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Discussion: TBE vaccine

in: Orienteering; General

Nov 1, 2022 10:09 PM # 
If you're from the US and thinking about summer travel in an area of Europe with endemic TBE & ticks, might be a good time to look into getting the TBE vaccine. It's been used in Europe for a long time, but only recently approved in the US. It's a 3-dose vaccine with the last dose between 5-12 months after the first.

Since summer travel is ~7 months away, figured this might be a good time to post this as a head's up.

Because ticks in the US don't have TBE, most Americans won't encounter this so most health care providers wouldn't offer it proactively. But, if you like to run around the woods in Europe... could be worth looking into :).

Geographic distribution:

CDC vaccine information:
Nov 7, 2022 3:35 PM # 
We tried to get this last year at our HMO near Boston. It was unavailable, and they seemed to have no clue it even existed. We got the first dose just before Covid, in Uppsala. But as we never got 2nd in time, we will start over, again in Uppsala.
Nov 7, 2022 6:37 PM # 
I was looking into travel clinics in Boston, which seem to have it.
Nov 7, 2022 7:37 PM # 
I signed up for a travel clinic in W Hartford, supposed to get it next week.
Nov 8, 2022 6:01 PM # 
Terje Mathisen:
I got my second dose a couple of months ago, will do the last this spring before tick season starts.
Nov 9, 2022 10:04 AM # 
Note also that the time before the third dose seems to be flexible by a few months, and the interval to the refresher after all three even more so, it used to be 5 years but has been reduced to 3 years not long ago, which I didn't know until I went "oops, I seem to be 1 year late" to have my refresher after 6 years and was told "actually, you're now 3 years late, but no worries, a jab is a jab and it all counts towards the immunisation, so just come back every 3 years from now on and you're good".

And also, just don't forget to check yourself for ticks after every fun in the forest, both directly after and the day after in case those nasty things had managed to hide somewhere.
Nov 9, 2022 5:22 PM # 
And if you live with dogs, check yourself daily when the temperature goes above 4C and for a couple of days after. Fortunately, we do this and I was recently reminded that I haven't been wasting my time. :(
Nov 10, 2022 7:16 AM # 
Interesting - at least in Switzerland the recurring jab moved in the early 2000's from 5 years after basic immunization to only every 10 years

You'll get it in many place as walk in.
Nov 10, 2022 5:48 PM # 
Got our second today in Uppsala, 410kr each. Also was told the timing of doses was flexible (our first was 2 years ago), the boosters in Sweden are every 5 years.
Nov 11, 2022 2:41 AM # 
I looked into this as I'm planning to go to SOW/WOC next summer. No TBE Vaccine available in Canada. Guess I'll just have to shower with a friend.
Nov 11, 2022 8:48 PM # 
Upnorthguy…I’m surprised; worth double checking? When I looked a few years ago it was available in Canada but not (yet) in the US. At least according to the internet, for whatever that is worth…

Maybe approved but not available???
Nov 11, 2022 11:34 PM # 
A TBE vaccine - FSME-IMMUN - was approved in Canada years ago but Health Canada's TBE web page now says that "TBE vaccine is only available in countries where the disease is present". Most travel health clinics say it's not available in Canada.
Nov 12, 2022 3:04 AM # 
Oh! Interesting.
Nov 12, 2022 12:53 PM # 
Not sure about the TBE vaccine approved in Canada but we did once have a vaccine for Lyme. A bit of a Public Health fiasco, mis information etc, ended up with the company pulling it. Interesting article from 10 yrs ago

I find Health Canada's "deal with the country you are travelling to" approach rather weak for a vaccine that needs three shots. I'm wondering if it is worth getting the family down to the US a couple of times before JWOC in Romania.
Nov 12, 2022 1:43 PM # 
Just a guess: The approval of the TBE vaccine in the U.S. (instigated by a U.S. Army request to protect troops) may have killed the Canadian version of the vaccine. This is from an archived page on the Health Canada website.

“FSME-IMMUN® 0.5 mL and its pediatric version, distributed in Europe, contain a small amount of human serum albumin (HSA) of European (German or Austrian) origin. As a result, there is a theoretical risk of transmitting the prion that causes variant Creutzfeldt-Jakob disease (vCJD)… Health Canada licensing regulations require that products containing plasma-derived substances use materials that originate from Canadian or US donors. A FSME-IMMUN® vaccine containing HSA of North American origin is approved for sale in Canada (see Availability of TBE vaccines in Canada).”

