Krbkova et al.
Tick-borne encephalitis in an 8.5-month-old boy suspected of febrile seizures.
Microorganisms. 2021; 9:1425. doi, 10.3390/microorganisms9071425

In young children, TBE is mostly mild and rare. Hence, most countries in which TBE is endemic do not recommend vaccinating very young children and infants. Generally, TBE vaccination starts at the age of three years (e.g., Germany) or not before six years (e.g., Switzerland), and only in highly endemic areas, vaccination below the age of three years is not uncommon (e.g., southeastern regions of Austria).

A Czech team has now published a case report about an 8.5-month-old boy – healthy and fully vaccinated according to the vaccination recommendations – who became ill one week after a tick bite. Symptoms started with an exanthema subitum and then, rectal temperature of 40°C was measured. Symmetric seizures pronounced in the lower extremities and unconsciousness were observed. After admission to the hospital, comprehensive clinical examinations and laboratory analyses were carried out. Lyme neuroborreliosis was suspected and treatment with ceftriaxone was started and dexamethasone was applied for five days. Antibiotic treatment was discontinued after Lyme borreliosis was excluded and TBE specific IgM and IgG ELISA antibodies were detected in the CSF. TBE virus infection was verified by neutralization assay.

The boy was discharged home with no detectable sequelae and neurological follow-up showed no abnormalities. NT antibody titers increased at his first control at one month and after half a year.

The authors conclude that this case provides information for discussions about early vaccination of individuals (already in infancy) living in highly endemic areas.

TBE Book