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Chapter 6

TBE in children

Mikael Sundin

Key Points

• Most cases of TBE in childhood will present similarly as in adults. However, a more diffuse clinical
picture is seen especially in preschool children.
• Laboratory evaluation may show elevated blood inflammatory indices, but cerebrospinal fluid
analysis and anti-TBEV serology are needed for establishing the diagnosis.
• There is no specific treatment for TBE; supportive care needs to be provided based on the
individual clinical course.
• Deaths occur seldom in pediatric TBE, but severe courses have been reported in a fraction of the
children.
• Long-term somatic residua exist, but are uncommon (2%) in childhood TBE. Yet, long-term
symptoms and neurodevelopmental/cognitive deficits are seen in 10–40% of infected children.
• Protective immunity can be elicited in children by TBE vaccines as of 1 year of age.

Children, ticks, and TBE

Childhood tick-borne encephalitis (TBE) has Awareness of TBE in general may be a factor
been described as a rare disease, particularly to some degree as well; in countries with a
in preschool children, compared with TBE in high TBE burden, such as Austria and Estonia,
1–4
adults. This is puzzling as children appear to the pediatric cohort accounts for a large
8
be perfect prey for ticks, primarily because of proportion of all cases. TBE awareness in
a high level of exposure (children often play these countries is further substantiated by the
outdoors and explore their surroundings) and fact that Austria has implemented a policy of
9
the short climbing distance to a proper bite general immunization against TBE and Baltic
site (children have a short stature and soft states have advocated for proper immuniza-
10
skin). The low incidence of pediatric TBE cases tion strategies. Hence, general knowledge of
becomes even more puzzling as Borrelia TBE is likely higher in the high-endemic areas
infections are well documented in children. 5–7 and as a consequence fewer cases are eluded.
Additionally, Borrelia infections have been
reported to be up to 5 times more common in In addition, some childhood TBE cases are not
preschool children than in older children and recognized probably because the disease
5
adults. This discrepancy (i.e., a high tick commonly presents with vague and non-
exposure but a low and varying incidence of specific symptoms (discussed in more detail
5,6,11
TBE in children) could stem from the fact that below). Younger children also seem to be
5
childhood TBE is underdiagnosed. less frequently considered for TBE, but the
disease can be seen in children as young as

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