Tickborne Disease Risks for Australians Travelling to Europe

Europe is a popular spring and summer time destination for Australian travellers.

While health concerns are rarely high on the agenda when planning for a European stay, those considering outdoor activities (camping. hiking, bicycling, fishing and hunting) should assess their level of risk for tickborne disease. Risk is more about region of travel, duration of travel and time of year rather than the incidence of disease in a particular country. It can also be driven by climatic conditions and host animal numbers.

If you are a permanent resident of Latvia, Estonia, Lithuania or Bavaria in south and southeastern Germany, you are likely to be vaccinated against tickborne encephalitis (TBE) and know the signs and symptoms of Lyme borreliosis. Vaccination rates and public health messaging do make a difference in the incidence of disease. Surveillance is also very important.

Australia is endemic for several tickborne diseases (Queensland tick typhus, Flinders Island spotted fever, Australian spotted fever and Q fever) but does not have tickborne encephalitis or Lyme disease (some may argue about the latter). Discussions about vaccination are often focused on cattle rather than people in Australia.

The role of vaccines must be considered when discussing risk of tickborne encephalitis in certain types of travel in Europe.

TBE in Europe - Surveillance data from 2012–2020

Eurosurveillance researched tickborne encephalitis cases between 2012 and 2020. Nineteen countries reported 29,649 cases. More than 52% came from Czechia, Germany and Lithuania. Countries with the highest incidence included Lithuania, Latvia and Estonia. Fifty regions from ten countries had incidence levels above the threshold for WHO to be recommending vaccination for residents. The study also suggested the annual number of cases was increasing and there was a geographic spread of the endemic zone towards northwestern Europe. A few cases of local TBE have now been reported in the UK (2019).

Across 19 selected countries of the European community/ European Economic Area, no cases were observed in France, Ireland, The Netherlands and Spain. Several other countries report the disease but were not included in the study (Bulgaria, Denmark, Liechtenstein, Croatia and Italy).

The researchers noted 2 peaks in disease reporting, the first in early July and the second in September. July was the most frequently reported month for the disease.

In 2022, twenty-eight countries reported surveillance data on TBE. Twenty countries reported 3,650 TBE cases. The highest numbers were in Czechia (709), Germany (554) and Sweden (465). The highest notification rates (number of cases/100,000 population) were in Lithuania and Estonia. Vaccination status data was available for 1620 confirmed cases and 94% were unvaccinated. Twenty-nine of the vaccinated group had received only 1 dose of a 3-dose course. Read the full report.

Preventing TBE - Personal protection & vaccination options

Prevention mostly lies with personal protection measures - see tick avoidance.

Vaccination is also available. WHO advises vaccination for those living in highly endemic areas.

There are currently 4 vaccines available in Europe, FSME-Immun, Encepur, TBE-Moscow, and Encevir. The first 2 are manufactured in Austria and Germany respectively.

A TBE vaccine is available under the special access scheme in Australia.

It is classified as SAS C: (A notification pathway for supplying goods that are deemed to have an established history of use). In other words, the vaccine has been used successfully for a period in other regions of the world.

It has been used for over 20 years in Europe and now (from August 2021) has FDA approval in the United States as Ticovac.

In Australia, a special application to the TGA for approval is required before giving the vaccine.

Vaccination schedule and efficacy

It is an inactivated viral vaccine (FSME-Immun). It must be prescribed by a medical practitioner and supplied through a pharmacy or medical practice.

It is important to assess the true risk of exposure before recommending a course of vaccination.

The schedule is 3 doses. Day 0, 1-3 months, and 5-12 months. A rapid course of vaccination may be considered if time is short before leaving. The first booster is given at 3 years and then 5 years thereafter. It may be given at 3 years in those over 60 years.

The vaccine is very effective with a protective efficacy of over 90% for those completing a primary course.