What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system caused by TBE virus — transmitted primarily by Ixodes tick bites in forested and rural areas of Europe and Asia (including the Caucasus). It has a characteristic biphasic course: an initial flu-like illness (Phase 1), followed by apparent recovery, then — in approximately 30% of symptomatic patients — a neurological phase (Phase 2) with meningitis, encephalitis or spinal cord involvement. There is no specific antiviral treatment; supportive intensive care is the only management for severe disease.

Is TBE present in Georgia?

Yes — TBE virus has been documented in Ixodes ticks and animals in the Caucasus region, including Georgia. TBE is an ECDC and WHO-recognised endemic infection in the Caucasus subregion. Human cases occur in rural and forested areas of Georgia. The Caucasus region harbours both European and Siberian TBE subtypes (the latter associated with more severe disease). Despite the endemic risk, TBE vaccination coverage in Georgia remains low — one of the most important vaccine-preventable disease gaps in Georgian public health.

What are the symptoms and how does TBE progress?

Phase 1 (after 7-14 day incubation): sudden fever (38-39°C), headache, myalgia, arthralgia, nausea — indistinguishable from any viral illness. Most patients recover. Phase 2 (5-7 days after Phase 1 resolves — the critical moment): in approximately 30% of symptomatic patients, fever recurs with neurological involvement. Presentations: meningitis (neck stiffness, photophobia — best prognosis, full recovery in most); encephalitis (confusion, behavioural change, tremor, ataxia, sleep disturbance); meningoencephalomyelitis (spinal cord involvement — flaccid weakness of upper limbs or quadriplegia, respiratory failure — worst prognosis, 10-20% mortality in Far Eastern subtype).

How effective is the TBE vaccine?

The TBE vaccines (FSME-IMMUN and Encepur) are among the most effective vaccines available: approximately 99% protection after the primary 3-dose series. The three-dose schedule: dose 1 (day 0) → dose 2 (1-3 months later) → dose 3 (5-12 months later). An accelerated schedule is available (0, 14 days, 5-12 months) for travellers. Boosters every 3-5 years maintain protection (every 3 years for those over 60). WHO recommends TBE vaccination for all people living in or travelling to endemic areas.

How is TBE prevented beyond vaccination?

Tick avoidance measures: wear long-sleeved clothing (light colours) in forested areas; tuck trousers into socks; use DEET-based repellents on exposed skin; permethrin on clothing. Tick checks: inspect the whole body — especially hairline, groin, axillae — after outdoor activity. Prompt tick removal: fine-tipped tweezers, within 24 hours (TBE can be transmitted in <1 hour unlike Lyme disease — tick attachment time protection is less reliable for TBE than Lyme). Avoid unpasteurised milk: eliminates alimentary TBE risk.

How does GMJ News cover TBE?

GMJ News covers ECDC TBE surveillance, Georgian Caucasus endemic risk, the biphasic clinical presentation, TBE vaccine evidence and schedules, climate change expanding tick ranges, the immunoglobulin withdrawal history, and milk-borne TBE. TBE is a directly relevant Georgian public health topic — among the most important tick-borne infections in the Caucasus region and a vaccine-preventable neurological disease requiring higher vaccination awareness in Georgia.

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Tick-borne Encephalitis

Q: How does GMJ News cover TBE?

GMJ News covers ECDC TBE surveillance, Georgian Caucasus endemic risk, the biphasic clinical presentation, TBE vaccine evidence and schedules, climate change expanding tick ranges, the immunoglobulin withdrawal history, and milk-borne TBE. TBE is a directly relevant Georgian public health topic — among the most important tick-borne infections in the Caucasus region and a vaccine-preventable neurological disease requiring higher vaccination awareness in Georgia.

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

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Tick-borne encephalitis (TBE) — caused by TBE virus (Flavivirus, family Flaviviridae), transmitted by Ixodes tick bites — is a potentially life-threatening neurological infection endemic across a broad arc from Central Europe to the Far East, including the Caucasus region and Georgia, where TBE virus has been documented in ticks and animals and human cases occur in rural and forested areas (ECDC). TBE causes a characteristic biphasic illness (initial flu-like phase → 7-10 day remission → neurological phase with meningitis, encephalitis or meningoencephalomyelitis in 30% of symptomatic patients), with no specific antiviral treatment available and long-term neurological sequelae in 10-30% of those who develop CNS disease. Highly effective TBE vaccines (FSME-IMMUN, Encepur) are available and WHO-recommended for residents and travellers to endemic areas — with particular importance for the Georgian and broader Caucasus public health context.

Key messages

Endemic in Caucasus — no specific treatment

TBE virus is endemic in the Caucasus region including Georgia, where it circulates in Ixodes ticks in forested and rural areas. No specific antiviral treatment exists; care is entirely supportive. Prevention through vaccination is critical (ECDC).

