Wednesday, June 01, 2016

Tickborne encephalitis (TBE) Outbreak In Košice, Slovakia


From its name, most people get that you can contract TBE (Tickborne Encephalitis) from the bite of an infected tick, but less well known is that you can also get it from consuming unpasteurized dairy products (i.e. milk and cheese) from infected goats, sheep, or cows.

While not as common a route of infection as a tick bite, it can nonetheless spark large outbreaks of the virus. 

TBE (of which there are three subtypes: European, Siberian, and Far Eastern) is endemic in many parts of Europe, the Former Soviet Union, and Asia, with Russia reporting the most cases each year. 

Although classic TBE isn't found in North America, we do have the Poswassan virus (POWV) - which like TBE is a member of the family Flaviviridae - and is carried by ticks and can cause encephalitis.

According to media reports, the town of Košice, in eastern Slovakia, is seeing an unusually large outbreak of TBE due to the consumption of sheep's cheese.

According to the CDC's Yellow Book:
  • The European subtype is associated with milder disease, a case-fatality ratio of < 2%, and neurologic sequelae in up to 30% of patients.
  • The Far Eastern subtype is often associated with a more severe disease course, including a case-fatality ratio of 20%–40% and higher rates of severe neurologic sequelae.
  • The Siberian subtype is more frequently associated with chronic or progressive disease and has a case-fatality ratio of 2%–3%.
Something to consider the next time you are traveling and are presented with the opportunity to consume unpasteurized dairy products. 

This from Radio Slovakia International.

Number of people infected with tick-borne encephalitis increases

The number of people suffering from tick-borne encephalitis in Košice has increased, and the city's Louis Pasteur University Hospital (UNLP) has accepted new patients, TASR learnt on Tuesday.
A local tick-borne encephalitis infection broke out in Košice last weekend. UNLP's Infectology and Travel Medicine Department (KICM) has admitted 18 patients since last week. 
The consumption of sheep's cheese is said to have caused the infection.
Two patients were released from the hospital on Monday (May 30). "At the moment, 24 patients are in hospital at KICM and four are being monitored as part of outpatient care. This number isn't necessarily definitive, as the incubation period of the disease hasn't expired", said the hospital's spokesperson Ladislava Šustová, adding that doctors haven't recorded any complications in treatment so far.
Šustová went on to explain the symptoms of the decease: "This infectious disease comes in two waves. The first looks like a mild flu, including a loss of appetite and intestinal problems. After three or four days these problems fade and the so-called asymptomatic phase occurs, which can last up to 20 days. Then a second phase sets in abruptly, featuring high fever, persistent headaches, vomiting, sensitivity to light, a stiff neck and other symptoms characteristic of the involvement of the central nervous system".
According to Šustová, KICM records six cases of tick-borne encephalitis on average per year. "Such a mass outbreak of tick-borne encephalitis hasn't been recorded at the hospital for the past six years", she added.

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