Imported Tick-borne Encephalitis in a traveller returning to North Macedonia from Switzerland, June 2024

Dejan Jakimovski, Kostadin Poposki, Mile Bosilkovski, Ivana Bogdan, Verica Simin and Pavle Banovic

In June 2024, a 26-year-old man from North Macedonia returned home from a family visit to Switzerland with an unwelcome souvenir—Tick-Borne Encephalitis (TBE). This vaccine-preventable disease highlights the risks faced by travelers visiting endemic areas without proper precautions.

The man, previously healthy, experienced a tick bite in Switzerland and removed it himself. Four days later, symptoms began with fatigue, headaches, and musculoskeletal pain, escalating to nausea, vomiting, and photophobia. By the sixth day, neurological symptoms prompted his transfer to the Clinic for Infectious Diseases in Skopje, where a lumbar puncture revealed signs of meningoencephalitis. Initial tests for rickettsial infections were inconclusive, leading to the suspicion of a flaviviral cause.

On the 10th day, further testing confirmed the presence of TBE virus (TBEV) through IgM reactivity and cerebrospinal fluid analysis. With supportive care, the patient improved, regaining full health by the 26th day of illness.

TBEV, a flavivirus transmitted by tick bites or unpasteurized dairy products, is endemic in many Eurasian countries but not in North Macedonia. This discrepancy underscores the vulnerability of travelers from non-endemic regions who may lack awareness or vaccination. Experts advocate pre-travel immunization and education to mitigate risks.

This case underscores the need for comprehensive strategies to protect travelers from TBEV exposure. Public health campaigns, improved vaccine uptake, and traveler advisories are critical in reducing disease burden, especially as international travel increases.

By turning a spotlight on this preventable disease, this case emphasizes the importance of proactive health measures when venturing into tick-endemic areas.