Tick-borne encephalitis (TBE) in children in Europe: Epidemiology, clinical outcome and comparison of vaccination recommendations.

Tick-borne encephalitis (TBE) vaccination recommendations for children residing in high-endemicity countries in Europe vary from universal recommendations to none at all. Such differences may result in uncertainty about the value of such prevention among public health authorities, healthcare professionals and parents. We conducted a systematic review of publications and data from the European Centres for Disease Prevention and Control focusing on the epidemiology, clinical characteristics, and outcomes of TBE in a pediatric population. TBE can affect children of any age, occasionally even before the first birthday. Overall, the clinical course of disease is milder compared to adults, and there are fewer neurologic sequelae persisting after the infection. However, recent follow-up surveys identified a substantial proportion of children with long-term cognitive impairment subsequent to TBE infection. Fortunately, two vaccines against western TBE are available, and both are effective and safe. It is an overly simplistic perception that TBE is severe in adults and mild in children, and to therefore conclude that vaccination is important mainly in older age groups. Even if TBE infection is less dramatic in pediatric populations, TBE often results in long-standing cognitive damage. Based on guidance from the World Health Organization, authorities in countries with high endemicity should either offer or recommend TBE vaccination to children at 1-3 years of age.