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Chapter 14: Prevention

though the vaccine used in this study is no endemic regions were issued in many
longer on the market (previous generation of countries (see Chapter 12b). As TBE disease
Encepur, stabilized with polygeline), the was believed to be less severe in children,
findings are consistent with more recent some countries had recommendations for
investigations. adults only. More recent publications on
severe disease courses and underestimation

of long-term sequelae in children have led to
Public health considerations adaptations of the vaccination recom-
mendations for children in some countries. For
instance, in Sweden, the age cut-off was
While no formal vaccine efficacy study has
been conducted with any TBE vaccine, reduced in 2012 from 7 years to 3 years of age
and in 2013 from 3 years to 1 year of age.
effectiveness and pharmacoeconomic studies
have been conducted, and the evidence for
In 2011, the WHO published a position paper
the public health impact of TBE immunization on TBE vaccination recommending
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is indisputable. The most impressive example vac-cina-tion of all age groups in areas of high
can be obtained from Austria, a country with a
pre-vaccination disease incidence, defined as
longstanding tradition of TBE immunization an incidence of ≥5/100,000 population per
and reliable epidemiological data since the year, while in regions with lower incidence,
early 1970s. Since that time, vaccination vaccination recommendations should be
coverage increased steadily with currently confined to groups of the population exposed
85% to 88% of the population having received to a particular risk. Furthermore, the WHO
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at least 1 dose of TBE vaccine. As a result, also recommends vaccination of travelers
disease incidence dropped from approxi-
planning outdoor activities in endemic areas
mately 700 to fewer than 100 cases per year, during the active tick season. In 2012, TBE
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while in neighboring countries, with low became notifiable on the European level at
vaccine coverage, the disease incidence has the European Centre for Disease Prevention
increased (see chapter on epidemiology).
and Control (ECDC), which is a further,
Little information is published on the important step towards comprehensive and
economic burden of TBE disease. Based on the continuous assessment of the disease
finding that the Austrian TBE vaccination epidemiology across Europe.
campaigns for the period 1981–1990 led to a
Recently a cost/benefit analysis became
reduction of more than 50% of clinical TBE available. In Sweden, where the area of
cases, a benefit of €24 million was calculated Stockholm is highly endemic and the number
versus the pre-vaccination era. Using a linear of cases is increasing despite the increased
trend prognostic model for the further decline uptake of TBE vaccines, earlier studies showed
of TBE cases while vaccination coverage that low-income households have lower
reached 85% by 2000, the author concluded
vaccination coverage even when they are at
that for the period 1991 to 2000, a total cost high risk. The newly performed analysis
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saving of €60 million can be estimated. showed a gain in cost per QALY (Quality-
Epidemiological trends and progress in
adjusted Life Years) of a free vaccinations
vaccination coverage have confirmed these program for the Stockholm county, especially
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assumptions. The majority of endemic
for children of 3 years old, below generally
countries in Europe, as well as Russia, have acceptable cost-effectiveness thresholds in
TBE vaccination recommendations in place, Sweden.
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targeting primarily at-risk groups. More
recently, recommendations for travelers to

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