{"id":8830,"date":"2017-11-04T21:06:37","date_gmt":"2017-11-04T13:06:37","guid":{"rendered":"https:\/\/id-ea.org\/tbe\/?p=8830"},"modified":"2019-05-07T19:17:43","modified_gmt":"2019-05-07T11:17:43","slug":"tbe12b24-2","status":"publish","type":"post","link":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/","title":{"rendered":"Norway"},"content":{"rendered":"<span class=\"cb-itemprop\" itemprop=\"reviewBody\"><div style=\"position: relative;\">\n<p style=\"font-size: 26px; color: #e76228;\"><strong>TBE in Norway<\/strong><\/p>\n<p><span style=\"position: absolute; right: -25px; top: 5px;\"><a href=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2018\/01\/Norway.pdf\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/02\/pdf_icon2.png\" width=\"45px\" height=\"45px\" \/><\/a><\/span><br \/>\n<script type=\"text\/javascript\" src=\"https:\/\/maps.googleapis.com\/maps\/api\/js?key=AIzaSyBui2XConXI6a2_Auuj7Aul5yX-ARPkT7s&#038;sensor=false\"><\/script>\n<\/div>\n<p>\n<strong>Katrine M. Paulsen<sup>a,b<\/sup>, Rose Vikse<sup>a<\/sup>, Arnulf Soleng<sup>a<\/sup>, Kristin S. Edgar<sup>a<\/sup>,<br \/> Susanne Dudman<sup>a<\/sup>, Berit Sofie Wiklund<sup>a<\/sup>, \u00c5shild K. Andreassen<sup>a<\/sup><\/strong>\n<\/p>\n<table style=\"border-collapse: collapse;\" id=\"top_table\">\n<tr>\n<td style=\"vertical-align:top;\">\n\t\t\t<sup>a<\/sup>\n\t\t<\/td>\n<td>\n\t\t\tNorwegian Institute of Public Health, Division for Infection Control and Environmental Health, Oslo, Norway\n\t\t<\/td>\n<\/tr>\n<tr>\n<td style=\"vertical-align:top;\">\n\t\t\t<sup>b<\/sup>\n\t\t<\/td>\n<td>\n\t\t\tNorwegian University of Life Sciences, Facility of Veterinary Medicine, Oslo, Norway\n\t\t<\/td>\n<\/tr>\n<\/table>\n<p>&nbsp;<\/p>\n<style>\n    body {margin: 0;    padding: 10px 20px 20px;    font-family: Arial;    font-size: 16px;  }.tablepress tfoot th, .tablepress thead th {    background-color:#e76228 !important;    height:3px !important;    color:#fff;   text-align:center;}.column-1 { background-color:#f6f6f6 !important;} #top_table td, th {\n    padding: 0;border: 1px solid white; }\n<\/style>\n<p>\n<span style=\"color:#e76228;\"><strong>History and Current Situation<\/strong><\/span>\n<\/p>\n<p><em>Ixodes ricinus<\/em> ticks are mainly distributed along the Norwegian coastline from \u00d8stfold County in the southeast up to 66\u00b0N in Nordland County.<sup ><a href=\"#r1\">1<\/a>&#8211;<a href=\"#r4\">4<\/a><\/sup> Ticks are in highest abundance in the southern parts of the country. The density of ticks varies between locations, even when separated by short distances. Locations with a high density of ticks are found all across the major distributional range (personal observation). The abundance of ticks declines rapidly with both increasing distance from the coast and higher altitude. According to the multi-source analysis by Jore et al. tick populations in Norway have recently undergone latitudinal and altitudinal range shifts.<sup ><a href=\"#r3\">3<\/a><\/sup> Their study identified ticks as far north as approximately 69\u00b0N. However, Jenkins et al. found few ticks attached to dogs and cats in the region north of 66\u00b0N, while Hvidsten et al. stated that further studies are needed in order to clarify if tick populations are established north of the Arctic Circle.<sup ><a href=\"#r5\">5<\/a>,<a href=\"#r6\">6<\/a><\/sup> According to our recent study, ticks were abundant at 64.5 and 65.1\u00b0N, but few ticks were found at locations close to 66\u00b0N. At several locations from 66.3\u00b0N up to 67.5\u00b0N, no ticks were found by flagging.<sup ><a href=\"#r4\">4<\/a><\/sup><\/p>\n<p>In Norway, tick-borne encephalitis (TBE) has been a mandatory notifiable disease to the Norwegian Surveillance System for Communicable Diseases (MSIS) since 1975. The first reported case of TBE occurred in 1997 at Trom\u00f8y in Aust-Agder County.<sup ><a href=\"#r7\">7<\/a><\/sup> This is a region with lots of holiday cabins and outdoor recreation for both local inhabitants and tourists, and it is known for high early spring and summer temperatures.<sup ><a href=\"#r7\">7<\/a>,<a href=\"#r8\">8<\/a><\/sup> In addition, TBE antibodies in dogs and tick-borne encephalitis virus (TBEV) in ticks have been detected previously in the same area.<sup ><a href=\"#r7\">7<\/a>&#8211;<a href=\"#r10\">10<\/a><\/sup><\/p>\n<p>Since the first human TBE case reported in 1997, there have been a total of 127 cases reported in Norway (data per January 5, 2017). According to MSIS these represent the counties of Vest-Agder, Aust-Agder, Vestfold, Telemark, and Buskerud, all located in the southern part of the country. In addition, there are a few cases with unknown infection history. No cases have been reported from the western or northern coastal areas, nor from the area east of Oslofjorden, even though outdoor recreation activities are common in the whole country.