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HEALTH

What you need to know about ticks in Denmark and how to avoid them

Thousands of people in Denmark are bitten by ticks each year, especially during the summer months. Although most people are left unaffected, an estimated three thousand cases a year in Denmark turn into Lyme disease.

What you need to know about ticks in Denmark and how to avoid them
You should be especially careful of ticks when spending lots of time in woodland, such as when camping or hiking. Photo by Bertrand Guay/ AFP

The humid and warm weather Denmark has experienced so far this year could make ticks even more common than usual this summer, an official said.

Ticks (skovflåter) can be found all over Denmark in forests, meadows, and long grass. They are particularly active during the summer months and increase in number if the weather has been warm and humid. So if you’re hiking, camping or berry-picking this summer, there’s a risk of getting a tick bite (skovflåtbid).

What are ticks?

Ticks are small, spider-like creatures which vary in size, usually between 1mm to 1cm long. They do not fly or jump but climb on to animals or humans as they brush past. Once a tick bites into the skin, it feeds on blood for a few days before dropping off. In Denmark, ticks are often found on rodents or deer and they are particularly prevalent between May and October. 

Lyme Disease (Borreliose

In Denmark, the most common disease ticks transmit is Lyme disease and around 15 per cent of ticks in Denmark’s forests carry this.

It is not known exactly how many people in Denmark get Lyme disease every year, but it is estimated that there are a few thousand cases.

However this is a very small percentage of those who have been bitten by a tick. Broadcaster TV2 has reported that in 98 per cent of cases, people do not get ill from a tick bite.

“If you remove the tick within 24 hours, you most likely won’t get Lyme disease, as it takes longer than this for the bacteria, called borrelia, to transfer to the bloodstream,” Peter Andersen, senior medical officer at the State Serum Institute’s Infectious Disease Epidemiology and Prevention department, told The Local.

Andersen said that humid and warm weather in Denmark so far this year has caused a high number of ticks.

For those who do develop Lyme disease, the symptoms usually appear between two and six weeks after the bite, but sometimes longer.

Some people can get flu-like symptoms a few days or weeks after being bitten by an infected tick. Children may complain of stomach ache, lose their appetite or lack energy.

But the most obvious sign of Lyme disease is a red circular rash around the bite.

“If you’ve had a tick bite, observe the area to check you don’t get a circular rash, which can indicate you’ve been infected. If this happens, contact a doctor to get treatment. Most infections will be treated with penicillin,” Andersen said, adding that treating Lyme disease is straight forward.

“But the danger is if you don’t acknowledge the rash, then the disease can spread to the nervous system,” Andersen warned.

This is called neuroborreliosis and occurs in around one in ten of of Lyme disease cases.

The symptoms of neuroborreliosis typically appear as headaches and neck or back stiffness and radiating nerve pain or muscle paralysis, typically in the face.

People with neuroborreliosis need to be treated in hospital.

There were 216 cases of neuroborreliosis in Denmark last year, according to the State Serum Institute, the country’s infectious disease control agency. That’s an increase from 197 cases in 2020 and 171 cases in 2019.

Most cases each year are detected between July and September and neuroborreliosis most frequently occurs in children aged 5-10 and adults aged 60-70.

TBE – Tick-borne encephalitis (flåtbåren hjernebetændelse)

This is more rare and is a viral brain infection caused by a particular tick bite. Flu-like symptoms can occur a week or more after the bite and can develop to include nausea, dizziness, and in around a third of cases, severe problems. 

In Denmark, TBE cases tend to only occur on Baltic Sea island Bornholm, where there are around 3 cases a year. There have been two reported cases in North Zealand in 2008 and 2009.

In Denmark, a TBE vaccination is recommended for people who travel regularly in areas with TBE. There isn’t a vaccination for Lyme disease.

What if I get bitten by a tick?

If you do find a tick, you should remove it quickly with a special tick remover (available at all pharmacies), tweezers or your nail. The sooner you can do this, the lower the risk the tick will be able to infect you.

The important thing is making sure you remove the whole tick, by grabbing it as close to the skin as possible and pulling slowly. Then wash and clean the bite, and contact a doctor if you’re worried.

Prevention

If you’ll be spending time in wooded areas with long grass, especially those known to have a high tick presence, you should wear boots along with long sleeved light clothing so you can see the ticks, and tuck trousers into socks. Mosquito repellent has also been proven to help deter ticks.

“Proper clothing is a good prevention but it’s not always realistic to wear long sleeves and trousers when it’s warm. So if you have been outside in nature, you should check yourself in the evening or get a family member to check you for ticks,” Andersen suggested to The Local.

Ticks tend to bite around thin areas of the skin such as kneecaps, groin, armpits and hairline. In children, they can often be found on their scalp and behind the ears.

“Ticks are very small and look like a tiny dot so they can be easily missed. They start to enlarge when they suck blood and then the red rash can appear,” Andersen said. 

Despite their high presence, ticks shouldn’t put you off enjoying Denmark’s nature this summer; keeping vigilant to the tiny black insects should keep any tick-related illness at bay.

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HEALTH

PFAS pollution: What do people living in Denmark need to know?

