Title

Tick-borne encephalitis among US travellers, 2010-20

Authors

Susan L. Hills, Arboviral Diseases Branch, Centers for Disease Control and Prevention
Kelly R. Broussard, Zoonosis Control Branch, Texas Department of State Health Services
James C. Broyhill, Division of Surveillance and Investigation, Virginia Department of Health
Lalita G. Shastry MD, Lehigh Valley Health NetworkFollow
Caitlin M. Cossaboom, Viral Special Pathogens Branch, Centers for Disease Control and Prevention
Jennifer L. White, Bureau of Communicable Disease Control, New York State Department of Health
Kimberly D. Machesky, Bureau of Infectious Diseases, Ohio Department of Health
Olga Kosoy, Arboviral Diseases Branch, Centers for Disease Control and Prevention
Kyle Girone, Division of Surveillance and Investigation, Virginia Department of Health
John D. Klena, Viral Special Pathogens Branch, Centers for Disease Control and Prevention
Bryon P. Backenson, Bureau of Communicable Disease Control, New York State Department of Health
Carolyn V. Gould, Arboviral Diseases Branch, Centers for Disease Control and Prevention
Leah Lind, Division of Infectious Disease Epidemiology, Pennsylvania Department of Health
Arielle Hieronimus, Disease Control and Response Unit, Delaware Public Health District
David N. Gaines, Division of Surveillance and Investigation, Virginia Department of Health
Susan J. Wong, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health
Mary J. Choi, Viral Special Pathogens Branch, Centers for Disease Control and Prevention
Janeen J. Laven, Arboviral Diseases Branch, Centers for Disease Control and Prevention
J Erin Staples, Arboviral Diseases Branch, Centers for Disease Control and Prevention
Marc Fischer, Arboviral Diseases Branch, Centers for Disease Control and Prevention

Document Type

Article

Publication Date

11-6-2021

Publication Title

Journal of travel medicine

E-ISSN

1708-8305

Department(s)

Department of Medicine

Keywords

USA, meningitis, tick-borne encephalitis, travel, traveller

Abstract

BACKGROUND: Tick-borne encephalitis (TBE) is an arboviral disease that is focally endemic in parts of Europe and Asia. TBE cases among US travellers are rare, with previous reports of only six cases among civilian travellers through 2009 and nine military-related cases through 2020. A TBE vaccine was licenced in the USA in August 2021. Understanding TBE epidemiology and risks among US travellers can help with the counselling of travellers going to TBE-endemic areas. METHODS: Diagnostic testing for TBE in the USA is typically performed at the Centers for Disease Control and Prevention (CDC) because no commercial testing is available. Diagnostic testing for TBE at CDC since 2010 was reviewed. For individuals with evidence of TBE virus infection, information was gathered on demographics, clinical presentations and risk factors for infection. RESULTS: From 2010-20, six patients with TBE were identified. Cases occurred among both paediatric and adult travellers and all were male. Patients were diagnosed with meningitis (n = 2) or encephalitis (n = 4); none died. Cases had travelled to various countries in Europe or Russia. Three cases reported visiting friends or relatives. Activities reported included hiking, camping, trail running, or working outdoors, and two cases had a recognized tick bite. CONCLUSIONS: TBE cases among US travellers are uncommon, with these six cases being the only known TBE cases among civilian travellers during this 11-year period. Nonetheless, given potential disease severity, pre-travel counselling for travellers to TBE-endemic areas should include information on measures to reduce the risk for TBE and other tick-borne diseases, including possible TBE vaccine use if a traveller's itinerary puts them at higher risk for infection. Clinicians should consider the diagnosis of TBE in a patient with a neurologic or febrile illness recently returned from a TBE-endemic country, particularly if a tick bite or possible tick exposure is reported.

DOI

10.1093/jtm/taab167

PubMed ID

34741518

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