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Tick-borne encephalitis - Treatment and prevention
Last reviewed: 04.07.2025
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Drug treatment of tick-borne encephalitis
Etiotropic treatment of tick-borne encephalitis is prescribed to all patients with tick-borne encephalitis, regardless of previous vaccination or prophylactic use of anti-encephalitis immunoglobulin.
Depending on the form of the disease, immunoglobulin against tick-borne encephalitis is administered intramuscularly in the following doses.
- For patients with the febrile form: daily in a single dose of 0.1 ml/kg, for 3-5 days until the general infectious symptoms regress (improvement of the general condition, disappearance of fever). The course dose for adults is at least 21 ml of the drug.
- For patients with the meningeal form: daily in a single dose of 0.1 ml/kg 2 times a day with an interval of 10-12 hours for at least 5 days until the patient's general condition improves. The average course dose is 70-130 ml.
- For patients with focal forms: daily in a single dose of 0.1 ml/kg 2-3 times a day at intervals of 8-12 hours for at least 5-6 days until the temperature decreases and neurological symptoms stabilize. The average course dose for an adult is at least 80-150 ml of immunoglobulin.
- In extremely severe cases of the disease, a single dose of the drug can be increased to 0.15 ml/kg.
The effectiveness of using interferon alpha-2 preparations and endogenous interferon inducers in the acute period has not been sufficiently studied.
Ribonuclease is administered intramuscularly at 30 mg every 4 hours for 5 days.
Non-specific treatment of tick-borne encephalitis is aimed at combating general intoxication, cerebral edema, intracranial hypertension, and bulbar disorders. Dehydrating agents (loop diuretics, mannitol), 5% glucose solution, and polyionic solutions are recommended; in case of respiratory disorders - artificial ventilation, oxygen inhalation; to reduce acidosis - 4% sodium bicarbonate solution. Glucocorticoids are prescribed for meningoencephalitic, poliomyelitis, and polyradiculoneuritic forms of the disease. Prednisolone is used in tablets at a rate of 1.5-2 mg/kg per day in equal doses in 4-6 doses for 5-6 days, then the dose is gradually reduced by 5 mg every 3 days (treatment course is 10-14 days). In case of bulbar disorders and disorders of consciousness, prednisolone is administered parenterally. In case of convulsive syndrome, anticonvulsants are prescribed: phenobarbital, primidone, benzobarbital, valproic acid, diazepam. In severe cases, antibacterial therapy is used to prevent bacterial complications. Protease inhibitors are used: aprotinin. The chronic form of tick-borne encephalitis is difficult to treat, the effectiveness of specific agents is significantly lower than in the acute period. General strengthening therapy is recommended, glucocorticoids in short courses (up to 2 weeks) at the rate of prednisolone at 1.5 mg / kg. Of the anticonvulsants, benzobarbital, phenobarbital, primidone are used for Kozhevnikovsky epilepsy. It is advisable to prescribe vitamins, especially group B, for peripheral paralysis - anticholinesterase agents (neostigmine methylsulfate, ambenonium chloride, pyridostigmine bromide).
Additional treatment for tick-borne encephalitis
In the acute period, physical activity, balneotherapy, exercise therapy, and massive electrical procedures are excluded. Sanatorium and resort treatment of tick-borne encephalitis is carried out no earlier than 3-6 months after discharge from the hospital in climatic and general health resorts.
Regime and diet for tick-borne encephalitis
Strict bed rest is recommended, regardless of the general condition and well-being during the entire febrile period and 7 days after the temperature has returned to normal. No special diet is required (common table). During the febrile period, plenty of fluids are recommended: fruit drinks, juices, hydrocarbonate mineral waters.
Approximate periods of incapacity for work
Patients with febrile and meningeal forms are discharged from the hospital on the 14th-21st day of normal temperature in the absence of meningeal symptoms, patients with focal forms - at a later date, after clinical recovery.
Approximate periods of disability, taking into account outpatient treatment and rehabilitation, are: for the febrile form - 2-3 weeks; for the meningeal form - 4-5 weeks; for the meningoencephalitic, polyradiculoneuritic form - 1-2 months; for the poliomyelitis form - 1.5-3 months.
Clinical examination
All those who have had tick-borne encephalitis, regardless of the clinical form, are subject to dispensary observation for 1-3 years. Dispensary observation of patients (except for the febrile form) is carried out jointly with a neurologist. The basis for removal from the dispensary register is full restoration of working capacity, satisfactory health, complete sanitation of the cerebrospinal fluid, absence of focal symptoms.
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What should a patient know about tick-borne encephalitis?
Patients with tick-borne encephalitis should have an idea of the ways the virus is transmitted and the rules for removing ticks. It is possible to examine the tick for the presence of pathogens of infectious diseases. Relatives should be explained that the patient poses no epidemiological danger to others. The patient is explained the possibility of the disease progressing and the associated need for strict bed rest throughout the febrile period. In the presence of a long-term asthenic syndrome, it is necessary to adhere to a protective regimen, adequate nutrition, and organize rest. It is recommended to exclude physical and mental overload. The patient is explained the need for dispensary observation to monitor the completeness of recovery.
How to prevent tick-borne encephalitis?
Prevention of tick-borne encephalitis is divided into two main groups: non-specific and specific.
Non-specific prevention of tick-borne encephalitis
Non-specific prevention of tick-borne encephalitis is associated with protecting humans from tick attacks. Public prevention of tick-borne encephalitis is aimed at destroying or reducing the number of ticks. Personal prevention measures include wearing specially selected clothing when visiting forests, using various repellents, and mutual inspections after visiting forests and parks within the city.
Specific prevention of tick-borne encephalitis
Specific prevention of tick-borne encephalitis includes active and passive immunization of the population. Vaccination against tick-borne encephalitis is carried out with a tissue culture vaccine (three vaccinations) with subsequent revaccination after 4, 6 and 12 months.
Specific seroprophylaxis is carried out with homologous donor immunoglobulin both pre-exposure (before the expected tick bite, when entering the risk zone) and post-exposure (after the tick bite). Immunoglobulin is administered intramuscularly at a rate of 0.1 ml/kg once several hours before entering the forest zone or during the first day after the tick bite. In the following 2-3 days, the effectiveness of post-exposure immunoprophylaxis decreases.
Tick-borne encephalitis is more common in unvaccinated patients, the percentage of residual effects and mortality is higher. Severe forms among unvaccinated patients are 4 times more common than among vaccinated patients.