Tick borne encephalitis TBE--vaccination in non-endemic countries.

The increase of TBE cases in Europe has become a problem of international public health and travel medicine, because it is not only of concern for endemic areas, but also for visitors from non-endemic countries. Although highly effective modern vaccines are on the market in 28 European countries, there are still 7, mainly Eastern European, countries with no or an uncertain number of cases and without licensed modern vaccines. The prevailing danger for travellers, however, lies in underestimation and not awareness of the disease by public authorities, travel agencies and by the travellers themselves, a lack of mandatory notifications and sometimes a lack of financial resources. Outside Europe TBE has mostly not been recognized as a travel associated disease. Recommendation for travellers to endemic countries and suggestions to extra-European travellers and health authorities as well as vaccination advices are summarized in this paper.