**11. Prevention**

## **11.1. Nonspecific preventive measures**

TBEV is transmitted to humans by a tick bite or consumption of infected milk. Therefore, nonspecific preventive measures consist of reduction of tick population, personal protective procedures, and—as milk from endemic regions may contain TBEV—pasteurization of milk, and avoiding consumption of unpasteurized milk and dairy products [30, 42].

Tick population can be diminished by taking environmental measures, such as control of deer population, treatment with acaricides, and/or regular cutting of grass around the residence.

Nonspecific personal preventive measures include avoidance of ticks (i.e. avoidance of contact with vegetation, especially in deciduous and mixed forests with a rich understory), wearing light‐colored clothing (light colors enable that ticks are better noticeable) with long sleeves and slacks stuck in socks or footwear (to diminish tick access to the skin), use of repellents, careful examination of the whole body for the presence of ticks, and removal of the attached ticks as soon as possible. However, TBEV is present in salivary glands of the infected tick and may be transmitted from the saliva within a few minutes after attachment [42]. Although the recommended personal measures for the prevention of tick-borne diseases such as TBE and Lyme borreliosis appear to be obvious, the efficiency of some of these procedures is inadequate, uncertain or has not been properly evaluated. Furthermore, in everyday life only a small proportion of exposed persons follow the recommended procedures [127, 128].

## **11.2. Prevention with immunoglobulins (passive immunization)**

In the TBE endemic regions, immunoglobulins containing gamma globulin against TBEV had been used as postexposure prophylaxis within 96 hours after a tick bite. Because protection was rather unreliable [129], and because several reports pointed toward a more severe disease course in children who had received the immunoglobulin [81, 129, 130], passive immunization (the usage of the immunoglobulins) in the European Union has been abandoned [131]. However, the specific immunoglobulins are still used in Russia; the reported protection rate is about 80% [132].

## **11.3. Vaccination**

of elevated concentration of C‐reactive protein and lactate dehydrogenase values direct toward the diagnosis of human granulocytic anaplasmosis and against the initial phase of TBE [119].

TBE needs to be differentiated from encephalitis or aseptic meningitis due to many other viruses. Differential diagnosis comprises also other tick‐borne diseases such as Lyme borreliosis, babesiosis, human granulocytic anaplasmosis, tick‐transmitted rickettsioses, and tularemia. Since these diseases are treatable with antibiotics, caution must be taken to distinguish

Concomitant TBEV and *Borrelia burgdorferi* sensu lato infections, as well as concomitant TBEV

There is no specific antiviral treatment for TBE. Patients as a rule need hospitalization, supportive care, symptomatic treatment based on the presence and severity of signs/symptoms and therapy of neurologic and systemic complications. The symptomatic treatment usually includes antipyretics, analgesics, antiemetics, maintenance of fluid and electrolyte balance, and if necessary administration of anticonvulsive agents and treatment of cerebral edema

In some countries corticosteroids are often used in patients with TBE. However, until reliable studies prove the benefits of corticosteroids, their usage for the treatment of TBE is not recom-

Several patients need intensive care management; in those with neuromuscular paralysis leading to respiratory failure, intubation and ventilatory support are required. In a large prospective study, encompassing 635 patients diagnosed with TBE in the period from 1994 to 1998 in Germany, 12% of patients were treated in intensive care unit and 5% of patients required assisted ventilation [46]. Among patients with TBE, treated at a single medical center in Slovenia in the period from 2000 to 2004, 6.9% were hospitalized in the intensive care unit

TBEV is transmitted to humans by a tick bite or consumption of infected milk. Therefore, nonspecific preventive measures consist of reduction of tick population, personal protective procedures, and—as milk from endemic regions may contain TBEV—pasteurization of milk,

Tick population can be diminished by taking environmental measures, such as control of deer population, treatment with acaricides, and/or regular cutting of grass around the residence.

and avoiding consumption of unpasteurized milk and dairy products [30, 42].

and *Anaplasma phagocytophilum* infections have been described [77, 113, 120–122].

34 Meningoencephalitis - Disease Which Requires Optimal Approach in Emergency Manner

them from TBE [32].

**10. Treatment**

[50, 123–125].

mended [47, 126].

**11. Prevention**

and 22.5% of them needed mechanical ventilation [33].

**11.1. Nonspecific preventive measures**

Active immunization is the most effective and reliable way to prevent TBE [12, 42].
