@entity17991 ( XXXX ) in Germany and clinical course of the disease.

@entity1 @entity17991 @entity5422 @entity16 @entity693 @entity1503 @entity1662 @entity2055
Between 1991 and 2000 about 1500 @entity1 fell ill in Germany (Baden-Wuerttemberg, Bavaria, Hesse) after infection with the @entity17991 ( @entity17991 ) virus. Detailed clinical and epidemiological data of @entity17991 were available from 850 @entity1 . A biphasic course of the disease occurred in 75% of @entity1 . @entity17991 presented as @entity693 in 400 @entity1 (47%), as @entity5422 in 356 (42%) and as meningoencephalomyelitis in 93 (11%). Nine of the @entity1 (1%) died from @entity17991 . Five hundred and ninety three @entity1 (70%) had noticed a tick bite and the first symptoms occurred, on average, seven days later. The most frequent @entity16 were an @entity1662 (31%), @entity2055 (18%) and paresis of the extremities (15%) and cranial nerves (11%). Laboratory investigations revealed @entity1503 in 74% of the @entity1 , elevation of the sedimentation rate in 91%, increased C-reactive protein in 82%, pleocytosis in the CSF of all @entity1 tested, damage of the blood-CSF-barrier in 79%, abnormalities in EEG in 77% and abnormalities in MRI in 18%. In general, adolescents up to 14 years of age had a more favourable course of the disease than adults. In view of the severity of the illness and the high frequency of sequelae, active immunisation against @entity17991 is recommended for all subjects living in and travelling to areas of risk. Regarding the higher risk of severe manifestations of @entity17991 in the elderly @entity1 and the higher risk of failure of immunisation in this population, vaccination against @entity17991 is more important in elderly subjects than in very young @entity1 . Prevention of @entity17991 by post exposure prophylaxis with hyperimmunoglobulins is less effective and should therefore not be performed.