It’s hard to tell for sure but it sounds like the U.S. may have approved the European version of the vaccine and accepted the small theoretical risk. If that were the case, Pfizer might not bother continuing to manufacture the special version just for Canada. They’ve been kinda busy in the last couple of years and may have discontinued some small product lines in any case.
Nov 12, 2022 1:52 PM # 
There is some hope for a Lyme vaccine in the next few years. After successful Phase 1 and 2 trials, a Phase 3 clinical trial was announced this summer. The FDA granted Fast Track designation to this project in 2017.
Nov 14, 2022 7:52 PM # 
FWIW, got a tick on me Sunday O'ing south of Stockholm..first time getting a bite in Europe.
Nov 16, 2022 7:30 AM # 
Yes - I confirmed today that the European and US vaccines are the same, but marketed under different names. My daughter got shots 1 and 2 in Sweden, and we are looking into getting number 3 in the US because we spend several weeks each summer in the Stockholm archipelago and the ticks on the island we go to are plentiful. Fortunately they are outnumbered by blueberries.
Nov 16, 2022 2:30 PM # 
The risk in Sweden is real. I got TBE at O-Ringen in Uppsala this year. I found a few ticks on me, I am not sure if the one that infected me was from an official O-Ringen race or one of the training runs I did on my own. A nasty thing about TBE is you can get infected instantly when the tick bites, unlike Lyme.
Nov 18, 2022 2:22 PM # 
MChub, tell us more. Are you OK now?
Nov 19, 2022 5:48 PM # 
Yes, I am OK now. Fortunately, it was mild, it could have been much worse. I thought about getting vaccinated before O-Ringen, but other things got in the way. During the second half of the O-Ringen week, I had what felt like a mild cold (it may have been an actual cold, not related to TBE, I am not sure). Then, when I returned to the UK, it got worse and as a COVID test was negative, I thought it was a flu. By the end of the week, I recovered enough to be able to do another 5-day event (Lakes 5 Days) the following week. Felt quite tired during that week, but otherwise OK. Then, the day I returned from the Lakes event (that's 15 days after the end of O-Ringen), the illness hit again and was worse, I had a fever (>39 C at times) and a pretty unpleasant headache, lost appetite completely and I was in bed all the time. Also, fainted once and fell. I called my clinic, told them about Sweden and ticks and mentioned in passing it could be TBE, but they prescribed an antibiotic in case it was Lyme. Then I read about TBE and realised that the pattern of the disease development (1 week, then nothing for a week, then the second, worse phase) matches TBE and became convinced it was TBE. I had a blood test, and, though it took ages to get the result, by which time I recovered, it did eventually confirm TBE. The fever and headache lasted a couple of weeks, I was only taking paracetamol and kept taking the antibiotic just in case. Then I felt weak for another week or so and after that it was back to normal. TBE is pretty much absent in the UK (only 2 known domestic cases in history iirc) so there is no doubt I got it in Sweden.
Nov 19, 2022 7:53 PM # 
There have indeed been two probable cases of UK transmission and it has been detected in the wild in ticks in the New Forest and in Thetford. There's a good overview here:
Nov 19, 2022 11:21 PM # 
By the way, I confirmed that we can get the vaccine in SF via a city vaccine clinic. They do require you to talk to a nurse before making the appt, but primarily to make sure you’re actually at risk (in forests) and not just walking around Stockholm. Still waiting to see if we can get via our insurance (Kaiser); have a phone appt scheduled.
Dec 2, 2022 5:24 PM # 
Turns out that it’s been FDA approved, but not CDC approved. Which is why you can find it sone places (like travel clinics) but not everywhere (as other places wait til CDC also approves).
Dec 5, 2022 9:53 PM # 
Many years ago I got the vaccine in Canada (albeit from a doctor in our club, who jabbed people on the side of the road at training events - good times :). In Norway we can get it administered at most pharmacies, similar price to what coach said.
Dec 5, 2022 10:52 PM # 
One facility here in Buffalo quoted me $465 per dose, not including the office visit charge of $89.
Dec 6, 2022 1:15 PM # 
For that price, you could fly to Stockholm and get the shot, probably get in some orienteering too.
Dec 6, 2022 10:37 PM # 
A good point. Bring your headlamp if you are going this time of year.
Dec 7, 2022 12:24 AM # 
If you’re only going for a short trip, you can of course just do tick checks, wear long socks/pants, etc. Don’t let this thread scare anyone off from visiting Sweden :). When I first posted I’d assumed that since it was approved it would be straightforward to access the vaccine.

In 2006 when I lived in Uppsala I don’t remember there being many ticks. But lots now in the archipelago. Presumably a mix of location and climate change.

Probably more relevant if you go regularly or for a long time or to an area where there are particularly many (like our family does).
Feb 17, 2023 8:48 PM # 
Trying to get this in Indiana is not easy. Found one clinic in Indianapolis offering it (PassportHealth), but they want $425 per dose (three doses needed) + office visit fee of $95. Ouch!
Any recent experience in the U.S. getting this vaccine for a more reasonable cost?
Feb 21, 2023 2:22 AM # 
For anyone planning to orienteer or just be in the woods in Sweden or many parts of Europe, especially Eastern, the TBE vaccine is essential. It can be an extremely serious disease. My older brother, an avid orienteer, got it in 2015. It nearly killed him, left his left arm permanently paralyzed, and caused damage to the brain such that his "brain fog" to this day means he can only work 50-75% and essentially cannot handle any large crowds or loud noises, including going out to restaurants.

Compared to the risks, whatever you have to pay is trivial...
Feb 21, 2023 6:18 PM # 
Are non-citizens eligible to receive the vaccine in Sweden or Switzerland?
Feb 23, 2023 1:28 AM # 
@David, good point! Assuming these price levels are the norm here rather than this clinic being an outlier, we'll likely go ahead and get it despite the outrageous cost.
Feb 23, 2023 4:32 AM # 
For price comparisons, in San Francisco we can get it through the city's vaccine program. $331 per dose plus $50 fee per person per visit to the clinic.

They have you call ahead of time, but that's mostly to make sure that you'll actually be at risk of exposure. IE - if you're just staying in Stockholm to visit they city, they don't recommend it. Orienteering is of course a different story :). When I explained that I visit the archipelago in the summer, they recommended getting the vaccine.
Feb 23, 2023 6:17 PM # 
Yes ,us noncitizens got, and are getting tomorrow, our booster TBE s. 410kr. In Uppsala.
Feb 23, 2023 6:33 PM # 
Thanks Jeff.
Apr 5, 2023 8:48 AM # 
Apparently it's now in the UK:

I'm not aware of UK residents getting vaccinated unless they are planning to visit the higher risk areas of mainland Europe. Yet...
Apr 6, 2023 10:49 AM # 
I have emailed my doctor - will let you know what they say...

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