ABSTRACT
BACKGROUND: Information on tick-borne encephalitis (TBE) in patients already vaccinated against the disease is limited. OBJECTIVES: To compare the course and outcome in patients with vaccination breakthrough TBE with findings in patients who developed TBE without previous vaccination. METHODS: All adult patients diagnosed with TBE at a single medical centre during a 16-year period and who had received at least two doses of TBE vaccine before the onset of illness qualified for the study. For each patient with breakthrough TBE, two unvaccinated sex- and age-matched patients, diagnosed with TBE in the same year, were included for comparison. RESULTS: Amongst 2332 patients diagnosed with TBE in the period 2000-2015, 39 (1.7%) had been vaccinated against the disease. Their median age was 59 (20-83) years; 22 of 39 (56.4%) were male. In comparison with unvaccinated patients with TBE, those with breakthrough disease more often experienced a monophasic course of illness (P = 0.006), had a higher CSF leucocyte count (P = 0.005), more often had urine retention (P = 0.012), more often needed ICU treatment (P = 0.009), were hospitalized for longer (P = 0.002) and had more severe acute illness (P = 0.004 for simple clinical assessment, P = 0.001 for severity score). CONCLUSION: In addition to several findings corroborating previous results in patients with vaccination breakthrough TBE, such as older age and the presence of a particular specific serum antibody pattern indicating anamnestic response, findings in this study indicate that the acute illness in patients with breakthrough TBE is more severe than in unvaccinated sex- and age-matched patients who develop the disease.
Subject(s)
Encephalitis, Tick-Borne/diagnosis , Vaccination , Viral Vaccines , Adult , Age Factors , Aged , Aged, 80 and over , Antibody Affinity , Encephalitis, Tick-Borne/complications , Encephalitis, Tick-Borne/prevention & control , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Length of Stay , Leukocyte Count , Male , Middle Aged , Severity of Illness Index , Treatment Failure , Urinary Retention/etiology , Viral Vaccines/immunology , Viral Vaccines/therapeutic use , Young AdultABSTRACT
Since an indirect fluorescence immunoassay (IFA) for the detection of specific antibodies against Babesia divergens in human sera is not commercially available, an in-house prepared B. divergens IFA for the examination of bovine sera was established for serological studies in humans. To determine whether the described IFA is appropriate for such studies, 2 B. divergens antigens (of human or bovine origin) were tested using serum samples obtained from febrile human patients with a history of 'tick bite'. Sera from other species of animals infected with B. divergens, Babesia EU1, B. microti or B. canis were also included for comparative purposes. All serum samples were also tested using a commercially available IFA for the detection of antibodies against B. microti, and the results compared with those obtained using blood smear and molecular techniques. This study showed that the evaluation and standardization of a B. divergens IFA for testing human sera is critical and that different B. divergens antigens provide different end-point titres of antibodies, leading to false negative or positive results. Serological cross-reactivity between B. divergens and Babesia EU1 needs to be taken into account when interpreting IFA results.