<\/p>\n<p>Recent studies in <em>I. ricinus<\/em> have detected TBEV in nymphs from the southern and eastern part of the country with a prevalence ranging from 0.14% to 1.22%.<sup ><a href=\"#r10\">10<\/a>,<a href=\"#r11\">11<\/a><\/sup> TBEV in nymphs and adults have been detected recently in northwestern Norway and in northern Norway up to approximately 66\u00b0N, with a prevalence variation of between 0% and 3.0% in nymphs and 0% and 9.0% in adults.<sup ><a href=\"#r4\">4<\/a>,<a href=\"#r12\">12<\/a><\/sup><\/p>\n<p>In addition to tick studies, seroprevalence studies have detected TBE antibodies in specimens from cervids (deer) collected in Farsund (Vest-Agder County) and Molde (M\u00f8re og Romsdal County). In Farsund, located on the southern coast of Norway, 41% (22 of 54 animals) were found to be TBE-positive in contrast to Molde, situated mid-west, with 1.6% (1 of 64 animals).<sup ><a href=\"#r13\">13<\/a><\/sup> The same study detected antibodies to Louping ill virus (LIV), a closely related flavivirus, in 14.8% (8 of 54) of the analyzed cervid sera from Farsund. However, LIV has not been detected in ticks in Norway previously. Recently 6850 nymphs and 765 adult ticks from eastern, western, and northern Norway were analyzed for LIV using an in-house real-time polymerase chain reaction (PCR) assay (designed by Torstein Tengs). No positive ticks were found (unpublished data from the Norwegian Institute of Public Health).<\/p>\n<p>Further, two seroprevalence studies in humans from presumed non-endemic areas have been published.<sup ><a href=\"#r11\">11<\/a>,<a href=\"#r14\">14<\/a><\/sup> Larsen et al. detected TBE immunoglobulin G (IgG) antibodies among 0.65% of blood donors in \u00d8stfold County in southeastern Norway.<sup ><a href=\"#r11\">11<\/a><\/sup> The second study in 1213 blood donors was performed in Sogn og Fjordane County, located in western Norway. TBE IgG antibodies were detected in 5 (0.4%) of the samples. However, these were all interpreted as false-positives owing to previous flavivirus vaccination causing antibody\u2013positive status in 4 individuals and a negative result in the neutralization test for the fifth person.<sup ><a href=\"#r14\">14<\/a><\/sup><\/p>\n<p>Historically, the first suggested TBEV isolate from Norway was collected in <em>I. ricinus<\/em> from Sogn og Fjordane County in June 1976 as described by Traavik and coworkers.<sup ><a href=\"#r15\">15<\/a><\/sup> Five virus strains with close serological relationship to the TBEV complex were detected in this study.<sup ><a href=\"#r16\">16<\/a><\/sup> In 1979, Traavik et al. detected a 19.6% seroprevalence from the same area. However, these results were not confirmed with a neutralization test<sup ><a href=\"#r17\">17<\/a><\/sup> and thus may be explained by cross-reactions to LIV, vaccine-related flaviviruses, or nonspecific binding in the test.<\/p>\n<p>The results from both prevalence studies in ticks and seroprevalence studies in humans and wild animals indicate that TBEV might be widespread in Norway, and not limited to the southern region. Further studies on tick distribution and prevalence of TBEV in ticks, humans, domestic animals, and wild animals in Norway are currently ongoing.<\/p>\n<p>&nbsp;<\/p>\n<p>\n<span style=\"color:#e76228;\"><strong>Overview of TBE in Norway<\/strong><\/span>\n<\/p>\n<p>&nbsp;<\/p>\n<div style=\"border:1px solid #A9A9A9;margin-top:-1em;padding:1em\">\n[table \u201cNO1\u201d not found \/]<br \/>\n\n<\/div>\n<p>&nbsp;<\/p>\n<div style=\"border:1px solid #A9A9A9;margin-top:-1em;padding:1em\">\n[table \u201cNO2\u201d not found \/]<br \/>\n\n<\/div>\n<p>&nbsp;<\/p>\n<div style=\"border:1px solid #A9A9A9;margin-top:-1em;padding:1em\">\n<p><span style=\"color:#e76228;\"><strong>Figure 1: Burden of TBE in Norway over time<\/strong><\/span><\/p>\n<p><span style=\"font-size:small;\">*data per 05.01.17.<\/p>\n<p><span style=\"font-size:small;font-style:italic;\">Click on image to see the enlarged version of the graph.<\/span><\/p>\n<p style=\"border: 1px solid #A9A9A9;\">\n<a class=\"example-image-link\" href=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/07\/Norway_Figure1a.jpg\" data-lightbox=\"Norway-Figure-1\" data-title=\"Burden of TBE in Norway over time\"><img fetchpriority=\"high\" decoding=\"async\" class=\"example-image\" src=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/07\/Norway_Figure1.jpg\" width=\"615\" height=\"246\" alt=\"\"\/><\/a>\n<\/p>\n<\/div>\n<p>\n[accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;]<br \/>\n[accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;]<br \/>\n[table \u201cNO3\u201d not found \/]<br \/>\n<br \/>\n[\/accordion-item]<br \/>\n[\/accordion]\n<\/p>\n<p>&nbsp;<\/p>\n<div style=\"border:1px solid #A9A9A9;margin-top:-1em;padding:1em\">\n<p>\n<span style=\"color:#e76228;\"><strong>Figure 2: Age and gender distribution of TBE in Norway 1994\u20132016<\/strong><\/span>\n  <\/p>\n<p style=\"font-size:small;font-style:italic;\">Click on image to see the enlarged version of the graph.