Tick-Borne Encephalitis (TBE) — The Vaccine Travellers in Europe Forget

Tick-borne encephalitis is one of the most commonly missed vaccines for travel in Europe and central Asia. Most travellers planning a hiking holiday in Austria, Slovenia, the Baltic states, or rural Russia never hear about it. Here's what it is and who should consider the vaccine.

What TBE is

Tick-borne encephalitis is a viral infection spread by the bite of infected Ixodes ticks. It affects the nervous system — in severe cases causing encephalitis (inflammation of the brain), meningitis, or myelitis (spinal cord inflammation). Most infections are mild or subclinical, but around 10–20% of symptomatic cases develop neurological complications, and some have lasting effects. There is no specific treatment once infection occurs — the vaccine is the main protection.

Where the risk is

TBE is present in forested and rural areas across a broad band from central Europe to eastern Asia. High-risk areas in Europe include Austria (one of the highest rates per capita), Slovenia, the Czech Republic, Slovakia, the Baltic states (Estonia, Latvia, Lithuania), southern Sweden, and parts of Germany, Poland, and Hungary. In Asia, risk extends through Russia (particularly Siberia and the Far East) into parts of China, Japan, and Korea.

Risk is seasonal — ticks are most active from spring through autumn, particularly April to November. The risk is highest in forested areas below 1500m altitude.

Who needs the vaccine

Anyone planning hiking, camping, cycling through forests, or significant time in rural or wooded areas in a TBE-endemic region during the active season. City tourists, beach holidays, and winter visits to the Alps are not relevant risk scenarios. A standard city break to Prague, Vienna, or Riga doesn't warrant TBE vaccination — a hiking tour in the Austrian or Slovenian countryside in summer does.

The vaccine

Two doses are needed for initial protection, with the second dose given 1–3 months after the first. A third dose 9–12 months later provides longer protection. An accelerated schedule is available — ask your travel clinic. The vaccine is highly effective and well-tolerated. It's worth noting it's not available as a routine vaccine in all countries — you may need to request it specifically at a travel clinic.

Tick prevention

Even if vaccinated, tick prevention makes sense in risk areas. Wear long sleeves and trousers, use DEET-based repellent on exposed skin, and do a full body tick check after time in wooded or grassy areas. Ticks carrying TBE are generally in undergrowth and leaf litter rather than open grassland.