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Tick-borne encephalitis (TBE) is a severe, vaccine-preventable viral infection of the central nervous system. Symptoms are generally milder in children and adolescents than in adults, though severe disease does occur. A better understanding of the disease burden and duration of vaccine-mediated protection is important for vaccination recommendations.


To estimate TBE vaccination coverage, disease severity and vaccine effectiveness (VE) among individuals aged 0–17 years in Switzerland.


Vaccination coverage between 2005 and 2022 was estimated using the Swiss National Vaccination Coverage Survey (SNVCS), a nationwide, repeated cross-sectional study assessing vaccine uptake. Incidence and severity of TBE between 2005 and 2022 were determined using data from the Swiss disease surveillance system and VE was calculated using a case–control analysis, matching TBE cases with SNVCS controls.


Over the study period, vaccination coverage increased substantially, from 4.8% (95% confidence interval (CI): 4.1–5.5%) to 50.1% (95% CI: 48.3–52.0%). Reported clinical symptoms in TBE cases were similar irrespective of age. Neurological involvement was less likely in incompletely (1–2 doses) and completely (≥ 3 doses) vaccinated cases compared with unvaccinated ones. For incomplete vaccination, VE was 66.2% (95% CI: 42.3–80.2), whereas VE for complete vaccination was 90.8% (95% CI: 87.7–96.4). Vaccine effectiveness remained high, 83.9% (95% CI: 69.0–91.7) up to 10 years since last vaccination.


Even children younger than 5 years can experience severe TBE. Incomplete and complete vaccination protect against neurological manifestations of the disease. Complete vaccination offers durable protection up to 10 years against TBE.


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  1. Steffen R. Tick-borne encephalitis (TBE) in children in Europe: epidemiology, clinical outcome and comparison of vaccination recommendations. Ticks Tick Borne Dis. 2019;10(1):100-10.  https://doi.org/10.1016/j.ttbdis.2018.08.003  PMID: 30241699 
  2. von Stülpnagel C, Winkler P, Koch J, Zeches-Kansy C, Schöttler-Glas A, Wolf G, et al. MRI-imaging and clinical findings of eleven children with tick-borne encephalitis and review of the literature. Eur J Paediatr Neurol. 2016;20(1):45-52.  https://doi.org/10.1016/j.ejpn.2015.10.008  PMID: 26586340 
  3. Fowler Å, Forsman L, Eriksson M, Wickström R. Tick-borne encephalitis carries a high risk of incomplete recovery in children. J Pediatr. 2013;163(2):555-60.  https://doi.org/10.1016/j.jpeds.2013.01.037  PMID: 23452585 
  4. Swiss Federal Office of Public Health (FOPH). Zahlen zu Infektionskrankheiten - Zeckenenzephalitis FSME. [Infectious diseases statistics - Tick-borne encephalitis TBE]. Bern: FOPH; 2023. German. Available from: https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-zu-infektionskrankheiten.exturl.html/aHR0cHM6Ly9tZWxkZXN5c3RlbWUuYmFnYXBwcy5jaC9pbmZyZX/BvcnRpbmcvZGF0ZW5kZXRhaWxzL2QvZnNtZS5odG1sP3dlYmdy/YWI9aWdub3Jl.html
  5. World Health Organization (WHO). Vaccines against tick-borne encephalitis: WHO position paper 2011. Weekly Epidemiological Record, 2011, vol. 86, 24. Geneva: WHO; 2011. Available from: https://www.who.int/publications/i/item/WHO-WER8624