Biphasic illness — the 10-day trap

TBE causes a characteristic two-phase illness: Phase 1 (viremia — flu-like, 4-5 days); apparent recovery (5-7 days — the deceptive “remission”); Phase 2 — in approximately 30% of symptomatic patients — meningitis, encephalitis or meningoencephalomyelitis.

ECDC mandatory surveillance — rising incidence

TBE is an ECDC notifiable disease. European TBE incidence has been rising for decades, with geographic expansion into new areas (UK, Netherlands, Scandinavia) linked to climate change and land-use changes expanding tick habitats.

TBE vaccine — highly effective, underused

TBE vaccines (FSME-IMMUN, Encepur) achieve approximately 99% protection after the primary 3-dose series and are highly safe. Despite excellent efficacy, vaccination coverage remains low in many endemic areas including the Caucasus.

10-30% develop long-term neurological sequelae

Neurological complications from TBE Phase 2 include meningitis (best prognosis), encephalitis (memory impairment, behavioural change) and meningoencephalomyelitis (spinal cord involvement — limb weakness, paralysis, respiratory failure). Approximately 10-30% of encephalitis patients develop lasting neurological deficits.

Three TBE subtypes — different severity

European subtype (I. ricinus): lowest case fatality (0.5-2%). Siberian subtype (I. persulcatus): intermediate (2-3%). Far Eastern/Russian Spring-Summer subtype (I. persulcatus): highest case fatality (5-20%) and chronic progressive encephalitis. The Caucasus region harbours both European and Siberian subtypes.

Key statistics

~10K

TBE cases reported to ECDC annually in EU/EEA

ECDC

~30%

of symptomatic TBE patients develop neurological Phase 2

ECDC/WHO

10-30%

of Phase 2 patients develop permanent neurological deficits

ECDC

~99%

protection from 3-dose TBE vaccine series

ECDC/WHO

Rising

TBE incidence and geographic expansion across Europe (ECDC)

ECDC 2024

specific antiviral treatment for TBE — supportive care only

WHO/ECDC

TBE endemic countries in Europe and Caucasus — ECDC risk zones

Source: ECDC. Risk zones expanding northward and westward with climate change. Georgia in Caucasus endemic zone.

Glossary of key terms

TBE virus (TBEV)
WHO/ECDCTick-borne encephalitis virus — family Flaviviridae, genus Flavivirus (related to dengue, Zika, West Nile, yellow fever). Three subtypes: European (TBEV-Eu), Siberian (TBEV-Sib) and Far Eastern (TBEV-FE). RNA virus. Transmitted by Ixodes tick bite (main route) or by ingestion of unpasteurised milk from viremic animals (ruminants — rare).

Ixodes ricinus (European tick)
ECDCThe sheep tick (castor bean tick) — the primary TBE vector in Europe. Also transmits Borrelia burgdorferi (Lyme disease) and other pathogens. Three-stage life cycle (larva → nymph → adult). Nymphs (spring-summer) are the most important human-biting stage. Active when temperatures >7°C.

Biphasic illness
ECDC/ClinicalPhase 1 (viremic, 4-5 days): fever, headache, myalgia, nausea — clinically indistinguishable from influenza. Apparent remission (5-7 days, temperature normalises — deceptive). Phase 2 (neurological — in approximately 30%): aseptic meningitis (least severe); meningoencephalitis (confusion, impaired consciousness); meningoencephalomyelitis (spinal cord — flaccid paralysis of upper limbs, respiratory involvement). The remission interval distinguishes TBE from other viral encephalitides.

FSME-IMMUN and Encepur
Pfizer/GSKFSME-IMMUN (Pfizer): inactivated TBEV grown on chick embryo fibroblasts. Primary schedule: 0, 1-3 months, 5-12 months (3 doses); accelerated (0, 14 days, 5-12 months). Encepur (GSK): similar composition and schedule. Both achieve approximately 99% protection after 3 doses. Boosters every 3-5 years thereafter (every 3 years for >60 years — reduced immune response with age).

Immunoglobulin controversy
ECDC/AustriaPassive immunisation with TBE hyperimmune globulin (FSME-Bulin) was historically used post-exposure in Austria but was withdrawn in 1999 after evidence it might worsen disease severity (antibody enhancement). Post-exposure prophylaxis with immunoglobulin is no longer recommended — this reinforces the importance of pre-exposure vaccination.

Alimentary (milk-borne) TBE
ECDCIngestion of raw (unpasteurised) milk or dairy products from viremic goats, sheep or cows can cause TBE — without any tick bite. Alimentary TBE clusters are reported, particularly in rural Europe. Pasteurisation eliminates the risk. This route accounts for approximately 1-5% of TBE cases in some endemic areas.

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