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Denmark



Capital: Copenhagen

Time Zone: +1 hours (GMT +2 hours from last Sunday in March to the last Sunday in October).
Tel. Country Code: 45
USADirect Tel.: 800
Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug K.


Travel Advisory - Denmark

Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.

Dr. Rose Recommends for Travel to Denmark


Resource Links

NaTHNaC
World Health Organization
CDC
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office

Embassies

• The U.S. Embassy
Dag Hammarskjolds Alle 24
Copenhagen
telephone: (45) 33-41-71-00
Consular Section fax: (45) 35-38-96-16
After-hours emergency telephone: (45) 35-55-92-70.
Website: http://http://denmark.usembassy.gov/index.html
The United States has no consular presence in Greenland or the Faroe Islands.

• Embassy of Canada
Kristen Bernikowsgade 1
Copenhagen
Tel: 45 33-48-32-00
Fax: 45 33-48-32-20
E-Mail: copen@international.gc.ca
Internet: http://www.canada.dk

• British Embassy
Kastelsvej 36-40
Copenhagen
Telephone:
Main Switchboard: [45] 35 44 52 00
Consular Enquiries: [45] 80 88 79 40
Website: www.britishembassy.dk

Entry Requirements

• Danish Entry Requirements for US Citizens: Same for Denmark, Greenland, & Faroe Islands. Passport required. No visas for visits of up to 3 months (from entering any Scandinavian country). Contact: Danish Embassy, 3200 Whitehaven Street NW, Washington, DC. 20008; (202) 234-4300. • HIV Test: Not required. • Vaccinations: None required.

Passport Information

Passport/Visa: Denmark is a highly developed stable democracy with a modern economy. Greenland is a self-governing dependency of Denmark. The Faroe Islands are a self-governing overseas administrative division of Denmark.
ENTRY REQUIREMENTS: Passport and visa regulations are similar for Denmark, Greenland, and the Faroes. A valid passport is required. U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days. That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, The Netherlands, Norway, Portugal, Spain, and Sweden. Contact the Royal Danish Embassy at 3200 Whitehaven Street, NW, Washington, DC Tel: (202) 234-4300.

HIV Test: Not required.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all travelers who might be exposed to blood or bodily fluids from unprotected sex with a high-risk partner; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for any traveler requesting protection against hepatitis B virus.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.


Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Hospitals / Doctors

Medical facilities widely available and of excellent quality.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers• diarrhea or other infections. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country•the equivalent drugs may not be available.
• Travelers are advised to obtain travel insurance that provides for medical evacuation to another medical facility in the event of serious illness or injury requiring specialty care not available locally. In Greenland & Faroe Islands, facilities are limited and aeromedical evacuation is required for serious illness/injury. Supplemental health insurance, including air evacuation & special insurance for arctic areas when visiting Greenland & Faroe Islands, is advisable.

The U.S. Embassy has a list of English-speaking physicans at: http://denmark.usembassy.gov/health-medical.html

More information on hospitals in Denmark is here:
http://americanairlines.wcities.com/en/record/72,84501/99/record.html

• Bispebjerb Hospital
Bispebjerg Bakke 23
K•benhavn
[45] 3531 3531
Copenhagen
Website: http://www.bispebjerghospital.dk
Bispebjerg Hospital is a teaching hospital and forms part of the Copenhagen University Hospital together with the 5 other H:S Hospitals and the University of Copenhagen. Emergency room and trauma unit.

• Privathospitalet Danmark
Jægersborg Alle 14, 2920
Charlottenlund, Denmark
[45] 3964 1949
Private hospital north of Copenhagen

Travel Medicine & Infectious Disease Specialists

• Dr. Mogens Rishoej Nielsen
Rejseklinikken
Ordrupvej 60
Charlottenlund
Tel: [45] (39) 630115
E-mail: kontakt@rejseklinikken.dk
Website: http://www.rejseklinikken.dk
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center
Post-Travel Medical Consultation.

• Dr. IB Fogh
Dyssegaardsvej 61-B
DK 2860 Soeborg
Tel: [45] (39) 69-3890
Pre-Travel Vaccination, Official Yellow Fever Vaccine Center
Post-Travel Medical Consultation.

