A Bite to Beware

When Boris Gomez noticed a tick on his arm during a trip to Slovenia and Croatia in June 2003, encephalitis did not cross his mind.

Only when he developed flu-like symptoms and "the most severe headache I ever had in my life" did he consult a general practitioner. Later he had a hospital-administered spinal tap, and tests on his spinal fluids revealed that he had caught tick-borne encephalitis.

For two weeks, he remained in hospital for tests. He lay with headaches from an inflammation in his brain, and backaches -- a reaction from the spinal tap that verified his encephalitis infection.

And for seven weeks after that, Gomez stayed home rehabilitating, with painkillers and a doctor's order "not to watch television or think too much" to ease the strain to his head.

As Gomez learned the hard way, ticks and tick-borne diseases can be a danger not only in remote parts of Siberia but also in relatively tame places where you least expect them.

The number of ticks and incidences of tick-borne infections such as encephalitis have grown in the past 10 years in Russia and Eastern Europe, said Valentin Vlasov, head of molecular biology at the Russian Academy of Sciences' Chemical Biology and Basic Medicine Institute in Novosibirsk.

In Moscow, cases of tick-borne Lyme disease have grown from about one to two a year in 2005 to about 20 to 25 in 2006, said Dr. Tatyana Loshkareva, an infections specialist at Medintsentr GlavUpDK.

Ticks, or kleshchi, are second only to mosquitoes as vectors of diseases, the World Health Organization said in a 2005 report. They are common from Siberia to Western Europe. In 18 federal regions tick-borne encephalitis is endemic, a January 2007 report by the Federal Consumer Protection Service found, based on statistics collected in 2006. The regions with the most cases of tick-borne encephalitis are Altai, Amur, Irkutsk, Omsk, Krasnoyarsk, Kostroma, Kaliningrad, Kemerovo, Perm, Primorye, Sverdlovsk, Tatarstan, Tver, Novgorod and Leningrad.

Ticks hatch every spring and flourish through summer. The blood-sucking parasites position themselves on the tips of tall grass blades to attack any passing animal, latching onto their victims with harpoon-like mouths.

A tick can be harmless if removed before it begins sucking the victim's blood, but once in contact with the bloodstream, it can transfer diseases that are lethal.

The minuscule arachnids, ranging from a barely visible dot to the size of a one-kopek coin, not only spread tick-borne encephalitis, or TBE, and Lyme disease, but can also cause other diseases, said Dr. Rose Gazin, a general practitioner at the European Medical Center.

About half of ticks carry encephalitis, Vlasov and Loshkareva said.

After entering the blood stream of a human, encephalitis is fatal in 0.5 to 20 percent of cases, with lower probabilities in Europe and the highest in the Far East, where strains are stronger, said the WHO.

But even if bitten by an infected tick, a victim might not receive any diseases, or may remain symptomless. On the other hand, if symptoms appear, they can include fevers and headaches for both Lyme disease and encephalitis infections; rashes and muscle and joint pains for the former; and photophobia, seizures and even paralysis for the latter, which can be fatal.

The rise in tick counts and disease cases is partly due to warmer weather in Eastern Europe and Russia, Vlasov said.

Mice and other small animals from which ticks receive diseases have migrated to those regions previously too cold for their survival, including many parts of Russia and Eastern Europe that in the past saw lower infection rates.

Another reason for the increase in recorded cases is that up until a decade ago, the technology was lacking to monitor them, Vlasov said. Those living in areas with large numbers of ticks adapt and have higher immunity to the diseases they carry.

Loshkareva said 70 percent of her infected patients did not leave Moscow in the time leading up to their contraction of Lyme disease, which shows the problem exists around the capital as well.

Doctors recommend that anyone going into wooded areas covers up their entire body by wearing long shirts and trousers tucked into their socks, and puts on insect repellent.

Boris Kavashkin / Itar-Tass
Ticks can range from a barely visible dot to the size of a one-kopek coin, and position themselves on the tips of tall grass blades.
There are different vaccinations for different kinds of encephalitis. For protection against Japanese encephalitis, transmitted by mosquitoes and found in Asian countries, a separate vaccination must be administered to the one against encephalitis in Russia.

On the other hand, although the encephalitis found in this country comes in many forms itself, one vaccination takes care of them all.

Many kinds of encephalitis vaccinations exist, in liquid and powder form. Doctors in Moscow recommended the Austrian-made Baxter vaccine, even though the WHO says a Russian version is highly effective and cheaper.

The encephalitis vaccination is recommended for travelers heading to the Far East, Siberia and the Baltics, and also for anyone going to the dacha and to collect mushrooms in the woods in Moscow and surrounding regions.

But Vlasov warned against walking into a false sense of security. "Even with the vaccination, ticks carry a myriad of other diseases, such as Rocky Mountain Fever and borrelioz," he said, referring to Lyme disease.

Curative medication for Lyme disease exists, but not a vaccination -- LYMErix was discontinued in February 2002.

The encephalitis vaccination process takes more than one dose over an extended period of time that varies between clinics and kinds of vaccine.

The European Medical Center gives the second dose three months after the initial one, and is not recommended before four weeks have lapsed, as it takes that long for antibodies to develop. The third shot is given nine months later, and boosters every three to five years. Each shot costs 70 euros ($93.50), including the vaccine for 20 euros and the administration of the vaccination for 50 euros.

At Medintsenter GlavUpDK, however, the second shot is administered from two weeks to two months after the first, and a third shot one year later. The vaccine plus its administration together is 1,200 rubles ($46).

Gomez, a Czech native who has lived in Ottawa and is the current director of external management consulting at ING Barings in Prague, was not vaccinated before his trip. He said he counts himself lucky to have made a full recovery. "I didn't get paralyzed," he said. "And encephalitis can kill."