Clinical Scorecard: Clinical Features of Tick-Borne Encephalitis in Adult Individuals: A Retrospective Analysis Over a Decade in Stockholm, Sweden
At a Glance
Category
Detail
Condition
Tick-borne encephalitis (TBE), a viral infectious disease affecting the central nervous system transmitted mainly by Ixodes ticks.
Key Mechanisms
Biphasic disease course with initial viremia causing nonspecific symptoms followed by meningitis, meningoencephalitis, or meningoencephalomyelitis; immune response influenced by age and vaccination status.
Target Population
Adult patients (≥18 years) in a high-endemic region (Stockholm, Sweden), including those with comorbidities and immunomodulatory therapy.
Care Setting
Hospital and outpatient healthcare settings in Region Stockholm, including follow-up and rehabilitation.
Key Highlights
Among 703 adult TBE patients, 75% were hospitalized and 11% experienced severe disease.
Severe disease was associated with age ≥50 years, comorbid conditions, immunomodulatory therapy, and previous complete vaccination (breakthrough infections).
More than 70% of patients followed >6 months had persisting symptoms; case fatality rate was 1.4%, rising to 15% in those on immunomodulatory therapy.
Guideline-Based Recommendations
Diagnosis
Confirm TBE by detection of specific IgM and IgG antibodies via enzyme-linked immunosorbent assay.
Consider vaccination history and perform additional neutralization tests in suspected breakthrough infections.
Management
No evidence-based antiviral treatment available; supportive care including hospitalization and intensive care as needed.
Emphasize prevention through vaccination, especially in high-risk groups.
Monitoring & Follow-up
Follow-up visits recommended to assess persisting symptoms and recovery status.
Standardize rehabilitation to address long-term sequelae.
Risks
Increased severity and mortality in patients aged ≥50 years, with comorbidities, or receiving immunomodulatory therapy.
Vaccination breakthrough infections may present with more severe disease.
Patient & Prescribing Data
Adult TBE patients in Stockholm, majority nonvaccinated; 4% on immunomodulatory therapy.
Vaccination highly effective (96%-99%) but breakthrough cases occur, particularly in older adults; immunomodulatory therapy linked to higher fatality.
Clinical Best Practices
Prioritize vaccination in endemic areas, especially for older adults and immunocompromised patients.
Recognize biphasic clinical presentation and monitor for neurological involvement.
Implement standardized follow-up and rehabilitation protocols to manage persistent symptoms.
Consider immunomodulatory therapy status as a significant risk factor for severe disease and mortality.
by Sofia Bartholdsson, Maria-Pia Hergens, Karin E Hansson, Josef Ragnarsson, Peter Hodosi, Ismail Kus, Mona Insulander, Sirkka Vene, Lars Lindquist, Helena H Askling, Sara Gredmark-Russ
