Tick-borne Encephalitis in Childhood: Rare or Missed?

Magnus E. A. Hansson, MD; Claes Örvell, MD, PhD; Mona-Lisa Engman, MD, PhD; Katarina Wide, MD, PhD; Lars Lindquist, MD, PhD; Karl-Johan Lidefelt, MD, PhD; Mikael Sundin, MD, PhD


Pediatr Infect Dis J. 2011;30(4):355-357. 

In This Article

Abstract and Introduction


Retrospective evaluation of medical history and 3635 anti-TBE (tick-borne encephalitis) serologies during the years 2003–2008 indicates that childhood TBE is characterized by vague symptoms. Clinical findings suggest a nonspecific inflammatory disease with restricted encephalitic profile compared with adult TBE. Childhood TBE might elude diagnosis, which is unsatisfactory because of potential long-term consequences.


In Europe, tick-borne encephalitis (TBE) is a common infection of the central nervous system with a 400% increase in reported cases during recent decades. TBE is caused by an RNA virus of the genus Flavivirus, also including the dengue, yellow fever, Japanese encephalitis, and West Nile viruses. The TBE virus (TBEV) is usually transmitted by bites of an infected tick. In most of Europe, the TBEV is endemic with seasonally distributed TBE cases due to temperature-dependant tick activity.[1,2] Generally, TBE is characterized by a biphasic course after an incubation period of ~1 to 2 weeks. Nonspecific flu-like symptoms 1 to 8 days are followed by an asymptomatic interval and thereafter symptoms from meningitis to meningoencephalomyelitis of varying severity occur.[1,3,4] Childhood TBE is considered to be a relatively mild condition with favorable outcome compared with adult TBE.[3,5,6] However, the general assumption of childhood TBE being insignificant is challenged by pediatric case-reports of severe acute TBE[7] and deficits in attention and psychomotor activity combined with electroencephalogram abnormalities as sequelae.[8] No specific treatment exists, but TBE is preventable by immunization.[1,4,9,10]

This study aimed to reevaluate symptomatology and clinical findings at diagnosis in childhood TBE. The algorithms for diagnostics are based on adult findings or studies in which children and adults are analyzed collectively. A better description of childhood TBE is essential for diagnostic accuracy and can lead to better understanding of the natural course of the disease in children.


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