  6. Swiss Federal Office of Public Health (FOPH). Aktualisierung und neue Darstellung der Karte mit Impfempfehlung für Frühsommer-Meningoenzephalitis per April 2013. [Update and new presentation of the map with vaccination recommendation for early summer meningoencephalitis as of April 2013]. Bern: FOPH; 2013. German. Available from: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/i-und-b/richtlinien-empfehlungen/empfehlungen-spezifische-erreger-krankheiten/zeckenenzephalitis/zeckenenzephalitis-impfung-karte.pdf.download.pdf/zeckenenzephalitis-impfung-karte-de.pdf
  7. Swiss Federal Office of Public Health (FOPH). Empfehlungen zur Impfung gegen Zeckenenzephalitis, [Recommendation for vaccination against tick-borne encephalitis]. Bulletin 13 ed. Bern: FOPH; 27 Mar 2006. German. Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/fsme.html
  8. Swiss Federal Office of Public Health (FOPH). Frühsommer-Meningoenzephalitis (FSME): Ausweitung der Risikogebiete. [Tick-borne encephalitis (TBE): expansion of risk areas]. Bern: FOPH; 4 Feb 2019. German. Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/fsme.html
  9. Rampa JE, Askling HH, Lang P, Zens KD, Gültekin N, Stanga Z, et al. Immunogenicity and safety of the tick-borne encephalitis vaccination (2009-2019): A systematic review. Travel Med Infect Dis. 2020;37:101876.  https://doi.org/10.1016/j.tmaid.2020.101876  PMID: 32931931 
  10. Heinz FX, Holzmann H, Essl A, Kundi M. Field effectiveness of vaccination against tick-borne encephalitis. Vaccine. 2007;25(43):7559-67.  https://doi.org/10.1016/j.vaccine.2007.08.024  PMID: 17869389 
  11. Heinz FX, Stiasny K, Holzmann H, Grgic-Vitek M, Kriz B, Essl A, et al. Vaccination and tick-borne encephalitis, central Europe. Emerg Infect Dis. 2013;19(1):69-76.  https://doi.org/10.3201/eid1901.120458  PMID: 23259984 
  12. Hansson KE, Rosdahl A, Insulander M, Vene S, Lindquist L, Gredmark-Russ S, et al. Tick-borne encephalitis vaccine failures: a 10-year retrospective study supporting the rationale for adding an extra priming dose in individuals starting at age 50 years. Clin Infect Dis. 2020;70(2):245-51.  https://doi.org/10.1093/cid/ciz176  PMID: 30843030 
  13. Lotrič-Furlan S, Bogovič P, Avšič-Županc T, Jelovšek M, Lusa L, Strle F. Tick-borne encephalitis in patients vaccinated against this disease. J Intern Med. 2017;282(2):142-55.  https://doi.org/10.1111/joim.12625  PMID: 28440879 
  14. Stiasny K, Holzmann H, Heinz FX. Characteristics of antibody responses in tick-borne encephalitis vaccination breakthroughs. Vaccine. 2009;27(50):7021-6.  https://doi.org/10.1016/j.vaccine.2009.09.069  PMID: 19789092 
  15. Andersson CR, Vene S, Insulander M, Lindquist L, Lundkvist A, Günther G. Vaccine failures after active immunisation against tick-borne encephalitis. Vaccine. 2010;28(16):2827-31.  https://doi.org/10.1016/j.vaccine.2010.02.001  PMID: 20167301 
  16. Swiss Federal Office of Public Health (FOPH). Schweizerischer Impfplan. [Swiss Immunization Schedule]. Bern: FOPH; 2024. German. Available from: https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/schweizerischer-impfplan.html
  17. Zens KD, Haile SR, Schmidt AJ, Altpeter ES, Fehr JS, Lang P. Retrospective, matched case-control analysis of tickborne encephalitis vaccine effectiveness by booster interval, Switzerland 2006-2020. BMJ Open. 2022;12(4):e061228.  https://doi.org/10.1136/bmjopen-2022-061228  PMID: 35459683 
  18. Nygren TM, Pilic A, Böhmer MM, Wagner-Wiening C, Wichmann O, Harder T, et al. Tick-borne encephalitis vaccine effectiveness and barriers to vaccination in Germany. Sci Rep. 2022;12(1):11706.  https://doi.org/10.1038/s41598-022-15447-5  PMID: 35810184 