<\/p>\n<p>  <a class=\"example-image-link\" href=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/12\/Norway_Figure2_b-e1512912004694.jpg\" data-lightbox=\"Norway-Figure-2\" data-title=\"Age and gender distribution of TBE in Norway\"><img decoding=\"async\" class=\"example-image\" src=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/12\/Norway_Figure2_S-e1512912013733.jpg\" width=\"620\" height=\"257\" alt=\"\"\/><\/a>\n<\/div>\n<p>\n[accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;]<br \/>\n[accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;]<br \/>\n[table \u201cNO4\u201d not found \/]<br \/>\n<br \/>\n[\/accordion-item]<br \/>\n[\/accordion]\n<\/p>\n<p>&nbsp;<\/p>\n<div style=\"border:1px solid #A9A9A9;margin-top:-1em;padding:1em\">\n<p><span style=\"color:#e76228;\"><strong>Figure 3: TBE cases in Norway 1994&#8211;2016<\/strong><\/span><\/p>\n<p>\n<img decoding=\"async\" src=\"https:\/\/id-ea.org\/tbe\/wp-content\/uploads\/2017\/07\/Norway_Figure3.jpg\" alt=\"\" width=\"620\" height=\"408\" class=\"alignnone size-medium\" \/>\n<\/p>\n<p style=\"font-size:small;\">Source: <a href=\"https:\/\/www.fhi.no\/nettpub\/smittevernveilederen\/sykdommer-a-a\/skogflattencefalitt-tbe-virusinfeks\/#forekomst-i-norge\">https:\/\/www.fhi.no\/nettpub\/smittevernveilederen\/sykdommer-a-a\/skogflattencefalitt-tbe-virusinfeks\/#forekomst-i-norge<\/a><\/p>\n<\/div>\n<p>\n<!--\n\n<div id=\"map_canvas\" style=\"width: 610px; height: 450px;\"><\/div>\n\n--><br \/>\n&nbsp;<br \/>\n<span style=\"color: #e76228;\"><strong>Literature<\/strong><\/span><\/p>\n<div style=\"overflow: hidden;\">\n<div style=\"width: 47%; float: left;font-size: 0.9em;margin-left: -1rem;\">\n<ol>\n<li ><a name=\"r1\"><\/a>Tambs-Lyche H. Ixodes ricinus og piroplasmisen i Norge (Meddelselse fra Bergens Museums zoologisk avdeling). <em>Norsk Veterin\u00e6rtidskrift<\/em> 1943;55:337-66.<\/li>\n<li ><a name=\"r2\"><\/a>Mehl R. The distribution and host relations of Norwegian ticks (Acari, Ixodides). <em>Fauna Norvegica Serie B, Norwegian Journal of Entomology <\/em>1983;30:46-51.<\/li>\n<li ><a name=\"r3\"><\/a>Jore S, Viljugrein H, Hofshagen M, et al. Multi-source analysis reveals latitudinal and altitudinal shifts in range of Ixodes ricinus at its northern distribution limit. <em>Parasites &#038; vectors <\/em>2011;4:84.<\/li>\n<li ><a name=\"r4\"><\/a>Soleng, A., Edgar, K.S., Paulsen, K.M., Pedersen, B.N., Okbaldet, Y.B.,<br \/>\nSkjetne, I.E.B., Gurung, D., Vikse, R., Andreassen, A.K., 2018. Distribution<br \/>\nof Ixodes ricinus ticks and prevalence of tick-borne encephalitis virus<br \/>\namong questing ticks in the Arctic Circle region of northern Norway. <em>Ticks<br \/>\nTick Borne Dis<\/em>. 9 (1), 97-103.<a href=\"https:\/\/doi.org\/10.1016\/j.ttbdis.2017.10.002\">https:\/\/doi.org\/10.1016\/j.ttbdis.2017.10.002<\/a><\/li>\n<li ><a name=\"r5\"><\/a>Hvidsten D, Stuen S, Jenkins A, et al. Ixodes ricinus and Borrelia prevalence at the Arctic Circle in Norway.<em> Ticks Tick Borne Dis<\/em> 2014;5:107-12.<\/li>\n<li ><a name=\"r6\"><\/a>Jenkins A, Hvidsten D, Matussek A, Lindgren PE, Stuen S, Kristiansen BE. Borrelia burgdorferi sensu lato in Ixodes ricinus ticks from Norway: evaluation of a PCR test targeting the chromosomal flaB gene. <em>Experimental &#038; applied acarology <\/em>2012;58:431-9.<\/li>\n<li ><a name=\"r7\"><\/a>Skarpaas T, Lj\u00f8stad U, Sund\u00f8y A. First human cases of tickborne encephalitis, <em>Norway. Emerging infectious diseases<\/em> 2004;10:2241-3.<\/li>\n<li ><a name=\"r8\"><\/a>Skarpaas T, Golovljova I, Vene S, et al. Tickborne encephalitis virus, Norway and Denmark. <em>Emerging infectious diseases <\/em>2006;12:1136-8.<\/li>\n<li ><a name=\"r9\"><\/a>Cs\u00e1ng\u00f3 PA, Blakstad E, Kirtz GC, Pedersen JE, Czettel B. Tick-borne encephalitis in southern Norway. <em>Emerging infectious diseases<\/em> 2004;10:533-4.<\/li>\n<li ><a name=\"r10\"><\/a>Andreassen A, Jore S, Cuber P, et al. Prevalence of tick borne encephalitis virus in tick nymphs in relation to climatic factors on the southern coast of Norway. <em>Parasites &#038; vectors<\/em> 2012;5:177.<\/li>\n<\/ol>\n<\/div\n\t\n\n<div style=\"width: 47%; float: right; display: block;font-size: 0.9em\">\n<ol start=\"11\">\n<li ><a name=\"r11\"><\/a>Larsen AL, Kanestr\u00f8m A, Bj\u00f8rland M, et al. Detection of specific IgG antibodies in blood donors and tick-borne encephalitis virus in ticks within a non-endemic area in southeast Norway. <em>Scandinavian journal of infectious diseases<\/em> 2014;46:181-4.<\/li>\n<li ><a name=\"r12\"><\/a>Paulsen KM, Pedersen BN, Soleng A, et al. Prevalence of tick-borne encephalitis virus in Ixodes ricinus ticks from three islands in north-western Norway. <em>APMIS : acta pathologica, microbiologica, et immunologica Scandinavica<\/em> 2015;123:759-64.