FSME (Frühsommer Meningoencephalopathie), or Early Summer Meningoencaphalitis is a form of tick-born illness. Tick-borne encephalitis (TBE) is an inflammation of the brain and brain membranes that is caused by a virus. The pathogen occurs in many European countries. In Germany, the main high-risk regions are Baden-Württemberg, Bavaria, Southern Hesse and southeast Thuringia, with isolated areas in central Hesse (Marburg-Biedenkopf district), Rhineland- Palatinate (Birkenfeld), Saxony (Vogtland district) and Saarland (Saar-Palatinate district). The TBE virus spreads primarily via small mammals such as mice. The virus is then transmitted to humans by infected ticks. Cases of TBE usually occur in spring and summer, occasionally in autumn.

By tick bites The virus is transmitted by infected ticks. A tick bite can enable the virus to enter the human blood system. Not every bite from an infected tick leads to infection, however. Via foodstuffs Very rarely, people can infect themselves by drinking tainted, unpasteurised milk from goats or sheep (and, in exceptional cases, from cows). Important: TBE is not transmitted from person to person!

Most of those infected (approx. 70–95%) will remain free of symptoms or their disease will not progress into the second phase. The symptoms of TBE disease usually occur in two phases: First, patients suffer flu-like symptoms such as fever, headaches, aching limbs and generally feeling unwell. Often, the tick bite has been forgotten by now and the symptoms are mistakenly attributed to a common cold. For most patients, the diseases progresses no further. For some patients, however, an inflammation of the brain membranes and the brain (meningoencephalitis) occurs around a week later. Inflammation of the spinal cord may also occur. Symptoms include a return of fever as well as nausea, vomiting and problems with the nervous system. If the disease takes a serious course, it may result in paralysis of the limbs, difficulty with swallowing or speech, respiratory paralysis, and coma. Complications can include paralysis, headaches, a general lack of resilience and mood swings, and may persist for several months. While a full recovery with no further complications is possible even at a late stage, patients may nonetheless suffer lasting damage. Around 1 in 100 patients with nervous system involvement will die of the infection.

If the illness breaks out, it usually happens 1 to 2 weeks after the tick bite, rarely up to 4 weeks after it.

People particularly at risk include those living in high-risk areas who spend their leisure time outside, especially if this involves contact with grass or low bushes, or have close contact with animals who spend a lot of time outside. As people grow older, the disease becomes more serious. Senior citizens in particular are at higher risk of complications.

Patients should stay in bed. Severe cases are treated in hospital and may require intensive care. Since there is no treatment available that targets the TBE disease directly, the aim is to alleviate the symptoms. After one TBE infection, the patient is usually immune and cannot develop the illness a second time. If you continue to be exposed to a TBE risk, however, immune protection should be refreshed by vaccination after 3 to 5 years, since there is insufficient experience about how long the immune protection will persist.

Vaccination Vaccination against TBE is recommended for: People who live in TBE high-risk areas and who spend a lot of time outdoors Travellers in areas with a special TBE risk, if there is likely to be any contact with ticks. (An overview of the current TBE high-risk areas in Germany is available from the Robert Koch Institute website: www.rki.de/fsme) Professionals such as forest wardens/workers or hunters Three injections are required to establish immunity. A booster should be given after 3 years if there is a persistent risk of infection. Subsequent boosters must then be given every 5 years. Depending on the particular vaccine used, a booster injection should be given every 3 years from the age of 50 or 60. If the person has already been infected, a subsequent injection will be unable to prevent an outbreak of the disease. Important facts: Ticks can transmit a range of pathogens. Alongside TBE, another is Lyme disease. There is no prophylactic vaccination against Lyme disease, however.