Kuchar Ernest, Zajkowska Joanna, Flisiak Robert, Mastalerz-Migas Agnieszka, Rosińska Magdalena, Szenborn Leszek, Wdówik Paweł, Walusiak-Skorupa Jolanta
Warszawski Uniwersytet Medyczny / Medical University of Warsaw, Warsaw, Poland (Klinika Pediatrii z Oddziałem Obserwacyjnym / Department of Pediatrics with Clinical Assessment Unit).
Uniwersytet Medyczny w Białymstoku / Medical University of Bialystok, Białystok, Poland (Klinika Chorób Zakaźnych i Neuroinfekcji / Department of Infectious Diseases and Neuroinfections).
Med Pr. 2021 Apr 9;72(2):193-210. doi: 10.13075/mp.5893.01063. Epub 2021 Feb 17.
Tick-borne encephalitis (TBE) is one of the most common viral neuroinfections in Poland. Detection of specific IgM and IgG anti- TBE antibodies in the serum or cerebrospinal fluid with enzyme-linked immunosorbent assay (ELISA) is a method of choice in TBE diagnostics. No effective antiviral treatment is available for TBE. Increased intracranial pressure, epileptic seizures, and other neurological symptoms in the course of TBE are managed with standard procedures. A routine use of corticosteroids is not recommended. Adults with TBE-related neurological sequelae should undergo physical mobilization and periodic neurological assessments. All patients ought to control their psychological condition and visit a physician in case of worrisome symptoms. Additionally, children need to undergo regular psychological and otolaryngologic consultations. Notably, TBE cases are reported across Poland; therefore, the entire country must be considered as a TBE risk region. The degree of endemicity can be variable in particular parts of the country. Immunization against TBE containing a European subtype of the virus is the most effective prophylactic method. In areas where the disease is highly endemic (according to the WHO definition of ≥5 cases/100 000 population/year), immunization needs to be offered to all ages. Vaccination is recommended in the communities living in areas of moderate TBE endemicity (1-5 cases/100 000/ year), in particular for individuals at high risk of a TBE infection as well as children and the elderly. Vaccination should also be offered to subjects living in areas where TBE occurrence is rare (<1 case/100 000/year) but who are at high risk of infection. A TBE vaccine is recommended to the following populations at high risk of TBE: a) individuals undertaking outdoor leisure activities, b) all professionals working outdoors, particularly in green areas, and c) individuals traveling to endemic areas, if activities during their visit may pose a risk of a tick bite. Post-exposure immunization is not recommended. Med Pr. 2021;72(2):193-210.
蜱传脑炎(TBE)是波兰最常见的病毒性神经感染疾病之一。采用酶联免疫吸附测定(ELISA)法检测血清或脑脊液中特异性抗TBE IgM和IgG抗体是TBE诊断的首选方法。目前尚无针对TBE的有效抗病毒治疗方法。TBE病程中出现的颅内压升高、癫痫发作及其他神经症状,采用标准程序进行处理。不建议常规使用皮质类固醇。患有TBE相关神经后遗症的成年人应进行身体活动并定期进行神经评估。所有患者都应关注自身心理状况,出现令人担忧的症状时应就医。此外,儿童需要定期进行心理和耳鼻喉科咨询。值得注意的是,波兰各地均有TBE病例报告;因此,整个国家都应被视为TBE风险地区。该国特定地区的流行程度可能有所不同。接种含欧洲病毒亚型的TBE疫苗是最有效的预防方法。在疾病高度流行的地区(根据世界卫生组织定义,≥5例/10万人口/年),所有年龄段的人群都需要接种疫苗。对于生活在TBE中度流行地区(1 - 5例/10万/年)的社区,建议接种疫苗,特别是对于TBE感染高危个体以及儿童和老年人。对于生活在TBE发病率较低地区(<1例/10万/年)但感染风险较高的人群,也应提供疫苗接种。以下TBE高危人群建议接种TBE疫苗:a)从事户外休闲活动的个体;b)所有户外工作的专业人员,特别是在绿地工作的人员;c)前往流行地区旅行的个体,前提是其旅行期间的活动可能有蜱叮咬风险。不建议进行暴露后免疫接种。《医学实践》。2021年;72(2):193 - 210。