<\/li>\n<li ><a name=\"r13\"><\/a>Ytrehus B, Vainio K, Dudman SG, Gilray J, Willoughby K. Tick-borne encephalitis virus and louping-ill virus may co-circulate in Southern Norway. <em>Vector borne and zoonotic diseases (Larchmont, NY)<\/em> 2013;13:762-8.<\/li>\n<li ><a name=\"r14\"><\/a>Hjetland R, Henningsson AJ, Vainio K, Dudman SG, Grude N, Ulvestad E. Seroprevalence of antibodies to tick-borne encephalitis virus and Anaplasma phagocytophilum in healthy adults from western Norway. <em>Infectious diseases (London, England) <\/em>2015;47:52-6.<\/li>\n<li ><a name=\"r15\"><\/a>Traavik T, Mehl R, Wiger R. The first tick-borne encephalitis virus isolates from Norway. <em>Acta pathologica et microbiologica Scandinavica Section B<\/em>, Microbiology 1978;86:253-5.<\/li>\n<li ><a name=\"r16\"><\/a>Gao GF, Jiang WR, Hussain MH, et al. Sequencing and antigenic studies of a Norwegian virus isolated from encephalomyelitic sheep confirm the existence of louping ill virus outside Great Britain and Ireland. <em>The Journal of general virology<\/em> 1993;74 (Pt 1):109-14.<\/li>\n<li ><a name=\"r17\"><\/a>Traavik T. Antibodies to tick-borne encephalitis virus in human sera from the western coast of Norway.<em> Acta pathologica et microbiologica Scandinavica Section B, Microbiology<\/em> 1979;87b:9-13.<\/li>\n<li ><a name=\"r18\"><\/a>Jaenson TG, Hjertqvist M, Bergstrom T, Lundkvist A. Why is tick-borne encephalitis increasing? A review of the key factors causing the increasing incidence of human TBE in Sweden. <em>Parasites &#038; vectors<\/em> 2012;5:184.<\/li>\n<\/ol>\n<\/div>\n<\/span>","protected":false},"excerpt":{"rendered":"<p>TBE in Norway Katrine M. Paulsena,b, Rose Viksea, Arnulf Solenga, Kristin S. Edgara, Susanne Dudmana, Berit Sofie Wiklunda, \u00c5shild K. Andreassena a Norwegian Institute of Public Health, Division for Infection Control and Environmental Health, Oslo, Norway b Norwegian University of Life Sciences, Facility of Veterinary Medicine, Oslo, Norway &nbsp; History and Current Situation Ixodes ricinus ticks are mainly distributed along the Norwegian coastline from \u00d8stfold County in the southeast up to 66\u00b0N in Nordland County.1&#8211;4 Ticks are in highest abundance in the southern parts of the country. The density of ticks varies between locations, even when separated by short distances. Locations with a high density of ticks are found all across the major distributional range (personal observation). The abundance of ticks declines rapidly with both increasing distance from the coast and higher altitude. According to the multi-source analysis by Jore et al. tick populations in Norway have recently undergone latitudinal and altitudinal range shifts.3 Their study identified ticks as far north as approximately 69\u00b0N. However, Jenkins et al. found few ticks attached to dogs and cats in the region north of 66\u00b0N, while Hvidsten et al. stated that further studies are needed in order to clarify if tick populations are established north of the Arctic Circle.5,6 According to our recent study, ticks were abundant at 64.5 and 65.1\u00b0N, but few ticks were found at locations close to 66\u00b0N. At several locations from 66.3\u00b0N up to 67.5\u00b0N, no ticks were found by flagging.4 In Norway, tick-borne encephalitis (TBE) has been a mandatory notifiable disease to the Norwegian Surveillance System for Communicable Diseases (MSIS) since 1975. The first reported case of TBE occurred in 1997 at Trom\u00f8y in Aust-Agder County.7 This is a region with lots of holiday cabins and outdoor recreation for both local inhabitants and tourists, and it is known for high early spring and summer temperatures.7,8 In addition, TBE antibodies in dogs and tick-borne encephalitis virus (TBEV) in ticks have been detected previously in the same area.7&#8211;10 Since the first human TBE case reported in 1997, there have been a total of 127 cases reported in Norway (data per January 5, 2017). According to MSIS these represent the counties of Vest-Agder, Aust-Agder, Vestfold, Telemark, and Buskerud, all located in the southern part of the country. In addition, there are a few cases with unknown infection history. No cases have been reported from the western or northern coastal areas, nor from the area east of Oslofjorden, even though outdoor recreation activities are common in the whole country. Recent studies in I. ricinus have detected TBEV in nymphs from the southern and eastern part of the country with a prevalence ranging from 0.14% to 1.22%.10,11 TBEV in nymphs and adults have been detected recently in northwestern Norway and in northern Norway up to approximately 66\u00b0N, with a prevalence variation of between 0% and 3.0% in nymphs and 0% and 9.0% in adults.4,12 In addition to tick studies, seroprevalence studies have detected TBE antibodies in specimens from cervids (deer) collected