  19. Erber W, Khan F, Zavadska D, Freimane Z, Dobler G, Böhmer MM, et al. Effectiveness of TBE vaccination in southern Germany and Latvia. Vaccine. 2022;40(5):819-25.  https://doi.org/10.1016/j.vaccine.2021.12.028  PMID: 34952753 
  20. Lang P, Zimmermann H, Piller U, Steffen R, Hatz C. The Swiss National Vaccination Coverage Survey, 2005-2007. Public Health Rep. 2011;126Suppl 2;97-108.  https://doi.org/10.1177/00333549111260S212  PMID: 21812174 
  21. Swiss Federal Office of Public Health (FOPH). Kantonales Durchimpfungsmonitoring Schweiz. [Cantonal vaccination coverage surveillance Switzerland]. Bern: FOPH. [Accessed: 26 Feb 2024]. German. Available from: https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/impfungen-prophylaxe/informationen-fachleute-gesundheitspersonal/durchimpfung.html
  22. Desgrandchamps D, Posfay-Barbe KM. TBE in Switzerland and Liechtenstein. In: Dobler G, Erber W, Bröker M, Chitimia-Dobler L, Heinz-Josef Schmit H-J (editors). The TBE Book. 6th ed. Singapore: Global Health Press; 2023. Available from: https://tbenews.com/tbe/
  23. Swiss Federal Office of Public Health (FOPH). Infektionskrankheiten melden. [Infectious Disease Reporting]. Bern: FOPH; 29 Feb 2024. German. Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/infektionskrankheiten-bekaempfen/meldesysteme-infektionskrankheiten/meldepflichtige-ik/meldeformulare.html#-1611150545
  24. Altpeter E, Zimmermann H, Oberreich J, Péter O, Dvořák C, Swiss Sentinel Surveillance Network. Tick related diseases in Switzerland, 2008 to 2011. Swiss Med Wkly. 2013;143:w13725.  https://doi.org/10.4414/smw.2013.13725  PMID: 23299974 
  25. Schmidt AJ, Altpeter E, Graf S, Steffen R. Tick-borne encephalitis (TBE) in Switzerland: does the prolongation of vaccine booster intervals result in an increased risk of breakthroughs? J Travel Med. 2022;29(2):taab158.  https://doi.org/10.1093/jtm/taab158  PMID: 34581402 
  26. Schuler M, Zimmermann H, Altpeter E, Heininger U. Epidemiology of tick-borne encephalitis in Switzerland, 2005 to 2011. Euro Surveill. 2014;19(13):20756.  https://doi.org/10.2807/1560-7917.ES2014.19.13.20756  PMID: 24721541 
  27. European Commission (EC). Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Brussels: EC; 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2018.170.01.0001.01.ENG
  28. Günther G, Haglund M, Lindquist L, Forsgren M, Sköldenberg B. Tick-borne encephalitis in Sweden in relation to aseptic meningo-encephalitis of other etiology: a prospective study of clinical course and outcome. J Neurol. 1997;244(4):230-8.  https://doi.org/10.1007/s004150050077  PMID: 9112591 
  29. Blackwell M, Iacus S, King G, Porro G. Cem: Coarsened Exact Matching in Stata. Stata J. 2009;9(4):524-46.  https://doi.org/10.1177/1536867X0900900402 
  30. Swiss Federal Statistical Office (SFSO). Demographic balance by age and canton. Bern: SFSO; 24 Aug 2023 .Available from: https://www.bfs.admin.ch/bfs/en/home/statistics/catalogues-databases.assetdetail.26645069.html
  31. Farrington CP. Estimation of vaccine effectiveness using the screening method. Int J Epidemiol. 1993;22(4):742-6.  https://doi.org/10.1093/ije/22.4.742  PMID: 8225751 
  32. Flannery B, Andrews N, Feikin D, Patel MK. Commentary: estimation of vaccine effectiveness using the screening method. Int J Epidemiol. 2023;52(1):19-21.  https://doi.org/10.1093/ije/dyac013  PMID: 35138384 
  33. Zimmermann H, Koch D. Epidemiologie der Frühsommer-Meningoenzephalitis (FSME) in der Schweiz 1984 bis 2004. [Epidemiology of tick-borne encephalitis (TBE) in Switzerland 1984 to 2004]. German. Ther Umsch. 2005;62(11):719-25.  https://doi.org/10.1024/0040-5930.62.11.719  PMID: 16350533 
