Lithuania Travel Health Guide: A Record-High Tick-Borne Encephalitis Rate, No Malaria, and the Belarus Border That Keeps Closing

Lithuania carries no malaria risk anywhere in the country, but in 2024 it recorded the highest tick-borne encephalitis (TBE) incidence in its surveillance history: 28.5 confirmed cases per 100,000 people, 807 cases that year and 642 in 2025, according to national data compiled in peer-reviewed literature. The European Centre for Disease Prevention and Control names Lithuania one of Europe's highest-burden countries for TBE. Measles has stayed limited, just 9 cases through mid-2026, two imported, unlike the outbreaks reported in several neighboring countries this series has covered. Smuggling balloons from Belarus disrupted Vilnius and Kaunas airports badly enough that Lithuania closed its last two Belarus border crossings for three weeks in late 2025, and its prime minister has warned the closure could return. In my clinical experience treating returning travelers, TBE prevention is the single most overlooked step before a Baltic trip. Start your visit on Wandr before you fly.

By Alec Freling, MD Last updated: September 19, 2026

Quick Facts: Lithuania Health at a Glance

• Region: Northern Europe, the southernmost and largest of the three Baltic states. EU, Schengen, and eurozone member. Borders Latvia, Belarus, Poland, and Russia's Kaliningrad exclave. Capital: Vilnius. Other major draws: Vilnius's UNESCO-listed Baroque old town, the Hill of Crosses, Trakai Island Castle, and the Curonian Spit's sand dunes.
• CDC/WHO Malaria Risk: None. The WHO European Region, which includes Lithuania, was certified malaria-free in 2016.
• Key Health Risks: Tick-borne encephalitis (a record-high national incidence in 2024), rabies in domestic animals and bats, and recurring smuggling-balloon disruptions at Vilnius and Kaunas airports tied to the Belarus border.
• Recommended Vaccines: Tick-borne encephalitis vaccine for anyone spending time hiking, camping, or working outdoors between spring and late autumn, MMR for any traveler without documented immunity, a routine tetanus booster if more than 10 years since the last dose, and rabies pre-exposure vaccination for extended stays or higher-risk animal contact.
• Recommended Medications: A just-in-case antibiotic for traveler's diarrhea, an antispasmodic for cramping, motion sickness medication for Baltic Sea ferries, and something for general nausea or travel anxiety on long flights.
• US State Department Advisory: Level 1, Exercise Normal Precautions, updated April 28, 2026.
• Travel Insurance Recommended: Yes. Vilnius has strong medical care, but rural and forested areas have more limited facilities, and a TBE diagnosis or a border-related travel disruption can both turn into unplanned costs quickly.

Overview

Lithuania's tourism numbers are climbing fast. The country's accommodation establishments hosted 935,000 total guests in the first quarter of 2026 alone, up 19% over the same period in 2025, with foreign tourist visits up 23% year over year, according to preliminary figures from Lithuania's State Data Agency reported through the national e.Turistas tracking system. Most American visitors land in Vilnius, walk the cobblestone streets of its UNESCO-listed Baroque old town, day-trip to the lakeside castle at Trakai, and add on the Curonian Spit's dramatic sand dunes or the folk-art pilgrimage site known as the Hill of Crosses.

The health picture here is a genuine surprise for travelers who assume a small, developed Baltic EU country carries minimal risk. There is no malaria anywhere in Lithuania. But tick-borne encephalitis, a viral infection of the brain and spinal cord spread by infected ticks, hit its highest recorded incidence in the country's history in 2024, and Lithuania's shared border with Belarus has become an active, unpredictable travel-planning variable rather than a footnote. Layer in a rabies picture that is present but manageable, and Lithuania needs a more specific pre-trip checklist than its reputation as an easy add-on to Latvia or Estonia might suggest.

Malaria: A Non-Issue Everywhere in the Country

You do not need antimalarial medication for any itinerary in Lithuania. The World Health Organization certified its European Region, all 53 member states including Lithuania, malaria-free in 2016, and no locally acquired case has been reported in the country since. If your itinerary continues on to a malaria-endemic country afterward, our clinical team can prescribe Malarone (atovaquone-proguanil) as part of your pre-trip visit, but Lithuania itself does not require it.

Tick-Borne Encephalitis: A Record Year, and One of Europe's Highest Burdens

This is the finding that should reshape how you pack for Lithuania. The European Centre for Disease Prevention and Control describes Lithuania as "one of the countries with the highest number of reported TBE cases in Europe," with the disease endemic nationwide and northern counties carrying a particularly elevated burden. A 2018 peer-reviewed study in the European Journal of Neurology documented the country's "high incidence in recent years" among adult TBE patients, consistent with that characterization.