in Farsund (Vest-Agder County) and Molde (M\u00f8re og Romsdal County). In Farsund, located on the southern coast of Norway, 41% (22 of 54 animals) were found to be TBE-positive in contrast to Molde, situated mid-west, with 1.6% (1 of 64 animals).13 The same study detected antibodies to Louping ill virus (LIV), a closely related flavivirus, in 14.8% (8 of 54) of the analyzed cervid sera from Farsund. However, LIV has not been detected in ticks in Norway previously. Recently 6850 nymphs and 765 adult ticks from eastern, western, and northern Norway were analyzed for LIV using an in-house real-time polymerase chain reaction (PCR) assay (designed by Torstein Tengs). No positive ticks were found (unpublished data from the Norwegian Institute of Public Health). Further, two seroprevalence studies in humans from presumed non-endemic areas have been published.11,14 Larsen et al. detected TBE immunoglobulin G (IgG) antibodies among 0.65% of blood donors in \u00d8stfold County in southeastern Norway.11 The second study in 1213 blood donors was performed in Sogn og Fjordane County, located in western Norway. TBE IgG antibodies were detected in 5 (0.4%) of the samples. However, these were all interpreted as false-positives owing to previous flavivirus vaccination causing antibody\u2013positive status in 4 individuals and a negative result in the neutralization test for the fifth person.14 Historically, the first suggested TBEV isolate from Norway was collected in I. ricinus from Sogn og Fjordane County in June 1976 as described by Traavik and coworkers.15 Five virus strains with close serological relationship to the TBEV complex were detected in this study.16 In 1979, Traavik et al. detected a 19.6% seroprevalence from the same area. However, these results were not confirmed with a neutralization test17 and thus may be explained by cross-reactions to LIV, vaccine-related flaviviruses, or nonspecific binding in the test. The results from both prevalence studies in ticks and seroprevalence studies in humans and wild animals indicate that TBEV might be widespread in Norway, and not limited to the southern region. Further studies on tick distribution and prevalence of TBEV in ticks, humans, domestic animals, and wild animals in Norway are currently ongoing. &nbsp; Overview of TBE in Norway &nbsp; &nbsp; &nbsp; Figure 1: Burden of TBE in Norway over time *data per 05.01.17. Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 2: Age and gender distribution of TBE in Norway 1994\u20132016 Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 3: TBE cases in Norway 1994&#8211;2016 Source: https:\/\/www.fhi.no\/nettpub\/smittevernveilederen\/sykdommer-a-a\/skogflattencefalitt-tbe-virusinfeks\/#forekomst-i-norge &nbsp; Literature Tambs-Lyche H. Ixodes ricinus og piroplasmisen i Norge (Meddelselse fra Bergens Museums zoologisk avdeling). Norsk Veterin\u00e6rtidskrift 1943;55:337-66. Mehl R. The distribution and host relations of Norwegian ticks (Acari, Ixodides). Fauna Norvegica Serie B, Norwegian Journal of Entomology 1983;30:46-51. Jore S, Viljugrein H, Hofshagen M, et al. Multi-source analysis reveals latitudinal and altitudinal<\/p>\n","protected":false},"author":3,"featured_media":12825,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[2],"tags":[],"coauthors":[65],"class_list":["post-8830","post","type-post","status-publish","format-standard","has-post-thumbnail","category-chapters"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Norway - TBE Book<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Norway - TBE Book\" \/>\n<meta property=\"og:description\" content=\"TBE in Norway Katrine M. Paulsena,b, Rose Viksea, Arnulf Solenga, Kristin S. Edgara, Susanne Dudmana, Berit Sofie Wiklunda, \u00c5shild K. Andreassena a Norwegian Institute of Public Health, Division for Infection Control and Environmental Health, Oslo, Norway b Norwegian University of Life Sciences, Facility of Veterinary Medicine, Oslo, Norway &nbsp; History and Current Situation Ixodes ricinus ticks are mainly distributed along the Norwegian coastline from \u00d8stfold County in the southeast up to 66\u00b0N in Nordland County.1&#8211;4 Ticks are in highest abundance in the southern parts of the country. The density of ticks varies between locations, even when separated by short distances. Locations with a high density of ticks are found all across the major distributional range (personal observation). The abundance of ticks declines rapidly with both increasing distance from the coast and higher altitude. According to the multi-source analysis by Jore et al. tick populations in Norway have recently undergone latitudinal and altitudinal range shifts.3 Their study identified ticks as far north as approximately 69\u00b0N. However, Jenkins et al. found few ticks attached to dogs and cats in the region north of 66\u00b0N, while Hvidsten et al. stated that further studies are