Miljø- og Fødevareudvalget 2020-21
MOF Alm.del Bilag 454
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Rapid communication
Preliminary report of an outbreak of SARS-CoV-2 in
mink and mink farmers associated with community
spread, Denmark, June to November 2020
Helle Daugaard Larsen¹ , Jannik Fonager¹ , Frederikke Kristensen Lomholt¹ , Tine Dalby¹ , Guido Benedetti¹ , Brian Kristensen¹
, Tinna Ravnholt Urth¹ , Morten Rasmussen¹ , Ria Lassaunière¹ , Thomas Bruun Rasmussen¹ , Bertel Strandbygaard¹ , Louise
Lohse¹ , Manon Chaine¹ , Karina Lauenborg Møller¹ , Ann-Sofie Nicole Berthelsen¹ , Sarah Kristine Nørgaard¹ , Ute Wolff
Sönksen¹ , Anette Ella Boklund² , Anne Sofie Hammer² , Graham J. Belsham² , Tyra Grove Krause¹ , Sten Mortensen³ , Anette
Bøtner
1,2
, Anders Fomsgaard¹ , Kåre Mølbak
1,2
1. Statens Serum Institut, Copenhagen, Denmark
2. Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
3. Department of Animal Health, Danish Veterinary and Food administration, Copenhagen, Denmark
Correspondence: Helle Daugaard Larsen ([email protected])
Citation style for this article:
Larsen Helle Daugaard, Fonager Jannik, Lomholt Frederikke Kristensen, Dalby Tine, Benedetti Guido, Kristensen Brian, Urth Tinna Ravnholt, Rasmussen Morten,
Lassaunière Ria, Rasmussen Thomas Bruun, Strandbygaard Bertel, Lohse Louise, Chaine Manon, Møller Karina Lauenborg, Berthelsen Ann-Sofie Nicole, Nørgaard
Sarah Kristine, Sönksen Ute Wolff, Boklund Anette Ella, Hammer Anne Sofie, Belsham Graham J., Krause Tyra Grove, Mortensen Sten, Bøtner Anette, Fomsgaard
Anders, Mølbak Kåre. Preliminary report of an outbreak of SARS-CoV-2 in mink and mink farmers associated with community spread, Denmark, June to November
2020. Euro Surveill. 2021;26(5):pii=2100009. https://doi.org/10.2807/1560-7917.ES.2021.26.5.210009
Article submitted on 08 Jan 2021 / accepted on 04 Feb 2021 / published on 04 Feb 2021
In June–November 2020, SARS-CoV-2-infected mink
were detected in 290 of 1,147 Danish mink farms. In
North Denmark Region, 30% (324/1,092) of people
found connected to mink farms tested SARS-CoV-
2-PCR-positive and approximately 27% (95% con-
fidence interval (CI): 25–30) of SARS-CoV-2-strains
from humans in the community were mink-associated.
Measures proved insufficient to mitigate spread. On
4 November, the government ordered culling of all
Danish mink. Farmed mink constitute a potential virus
reservoir challenging pandemic control.
Until recently, Denmark was a leading producer of mink
pelts. In June 2020, severe acute respiratory coronavi-
rus 2 (SARS-CoV-2) began to spread among mink farms
[1] and, along with infections in mink, infections in
people connected to mink farms were detected. Whole
genome sequencing (WGS) confirmed community
spread of mink-associated SARS-CoV-2 strains (mink
variant). We briefly describe the human outbreaks
related to mink and the public health response.
(SSI). Case reports were linked to an address register
and a database of mink farm owners, provided by the
Danish Veterinary and Food Administration (DVFA),
thereby identifying human cases residing on mink
farms. This group was encouraged to take a weekly
PCR-test, in order to prevent spread of infection to the
mink. (ii) Contact tracing of human cases, carried out
by the Danish Patient Safety Authority, enabled iden-
tification of case patients with any connection to mink
production. (iii) A surveillance programme established
by DVFA, based on submission of samples from dead
mink from all mink farms to SSI. (iv) Reporting of clini-
cal signs in mink by veterinarians. Infection in mink on
farms was confirmed after sampling by DVFA and sub-
mission of samples to SSI for SARS-CoV-2-testing by
PCR and antibody test.
