Tick-borne encephalitis (TBE) virus is spread through the bite of an infected tick. Occasionally, TBE virus can spread to people through eating or drinking raw milk or cheese from infected goats, sheep, or cows.

TBE virus can be found in parts of the region stretching from western and northern Europe through northern and eastern Asia. People who travel to these areas might be at risk for infection. TBE virus is not found in the United States. The ticks that spread TBE virus are most active in warmer months (April through November). People who spend time outdoors in or near forests are at highest risk of being bitten by a tick infected with TBE virus.

General distribution of tick-borne encephalitis (TBE) virus: Country-specific risk information provided below the map

Country-specific risk information (as of March 7, 2022)

The information should be interpreted cautiously because TBE virus transmission can be highly variable within risk areas and from year to year. Additional information is available on websites or publications from national authorities in some TBE-endemic countries.

Ticks, specifically hard ticks of the family Ixodidae, transmit tick-borne encephalitis (TBE) virus. Ticks become infected when they feed on blood from infected vertebrate hosts, particularly small rodents, and can subsequently transmit the virus during the next blood meal. Ticks can also get the virus transtadially (from larva to nymph to adult ticks), transovarially (from adult female tick to eggs), or when cofeeding on infected animals. The highest period of tick activity and risk of spread is during the warmer months from April through November.

Infection also may follow consumption of unpasteurized milk or cheese from infected goats, sheep, or cows. Other rare modes of transmission include through slaughtering of infected animals, blood transfusion, organ transplantation, breastfeeding, or from exposure to the virus in the laboratory.

Many people infected with tick-borne encephalitis (TBE) virus do not have symptoms. For people with symptoms, the time from tick bite to feeling sick (incubation period) is usually about 7 to 14 days, but can range from about 4 to 28 days.

• Severe disease often occurs including infection of the brain (encephalitis) or the membranes around the brain and spinal cord (meningitis).
  • Initial symptoms can include fever, headache, vomiting, and weakness.
  • A few days later, severe symptoms can develop including confusion, loss of coordination, difficulty speaking, weakness of the arms or legs, and seizures.
  • Sometimes initial symptoms last a few days and completely resolve, but then about a week later the more severe symptoms develop (known as “biphasic illness”).

If you think you or a family member might have TBE, see your healthcare provider.

• Healthcare providers diagnose TBE virus infection based on:
  • Signs and symptoms
  • Travel history and possible exposure to ticks while traveling
  • Laboratory testing of blood or spinal fluid
• Your healthcare provider can order tests to look for TBE virus infection or other infections that can cause similar symptoms.

There is no medication to treat TBE virus infection. However, a vaccine is available to prevent infection.

Rest, fluids, and over-the-counter pain medications may relieve some symptoms.

People with severe disease often need to be hospitalized to receive support for breathing, staying hydrated, or reducing swelling in the brain.

Tick-borne encephalitis (TBE) virus is most commonly spread to people through the bite of an infected tick. Ticks that spread TBE virus live in or near forests in parts of Europe and Asia. The best way to prevent TBE is to protect yourself from tick bites. Use insect repellent and treat clothing and gear with 0.5% permethrin. Inspect your body and clothing for ticks during and after outdoor activities.

To avoid getting TBE from infected dairy products, avoid eating or drinking unpasteurized (raw) milk and cheese from goats, sheep, or cows in affected areas.

Get vaccinated before traveling, if vaccination is recommended for you.

In 2021, the U.S. Food and Drug Administration approved a tick-borne encephalitis (TBE) vaccine for use in the United States, called TICOVAC. This vaccine has been used for over 20 years in Europe. U.S. travelers visiting parts of Europe and Asia where TBE is found who might participate in outdoor activities with risk of tick exposure should talk to their healthcare provider about vaccination.

Who Should Get Vaccinated?

The risk for TBE is very low for most travelers visiting countries where TBE is found. However, travelers are at increased risk if they plan to:

• Visit areas with TBE when ticks are most active (April through November)
• Take part in outdoor activities in or near forested areas such as hiking, camping, hunting, fishing, or birdwatching.

All travelers visiting countries with TBE should take steps to avoid tick bites. If you plan to travel during the warmer months of the year and participate in outdoor activities, you should discuss the need for vaccination with your healthcare provider. When discussing whether or not to be vaccinated against TBE, consider the following:

• What locations you will be visiting
• What activities you will participate in while traveling
• Likelihood of future travel to countries where TBE is found
• Potential severe outcomes of TBE disease
• Vaccine doses, cost, and possible side effects

The TBE vaccine is available for children aged 1 year and older and adults. Three doses are needed to complete the series so you should talk to your healthcare provider as early as possible before travel.

What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a disease caused by a virus. The virus spreads to people in a few ways:

• Bite from an infected tick
• Eating or drinking unpasteurized dairy products (milk and cheese) from infected goats, sheep, or cows.

Most people infected with tick-borne encephalitis do not feel sick. When symptoms occur, they may include fever, aches, loss of appetite, headache, nausea, and vomiting. Some people develop swelling of the brain and/or spinal cord, confusion, and sensory disturbances. Tick-borne encephalitis can sometimes cause death.

Who can get tick-borne encephalitis?

Travelers to many parts of Europe and Asia may be at risk for infection with TBE virus. Check if this disease is a concern at your destination.

Activities that increase a travelers’ chances getting tick-borne encephalitis include camping, hiking, and hunting. Travelers are more likely to get infected with TBE when traveling to affected areas April through November, this is when ticks are most active.

What can travelers do to prevent tick-borne encephalitis?

Travelers can protect themselves against TBE by taking the following precautions:

Prevent Tick Bites

• Know where to expect ticks. Ticks live in grassy, brushy, or wooded areas, or even on animals. Spending time outside camping, gardening, or hunting could bring you in close contact with ticks. Many people get ticks in their own yard or neighborhood.
• Treat clothing and gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings. Alternatively, you can buy permethrin-treated clothing and gear.
• Use Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone. EPA’s helpful search tool can help you find the product that best suits your needs. Always follow product instructions. Do not use products containing OLE or PMD on children under 3 years old.
• Avoid Contact with Ticks
  • Avoid wooded and brushy areas with high grass and leaf litter.
  • Walk in the center of trails.

Find and Remove Ticks

• Check your clothing for ticks. Ticks may be carried into the house on clothing. Any ticks that are found should be removed. When possible, tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed. If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks.
• Examine gear and pets. Ticks can ride on clothing and pets, then attach to a person later, so carefully examine pets, coats, and daypacks.
• Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting tick-borne diseases. Showering may help wash off unattached ticks and it is a good opportunity to do a tick check.
• Check your body for ticks. Conduct a full body check upon return from potentially tick-infested areas. Use a hand-held or full-length mirror to view all parts of your body. Check these parts of your body for ticks:
  • Under the arms
  • In and around the ears
  • Inside belly button
  • Back of the knees
  • In and around the hair
  • Between the legs
  • Around the waist
• If you find a tick attached to your skin, simply remove the tick as soon as possible.

Eat only pasteurized dairy products

Get vaccinated if recommended

Tick-borne encephalitis vaccine is recommended for travelers who are moving or traveling to a TBE-endemic area and will have extensive exposure to ticks based on their planned outdoor activities and itinerary.

In addition, TBE vaccine may be considered for persons traveling or moving to a TBE-endemic area who might engage in outdoor activities in areas ticks are likely to be found. The decision to vaccinate should be based on an assessment of their planned activities and itinerary, risk factors for a poorer medical outcome, and personal perception and tolerance of risk.

After Travel

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel.