Foreword to the 8th Edition of THE TBE BOOK:
A comprehensive guide to Tick-Borne Encephalitis

Tick-Borne Encephalitis (TBE):
A serious disease transmitted by ticks

Tick-borne encephalitis (TBE) has been known in Central Europe for about 85 years. Over the past decade, there has been a clear upward trend in reported cases. In Germany, for example, the number of cases has more than doubled since reporting became mandatory, rising from an average of 300 to around 500 to 700 cases per year. Switzerland shows a similar increase, from about 150 to more than 450 cases. Austria, too, has seen a rise, from around 70 to approximately 150 cases annually.

Austria’s example illustrates that high vaccination rates have had little impact on this trend: the TBE vaccine provides individual protection only, but does not offer herd protection like the measles vaccine. While Austria still maintains relatively high vaccination coverage, case numbers continue to rise among the unvaccinated. Recent studies show the TBE vaccine is over 85% effective in children, adolescents, and adults.

In eastern Bavaria’s Passau region, vaccine protection rates of about 80% or more have also been recorded. Among unvaccinated individuals, the annual infection rate exceeds 1%, but only a few of those infected develop illness. Newer studies have shown that protective antibodies from the vaccine remain detectable for more than 10 years in most individuals. Breakthrough infections are still very rare.

The reasons for the rise in reported TBE cases in Central Europe are not fully understood. Possible explanations include:

  1. Increased infection pressure (i.e., more infected ticks),
  2. More people are spending time in nature and being exposed to ticks, and
  3. Physicians are more frequently testing suspected cases of TBE than in the past.

There is no treatment for TBE. Vaccination remains the only effective protection against the severe consequences of infection. As outlined in the newly revised TBE handbook, the virus exists across a wide geographic belt—from the Arctic Circle to Tunisia (!) and from England to China and Japan. Travelers abroad should always consider the risk of TBE.

Gerhard Dobler, Michael Bröker, Lydia Chitima-Dobler, Willi Erber, Joe Schmitt

May, 2025
The Editors

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Publication of this book was funded by Pfizer Inc.

ISSN: 2661-3980 | Published online on May 15, 2025

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