Page 437 - TBE_Book_V2_2019

Chapter 13: TBE as a matter of public health

In children, too, TBE can run a severe course Protective clothes and repellents
and may lead to permanent sequelae (see
chapter 6). Retrospective studies have shown 1. As ticks attach to any spot on the host and
TBE infection to occur in infants as young as 3 from there try to reach an uncovered part
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months. A higher incidence of TBE has been of the skin, adequate clothing may help to
reported in boy:girl (ratio 7:3), who more make access to the skin more difficult for
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often show signs of focal encephalitis. ticks. Protective clothes must be completely
closed to be really effective, but this may

not be acceptable to people spending their
leisure time or holidays in endemic areas
General aspects of TBE
during the warm season.
prevention
2. If we apply terminology strictly, then
No therapy, and specifically no antiviral agent, discriminating between types of repellents
is available against TBEV. Control of reservoir is important. In the narrow sense (s.s.)
animals and of ticks is not feasible and/or has repellents include formulations that repel
limited to no impact on TBE incidence. (keep off arthropods like ticks), while
Prevention thus relies on 1) avoidance of insecticides act as neurotoxic agents that
exposure and 2) vaccination. Success of paralyze or even kill arthropods after
vaccination is based on TBE awareness among contact. The expression ‘repellent’ in the
those at risk and – perhaps more importantly broad sense (s.l.) combines both means of
– those counseling them. action and will be used henceforth for
simplicity.

For the impregnation of clothes, permethrin
Primary prophylaxis
or other pyrethroids are recommended. The
impregnation of clothes usually provides long-
Behavior
lasting protection (weeks to months), even
Since ticks may transmit diseases other than though the solutions typically used for soaking
TBE (borreliosis being most common), the clothes are water-based. For skin
avoidance of exposure to ticks is crucial. Not impregnation, products with proven efficacy
entering TBEV-endemic areas would be the like N-diethyl-3-methylbenzamide (formerly N,
safest way to avoid any risk of TBE infection. N-diethyl-m-toluamide / DEET; in higher
This may be an option for travelers, but it does concentrations, i.e., preferrably >20%), (p)
not solve the problem for the population living icaridin or p-menthane-3, 8-diol (PMD) are
in TBEV- endemic areas. For anyone entering recommended. The efficacy of cutaneous
endemic areas, the TBE risk can be reduced by repellents decreases in a comparably short
personal behavior like not running or walking time (a few hours at maximum), which in
through high grasses or on narrow paths that addition to chemical characteristics depends
present repeated and unavoidable contact on factors such as the concentration of the
with bushes during seasons and in areas with chemical compound, the user’s degree of
tick activity. Persons at risk should be aware of sweating, and environmental moisture.
the fact that avoiding attachment of ticks to Whereas the water solubility of these
the skin is facilitated when the contact time is products primarily might be judged as a
not more than 0.1 second. disadvantage, this quality allows quick
removal from skin or mucous membranes
Additional recommendations (below) also may should they become contaminated un-
reduce the risk for TBE. intentionally.

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