Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Medical Faculty, Institute for Microbiology and Immunology, Ljubljana, Slovenia.
J Intern Med. 2017 Aug;282(2):142-155. doi: 10.1111/joim.12625. Epub 2017 May 23.
Information on tick-borne encephalitis (TBE) in patients already vaccinated against the disease is limited.
To compare the course and outcome in patients with vaccination breakthrough TBE with findings in patients who developed TBE without previous vaccination.
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.
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).
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.
关于已接种疫苗的患者中蜱传脑炎（TBE）的信息有限。
比较突破型 TBE 患者的病程和结局与未接种疫苗但发生 TBE 的患者的发现。
在 16 年期间，在一个医疗中心诊断出患有 TBE 的所有成年患者，如果在发病前至少接受了两剂 TBE 疫苗，则有资格参加该研究。对于每个突破型 TBE 患者，都纳入了两名同年未接种疫苗的性别和年龄匹配的患者进行比较。
在 2000-2015 年期间诊断出的 2332 名 TBE 患者中，有 39 名（1.7%）接种过 TBE 疫苗。他们的中位年龄为 59 岁（20-83 岁）；39 名患者中有 22 名（56.4%）为男性。与未接种疫苗的 TBE 患者相比，突破型疾病患者更常经历单相病程（P=0.006），脑脊液白细胞计数更高（P=0.005），更常发生尿潴留（P=0.012），更常需要 ICU 治疗（P=0.009），住院时间更长（P=0.002），急性病更严重（单纯临床评估为 P=0.004，严重程度评分为 P=0.001）。
除了几项发现与之前突破型 TBE 患者的结果相符，如年龄较大和存在特定的特定血清抗体模式表明既往反应外，本研究中的发现表明，突破型 TBE 患者的急性病比未接种疫苗的性别和年龄匹配的患者更严重，这些患者发生了该疾病。