Estimates of the cumulative regional incidence rates
per 100,000 population of human mink variant strain
infections in the community were calculated. This was
done by adding the weekly estimates (the number of
all SARS-CoV-2-positive samples multiplied by the fre-
quency of the mink variant strain among sequenced
samples) and their variances, to take into account the
variability of sample size and prevalence of mink vari-
ant strain over time.
Maps were created with R version 4.0.2 [2].
WGS was undertaken on virus samples from mink and
human cases [1]. The Danish sequencing programme
was established early during the coronavirus disease
(COVID-19) pandemic with collaborators at SSI and
Epidemiological and laboratory
investigations
Mink farms with SARS-CoV-2 circulating in mink, as
well as people connected to mink farms (all residents
on a mink farm production site or residing at the same
address than a mink-farm owner; employees living out-
side mink farms could not be identified), were iden-
tified by four different approaches. (i) In Denmark,
human SARS-CoV-2 infections (confirmed by PCR) are
reportable by laboratories, and laboratory data are
electronically submitted to Statens Serum Institut
www.eurosurveillance.org
1
 MOF, Alm.del - 2020-21 - Bilag 454: Kopi af sundhedsministerens svar på SUU alm. del - svar på spm. 36 om, hvilke beviser der er for at coronavirus muterer i mink fra minkfarme
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Figure 1
Proportion by municipality of (A) farms with SARS-CoV-2-positive mink among mink farms and (B) COVID-19 cases
among people identified as connected to mink farms
a
, Denmark, 10 August–29 November 2020
b
A. Farms with SARS-CoV-2-positive mink (%)
B. COVID-19 cases among people connected to mink farms (%)
Q1: 4−12%
Q2: 12.1−20%
Q3: 20.1−39%
Q4: 39.1−67%
Q1: 4−15%
Q2: 15.1−21%
Q3: 21.1−26%
Q4: 26.1−50%
Source: The original shapefile of Danish municipalities is from the Database of Global Administrative Areas, GADM (www.gadm.org), version
2.5, July 2015.
Q1-4: quartile percent range; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
a
As representatives for the occupational risk.
The three farms with SARS-CoV-2-infected mink in June were incidentally detected. During July the ad-hoc surveillance became operational.
Only data from 10 August onwards, which were collected once the surveillance was in place are included in the Figure.
b
To maintain patient confidentiality, the municipalities of Læsø and Frederikshavn, and the municipalities of Silkeborg and Ikast –Brande, were
merged. In the municipalities of Egedal and Stevns (within Zealand), only a few people were connected to mink production, and therefore
the one and four positive samples, respectively, constituted large proportions of this group of people.
at Aalborg University. The consortium is described
at  https://www.covid19genomics.dk. The sequenc-
ing technology was Oxford nanopore. The sequencing
consortium receives samples from all laboratories in
Denmark, and thereby characterises an unbiased sam-
ple of strains. As the typing efforts were intensified as
a response to the outbreak, we stratified for week and
region in the statistical analysis in order to obtain valid
estimates at the population level. A total of 13,355 sam-
ples (20% of all 65,872 PCR-positive samples) were
sequenced during the period between 10 August and
29 November 2020.
Region), and spread to other areas of Jutland during
October. Overall, 643 of 3,319 (19%) people identified
as being connected to mink farms became infected.
The attack rate was highest in North Denmark where
30% (324/1,092) became infected.  Figure 1  shows
the situation in the country with, by municipality, the
proportion of farms with SARS-CoV-2-positive mink,
as well as the proportion of COVID-19 cases among
people found connected to mink farms. Figure 2 shows
development over time for farms with SARS-CoV-2-
positive mink and connected human cases, by region.
