Tick-Borne Encephalitis (TBE)
What is TBE?
Tick-borne encephalitis is a viral infection that can affect the brain and central nervous system. It is caused by tick-borne encephalitis virus (TBEV), a flavivirus transmitted by tick bites. TBE is well established in parts of central and northern Europe and is a significant public health concern in those regions.
In the UK, confirmed human cases are extremely rare. However, TBEV was detected in ticks in parts of southern England (Thetford Forest area and Hampshire) in 2019, and a small number of probable UK-acquired cases have been identified. Surveillance is ongoing.
How You Get It
- Tick bites are the main route. In Europe, the vector is Ixodes ricinus.
- Unpasteurised dairy — rarely, TBE has been acquired through unpasteurised milk or cheese from infected goats in endemic areas abroad. This is not considered a risk in the UK.
Signs & Symptoms
TBE typically develops in two phases:
- Phase 1 (1–2 weeks after bite): Flu-like illness — fever, headache, fatigue, muscle aches. Many people recover fully at this stage.
- Phase 2 (affects ~1/3 patients): After a symptom-free gap of about a week, a second phase can develop with high fever, severe headache, neck stiffness, confusion, and in serious cases encephalitis (inflammation of the brain).
Most infections are mild or asymptomatic. Severe neurological disease occurs in a minority of cases but can cause long-term complications. Fatality rates for the European subtype are about 1–2%.
Diagnosis & Treatment
Diagnosis is by blood test (antibody detection). There is no specific antiviral treatment for TBE; care is supportive (rest, fluids, pain relief, hospital care for severe cases).
Vaccination
Unlike most tick-borne diseases, an effective vaccine exists for TBE. In the UK, vaccination is only recommended for:
- People travelling to endemic areas in Europe (Austria, Scandinavia, the Baltics, parts of Germany, etc.) who will spend time outdoors.
- Laboratory workers handling the virus.
The vaccine is available privately and through travel health clinics. It is not currently recommended routinely for UK residents, given the very low domestic risk.
UK Context
The 2019 detection of TBEV in UK ticks was significant but does not mean TBE is established here. UKHSA continues to monitor ticks and deer for the virus. The risk to the UK public remains very low, but awareness is important, particularly for people spending time in areas where the virus has been detected.
Prevention
- Follow our bite prevention guide.
- Remove ticks promptly.
- Consider vaccination if travelling to TBE-endemic countries in Europe.