The numbers have only grown since. National surveillance data compiled in the TBE Book, a peer-reviewed reference tracking country-level TBE epidemiology, puts Lithuania's 2024 incidence at 28.5 confirmed cases per 100,000 people, the highest annual rate on record for the country, with 807 total cases that year. The rate eased somewhat to 642 cases in 2025, but Lithuania still logged more than 13,300 cumulative TBE cases between 1990 and 2023, with 22 deaths in the decade from 2013 to 2023. Utena county in the northeast has been the hardest hit region over the past five years, reaching an incidence of 66 cases per 100,000 in 2020, roughly six times the 2024 national rate.

TBE has no specific antiviral treatment and no medication in Wandr's catalog treats it directly, so prevention is the entire strategy. A TBE vaccine series is the single most effective protection for anyone spending meaningful time outdoors in rural or forested parts of Lithuania between spring and late autumn. In my clinical experience, this is the vaccine travelers to the Baltics most often skip simply because they have not heard of TBE before booking the trip. Our clinical team can help you determine whether your itinerary calls for it. Book your vaccine appointment through Wandr.

Practical prevention matters just as much as the vaccine decision. Use an EPA-registered tick repellent (DEET or picaridin) on skin and permethrin-treated clothing if you plan to hike, camp, or spend time in Lithuania's forests or the Curonian Spit's dune trails, do a full-body tick check each evening, avoid unpasteurized dairy products (a secondary TBE exposure route across the Baltics), and remove any attached tick promptly with fine-tipped tweezers, pulling straight out without twisting.

Measles: Limited So Far, Unlike Several Neighbors

This is one of the few genuinely reassuring facts in this guide. Lithuania's National Public Health Centre confirmed just 9 measles cases through early June 2026, two of them imported (from Poland and South Korea), with seven cases concentrated in Kaunas district and two in Panevėžys district. That compares with 11 cases in all of 2025, seven of which were imported. For context, the European Centre for Disease Prevention and Control tracked roughly 3,700 measles cases across Europe in the 12 months ending April 2026, and Lithuania's own Baltic neighbor Latvia confirmed 49 cases by mid-April alone.

That does not mean vaccination status stops mattering. Lithuania's own health authorities have flagged that childhood MMR coverage has fallen below 90% in recent years, short of the roughly 95% threshold needed to prevent the virus from re-establishing itself in a population. If you cannot document two prior MMR doses or a positive immunity titer, closing that gap before this trip is still worthwhile, particularly given how quickly measles has spread through under-vaccinated pockets elsewhere in Europe this year. Book your vaccine appointment through Wandr, and see our MMR vaccine guide for travelers for how to check your immunity status quickly.

Rabies: Present, Not Widespread

Rabies is considered a risk in Lithuania, according to UK travel health guidance, with domestic and stray animals as the primary concern and bats capable of carrying rabies-like lyssaviruses as a secondary source. This is a lower-intensity risk than the active outbreaks this series has documented in parts of the Balkans, but the practical advice does not change: never approach, feed, or pet stray or unfamiliar animals, including seemingly friendly dogs near tourist sites, and seek same-day medical care for any bite, scratch, or lick to broken skin, since rabies post-exposure treatment works only if it starts promptly.

Travelers planning extended stays, rural travel, caving, or close wildlife contact should ask our clinical team about rabies pre-exposure vaccination before departure. Our rabies vaccine guide covers the current pre-exposure schedule and what to do if you're bitten.

The Belarus Border: A Real Logistics Risk, Not a Health One

This is the fact that separates a real Lithuania travel guide from a generic one, and it has nothing to do with disease. Lithuania shares a roughly 420-mile border with Belarus, and in late October 2025 the government closed its last two operating checkpoints, Šalčininkai entirely and Medininkai with restrictions, after smuggling balloons launched from Belarus repeatedly disrupted air traffic. Vilnius Airport had traffic interruptions four times in one week and five times over the course of October 2025, with Kaunas Airport affected as well, according to reporting on the closure at the time. The crossings reopened on November 19, 2025, after roughly three weeks, but Lithuania's prime minister has since said publicly that the border could close again if the balloon incidents resume.

This has no bearing on any vaccine, medication, or infectious disease risk in this guide, and Wandr does not make visa or immigration determinations. But if your itinerary includes overland travel near the Belarus border, or you are flying through Vilnius or Kaunas, build in flexibility and check the current status with the Lithuanian State Border Guard Service or your airline before you travel, since this has proven to recur with little notice.

