After a tick bite in a tick-borne encephalitis virus endemic area: current positions about post-exposure treatment

Vaccine
Michael Bröker, Herwig Kollaritsch

Abstract

If a person suffers a tick bite in tick-borne encephalitis (TBE) endemic areas, there is uncertainty on post-exposure treatment of naïve (non-immune) persons in order to protect the patient against TBE. Particularly, there are no distinct positions on the use of TBE active immunization as post-exposure treatment. Of special concern is the possibility of antibody-dependent enhancement of infection and exacerbation of disease in case of post-exposure vaccination. Such phenomena have been reported for other flavivirus infections. In the past, immune globulin treatment was recommended, but these preparations are no longer available. Active immunization by using the current immunization schedules after a tick bite will not result in appropriate neutralizing antibody concentrations within due time. Based on the assumptions that vaccination is not quick acting enough after a tick bite and that the theoretical risk of antibody-dependent enhancement cannot be excluded, no vaccination or other specific measure is currently recommended after a tick bite in non-vaccinated patients, leaving the patient in a completely dissatisfactory position. A risk/benefit analysis has been re-assessed for persons with a history with at least one vaccine ...Continue Reading

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Citations

Dec 9, 2009·Expert Review of Anti-infective Therapy·Maja Arnez, Tatjana Avsic-Zupanc
Nov 16, 2012·Expert Review of Vaccines·Herwig KollaritschAlan Barrett
Oct 26, 2010·Travel Medicine and Infectious Disease·Eckhardt PetriOlaf Zent
Feb 20, 2010·Vaccine·Charlotta Rydgård AnderssonGöran Günther
Nov 6, 2008·Travel Medicine and Infectious Disease·Angelika BanzhoffOlaf Zent
Feb 1, 2012·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·M PonfickD A Nowak
Jun 12, 2010·Vaccine·Lev N LevanovNina V Tikunova
May 20, 2014·Vaccine·Ivan K BaykovNina V Tikunova
Jun 19, 2013·PloS One·Nataša Knap, Tatjana Avšič-Županc
May 20, 2015·World Journal of Clinical Cases·Petra Bogovic, Franc Strle
Aug 2, 2017·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·P TabaI Steiner
Oct 12, 2018·Experimental & Applied Acarology·Fawzeia ElmhalliGiulio Grandi
Jan 1, 2017·Uirusu·Kentaro Yoshii
Apr 9, 2021·The Journal of Experimental Medicine·Laura A VanBlarganMichael S Diamond
Sep 24, 2021·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·E M SamoilovaV P Baklaushev

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