needed in order to clarify if tick populations are established north of the Arctic Circle.5,6 According to our recent study, ticks were abundant at 64.5 and 65.1\u00b0N, but few ticks were found at locations close to 66\u00b0N. At several locations from 66.3\u00b0N up to 67.5\u00b0N, no ticks were found by flagging.4 In Norway, tick-borne encephalitis (TBE) has been a mandatory notifiable disease to the Norwegian Surveillance System for Communicable Diseases (MSIS) since 1975. The first reported case of TBE occurred in 1997 at Trom\u00f8y in Aust-Agder County.7 This is a region with lots of holiday cabins and outdoor recreation for both local inhabitants and tourists, and it is known for high early spring and summer temperatures.7,8 In addition, TBE antibodies in dogs and tick-borne encephalitis virus (TBEV) in ticks have been detected previously in the same area.7&#8211;10 Since the first human TBE case reported in 1997, there have been a total of 127 cases reported in Norway (data per January 5, 2017). According to MSIS these represent the counties of Vest-Agder, Aust-Agder, Vestfold, Telemark, and Buskerud, all located in the southern part of the country. In addition, there are a few cases with unknown infection history. No cases have been reported from the western or northern coastal areas, nor from the area east of Oslofjorden, even though outdoor recreation activities are common in the whole country. Recent studies in I. ricinus have detected TBEV in nymphs from the southern and eastern part of the country with a prevalence ranging from 0.14% to 1.22%.10,11 TBEV in nymphs and adults have been detected recently in northwestern Norway and in northern Norway up to approximately 66\u00b0N, with a prevalence variation of between 0% and 3.0% in nymphs and 0% and 9.0% in adults.4,12 In addition to tick studies, seroprevalence studies have detected TBE antibodies in specimens from cervids (deer) collected in Farsund (Vest-Agder County) and Molde (M\u00f8re og Romsdal County). In Farsund, located on the southern coast of Norway, 41% (22 of 54 animals) were found to be TBE-positive in contrast to Molde, situated mid-west, with 1.6% (1 of 64 animals).13 The same study detected antibodies to Louping ill virus (LIV), a closely related flavivirus, in 14.8% (8 of 54) of the analyzed cervid sera from Farsund. However, LIV has not been detected in ticks in Norway previously. Recently 6850 nymphs and 765 adult ticks from eastern, western, and northern Norway were analyzed for LIV using an in-house real-time polymerase chain reaction (PCR) assay (designed by Torstein Tengs). No positive ticks were found (unpublished data from the Norwegian Institute of Public Health). Further, two seroprevalence studies in humans from presumed non-endemic areas have been published.11,14 Larsen et al. detected TBE immunoglobulin G (IgG) antibodies among 0.65% of blood donors in \u00d8stfold County in southeastern Norway.11 The second study in 1213 blood donors was performed in Sogn og Fjordane County, located in western Norway. TBE IgG antibodies were detected in 5 (0.4%) of the samples. However, these were all interpreted as false-positives owing to previous flavivirus vaccination causing antibody\u2013positive status in 4 individuals and a negative result in the neutralization test for the fifth person.14 Historically, the first suggested TBEV isolate from Norway was collected in I. ricinus from Sogn og Fjordane County in June 1976 as described by Traavik and coworkers.15 Five virus strains with close serological relationship to the TBEV complex were detected in this study.16 In 1979, Traavik et al. detected a 19.6% seroprevalence from the same area. However, these results were not confirmed with a neutralization test17 and thus may be explained by cross-reactions to LIV, vaccine-related flaviviruses, or nonspecific binding in the test. The results from both prevalence studies in ticks and seroprevalence studies in humans and wild animals indicate that TBEV might be widespread in Norway, and not limited to the southern region. Further studies on tick distribution and prevalence of TBEV in ticks, humans, domestic animals, and wild animals in Norway are currently ongoing. &nbsp; Overview of TBE in Norway &nbsp; &nbsp; &nbsp; Figure 1: Burden of TBE in Norway over time *data per 05.01.17. Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 2: Age and gender distribution of TBE in Norway 1994\u20132016 Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 3: TBE cases in Norway 1994&#8211;2016 Source: https:\/\/www.fhi.no\/nettpub\/smittevernveilederen\/sykdommer-a-a\/skogflattencefalitt-tbe-virusinfeks\/#forekomst-i-norge &nbsp; Literature Tambs-Lyche H. Ixodes ricinus og piroplasmisen i Norge (Meddelselse fra Bergens Museums zoologisk avdeling). Norsk Veterin\u00e6rtidskrift 1943;55:337-66. Mehl R. The distribution and host relations of Norwegian ticks (Acari, Ixodides). Fauna Norvegica Serie B, Norwegian Journal of Entomology 1983;30:46-51. Jore S, Viljugrein H, Hofshagen M, et al. Multi-source analysis reveals latitudinal and altitudinal\" \/>\n<meta property=\"og:url\" content=\"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/\" \/>\n<meta property=\"og:site_name\" content=\"TBE Book\" \/>\n<meta property=\"article:published_time\" content=\"2017-11-04T13:06:37+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-05-07T11:17:43+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/11\/Norway.