), sexual behavior, etc. In particular, the patient and his wife did not report use of unpasteurized milk products (another known way of TBE transmission).2,3 The second aspect to be discussed is the travelers’ underestimation of usefulness of preventive measures, including the non-vaccination

against TBE before the bike tour. Among the visited countries, Austria, Estonia, Finland, Germany, Lithuania, Poland, and Slovenia reported to an ECDC survey that they had more or less official recommendations regarding TBE prevention for people traveling to endemic areas.1 In general, travelers at risk of TBE are usually considered those who walk and camp in infested areas during the tick season (used to be spring to early autumn, but tick seasons are broadening during

recent years)3,7 and vaccination is in fact recommended for them.1,6 In addition, some degree of protection selleck is afforded by clothing that covers as much skin as possible and by applying insect repellent.3 The vaccine should be, however, offered to high-risk travelers. Unfortunately, outside endemic countries, the vaccines may not be licensed and will have to be obtained by special request, but vaccine against TBE is available in the United Kingdom at Travel Clinics. What was really surprising Stem Cell Compound Library was that the patient and his wife had not been fully informed about the risks of TBE and were not recommended vaccination. In addition, they did not present any known contraindication for TBE vaccination.6 They had planned most of their trip surfing various websites (although they did not provide us a complete list), but they probably missed the key one that would have prevented them from suffering such a bad experience. In fact, their Cell press own National Health Service (NHS of the United Kingdom) reported specific recommendations for TBE prevention for travelers to endemic areas with last update well before their travel.8 TBE infection is now becoming a more important issue of travel medicine because of the increasing international travel streams of tourists from non-endemic countries to TBE risk areas. The risk depends on both the traveling

season and the degree of unprotected outdoor exposure to infested areas (eg, bicycling, camping, hiking, or collecting flowers, berries or mushrooms, etc.).2,3 Tourists probably underestimate their risk for this preventable disease and have little awareness of the actual risk potential, especially when traveling to a knowingly “safe” Europe. In addition, as reported by a recent survey, information for travelers about TBE is not uniform across Europe in content and recommendations.1 Vaccination against TBE may be important for some tourists, depending on travel destination and behavior, but it should be planned well in advance and tourists should be always reminded that no last-minute vaccination is possible against TBE. The authors state they have no conflicts of interest to declare.