{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:43:20Z","timestamp":1782319400116,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T00:00:00Z","timestamp":1582156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Vaccination is an effective means to prevent infectious diseases including tick-borne encephalitis (TBE), an emerging Flavivirus infection. There is, however, only limited knowledge about risk of vaccination failure, the disease course and the challenges for work-up and care. Of note, there is evidence that patients with breakthrough disease experience a more severe disease course. We report the case of a previously healthy 49-year-old woman who developed severe myeloradiculitis caused by the TBE virus despite receiving a complete cycle of primary immunization and booster vaccinations within the recommended timeframe. The disease course was characterized by progressive tetraparesis, pain and bladder dysfunction and necessitated intensive care unit admission (ICU) and the escalation of pain management. This case raises awareness for the recognition of breakthrough disease in younger patients and reinforces the need to develop measures to identify patients with insufficient protection.<\/jats:p>","DOI":"10.3390\/vaccines8010093","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T08:59:47Z","timestamp":1582275587000},"page":"93","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Challenges in a 49-Year-Old Patient with Severe Tick-Borne Myeloradiculitis Despite Complete Active Vaccination"],"prefix":"10.3390","volume":"8","author":[{"given":"Julia","family":"Feige","sequence":"first","affiliation":[{"name":"Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5397-5595","authenticated-orcid":false,"given":"Tobias","family":"Moser","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Hauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slaven","family":"Pikija","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-5533","authenticated-orcid":false,"given":"Johann","family":"Sellner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Department of Neurology, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"},{"name":"Department of Neurology, Landesklinikum Mistelbach-G\u00e4nserndorf, 2130 Mistelbach, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,20]]},"reference":[{"key":"ref_1","unstructured":"(2011). Vaccines against tick-borne encephalitis: WHO position paper. Wkly. Epidemiol. Rec., 86, 241\u2013256."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejim.2019.01.004","article-title":"Tick-borne encephalitis in Europe: A brief update on epidemiology, diagnosis, prevention, and treatment","volume":"62","author":"Riccardi","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jns.2017.02.003","article-title":"Magnetic resonance imaging and clinical findings in adults with tick-borne encephalitis","volume":"375","author":"Pichler","year":"2017","journal-title":"J. Neurol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1111\/j.1468-1331.2011.03651.x","article-title":"Meningoencephaloradiculomyelitis after tick-borne encephalitis virus infection: A case series","volume":"19","author":"Ponfick","year":"2012","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/1756285615621687","article-title":"Nontraumatic spinal cord injury at the neurological intensive care unit: Spectrum, causes of admission and predictors of mortality","volume":"9","author":"Grassner","year":"2016","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1111\/ene.13356","article-title":"EAN consensus review on prevention, diagnosis and management of tick-borne encephalitis","volume":"24","author":"Taba","year":"2017","journal-title":"Eur. J. Neurol."},{"key":"ref_7","unstructured":"Report, T. (2012). Epidemiological Situation of Tick-Borne Encephalitis in the EU and EFTA, European Centre for Disease Prevention and Control."},{"key":"ref_8","unstructured":"Schaar, C. (2018). FSME: Viele Sind Geimpft\u2013Aber Nicht Richtig, Verlagshaus der \u00c4rzte-Gesellschaft f\u00fcr Medienproduktion und Kommunikationsberatung GmbH. \u00d6sterreichische \u00c4rztezeitung 10.4.2018."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Beaute, J., Spiteri, G., Warns-Petit, E., and Zeller, H. (2018). Tick-borne encephalitis in Europe, 2012 to 2016. Eurosurveillance, 23.","DOI":"10.2807\/1560-7917.ES.2018.23.45.1800201"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2827","DOI":"10.1016\/j.vaccine.2010.02.001","article-title":"Vaccine failures after active immunisation against tick-borne encephalitis","volume":"28","author":"Andersson","year":"2010","journal-title":"Vaccine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/cid\/ciz176","article-title":"Tick-borne Encephalitis Vaccine Failures: A 10-year Retrospective Study Supporting the Rationale for Adding an Extra Priming Dose in Individuals Starting at Age 50 Years","volume":"70","author":"Hansson","year":"2020","journal-title":"Clin. Infect Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3389\/fneur.2017.00119","article-title":"Fatal Outcome of European Tick-borne Encephalitis after Vaccine Failure","volume":"8","author":"Sendi","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3201\/eid1901.120458","article-title":"Vaccination and tick-borne encephalitis, central Europe","volume":"19","author":"Heinz","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.ttbdis.2018.02.021","article-title":"Clinical outcome and cerebrospinal fluid profiles in patients with tick-borne encephalitis and prior vaccination history","volume":"9","author":"Lenhard","year":"2018","journal-title":"Ticks Tick Borne Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7021","DOI":"10.1016\/j.vaccine.2009.09.069","article-title":"Characteristics of antibody responses in tick-borne encephalitis vaccination breakthroughs","volume":"27","author":"Stiasny","year":"2009","journal-title":"Vaccine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3389\/fneur.2017.00199","article-title":"Herpes Simplex Virus Type 2 Myelitis: Case Report and Review of the Literature","volume":"8","author":"Nardone","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.3201\/eid1107.040991","article-title":"West Nile virus-associated flaccid paralysis","volume":"11","author":"Sejvar","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00415-004-0329-z","article-title":"Two severe cases of tick-borne encephalitis despite complete active vaccination\u2013the significance of neutralizing antibodies","volume":"251","author":"Bender","year":"2004","journal-title":"J. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/INF.0b013e318162a18e","article-title":"A fatal tick bite occurring during the course of tick-borne encephalitis vaccination","volume":"27","author":"Brauchli","year":"2008","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s00115-010-3190-6","article-title":"[Fatal outcome of tick-borne encephalitis despite complete active vaccination]","volume":"82","author":"Koppi","year":"2011","journal-title":"Nervenarzt"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7396","DOI":"10.1016\/j.vaccine.2010.09.003","article-title":"Tick-borne encephalitis after vaccination: Vaccine failure or misdiagnosis","volume":"28","author":"Klavs","year":"2010","journal-title":"Vaccine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s15010-006-6614-2","article-title":"Delayed humoral immunity in a patient with severe tick-borne encephalitis after complete active vaccination","volume":"35","author":"Kleiter","year":"2007","journal-title":"Infection"},{"key":"ref_23","first-page":"33","article-title":"[Tick-borne encephalitis with fulminant course and lethal outcome in patients after plural vaccination]","volume":"58","author":"Pogodina","year":"2013","journal-title":"Vopr. 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