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This annual report covers the period. For many years, the island of Bornholm was the only known endemic risk area in Denmark. Another two persons became infected with TBE on Bornholm in The four TBE cases in who had become infected in Denmark are more than the usual annual cases observed in the period.
The figures are, however, small, and must therefore be interpreted with caution. In , from June to September, a total of four persons with great certainty became infected with TBE virus from infected ticks in and around Tisvilde Hegn in North Zealand. The affected persons were three men and one woman aged years who either resided close to Tisvilde Hegn or used the woods for recreational purposes. All four patients ran a two-phased disease course presenting with fever, fatigue and influenza-like or gastrointestinal symptoms followed by admission due to a clinical presentation similar to that of meningitis or meningo-encephalitis.
Several of the patients have experienced sequelae after their infection. In September , ticks were collected by dragging a white piece of cloth across the forest floor so-called flagging in a small area in the northeastern corner of Tisvilde Hegn. The collected ticks were separated into nymphs and adults, and collected in pools each counting approx.
An additional collection of ticks in October in a more limited part of the area confirmed the findings, and the ticks nymphs only in an approx. Based on these findings, the Ministry of Environment and Food of Denmark and the Municipality of Gribskov in October decided to put up signs for the users of the natural playground warning them of the risk of tick bites and to remove part of the shrubbery in the area due to the risk of tick-borne TBEV infection.
Through subsequent whole-genome sequencing and phylogenetic analyses, three complete whole-genome sequences of TBE virus were attained. The three sequences were identical and characterised by considerable genetic resemblance to a TBE virus strain from Mandal, Norge, from where the infected ticks have probably been brought to Tisvilde Hegn by migratory birds.