Ticks: advice that sticks

As soon as temperatures rise, the enquiries multiply: “I was in the woods – do I need a tick vaccination?”, “There’s something sitting there, can you take it out?”, “Is this redness dangerous?” Ticks have long since ceased to be a marginal topic in Switzerland: the castor bean tick (Ixodes ricinus) occurs nationwide up to around 2,000 metres above sea level, preferring deciduous forests with lush undergrowth.[4] The pharmacy is often the first port of call – low-threshold, no appointment, and in many places now also for the vaccination itself.

This guide sorts out the two important pathogens, clarifies the TBE vaccination including the question “may vaccination be done in the pharmacy?”, and shows step by step what to do when someone stands at the counter with an embedded tick, looking for help.

Two pathogens, two counselling logics

In Switzerland, ticks transmit above all two diseases – and the decisive counselling error is to lump them together. TBE (tick-borne encephalitis) is a viral infection of the central nervous system for which there is no causal treatment – only vaccination protects.[3] Lyme borreliosis is a bacterial infection (Borrelia burgdorferi) for which there is no vaccination, but an effective antibiotic therapy.[6]

The practically most important difference concerns the transmission time – and it turns a widespread customer assumption on its head. Borrelia sit in the tick’s gut and usually reach the human bloodstream only after around 12 to 24 hours; rapid, correct removal therefore markedly lowers the borreliosis risk.[6] The TBE virus, by contrast, sits in the salivary glands and is transmitted within minutes of the bite – rapid removal does not reliably protect here.[1] From this follows the core message: against borreliosis, rapid removal helps; against TBE, only vaccination.

Epidemiology in Switzerland: the essentials

TBE is notifiable; over the last two decades around 50 to 400 people fell ill each year (some 380 cases in 2022, 298 cases in 2023), with the FOPH observing a rising incidence in recent years.[10] Although only about 0.5 to 5 % of ticks carry the virus, 5 to 15 % of those who fall ill develop meningoencephalitis, which can leave lasting damage or – rarely, above all in older people – prove fatal.[9]

Borreliosis is the most frequent tick-associated disease, but is not notifiable; depending on the region, 5 to 30 % of ticks are infected with Borrelia, in some places around half.[11] Geographically, since the inclusion of the canton of Geneva (2024), all of Switzerland with the exception of Ticino counts as a TBE risk area; borreliosis occurs nationwide including Ticino.[2]

The TBE vaccination: indication, vaccines, schedule

The FOPH recommends TBE vaccination to all adults and children from age 3 (until 2024: from age 6) who live in a risk area or spend time there; where exposure is high, it is possible from age 1.[2] Two inactivated vaccines are approved in Switzerland: Encepur N / Encepur N Children and FSME-Immun CC / FSME-Immun 0.25 ml Junior; administration is preferably intramuscular into the upper arm.[1]

Three doses are needed for basic immunisation: doses 1 and 2 two to four weeks apart (after 14 days if faster protection is desired), dose 3 at the earliest five months after the second. Full vaccination offers protection of over 95 % for at least ten years; thereafter a booster every ten years is recommended.[3] Important in the consultation: the first two doses already create effective but time-limited protection – the third dose is indispensable for long-term effect.

May vaccination be done in the pharmacy?

In short: yes – and TBE is a prime example. Since the revision of the Medical Professions Act (2015), pharmacists’ vaccination competence has been anchored in law; vaccination in the pharmacy is now possible in every canton, and around two thirds of pharmacies vaccinate without prior registration and without a prescription.[7] Since TBE vaccines are inactivated vaccines, they are among the most widely permitted pharmacy vaccinations.

The details are governed by the cantons, however, and they differ: some cantons permit only inactivated vaccines, others also live vaccines; in some, pharmacies may only give follow-up vaccinations, while the first vaccination must be given by a doctor.[12] Those vaccinated are as a rule healthy people aged 16 (in some cases 18) and over.[7] On the pharmacy side, the certificate of competence “FPH vaccination and blood sampling” as well as a cantonal authorisation are required; for pharmacists with a federal diploma from 2022 onwards the certificate is already contained in the basic degree course, but the cantonal authorisation remains necessary.[7]

Cost point – important for managing expectations at the counter: where vaccination is given in the pharmacy without a medical prescription, customers currently mostly pay for it themselves; reimbursement through the basic insurance at present presupposes a medical prescription.[12] With the revision of the Health Insurance Act adopted in 2025, direct billing of vaccinations in the pharmacy without a medical prescription is expected to become possible from 2027.[7]

Since cantonal rules change, it is worth consulting pharmaSuisse’s continuously updated overview “Permitted vaccinations in the pharmacy by canton” before an offering is communicated.[8]

Case: patient with a tick at the counter

Removing a tick is not a procedure reserved to doctors – the pharmacy can help directly and competently here or guide the correct technique. What matters is doing it calmly and correctly, and then advising cleanly.

The actual counselling follows. Explain the observation phase: keep an eye on the bite site over the coming weeks. Small, immediate redness like after a mosquito bite is harmless. Attention is needed if, days to weeks later, a spreading, ring-shaped redness (erythema migrans) appears or flu-like symptoms occur – then a medical assessment is indicated.[5]

Three points that ground the conversation: first, rapid removal reduces the borreliosis risk but does not exclude it – and it does not protect against TBE anyway. Second, precautionary antibiotics are not indicated; the pharmacy does not initiate antibiotics but observes and refers when symptoms appear. Third, a tick bite counts legally in Switzerland as an accident – relevant for cost coverage should treatment become necessary.[11]

Recognising borreliosis – and referring correctly

Borreliosis typically runs in stages. In the localised early stage (1 to 30 days after the bite) the erythema migrans forms around the bite site, usually with a diameter of at least five centimetres.[5] Decisive for the consultation: this cardinal symptom is absent in around half of those affected – its absence therefore does not exclude an infection.[11]

Untreated, the disease can progress to later stages, involving the nervous system, the joints or – more rarely – the heart and eyes. Antibiotic therapy should begin as quickly as possible in the case of erythema migrans; the earlier, the better the prognosis.[6] Prescription is a medical matter – the pharmacy’s role is to take erythema migrans and non-specific accompanying symptoms seriously and to refer promptly.

Outlook: there is as yet no borreliosis vaccine, but one could be drawing closer. The candidate VLA15 (Valneva/Pfizer), directed against six Borrelia strains, showed in the phase 3 study VALOR (results in March 2026) a protective effect of 73.2 % against Lyme borreliosis; the primary statistical endpoint was narrowly missed. The partners are sticking to applications to the FDA and EMA in 2026, with market launch envisaged at the earliest for the second half of 2027.[13] Until then, exposure protection and rapid removal remain the only means against borreliosis.

Prophylaxis and the essentials for the counter

Exposure protection includes closed, light-coloured clothing (on which ticks are more visible), repellents (e.g. with DEET or icaridin) as well as systematically searching the body after time spent outdoors – with particular attention to the backs of the knees, groin, armpits and hairline. For in-depth information, zecken-stich.ch (the official awareness campaign, supported by pharmaSuisse) is a reliable address for customers.[6]