Tick-borne encephalitis (TBE)

TBE virus lives in small mammals and is passed on by ticks that feed on them. People are bitten when walking, camping, foraging or working in forest and grassland where ticks are active, typically in warmer months. TravelHealthPro lists endemic areas as parts of central, northern and eastern Europe, Siberia and parts of Asia, and notes six confirmed UK cases since 2011 among travellers returning from endemic European areas, so it is a travel-related rather than a UK-acquired infection.

A secondary route is the consumption of unpasteurised dairy products from infected animals in risk areas, which TravelHealthPro flags as a potential way of becoming infected without any tick bite.

TravelHealthPro describes TBE as unfolding in two stages: an initial mild flu-like illness, followed in some people, after a symptom-free interval, by a potentially severe second phase when the virus affects the central nervous system. The second phase can cause meningitis, encephalitis or inflammation of the spinal cord, with headache, fever, neck stiffness, confusion, seizures, weakness or paralysis. Many infections never progress to this stage.

Outcomes differ by virus subtype. TravelHealthPro notes it is rarely fatal in Europe but can be fatal in up to 20 per cent of cases in Asia, and long-term neurological complications are common after the severe form. Older adults tend to have more serious disease.

• Phase one: fever, tiredness, headache and muscle aches.

• Quiet interval of days to a couple of weeks in some people.

• Phase two: severe headache, stiff neck, drowsiness, confusion, seizures or limb weakness.

Diagnosis relies on the story of tick exposure or travel in a risk area and blood or cerebrospinal fluid tests for TBE antibodies; a lumbar puncture and brain imaging are used to assess the severity. There is no specific antiviral treatment. Hospital care supports breathing, controls seizures and treats symptoms, and recovery from neurological injury can need rehabilitation.

Because other infections spread by ticks, notably Lyme disease, can cause similar early symptoms, your doctors may test for more than one infection if you were bitten.

TravelHealthPro states vaccination is available for at-risk travellers and occupational groups, using TicoVac for adults and TicoVac Junior for children. Those most likely to be advised are people planning to hike, camp, cycle or work outdoors in endemic regions during tick season, rather than city visitors. A travel clinic will use the destination, dates and planned activities to decide, and the course takes several weeks to complete, so plan well ahead.

TravelHealthPro advises avoiding heavily tick-infested areas in high-risk seasons, wearing appropriate clothing and using effective insect repellents. Check skin carefully after outdoor activity, particularly behind knees, in the groin, armpits and on the scalp. If you find a tick, remove it promptly using fine-tipped tweezers or a tick remover, as TravelHealthPro advises, rather than bare fingers. Wash the area and note the date, as symptoms can follow after days to weeks.

Seek urgent advice from NHS 111 or a doctor for fever, severe headache, stiff neck or confusion in the weeks after tick exposure or travel to a risk area, and call 999 for seizures, reduced consciousness or weakness. Mention the tick bite and the destination, as the combination guides testing.