Tick-borne encephalitis (TBE) in Switzerland: Does the prolongation of vaccine booster intervals result in an increased risk of breakthroughs?

BACKGROUND: In 2006, the Swiss Federal Office of Public Health decided recommending a prolongation of vaccine booster intervals after the 3rd dose for the prevention of tick-borne encephalitis (TBE) from 3 to 10 years. METHODS: To ascertain whether this amendment resulted in an increased rate of vaccine breakthroughs we conducted a retrospective analysis of surveillance data collected 2000-2019 by mandatory reporting to the Swiss Federal Office of Public Health (FOPH). Fractions of breakthroughs (with 95% confidence intervals)-0 to 3 years vs. > 3 to 10 years after the 3rd vaccination dose-were compared across time periods and age groups. RESULTS: Among 3205 notified TBE cases, known vaccination status was reported in 2562 (79.9%), including 103 patients with ≥3 vaccine doses (4.0%). Among those, there were 39 patients who had received the last dose within 3 years and 48 patients in the > 3 to 10 years group. During the 2010 to 2019 period in which the new booster strategy was implemented there were 23 and 38 breakthroughs, respectively, and the annual breakthrough rate was 7.7 (95% C.I. 5.0-11.7) cases during the first three years after the last dose, and 5.4 (95% C.I. 3.9-7.5) cases in following seven years. We observed no significant trend of TBE breakthroughs with increasing age. Increasing numbers of TBE and of vaccine breakthroughs over time have been associated with spreading endemicity and higher vaccination coverage in Switzerland. CONCLUSIONS: there is no indication that extended booster intervals resulted in an increased rate of breakthroughs, but there was a marked public health benefit with respect to increased acceptability of TBE immunization in the general population