Food and Water Safety

Tap water in Vilnius and other Lithuanian cities is treated to EU standards and is generally considered safe to drink, consistent with the picture across the rest of the Baltics. Standard precautions still apply in rural areas or smaller towns: stick to bottled or filtered water if you are uncertain about the local supply.

Lithuanian cuisine leans on potatoes, rye bread, and cold soups, most of it served hot or freshly prepared, which works in your favor. As with the rest of Northern Europe, ordinary traveler's diarrhea from restaurant food, not the water itself, is still the most common reason a visitor to Lithuania ends up needing a prescription mid-trip.

What to Pack: Practical Medications

• Traveler's diarrhea: Azithromycin is our first-line prescription antibiotic for traveler's diarrhea; ciprofloxacin is a reasonable alternative when azithromycin is not appropriate. An antispasmodic (dicyclomine) can help with cramping.
• Motion sickness: Baltic Sea ferry routes, including the Klaipėda-Kiel crossing to Germany and the short ferry to the Curonian Spit, are a common trigger. Meclizine or a scopolamine patch cover most itineraries.
• General nausea: Ondansetron is useful for nausea from ferry crossings, food, or general travel illness.
• Sleep and anxiety: Hydroxyzine can help with travel anxiety or disrupted sleep on long flights, particularly given the limited direct US flight options into Vilnius.

Lithuania's terrain is flat (its highest point, Aukštojas Hill, is just 294 meters), so altitude sickness medication is not something our clinical team typically recommends here. Our providers review your health profile and itinerary before prescribing, so you get what actually fits your trip rather than a generic kit.

Vaccines: What to Get Before You Go

• Tick-borne encephalitis: A priority for 2026 given Lithuania's record-high 2024 incidence. Strongly consider this if your trip includes hiking, camping, or extended time outdoors between spring and late autumn.
• MMR (measles, mumps, rubella): Confirm documented immunity (two prior doses or a positive titer) before you travel, particularly if your own childhood vaccination records are uncertain.
• Routine tetanus booster: Confirm your status is current, especially if hiking or cycling is part of your itinerary.
• Rabies pre-exposure vaccine: Discuss this with our clinical team if your trip involves extended rural time, forestry work, or planned wildlife contact.

Vaccines on Wandr work differently from prescriptions: you pick a partner pharmacy location and time, we book the appointment, and the pharmacist administers your travel vaccines on-site. Schedule your vaccine appointments through Wandr before you fly.

Travel Advisory and Practical Safety

The US State Department rates Lithuania Level 1, Exercise Normal Precautions, as of an April 28, 2026 update, describing it as "generally a safe destination for travelers" with no change to the advisory level or risk indicators in that update. This advisory is separate from, and has nothing to do with, the TBE, measles, or Belarus border information in this guide; each is tracked and updated independently.

Health and Safety Tips

• Use an EPA-registered tick repellent and do a daily tick check if you plan to hike, camp, or spend time in Lithuania's forests or the Curonian Spit.
• Avoid unpasteurized dairy products, particularly from small rural producers.
• Avoid contact with stray animals and bats; seek care immediately for any bite or scratch.
• Confirm your MMR and routine vaccines are current before you travel.
• If your itinerary touches the Belarus border or routes through Vilnius or Kaunas airports, check current conditions before you fly given the pattern of recurring disruptions.
• Carry a copy of your prescriptions and keep medications in their original, labeled packaging.

FAQ

Do I need malaria pills for Lithuania? No. Lithuania has no malaria risk anywhere in the country, and the World Health Organization certified its entire European Region malaria-free in 2016. If your itinerary continues to a malaria-endemic country afterward, our clinical team can prescribe Malarone for that leg of the trip.

Why does Lithuania have such a high tick-borne encephalitis rate? Lithuania is one of the countries with the highest number of reported TBE cases in Europe, according to the European Centre for Disease Prevention and Control. The country recorded its highest-ever incidence in 2024, 28.5 cases per 100,000 people (807 cases), before easing slightly to 642 cases in 2025. The TBE vaccine is the most effective protection for travelers spending time outdoors between spring and late autumn.

Is there a measles outbreak in Lithuania? No, and this is one of the better health stories in the region right now. Lithuania confirmed just 9 measles cases through early June 2026, two imported, compared with active outbreaks reported in some neighboring countries. Confirming your own MMR immunity before travel is still worthwhile given how quickly measles has spread elsewhere in Europe this year.

Is rabies a real risk in Lithuania? Rabies is considered a risk in Lithuania, primarily through domestic and stray animals, with bats as a secondary source of rabies-like viruses. Avoid handling any wild or unfamiliar animal, and seek medical care immediately for any bite or scratch.

