Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

Image of Cover 4. iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia.1 In Germany, the rate of 0.5 confirmed cases per 100,000 people in 2019 was the third highest of the 25 European countries reporting data on TBE.1 TBE has been of historical military significance because there are a large number of U.S. service members stationed in Germany, with an estimate of about 35,000 active duty members as of September 2021.2 In the Department of Defense (DOD) reportable medical event guidelines, TBE is a notifiable event listed under arboviral diseases.3

In August 2021, the U.S. Food and Drug Administration (FDA) approved a TBE vaccine (“TICOVAC”) for U.S. travelers visiting or living in endemic areas.4 In February 2022, the U.S. Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend Pfizer’s TICOVAC vaccine for use in U.S. populations who travel or move to endemic areas and will have extensive exposure to ticks based on their planned outdoor activities, including many service members serving in these locations.5

A 2019 MSMR report described the cases of TBE occurring among U.S. military service members and other beneficiaries between 2006 and 2018.6 This snapshot updates these results through the end of 2021 using confirmed and probable medical event reports of TBE cases contained in the U.S. military’s Disease Reporting System internet, with a focus on the past 10-year surveillance period.

The reported TBE cases between 2012 and 2018 have been previously described,6 consisting of 1 active component service member in 2012, 4 in 2017, and 3 other beneficiaries in 2018 (Figure). In 2019, there was 1 probable case reported in a 45 year-old male Army active component service member, and in 2020 there was 1 confirmed case in a 38 year-old male Army active component service member. In 2021, there were 2 cases reported: 1 probable case in a 6 year-old female Army dependent, and 1 probable case in a 34 year-old Army active component service member. All cases reported between 2019 and 2021 occurred in Germany in the months of June and July. Case comments were available for 2 of the 4 cases; both indicated that tick exposure likely occurred from living or exercising in a wooded area. None of the cases had a prior history of TBE vaccination.

The number of TBE cases per 5-year period among military health system beneficiaries grew from 1 in 2012–2016 to 11 in 2017–2021. Although the total number of cases is small, the increase in recent years provides information that should be considered when contemplating use of the FDA-approved vaccine for U.S. service members and beneficiaries who live or participate in extensive outdoor activities in a TBE-endemic area.

References

1. European Centre for Disease Prevention and Control. Tick-borne Encephalitis – Annual Epidemiologic report for 2019. Accessed 1 April 2022. https://www.ecdc.europa.eu/en/publications-data/tick-borne-encephalitis-annual-epidemiological-report-2019

2. Defense Manpower Data Center. Number of Military and DoD Appropriated Fund (APF) Civilian Personnel Permanently Assigned By Duty Location and Service/Component. September 30, 2021. Accessed 24 March 2022. https://dwp.dmdc.osd.mil/dwp/app/dod-data-reports/workforce-reports

3. Armed Forces Health Surveillance Branch. Armed Forces Reportable Medical Events, Guidelines and Case Definitions. January 2020. Accessed 2 April 2022. https://health.mil/Reference-Center/Publications/2020/01/01/Armed-Forces-Reportable-Medical-Events-Guidelines

4. Pfizer Press Release. U.S. FDA Approves TICOVAC, Pfizer’s Tick-Borne Encephalitis (TBE) Vaccine. 13 August 2021. Accessed 1 April 2022. https://www.pfizer.com/news/press-release/press-release-detail/us-fda-approves-ticovactm-pfizers-tick-borne-encephalitis

5. Pfizer Press Release. CDC Advisory Committee on Immunization Practices Votes to Recommend TICOVAC, Pfizer’s Tick-Borne Encephalitis (TBE) Vaccine, For Those at Risk of Virus Exposure. 23 February 2022. Accessed 1 April 2022. https://www.pfizer.com/news/press-release/press-release-detail/cdc-advisory-committee-immunization-practices-votes

6. Mancuso JD, Bazaco S, Stahlman S, Clausen SS, Cost AA. Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018. MSMR. 2019;26(11):4–10.

FIGURE. Confirmed or probable TBE cases among U.S. military service members and other beneficiaries, 2012–2021

 

 

You also may be interested in...

Article
Jun 1, 2022

Hospitalizations, Active Component, U.S. Armed Forces, 2021

The hospitalization rate in 2021 was 48.0 per 1,000 person-years (p-yrs), the second lowest rate of the most recent 10 years. For hospitalizations limited to military facilities, the rate in 2021 was the lowest for the entire period. As in prior years, the majority (71.2%) of hospitalizations were associated with diagnoses in the categories of mental ...

Article
Jun 1, 2022

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2021

In 2021, mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups. Among adults aged 45–64 and those aged 65 or older, musculoskeletal diseases accounted for the most morbidity and health care burdens. As in previous years, this report ...

Article
Jun 1, 2022

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total ...

Article
Jun 1, 2022

Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were ...

Article
Jun 1, 2022

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared ...

Article
May 1, 2022

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in ...

Article
May 1, 2022

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, ...

Article
Mar 1, 2022

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not ...

Article
Mar 1, 2022

Brief Report: Refractive Surgery Trends at Tri-Service Refractive Surgery Centers and the Impact of the COVID-19 Pandemic, Fiscal Years 2000–2020

Cadet Saverio Macrina, U.S. Military Academy West Point, receives corneal cross-linking procedure at Fort Belvoir Community Hospital, Va., Nov. 21, 2016. (DoD photo by Reese Brown)

Since the official introduction of laser refractive surgery into clinical practice throughout the Military Health System (MHS) in fiscal year 2000, these techniques have been heavily implemented in the tri-service community to better equip and improve the readiness of the U.S. military force.

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery