Tick-borne encephalitis in pediatrics: An often overlooked diagnosis - 05/03/23
Highlights |
• | In high endemic countries, the rates of children ≤ 14 years with TBE range from 6.6 % to 16 %, and TBE incidence increases with age. However, this incidence rate is probably underestimated, whatever the region considered. |
• | Though children often show mild clinical presentation of TBE compared to adults, severe forms have been reported, including in infants and newborns. Up to 22% of them are admitted to ICUs for TBE. |
• | Long-term sequelae associated with pediatric TBE (fatigue, cognitive problems, behavioral changes affecting daily life/school performances) call for long-term follow-up at least six months after discharge. While the severity of the initial illness in children does not seem to be predictive of later outcomes, high concentrations of pro-inflammatory cytokines (IFN-γ, IL-4, 6, 8) in CSF might indicate a risk of incomplete recovery. |
• | The vaccination recommendations for children are different across Europe. However, the two commercialized TBEV vaccines are available for children from 1 year of age and show good safety. Vaccination coverage has remained low, even in highly endemic countries. |
Abstract |
Tick-borne encephalitis (TBE) is a vector-borne disease caused by a flavivirus, the tick-borne encephalitis virus (TBEV), and transmitted by the bite of infected Ixodes ricinus ticks. The European subtype (TBEV-Eu) is endemic in 27 European countries. During the last decade, increased TBE incidence was observed in many countries, including some of those believed to be of low endemicity/devoid of TBEV circulation. However, data dealing with TBE in children are far less profuse than with adults. Historically, children are known to have mild TBEV infection with favorable outcomes. That said, recent case reports and observational studies on pediatric cohorts have challenged this point of view. Like adults, children may present severe forms and fail to completely recover following TBE infection, at times leading to long-term cognitive impairment.
In this review, we comprehensively describe the incidence, exposure factors, and transmission routes of TBEV in children, as well as the clinical and biological manifestations of TBE and imaging findings in this population. We also harness new data on long-term outcomes and sequelae in pediatric cohorts. Finally, we provide an overview of vaccination recommendations for children in European countries.
Le texte complet de cet article est disponible en PDF.Keywords : Tick-borne encephalitis (TBE), Pediatric infectious diseases, Long-term sequelae, Epidemiology, Vaccination policy
Plan
Vol 53 - N° 2
Article 104645- mars 2023 Retour au numéro
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