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1180\" \/>\n\t<meta property=\"og:image:height\" content=\"250\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Administrator admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Administrator admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/\"},\"author\":{\"name\":\"Administrator admin\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#\\\/schema\\\/person\\\/dd436937ad52c89f92315a6488c1d2c7\"},\"headline\":\"Norway\",\"datePublished\":\"2017-11-04T13:06:37+00:00\",\"dateModified\":\"2019-05-07T11:17:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/\"},\"wordCount\":1220,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/wp-content\\\/uploads\\\/2017\\\/11\\\/Norway.jpg\",\"articleSection\":[\"Chapters\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/\",\"url\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b24-2\\\/\",\"name\":\"Norway - 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TBE Book","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/","og_locale":"en_US","og_type":"article","og_title":"Norway - TBE Book","og_description":"TBE in Norway Katrine M. Paulsena,b, Rose Viksea, Arnulf Solenga, Kristin S. Edgara, Susanne Dudmana, Berit Sofie Wiklunda, \u00c5shild K. Andreassena a Norwegian Institute of Public Health, Division for Infection Control and Environmental Health, Oslo, Norway b Norwegian University of Life Sciences, Facility of Veterinary Medicine, Oslo, Norway &nbsp; History and Current Situation Ixodes ricinus ticks are mainly distributed along the Norwegian coastline from \u00d8stfold County in the southeast up to 66\u00b0N in Nordland County.1&#8211;4 Ticks are in highest abundance in the southern parts of the country. The density of ticks varies between locations, even when separated by short distances. Locations with a high density of ticks are found all across the major distributional range (personal observation). The abundance of ticks declines rapidly with both increasing distance from the coast and higher altitude. According to the multi-source analysis by Jore et al. tick populations in Norway have recently undergone latitudinal and altitudinal range shifts.3 Their study identified ticks as far north as approximately 69\u00b0N. However, Jenkins et al. found few ticks attached to dogs and cats in the region north of 66\u00b0N, while Hvidsten et al. stated that further studies are needed in order to clarify if tick populations are established north of the Arctic Circle.5,6 According to our recent study, ticks were abundant at 64.5 and 65.1\u00b0N, but few ticks were found at locations close to 66\u00b0N. At several locations from 66.3\u00b0N up to 67.5\u00b0N, no ticks were found by flagging.4 In Norway, tick-borne encephalitis (TBE) has been a mandatory notifiable disease to the Norwegian Surveillance System for Communicable Diseases (MSIS) since 1975. The first reported case of TBE occurred in 1997 at Trom\u00f8y in Aust-Agder County.7 This is a region with lots of holiday cabins and outdoor recreation for both local inhabitants and tourists, and it is known for high early spring and summer temperatures.7,8 In addition, TBE antibodies in dogs and tick-borne encephalitis virus (TBEV) in ticks have been detected previously in the same area.7&#8211;10 Since the first human TBE case reported in 1997, there have been a total of 127 cases reported in Norway (data per January 5, 2017). According to MSIS these represent the counties of Vest-Agder, Aust-Agder, Vestfold, Telemark, and Buskerud, all located in the southern part of the country. In addition, there are a few cases with unknown infection history. No cases have been reported from the western or northern coastal areas, nor from the area east of Oslofjorden, even though outdoor recreation activities are common in the whole country. Recent studies in I. ricinus have detected TBEV in nymphs from the southern and eastern part of the country with a prevalence ranging from 0.14% to 1.22%.10,11 TBEV in nymphs and adults have been detected recently in northwestern Norway and in northern Norway up to approximately 66\u00b0N, with a prevalence variation of between 0% and 3.0% in nymphs and 0% and 9.0% in adults.4,12 In addition to tick studies, seroprevalence studies have detected TBE antibodies in specimens from cervids (deer) collected in Farsund (Vest-Agder County) and Molde (M\u00f8re og Romsdal County). In Farsund, located on the southern coast of Norway, 41% (22 of 54 animals) were found to be TBE-positive in contrast to Molde, situated mid-west, with 1.6% (1 of 64 animals).13 The same study detected antibodies to Louping ill virus (LIV), a closely related flavivirus, in 14.8% (8 of 54) of the analyzed cervid sera from Farsund. However, LIV has not been detected in ticks in Norway previously. Recently 6850 nymphs and 765 adult ticks from eastern, western, and northern Norway were analyzed for LIV using an in-house real-time polymerase chain reaction (PCR) assay (designed by Torstein Tengs). No positive ticks were found (unpublished data from the Norwegian Institute of Public Health). Further, two seroprevalence studies in humans from presumed non-endemic areas have been published.11,14 Larsen et al. detected TBE immunoglobulin G (IgG) antibodies among 0.65% of blood donors in \u00d8stfold County in southeastern Norway.11 The second study in 1213 blood donors was performed in Sogn og Fjordane County, located in western Norway. TBE IgG antibodies were detected in 5 (0.4%) of the samples. However, these were all interpreted as false-positives owing to previous flavivirus vaccination causing antibody\u2013positive status in 4 individuals and a negative result in the neutralization test for the fifth person.14 Historically, the first suggested TBEV isolate from Norway was collected in I. ricinus from Sogn og Fjordane County in June 1976 as described by Traavik and coworkers.15 Five virus strains with close serological relationship to the TBEV complex were detected in this study.16 In 1979, Traavik et al. detected a 19.6% seroprevalence from the same area. However, these results were not confirmed with a neutralization test17 and thus may be explained by cross-reactions to LIV, vaccine-related flaviviruses, or nonspecific binding in the test. The results from both prevalence studies in ticks and seroprevalence studies in humans and wild animals indicate that TBEV might be widespread in Norway, and not limited to the southern region. Further studies on tick distribution and prevalence of TBEV in ticks, humans, domestic animals, and wild animals in Norway are currently ongoing. &nbsp; Overview of TBE in Norway &nbsp; &nbsp; &nbsp; Figure 1: Burden of TBE in Norway over time *data per 05.01.17. Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 2: Age and gender distribution of TBE in Norway 1994\u20132016 Click on image to see the enlarged version of the graph. [accordion autoclose=&#8221;false&#8221; openfirst=&#8221;false&#8221; openall=&#8221;false&#8221; clicktoclose=&#8221;true&#8221;] [accordion-item id=&#8221;accordionTBE2&#8243; title=&#8221;Source data (Click here to view)&#8221; state=&#8221;closed&#8221;] [\/accordion-item] [\/accordion] &nbsp; Figure 3: TBE cases in Norway 1994&#8211;2016 Source: https:\/\/www.fhi.no\/nettpub\/smittevernveilederen\/sykdommer-a-a\/skogflattencefalitt-tbe-virusinfeks\/#forekomst-i-norge &nbsp; Literature Tambs-Lyche H. Ixodes ricinus og piroplasmisen i Norge (Meddelselse fra Bergens Museums zoologisk avdeling). Norsk Veterin\u00e6rtidskrift 1943;55:337-66. Mehl R. The distribution and host relations of Norwegian ticks (Acari, Ixodides). Fauna Norvegica Serie B, Norwegian Journal of Entomology 1983;30:46-51. Jore S, Viljugrein H, Hofshagen M, et al. Multi-source analysis reveals latitudinal and altitudinal","og_url":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/","og_site_name":"TBE Book","article_published_time":"2017-11-04T13:06:37+00:00","article_modified_time":"2019-05-07T11:17:43+00:00","og_image":[{"width":1180,"height":250,"url":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/11\/Norway.jpg","type":"image\/jpeg"}],"author":"Administrator admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Administrator admin","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/#article","isPartOf":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/"},"author":{"name":"Administrator admin","@id":"https:\/\/tbenews.com\/tbe\/#\/schema\/person\/dd436937ad52c89f92315a6488c1d2c7"},"headline":"Norway","datePublished":"2017-11-04T13:06:37+00:00","dateModified":"2019-05-07T11:17:43+00:00","mainEntityOfPage":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/"},"wordCount":1220,"commentCount":0,"publisher":{"@id":"https:\/\/tbenews.com\/tbe\/#organization"},"image":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/#primaryimage"},"thumbnailUrl":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/11\/Norway.jpg","articleSection":["Chapters"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/tbenews.com\/tbe\/tbe12b24-2\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/","url":"https:\/\/tbenews.com\/tbe\/tbe12b24-2\/","name":"Norway - 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