Destination Health Info for Travelers

AIDS/HIV: Heterosexual contact has been the most frequent transmission mode in the West since 1999. It is responsible for the largest proportion of diagnosed HIV infections in every country except Germany, Greece and the Netherlands, in which men who have sex with men form the largest transmission group. In the heterosexual contact group, a large proportion are among persons originating from countries with generalised HIV/AIDS epidemics. The prevalence of HIV adults in Denmark is estimated at 0.2 percent. This is well below France (0.4%), Italy (0.5%) and Spain (0.6%).
(Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3312)
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Avian Influenza A (Bird Flu): The Danish authorities have confirmed that there have been outbreaks of Avian Influenza (Bird Flu) in wild birds and domestic birds in Denmark. No human infections or deaths have been reported.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with another person’s body fluids or blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Food-Borne Disease: An outbreak of Shigella sonnei infections involving ten cases was reported in Denmark in April and May 2009. The likely source was consumption of fresh, raw sugar peas (sugar snaps) imported from Africa. Fresh imported produce may occasionally be contaminated with pathogenic bacteria even when sold as ready-to-eat.

Food-Borne Disease: Salmonellosis: An outbreak of Salmonella typhimurium has been ongoing in Denmark since April 2008, with 1,054 cases registered through October 2008. Extensive investigations have not provided clear indications of a specific source of infection but various contaminated pork products are considered the culprit.
• Salmonella typhimurium is a particular strain of Salmonella enterica. Up to 2000 salmonella strains have been described, the best known being Salmonella typhi, the cause of typhoid fever. Strains such as Typhimurium (now endemic in Denmark and other European countries) can lead to a form of human bacterial gastroenteritis, sometimes referred to as salmonellosis.
• Salmonellosis is the second most common food-borne infection in the European Union (EU). Symptoms include nausea and vomiting, abdominal cramps, diarrhea, and fever starting 12 to 72 hours after infection and may last for up to 7 days. Severe cases should be hospitalised. Salmonella infections can lead to septicemia and sometimes death. Salmonella bacteria are readily transmitted through the feces of people or animals. Humans generally become infected by eating contaminated, insufficiently cooked food or consuming contaminated dairy products.
• Salmonella gastroenteritis is usually a self-limiting disease. Fluid and electrolyte replacement are the mainstays of treatment. Because antibiotics do not appear to shorten the duration of symptoms, they are not routinely used to treat uncomplicated nontyphoidal gastroenteritis. Current recommendations are that antibiotics (fluoroquinolnes or azithromycin preferred) should be reserved for patients with severe disease or patients who are at a high risk of invasive disease.
Note: Obviously, people with acute gastroenteritis (i.e., travelers’ diarrhea) will not know the bacteriological cause of their symptoms and may have empirically started antibiotic self-treatment for their symptoms. Such treatment may limit the severity of their illness. (Read more: http://www.emedicine.com/MED/topic2058.htm)

Hepatitis: The incidence of hepatitis A in this country is among the lowest in Europe. Hepatitis A vaccine, however, should be considered by nonimmune travelers desiring maximum protection. Sporadic outbreaks have occurred in developd countries. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic endemic but levels are unclear. There is a high prevalence (16.9%) of hepatitis E antibodies among Danish prisoners and drug users (http://www.ncbi.nlm.nih.gov/pubmed/11748658). Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate is estimated at <2% in the general population. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at low levels, with a prevalence of 0.1% in healthy people. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.


Influenza: Influenza is transmitted from November through March. The flu vaccine is recommended for all travelers over age 6 months.

Lyme Disease: Up to 20% of ticks in forested areas throughout the country are infected with the Lyme disease bacterium. Peak tick density occurs in April and May and most cases of Lyme disease occur in July and August.
• All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease in someone who has just been bitten by an infected tick. (http://content.nejm.org/cgi/content/abstract/345/2/79).

Other Diseases/Hazards: An epidemic of mycoplasma pneumonia was reported in 1998, primarily in school children and young adults.
• In February 2002, 19 cases of measles reported in North Jutland and Copenhagen. A measles outbreak was reported from the Scandinavian region of Øresund in January 2006, resulting in 18 cases as of late March (nine in Denmark and nine in Sweden). All the Danish patients resided on Zealand, mostly in the greater Copenhagen area. All travelers should be fully immunized against measles and other childhood diseases.
• Legionnaires diseasesis reported more frequently from Denmark than from other European countries, but this may be due to increased awareness of the disease among physicians in Denmark, resulting in more frequent diagnoses, rather than increased prevalence compared to other countries.