The issue of pollution with chemicals known as PFAS has returned to the fore in Denmark after an expert said they did not agree with parts of government advice. What should people living across the country know about the problem?

PFAS pollution: What do people living in Denmark need to know?

What are PFAS? 

PFAS (per- and polyfluoroalkyl substances) are a large group of synthetic chemicals used in various products since the early 1950s. Their past uses include foam in fire extinguishers, food packaging and in textiles, carpets and paints. Also known as ‘forever chemicals’, they persist in water and soil and can cause harm to human health. 

Due to their chemical properties, they take a long time to break down and can be found in very low concentrations in blood samples from populations all over the world.

They are, however, unwanted in the environment because they have been found to have concerning links to health complications. Their use in materials which come into contact with foods, like paper and card, has been banned in Denmark since 2020.

PFAS have been linked to a series of health complications and, if ingested in high enough amounts, are suspected of causing liver damage, kidney damage, elevated cholesterol levels, reduced fertility, hormonal disturbances, weaker immune systems, negatively affecting foetal development and being carcinogenic.

Last year, high concentrations of PFOS, a subgroup of PFAS, were detected in waste water from a treatment plant at Korsør on Zealand, and later at a field where cattle had grazed.

That led to high levels of the substance being detected in 118 people who lived in the area.

The issue led to several locations across Denmark, mostly in the vicinity of fire service training locations, undergoing investigations for presence of the chemical.

In May, a report by the Danish Regions, the country’s regional health authorities, found that up to 14,607 places in Denmark are suspected of being contaminated by PFAS.

Who is dealing with the problem? 

On its website, the Danish Health Authority states that the responsibility for managing PFAS pollution is shared between several authorities including Regions, Municipalities, the Environmental Agency, the Veterinary and Food Administration, the Patient Safety Authority and the Danish Health Authority.

The tasks of these authorities include localising places with suspected PFAS pollution, finding the source of the contamination and bringing in relevant advice from other authorities; monitoring the levels of PFAS in water and food; giving appropriate health advice to local governments in areas where PFAS is found in local environments; and investigating possible health effects of PFAS exposure and offering the appropriate advice, investigations and treatment to members of the public.

You say there’s suspected PFAS pollution at 14,607 locations. What does this mean?

The Danish Regions in May said they had identified almost 15,000 locations across Denmark where there “could be” PFAS pollution.

The figure comes from “localities in the regions’ databases which have had an activity which can result in pollution with PFAS”. These include fire service exercises and locations used by industries such as waste disposal, iron and metal or wood and furniture.

The localities are “in an area where it can affect housing or important groundwater” the Regions said in a statement published on their website.

Each of the locations would have to be analysed and potentially cleansed, should PFAS contamination be confirmed, the Regions said, calling for a 100 million kroner state investment to pay for this.

Around 8 percent of the 15,000 locations had already been analysed as of May, with PFAS confirmed at around 900 places.

How does this affect drinking water?

“All waterworks in Denmark must be tested for PFAS, both in boreholes and in in the water that is sent out to people’s taps – this has been the case since 2015,” Susan Münster, director of Danske Vandværker, the industry organisation for Denmark’s water suppliers, told The Local in a written comment.

“From January 2022, the threshold values for four PFAS substances were changed [reduced, ed.] to two nanograms per litre,” she said.

Testing programmes are set out by local municipalities in accordance with national directives, and independent analysis companies carry out the tests, she explained.

“Both the water supplier and the municipality will be informed if thresholds are exceeded in connection with the testing,” Münster said.

The Environmental Agency stated in a September 2021 memorandum that municipal authorities, along with the Danish Patient Safety Authority, should assess potential health risks in water, if contamination is suspected. The safety authority should then advise municipalities, who should then inform residents of the situation and what actions they should take.

In other words, if your tap water is considered to be contaminated following testing, your local municipality is required to inform you.

Do I need to do anything? Should I stop drinking my tap water?

“Unless you specifically receive information from either the water supplier or the municipality telling you not to drink the local water, you can comfortably continue to drink water from the tap in Denmark,” Münster told The Local.

“But if you are pregnant or breastfeeding and, for example, live on an island, it may be a good idea to follow the advice of Professor Phillippe Grandjean,” she added, referring to senior researcher and professor of environmental medicine at the University of Southern Denmark, Philippe Grandjean.

Earlier this week, the Danish Health Authority said it had recalled an expert advice group for further consultation, following criticism of guidelines issued for pregnancy and breastfeeding following exposure to PFAS.

The guidelines are part of a broader set of advisories on PFAS exposure issued by the Danish Health Authority earlier this year.

The Health Authority faced criticism from experts for failing to go far enough with existing recommendations, which state there is not considered to be any cause to delay pregnancy or breastfeeding following exposure to PFAS.

That recommendation is incorrect, according to 14 experts which formed part of the group that advised the Health Authority on its recommendations.

“It seems completely wrong when our conclusion states that women exposed to PFAS can safely get pregnant and breastfeed. Because it’s not our view that there is scientific documentation for this,” Grandjean told TV2.

A number of political parties have called for blood tests to be offered to women considering pregnancy and breastfeeding if they live in areas where PFAS is detected above threshold levels.

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