life. The most common is one of them Encepur-Children, which is approved for children from the first to 11th year of age. The adult vaccine is used for children and adolescents from the age of 12.

The same safety instructions apply to vaccinating children as to adults. A TBE vaccination should not be carried out immediately after an infection. There must be a gap of at least two weeks from the last illness.

Especially in small children, fever occurs more frequently after the first vaccination, but this is less pronounced or no longer occurs after the second vaccination. The children's vaccine contains a lower dose of the TBE vaccine and thus 0.25 instead of 0.5 ml.

A vaccination against meningitis is the safest prophylaxis to prevent meningitis caused by TBE in children.

TBE vaccination during pregnancy

A TBE vaccination during pregnancy was approved for the vaccine Encepur not examined. Any vaccination should therefore be checked carefully and only carried out in urgent cases. A time interval to other vaccinations does not have to be observed, so that the Encepur- Vaccination can also be carried out in parallel to other vaccinations.

Read more on the topic: Vaccination during pregnancy

TBE vaccination during breastfeeding

It is actually possible to have a TBE vaccination while breastfeeding. In general, however, both during breastfeeding and pregnancy, the indication, i.e. the reason for the vaccination, should be carefully considered. The indication can, for example, be frequent walks in areas near the forest. Vaccination against TBE while breastfeeding is possible because the vaccine is an inactivated virus. So this does not trigger a pronounced reaction of the immune system in the body.