Page 304 - TBE_Book_V2_2019

Chapter 12b: TBE in Hungary

Table 2: TBE reporting and vaccine prevention in Hungary
Every physician who establishes a diagnosis of TBE must report it. Practically,
these are hospital-based specialists for infectious diseases, pediatricians,
internists, and neurologists.

Mandatory TBE reporting Case definition: clinical symptoms of central nervous infection + presence of
TBE immunoglobulin M (IgM) antibodies in serum and cerebrospinal fluid (CSF)
OR TBEV-specific IgM in CSF OR isolation of infectious virus from clinical
samples OR detection of TBEV RNA in clinical samples OR seroconversion and/
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or 4-fold specific IgG increase in a sample pair.
Other TBE surveillance No
 In one study, 21% of retrospectively collected patient cases were agrarian,
8
16% forestry workers.
 Other work has shown 12% to 16% of patients with TBE were forestry
workers. 9,10
Special clinical features  Similarly, another report found 10.4% of 5196 cases were forestry, 11%
15
other agrarian workers.
 Also, 2% of the 1670 forestry workers screened for Lyme borreliosis went
through TBE (Lakos, unpublished data).
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 65% of hospitalized patients could recall a biphasic course of their TBE.
In the same department of the Central Hospital for Infectious Diseases, during
the years 1976-1980 (n=100), 27 patients showed paresis, 2 died. In 1987-1991
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(n=93), only 5 patients had paresis, none of them died.

From 1985 to 2008, the death rate from TBE in Hungary was 29/3987
18
(0.73%). However, in an earlier period from 1977 to 1996, the fatality rate
was higher – 43/5196 (0.83%). Most of the fatal cases were male (85%), while
15
the proportion of male patients in the total TBE population was 70%.
FSME Immune Inject is a vaccine available for public use since 1992; another
vaccine, Encepur, launched in 1995. Previously, between 1977 and 1990, some
150,000 doses were distributed for the at-risk population. (Note: during 1979
19
to 1983, the FSME vaccine was ineffective both clinically and serologically. It
Available vaccines
has to be mentioned, that TBE vaccination in Austria at the same time showed
a field effectiveness 79.4%-100% after the second dose and 97.3%-100% after

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the third dose ) From 1990 to 2017, 6 million doses were sold. (The Hungarian
population is 10 million.)
When FSME Immune Inject was first available in Hungary in the early 1990s,
the reimbursement rate was 95%; the pharmacy price was 59 HUF (≈20 euro
Vaccination cents). After a gradual decrease, the reimbursement was cancelled for the
recommendations and FSME and Encepur vaccines in 2008 and 2012, respectively. The present price
reimbursement
is around 13,000 HUF (40 euros). For occupationally exposed workers,
20
vaccination has been mandatory at the employers’ expense since 1999.
Vaccine uptake by age
group/risk group/general Not available.
population

Name, address/website of
TBE National Reference National Centre for Epidemiology, National Reference Laboratory for Viral
Center Zoonoses, Budapest, Hungary [http://www.oek.hu]

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