Tick-borne encephalitis virus infection in beneficiaries of the U.S. military healthcare system in southern Germany

Tick-borne encephalitis (TBE) is caused by a flavivirus usually transmitted to humans via the bite of an infected Ixodes ricinus tick. The disease is endemic to central Europe, including Germany where it is a potential threat to U.S. service members and other beneficiaries. This report describes 3 cases of TBE in persons living during 2017 and 2018 in the region of Germany with the highest incidence of TBE: a 36-year-old active duty service member and 2 non-service member beneficiaries aged 17 and 7 years. Each patient pre-sented with debilitating symptoms and, following recovery from their acute illnesses, experienced troubling sequelae for months afterward. The nature of their initial illnesses varied from one another, as did the length and nature of their sequelae. The criteria for diagnosing TBE based upon clinical symptoms and laboratory test results are described. Preventive strategies for protecting residents in Germany from TBE include measures to avoid tick bites. The potential for use of the TBE virus vaccine, not Food and Drug Administra-tion-approved in the U.S. but available in Europe, is discussed.