Information about ticks and TBE

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Spending time outdoors is important for both physical and mental health.

Physical activity in the form of brisk walks, gardening or other outdoor activities can reduce the risk of, among other things, cardiovascular disease, cancer, and mental health disorders. 
However, it is important to know that out there, in the green grass, may be ticks, small arthropods, that can bite and spread diseases.

Ticks are found in nature and can spread diseases through their bite

The tick is a small arthropod, related to mites and arachnids. It thrives best in grass, in shady and humid places. The tick lives for two to three years and develops from a few tenths of a mm as a larva to 3–4 mm as an adult. As long as it is warmer than 5 degrees outside, the tick is active.

The tick needs blood from a host animal to develop from a larva to a nymph and then to an adult. 

Diseases can be spread from the tick to us humans through tick bites. The most common diseases that are spread via tick bites here in Sweden are Lyme disease and TBE.

Lyme disease is more common than TBE but can usually be successfully treated with antibiotics. 

TBE is less common but cannot be treated. There are vaccines that protect against TBE – find your nearest vaccination clinic here.
 

Information about ticks

Information in Swedish

Lyme disease – a serious disease that can be treated

Lyme disease is caused by a tick-borne bacterium. Every year, it is estimated approximately 10 000 people fall ill with Lyme disease in Sweden. It is not possible to get vaccinated against Lyme disease, but it can be treated with antibiotics. It is also possible to get infected with Lyme disease several times. 
The most common sign of Lyme infection is that you see an expanding redness that is larger than five centimeters in diameter at the bite site. It occurs one to four weeks after the tick bite and can fade from the center outwards. Sometimes you can feel like you are getting sick and may have a fever. Lyme infection usually starts in the skin and if it is not treated, there is a risk that the bacteria will spread to the nervous system or to the joints. If you suspect Lyme disease, you should seek medical attention.
 

TBE – a serious disease that can be prevented with vaccination

TBE virus can be found in tick saliva. During the actual tick bite, the tick-borne encephalitis virus (TBE virus) is transmitted quickly via the tick’s salivary glands. 
The first signs and symptoms of the transmitted TBE virus are acute symptoms of infection, such as fever, headache and general malaise that last for up to a week. In some cases, nothing more happens, and a lifelong immunity occurs. However, in about one in every third person infected, the disease returns with more pronounced symptoms – high fever, headache, nausea, vomiting and an affected general condition. The TBE virus then affects the brain and meninges and causes a severe illness that requires hospital care and sometimes even intensive care.

Of those who are infected with TBE, approximately 40% have residual symptoms, such as headaches and fatigue. 
Common is also increased fatigue that leads to impaired attention and memory, which can prevent you going back working full-time. In some cases, direct nerve damage causes symptoms of paralysis, and if the auditory nerve is affected, it can lead to hearing loss or balance disorders. Deaths from TBE occur, but the risk is very small in Sweden. 
There is no treatment for TBE. It is therefore important to get vaccinated against TBE if you spend time outdoors or if you live in areas known for TBE-borne infection. 

TBE in children

Even small children can get infected with TBE and can have long-lasting symptoms such as fatigue, difficulty concentrating and memory problems. Vaccine can be given to children 1 years of age and older.

 

TBE is spreading in Sweden

Every year, 200–500 cases of TBE are reported in Sweden. The regions where most cases were reported in 2021 where Stockholm, Västra Götaland, Uppsala, and Sörmland. The five regions with highest incidence per inhabitants where Uppsala, Sörmland, Västmanland, Örebro and Värmland. TBE is becoming more prevalent in Sweden, see the map below showing the areas where cases of TBE have been reported in recent years.

The Public Health Agency of Sweden recommends vaccination against TBE for those who spend time outdoors in risk areas for TBE. Ticks can be found, for example, in parks, near lakes, in the forest or in the garden. 

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Questions and answers

  1. How do I remove a tick?
    1. Use fine-tipped tweezers or a tick remover to remove the tick.
    2. Grasp the tick mouthparts, as close to the skin as possible.
    3. Carefully pull straight out.

    Watch our instructional video (information in Swedish)
     

  2. How can I protect myself against TBE?

    There is currently no medicine that cures TBE and the treatment given is intended to relieve the symptoms. That is why it is so important to get vaccinated against TBE if you live in risk areas for TBE.

    Read more about protecting yourself against TBE (link to Swedish information)

    Find a vaccination clinic near you
     

  3. Who should get vaccinated?

    Source: Adapted from www.folkhalsomyndigheten.se

    Do you live or spend time in one of the areas known for TBE? Then you should consider getting vaccinated against TBE.
    Vaccination is also recommended for children over the age of 1 who spend time in risk areas for TBE.

    Find a vaccination clinic near you (information in Swedish)
     

  4. How often should I take a booster dose of the vaccine?

    To maintain your protection, you need to take a fourth dose three years after the third dose and every five years thereafter. An alternative vaccination schedule may be appropriate if you are over 50 years old or have a weakened immune system. Consult your vaccination clinic.

  5. Can I get vaccinated if I am pregnant or breastfeeding?

    There is insufficient documentation on vaccination against TBE during pregnancy to be able to make a safe assessment of the risks. Risks and benefits should be carefully considered. Talk to your doctor about this.

  6. Can children get vaccinated against TBE?

    Children older than 1 years of age can also get vaccinated against TBE. Ahead of the 2013 TBE season, the Public Health Agency of Sweden, together with the country’s infection control units, have chosen to lower the age limit at which vaccines are being recommended for children in risk areas from 3 to 1 year. This was based on new studies at Astrid Lindgren’s Children’s Hospital in Stockholm that showed that even small children can suffer from long-term symptoms such as memory problems and lack of energy, which was not previously believed to be the case. In addition, vaccination from the age of 1 is recommended in other European countries where TBE occurs.

  7. Can you get vaccinated against Lyme disease?

    It is not possible to get vaccinated against Lyme disease, but it can be treated. In most cases, antibiotics are used with success.

  8. What are the most common symptoms of a Lyme disease?

    The most common sign of a Lyme infection is that you see an expanding redness that is larger than five centimeters in diameter at the site of the tick bite. It occurs one to four weeks after the tick bite and may fade in the middle. Sometimes you can feel like you are getting sick and may have a fever.

    If you suspect a Lyme infection, you should seek medical attention.
     

  9. How can I protect myself against ticks?

    You can protect yourself by:

    • Wearing full-coverage clothing – long-sleeved sweater, long trousers, socks, and full-coverage shoes, preferably boots.
    • Doing a thorough search of your body for ticks after you have been outside. It helps reduce the risk of getting Lyme disease, as the bacteria is transmitted about 24 hours after the bite.
    • Getting vaccinated against TBE. The TBE virus is transmitted directly via the bite and vaccination is recommended when spending time outdoors in risk areas.

  10. When will the vaccination bus be in my area?

    Click here to find information about where and when the vaccination bus, tent or boat arrive and which vaccination clinic is responsible for vaccination.
    NOTE! Each vaccination clinic is responsible for updating fästing.nu with current information about their clinics and schedules for mobile units. If you have any questions, please contact the vaccination clinic directly
     

  11. When is it time for my next dose?

    To find out when it’s time for your next dose of the TBE vaccine, you should first check if you still have your vaccination card with information about when you got your last dose. If you have questions about the TBE vaccination schedule, you can read more at 1177.se.

    If you do not find your vaccination card, you can contact the vaccination clinic where you received your most recent vaccination. Vaccination clinics usually store information about all vaccinations in their medical record system and are usually able to find the history of those who are vaccinated at their clinics (both regular clinics and mobile clinics).
     

  12. Do I live in a risk area for TBE?

    TBE is spreading in Sweden. Statistics from 2021 show that cases of infection have been reported from Skåne to Gävleborg. The regions where most cases were reported in 2021 where Stockholm, Västra Götaland, Uppsala, and Sörmland. The five regions with highest incidence per inhabitants were Uppsala, Sörmland, Västmanland, Örebro and Värmland. And the geographical spread has continued to increase.

    Source: Adapted from www.folkhalsomyndigheten.se

    See the map here showing where people have been infected with TBE between 2011 and 2020. The number of reported TBE cases is influenced by several different factors such as temperature and weather that affect the number of ticks and how much time we humans spend being out in nature. If many are vaccinated, fewer cases can also be reported, but this does not mean that the risk in that area has decreased, as the virus can remain in the ticks.
     

References:

  • Engman ML et al One-year follow-up of tick-borne central nervous system infections in childhood Pediatr Infect Dis J 2012 Jun;31(6):570-4. doi: 10.1097/INF.0b013e31824f23c0
  • Lindquist L Tick-borne encephalitis Lancet 2008 May 31;371(9627):1861-71. doi: 10.1016/S0140-6736(08)60800-4
  • Vårdguiden 2021: https://www.1177.se/Stockholm/sjukdomar--besvar/hjarna-och-nerver/infektioner-i-hjarna-och-nerver/tbe---fastingburen-hjarninflammation/
  • Folkhälsomyndigheten 2022: https://www.folkhalsomyndigheten.se/smittskydd-beredskap/smittsamma-sjukdomar/tick-borne-encephalitis-tbe/

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