Rabies: Denmark is reported to be free of canine rabies. All wild animal bites, however, especially from a racoon dog or fox, should be medically evaluated for possible post-exposure treatment.
Rabies is still present in Europe. Its incidence in humans remains limited (fewer than 5 human cases per year) through the application of strict prophylactic measures (anti-rabies treatment) and by means of veterinary rabies control measures in the domesticated and wild animal populations. The main indigenous animal reservoirs are: the dog in eastern European countries and on the borders with the Middle East; the fox in central and eastern Europe; the racoon dog in northeastern Europe; and the insectivorous bat throughout the entire territory.
Eurosurveillance: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=575

Road Safety: Roads of high quality connect all areas. It is possible to drive from northern tip of the country to the German border in 4 hours. Greenland has no established road system; domestic travel is performed by foot, boat or air. The majority of Faroe Islands are connected by bridges or serviced by boat. Although largest islands have roads, most domestic travel done by foot, horseback, boat or air. A valid US driver's license is acceptable. Bicyclists have right-of-way over pedestrians & autos.

Seafood-Related Illness: Anisakiasis is a parasitic disease of fish transmitted by eating raw, smoked, undercooked, or lightly pickled saltwater fish, especially salmon, herring, mackerel, gefiltefish, whitefish, cod, and sole. The parasite is the larval form of a marine roundworm, which may be present in the muscles and organs of the fish just mentioned. The worm is harmless when cooked to an internal temperature of 140 degrees F or frozen (rapid freeze) to -40 degrees or to -4 degrees for three to five days. If salmon is to be eaten raw or cold-smoked, it should have been frozen properly beforehand.
The worm attaches to the lining of the stomach or intestine. Symptoms include nausea and vomiting, or abdominal pain that mimics appendicitis. The treatment is surgical excision of the worm from the intestinal tract.
• Diphyllobothriasis (fish tapeworm disease) This is an infection caused by a fish tapeworm called Diphyllobothrium latum and occurs among people who eat raw, smoked, pickled, or undercooked freshwater fish. These include Eskimos, fishermen, devotees of sushi bars (salmon), and people who taste raw fish (such as whitefish) while cooking. Symptoms are uncommon but may include primarily abdominal cramps and diarrhea, but fatigue and, rarely, anemia from vitamin B12 deficiency can also occur because fish tapeworms consume this important vitamin. Treatment (adults and children) is with a single dose of praziquantel, 10 mg/kg.
Travelers to Denmark and other Scandinavian countries should be aware of the potential risks (not clearly defined) of eating raw, undercooked, salted, or smoked fish.

Tick-Borne Encephalitis (TBE): Tick Borne Encephalitis (TBE) has been found on Zealand. Zealand is the largest island in Denmark. The capital of Denmark, Copenhagen, is partly located on the eastern shore of Zealand. Tickk-borne encephalitis causes fever, influenza-like symptoms, headache, myalgia, and arthralgia. Long-lasting or permanent brain damage has been observed in 10-20% of infected patients. There is no specific treatment. The forests in northern Zealand are visited by more than 2.3 million people annually. Following cases of TBE, all forest workers have been offered vaccination against TBE. Travelers to Europe need to be mindful of avoiding tick bites. The TBE vaccine is not available in the US, but is available in Canada and Europe. The vaccine is only recommended for people with intense exposure to ticks in forested areas.
• You should exercise insect-bite prevention measures in this country. For maximum protection, apply a DEET-containing repellent to exposed skin (30%–50% concentration recommended), apply permethrin spray or solution to your clothing and gear, and sleep under a permethrin-treated bednet (if available).

Travelers' Diarrhea: Low risk. Tap water is generally potabl in this country. Outside of hotels and resorts, we recommend that you filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Denmark is currently experiencing an unusually large outbreak of gastrointestinal illness caused by Salmonella typhimurium. The outbreak was discovered in early April 2008. The outbreak appears to be fully confined to Denmark; no cases have been reported from other countries including neighbouring Scandinavian countries or Germany. The main working hypothesis is that the outbreak originates from infected pigs. You should be sure all pork products are thoroughly cooked before eating.
Note: Salmonellosis accounts for 5% of diarrhea episoded in children below age 5 years. Salmonellosis was the most common bacterial zoonosis in Denmark prior to 1998; since that year, it has ranked second to Campylobacteriosis. Most cases of salmonellosis, historically, is from the consumption of contaminated eggs.