  34. Van Heuverswyn J, Hallmaier-Wacker LK, Beauté J, Gomes Dias J, Haussig JM, Busch K, et al. Spatiotemporal spread of tick-borne encephalitis in the EU/EEA, 2012 to 2020. Euro Surveill. 2023;28(11):2200543.  https://doi.org/10.2807/1560-7917.ES.2023.28.11.2200543  PMID: 36927718 
  35. Baroutsou V, Zens KD, Sinniger P, Fehr J, Lang P. Analysis of tick-borne encephalitis vaccination coverage and compliance in adults in Switzerland, 2018. Vaccine. 2020;38(49):7825-33.  https://doi.org/10.1016/j.vaccine.2020.10.022  PMID: 33164805 
  36. Swiss Federal Office of Public Health (FOPH). Frühsommer-Meningoenzephalitis (FSME). [Tick-borne Encephalitis (TBE)]. Bern: FOPH; 6 Nov 2023. German. Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/fsme.html
  37. Zlamy M, Haberlandt E, Brunner J, Dozcy L, Rostasy K. Tick-borne encephalitis in a child with previous history of completed primary vaccination. Pediatr Int. 2016;58(1):56-8.  https://doi.org/10.1111/ped.12752  PMID: 26541246 
  38. Lenhard T, Ott D, Jakob NJ, Martinez-Torres F, Grond-Ginsbach C, Meyding-Lamadé U. Clinical outcome and cerebrospinal fluid profiles in patients with tick-borne encephalitis and prior vaccination history. Ticks Tick Borne Dis. 2018;9(4):882-8.  https://doi.org/10.1016/j.ttbdis.2018.02.021  PMID: 29576392 
  39. Sendi P, Hirzel C, Pfister S, Ackermann-Gäumann R, Grandgirard D, Hewer E, et al. Fatal outcome of European tick-borne encephalitis after vaccine failure. Front Neurol. 2017;8:119.  https://doi.org/10.3389/fneur.2017.00119  PMID: 28421031 
  40. Finnish Institute for Health and Welfare (THL). TBE, or ’tick vaccine‘. Helsinki: THL; 7 Dec 2023. Available from: https://thl.fi/en/topics/infectious-diseases-and-vaccinations/vaccines-a-to-z/tbe-or-tick-vaccine-
  41. Santonja I, Stiasny K, Essl A, Heinz FX, Kundi M, Holzmann H. Tick-borne encephalitis in vaccinated patients: a retrospective case-control study and analysis of vaccination field effectiveness in Austria from 2000 to 2018. J Infect Dis. 2023;227(4):512-21.  https://doi.org/10.1093/infdis/jiac075  PMID: 35235953 
  42. Zavadska D, Freimane Z, Karelis G, Ermina I, Harper LR, Bender C, et al. Effectiveness of tick-borne encephalitis vaccination in Latvia, 2018-2020: an observational study. Clin Microbiol Infect. 2023;29(11):S1198-743X.  https://doi.org/10.1016/j.cmi.2023.06.028  PMID: 37422077 
  43. Dengler TJ, Zimmermann R, Meyer J, Sack FU, Girgsdies O, Kübler WE. Vaccination against tick-borne encephalitis under therapeutic immunosuppression. Reduced efficacy in heart transplant recipients. Vaccine. 1999;17(7-8):867-74.  https://doi.org/10.1016/S0264-410X(98)00272-2  PMID: 10067693 
  44. Hertzell KB, Pauksens K, Rombo L, Knight A, Vene S, Askling HH. Tick-borne encephalitis (TBE) vaccine to medically immunosuppressed patients with rheumatoid arthritis: A prospective, open-label, multi-centre study. Vaccine. 2016;34(5):650-5.  https://doi.org/10.1016/j.vaccine.2015.12.029  PMID: 26718689 
  45. Panasiuk B, Prokopowicz D, Panasiuk A. Immunological response in HIV-positive patients vaccinated against tick-borne encephalitis. Infection. 2003;31(1):45-6.  https://doi.org/10.1007/s15010-002-2020-6  PMID: 12590332 
  46. Jilich D, Maly M, Kosina P, Fleischhans L, Machala L. Immunogenicity and safety of rapid scheme vaccination against tick-borne encephalitis in HIV-1 infected persons. Epidemiol Infect. 2021;149:e41.  https://doi.org/10.1017/S0950268821000194  PMID: 33504405 

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