Jakimovski et al.
Imported Tick-borne Encephalitis in a traveller returning to North Macedonia from Switzerland, June 2024. J Travel Med. Published online January 10, 2025. doi:10.1093/jtm/taaf001
A previously healthy 26-year-old male returned to North Macedonia after a two-week stay in Switzerland. He recalled being bitten by a tick one day before leaving Switzerland. Four days after removing the tick, he developed malaise, nausea, musculoskeletal pain, and a severe headache. His condition progressively worsened in the following days.
On the tenth day after symptom onset, TBE IgM serology tested positive, while IgG remained negative. This result was confirmed by a neutralization assay. By the 25th day of illness, paired serum and cerebrospinal fluid (CSF) samples were collected, both showing positive titers.
Recently, a similar case of TBE virus infection was reported in a traveler returning from Switzerland to Serbia (Simin et al., Pathogens 2024, 13:1013, doi.org/10.3390/pathogens13111013). These cases highlight the challenge that most Balkan states do not offer a TBE vaccine, leaving travelers in the region without the option of immunization before visiting TBE-endemic areas.