Tick-borne diseases are on the rise in both the U.S. and Europe, posing greater clinical difficulties. An increasing number of patients are presenting with early-stage Lyme disease, asking about preventive measures, and looking for travel guidance regarding tick-borne encephalitis (TBE). Thankfully, vaccine research in this field is progressing following a period of stagnation.
In the U.S., Lyme Disease remains the leading vector-borne illness, with cases exceeding 89,000 in 2023, and estimates indicate nearly half a million yearly diagnoses and treatments. Healthcare providers are observing a geographical spread of cases and extended tick seasons due to climate shifts, which demand a heightened clinical awareness for Lyme disease symptoms, including flu-like illnesses in summer, rashes, or neurological issues.
**Lyme Vaccine Landscape in 2025**
The first Lyme vaccine, LYMErix, was withdrawn in 2002 because of concerns over autoimmune reactions, but subsequent reviews found no evidence connecting the vaccine to such effects. Presently, attention is on VLA15, a multivalent OspA-based vaccine developed by Pfizer and Valneva, aimed at the prevalent Borrelia serotypes in North America and Europe. This vaccine is currently undergoing Phase 3 trials with over 9,000 participants, with efficacy results expected in 2026. Preliminary studies point to robust immunogenicity, broad protection, favorable tolerability, and potential for seasonal dosing. Clinicians should remain updated on recommendations concerning booster intervals, its application in pediatric patients, co-administration with other vaccines such as influenza/COVID-19, and safety for individuals with previous Lyme infections or autoimmune conditions.
**Monoclonal Antibody “Lyme PrEP”**
An additional encouraging strategy includes seasonal anti-OspA monoclonal antibodies aimed at neutralizing Borrelia in ticks before it is transmitted. One of these antibodies, TNX-4800, received a license for development in 2025, possibly providing seasonal protection, particularly beneficial for travelers, outdoor workers, or those who prefer passive immunization.
**Lyme Treatment and Prophylaxis**
The management of Lyme disease continues to include:
– *Early localized disease:* Effectively treated with doxycycline, amoxicillin, or cefuroxime.
– *Post-exposure prophylaxis:* A single 200-mg dose of doxycycline (or weight-adjusted dosing for children ≥8) within 72 hours following high-risk tick removal.
– *Erythema migrans:* Immediate treatment required without lab tests.
Timely treatment of early Lyme disease averts complications.
**Tick-borne Encephalitis (TBE)**
While not endemic to the U.S., travelers from America and Europe are increasingly visiting areas infested with TBE, particularly in Central and Eastern Europe, Scandinavia, the Baltics, and mountainous regions. The FDA-approved TICOVAC vaccine (2021) facilitates prevention in the U.S.:
– Approved for individuals aged 1 and older
– 3-dose primary immunization with subsequent boosters
– High effectiveness
The ACIP’s 2023 recommendations endorse vaccination for travelers at significant risk of tick exposure and laboratory personnel working with the virus.
Internationally, TICOVAC (FSME-IMMUN) and Encepur are frequently used. Encepur offers two schedules:
– A conventional extended schedule
– An “Express” schedule completing three doses in just 21 days
For travelers making last-minute plans, the Encepur Express option can be vital, granting immunity before departure and boosters for sustained protection. Patients should understand that immunity is enhanced with each dose, and it is crucial to complete a minimum of two doses ahead of travel. Travel medicine practices should assess outdoor activities, exposure to rural environments, hikes, and camping intentions, which affect TBE risk.
**Babesiosis: Rising, Serious, and Without Vaccine**
Babesiosis is becoming more prevalent in the Northeast and upper Midwest, particularly severe in older adults and those with compromised immune systems. Treatment approaches include:
– *Preferred Therapy:* Atovaquone + azithromycin
– *Alternative:* Clindamycin + quinine
– *Severe Disease:* Consideration of exchange transfusion
– *Immunocompromised Patients:* May necessitate extended therapy and repeated PCR testing
With no vaccine available, efforts are concentrated on early identification and appropriate management.
**Powassan Virus: Rare yet Significant**
The Powassan virus, while uncommon, poses significant neuroinvasive risks. There are currently no vaccines or antivirals available, leading to supportive treatment measures, and several vaccine candidates are in preclinical stages. Clinicians should suspect Powassan in symptomatic patients with a history of tick exposure in endemic areas. Prevention strategies involving repellents, treated garments, and thorough tick checks are essential.
**Kyasanur Forest Disease: A Travel Medicine Issue**
Kyasanur Forest Disease (KFD), found in certain regions of India, is a serious viral infection to be considered by travel clinics. India employs a formalin-inactivated vaccine with multiple doses and boosters, and new vaccines are in development. Although rare for U.S. healthcare providers, KFD should be included in risk assessments for travelers.