Why did Lithuania close its border with Belarus? In late October 2025, Lithuania closed its last two Belarus border checkpoints after repeated smuggling-balloon incidents disrupted air traffic at Vilnius and Kaunas airports. The crossings reopened on November 19, 2025, but Lithuania's prime minister has said the closure could happen again if the balloon incidents resume, so travelers with itineraries touching the border or those airports should check current conditions before flying.

Is tap water safe to drink in Vilnius? Yes. Tap water in Vilnius and other Lithuanian cities is treated to EU standards and is generally considered safe to drink. In rural areas or smaller towns, bottled or filtered water is a reasonable precaution if you are uncertain about the local supply.

Why is Lithuania's US travel advisory at Level 1? The US State Department rates Lithuania Level 1, Exercise Normal Precautions, its lowest advisory level, as of an April 28, 2026 update describing it as "generally a safe destination for travelers," with no elevated risk indicators noted.

Do I need travel insurance for Lithuania? We recommend it, especially if your itinerary includes rural or forested travel outside Vilnius. Medical care in Vilnius is strong, but facilities are more limited outside the capital, and a TBE diagnosis or a border-related travel disruption can both turn into unplanned costs.

The Bottom Line

Lithuania is not a malaria destination, and its reputation as a clean, walkable Baltic capital city trip is fair for most visitors sticking to Vilnius. But it carries one of Europe's highest documented tick-borne encephalitis burdens, hit a record incidence in 2024, and sits on a Belarus border that has proven it can close with little warning. None of that calls for an elaborate medical kit, but it does call for a TBE vaccine conversation if you are headed outdoors between spring and fall, a quick MMR immunity check, and a flexible mindset if your trip touches the eastern border or Vilnius and Kaunas airports. Our providers can build the right prevention plan for your specific itinerary. Start your visit on Wandr, or explore our full travel medication lineup and vaccine booking before you fly.

For more on the vaccines at the center of this guide, see our tick-borne encephalitis vaccine guide, MMR vaccine guide, and rabies vaccine guide. Planning a wider Baltic trip? Read our guides to Latvia and Estonia.

This article is for general educational purposes and is not a substitute for personalized medical advice. Medication and vaccine recommendations depend on your individual health history, itinerary, and length of stay. This guide does not provide visa or immigration determinations; confirm current entry and border requirements with the Embassy of Lithuania or the US Department of State before you travel. Get travel insurance with medical evacuation coverage before departure.

Sources

1. World Health Organization. Europe commits to staying malaria-free (2017), referencing the 2016 certification of the WHO European Region. https://www.who.int/news/item/04-09-2017-europe-commits-to-staying-malaria-free
2. European Centre for Disease Prevention and Control. Country profile: Lithuania. Tick-borne encephalitis (TBE). https://www.ecdc.europa.eu/en/publications-data/country-profile-lithuania-tick-borne-encephalitis-tbe
3. Radzišauskienė D, et al. Epidemiological patterns of tick-borne encephalitis in Lithuania and clinical features in adults in the light of the high incidence in recent years: a retrospective study. European Journal of Neurology, 2018. https://pubmed.ncbi.nlm.nih.gov/29053888/
4. TBE Book / tbenews.com. Lithuania country chapter: TBE incidence data 1990-2025. https://tbenews.com/tbe/13-20-9/
5. TravelHealthPro (NaTHNaC) / patient.info. Lithuania country health guidance. https://patient.info/travel-and-vaccinations/lithuania
6. LRT (Lithuanian National Radio and Television). NVSC: nine measles cases confirmed this year, two imported (June 11, 2026). https://www.lrt.lt/naujienos/sveikata/682/2957268/nvsc-siemet-fiksuoti-devyni-tymu-atvejai-du-is-ju-iveztiniai
7. US Department of State. Lithuania Travel Advisory, updated April 28, 2026. https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories/lithuania-travel-advisory.html
8. LSM (Latvian Public Broadcasting), eng.lsm.lv. Lithuania closes border with Belarus (October 29, 2025). https://eng.lsm.lv/article/economy/transport/29.10.2025-lithuania-closes-border-with-belarus.a620311/
9. Euronews. Lithuania reopens border crossings with Belarus after tensions over smuggling balloons (November 19, 2025). https://www.euronews.com/2025/11/19/lithuania-reopens-border-crossings-with-belarus-after-tensions-over-smuggling-balloons
10. Infoerdve, citing Lithuania's State Data Agency / ELTA. Tourist numbers in Lithuania rose nearly 20% in Q1 2026. https://infoerdve.lt/en/tourist-numbers-in-lithuania-rose-nearly-20-in-q1-2026/