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Monkeypox in Denmark: what causes it, and is it serious?

Denmark reported its first case of the monkeypox virus on May 23rd. What causes the virus, and should we be worried?

An electron microscopic (EM) image shows mature, oval-shaped monkeypox virus particles
An electron microscopic (EM) image shows mature, oval-shaped monkeypox virus particles. File photo: Russell Regnery/cdc Cynthia S. Goldsmith/Reuters/Ritzau Scanpix

What is monkeypox?

Monkeypox, abekopper in Danish, is a zoonotic virus (a virus spread from animals to humans) which most often occurs in areas of tropical rainforest in Central and West Africa. It is occasionally found in other regions, and cases have recently been discovered in Europe, North America and Australia.

“We’ve known about this virus in apes since the 1950s,” Fredrik Elgh, consultant and professor of virology at the University Hospital of Umeå in Sweden, told Swedish news wire TT.

“Every type of animal has its own type of pox, us humans had closely-related smallpox which was wiped out in the 1980s. Smallpox were an enormous issue throughout the history of humanity, we can see that on old mummies.”

“In more recent times, like the 1700s, we know that in every family, multiple children died of smallpox.”

There is no vaccine for monkeypox approved in Europe, but vaccines for smallpox are effective against the virus, as the two viruses are members of the same family.

“The vaccine used against smallpox also has an effect on monkeypox,” Elgh told TT. “That means that those born in the mid-70s or earlier will have a degree of immunologic memory. Young people have no immunity. There’s also a new, sophisticated vaccine which gives good coverage after two doses.”

“What’s good about poxes is that even if you take the vaccine after you’ve been infected, it has an effect on the progress of the illness. There are also antiviral medicines,” Elgh explained to TT.

What causes it?

Monkeypox is spread via close contact with an animal or human with the monkeypox virus. It can be transmitted via bodily fluids, lesions, respiratory droplets or through contaminated materials, such as bedding.

Recent cases of the virus in Europe are thought to have been spread through sexual activity, Bolette Søborg, head of section with the Danish Health Authority, said via a statement on Monday.

“There are indications that the infection is particularly found among men who have sex with men,” Søborg said.

“We were therefore last week in contact with the (organisations) AIDS-fondet and LGBT+ Danmark and asked them to help us create awareness in those groups that there is currently a need to be aware of guidelines relating to hygiene and use of protection during sex,” she said.

Denmark is not the only European country to have detected cases of monkeypox. Cases have also been reported in the United Kingdom, Spain, Netherlands, Germany and Sweden.

READ ALSO: Denmark registers first case of monkeypox

What are the symptoms?

The Danish health ministry describes the symptoms of monkeypox as including fever, shivering and a rash with blisters that can leave wounds when they heal.

Monkeypox typically has an incubation period of six to 16 days, but it can be as long as 21 days. Once lesions have scabbed over and fallen off, the person with the virus is no longer infectious.

Why is it in the news now?

Although cases of monkeypox have been reported outside of affected areas of Central and West Africa previously, the virus is making headlines in parts of Europe now because this is the first time cases have been identified in persons with no recent history of travel to affected areas and no history of contact with previous imported cases.

Danish infectious disease control agency State Serum Institute (SSI) states that 83 cases have been reported across Europe including 23 in Spain. The man who tested positive in Denmark recently visited Gran Canaria, according to SSI.

Is it dangerous?

The type of monkeypox seen in affected areas of Central and West Africa can be serious and, occasionally, deadly. However, it appears that the cases detected so far in Europe have been relatively mild.

“In those countries where it is more prevalent, which is in Central and West Africa, a fatality rate between one and ten percent has been reported,” Elgh told TT. “But then, you have to remember that that’s in an African context where people are not as well-nourished and there isn’t the same access to healthcare, so it can’t be directly translated.”

“There’s not that much data, especially not on how it behaves in our part of the world. There are also different genetic variants of the virus with different levels of severity, so it’s not possible to comment on [how dangerous it is] before we know more,” he further told TT.

Could this cause a new pandemic?

It’s unlikely, Elgh believes. He told TT that “this is not a new pandemic”.

“The general public do not need to be worried about monkeypox,” he added. “But my belief and hope is that this will not be a pandemic like corona. The most likely scenario is that as long as we contact trace properly, it will ebb out,” he told TT.

He explained that the two viruses are different types of viruses, meaning that monkeypox cannot adapt as easily as the Covid-19 virus.

“Monkeypox is a DNA virus, while coronavirus is a RNA virus,” he explained to TT. “DNA viruses are much more stable, which means that you don’t need to be worried that they will adapt as quickly. It would take a lot and a long time before they adapt to humans.”

The Danish Patient Safety Authority said on Monday that contact tracing for monkeypox was being undertaken.

“The Danish Patient Safety Authority is now contact tracing so that close contacts to the patient can be given guidance as to how they should respond,” Health Minister Magnus Heunicke said in a statement.

“Health authorities do not expect broad community infections in Denmark, but we are following the situation closely so we can be as well prepared as possible for any development in the situation,” he said.

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Ticks in Denmark: How to protect yourself and what to do if you get bitten

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.

Ticks in Denmark: How to protect yourself and what to do if you get bitten

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.


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.