A mink variant SARS-CoV-2 strain, which had the spike
protein change Y453F, was initially observed in an out-
break in mink and humans in June 2020 [1]. The pro-
portion of mink variant strains [4] among all sequenced
samples was estimated separately by week and region,
in order to adjust for variations before calculating the
cumulative incidence (Table 1). Approximately 4,000
human cases were estimated to be infected with a
mink variant. The proportion of mink variant strains
varied between regions, with the highest average pro-
portion during the period of August to November (27%)
Ethical statement
No ethical approval was required for this register-
based study.
Outbreak description
From 8 June to the end of November, SARS-CoV-2 was
detected in mink from 290 (25%) of 1,147 Danish mink
farms, with the highest proportion of affected farms
in North Denmark Region (48%) (190/394) [3]. The
epidemic started in Northern Jutland (North Denmark
2
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Figure 2
Cumulative numbers of (A) cases of COVID-19 among people identified as connected to mink farms
a
and (B) farms with
SARS-CoV-2-positive mink, by geographical region, Denmark, June–November 2020
A. COVID-19 cases among people connected to mink farms
Cumulative number of farms with infected mink
Cumulative number of cases among people
connected to mink farms
350
300
250
200
150
100
50
0
1 Mar
1 Apr
1 May
1 Jun
1 Jul
2020
Capital
Central Denmark
Zealand
North Denmark
Southern Denmark
Unknown
Southern Denmark
Central Denmark
1 Aug
1 Sep
1 Oct
1 Nov
200
180
160
140
120
100
80
60
40
20
0
1 Mar
1 Apr
1 May
1 Jun
1 Jul
2020
North Denmark
1 Aug
1 Sep
1 Oct
1 Nov
B. Farms with SARS-CoV-2-positive mink
COVID-19: coronavirus disease; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
a
As representatives for the occupational risk.
found in North Denmark Region (Table 1). In this region,
human COVID-19-cases identified caused by a mink var-
iant constituted 53% (101 of 190 sequenced samples;
95% confidence interval (CI): 46–60) in weeks 41–42
but decreased to 26% (206 of 780 sequenced sam-
ples; 95% CI: 23–30) in weeks 46–48. Mink variant
strains also became common in the regions of Central
Denmark and Southern Denmark during weeks 46–48,
as the number of farms with infected mink increased
in these areas. In the Capital Region, 45 human cases
infected with the mink variant, within 42 different
households were identified and, in the Zealand Region,
12 human cases of mink variant infections, within 10
different households were identified. Estimates of the
cumulative incidence can be seen from Table 1.
and spillback from humans to mink,  Table 2. After the
first three farms with SARS-CoV-2-positive mink were
identified and animals in these farms were culled in
June, a policy, based on surveillance in the human–
animal interface, enhanced biosecurity, and use of
personal protective equipment, was adopted. This
policy proved insufficient to stop the extensive spread
of infections among mink farms, and the subsequent
spread of mink-associated strains to the communities.
The main reason for this seems to be late detection of
farms with SARS-CoV-2-positive mink, i.e. at the time
of detection, the infection was widespread within the
farm, the mink tested antibody positive and persons
related to the farms were already infected [1,6].
On 1 October, when it was decided to cull mink on farms
with SARS-CoV-2-positive mink and mink in neighbour-
ing farms situated within a distance of 7.8 km, there
were 41 farms with SARS-CoV-2-positive mink, primar-
ily in the North Denmark Region (Figure 2,panel B).
A month later, there were 207. Overall, by the end of
October, there was a continued geographical spread
and an increasing number of farms with SARS-CoV-
2-positive mink in several municipalities over most
of the peninsula of Jutland (Figure 1). On 4 November
2020, the government decided to cull all farmed mink
in Denmark. Despite the intensive culling activity for
either destruction or pelting, the number of farms with
SARS-CoV-2-positive mink reached 290 before almost
all mink were culled by 27 November. This decision
was made following lessons learned, i.e. it had not
been possible to prevent the spread of infection from
humans to animals, from farm to farm, or from animals
to humans, and thereby mink contributed substantially
to the ongoing transmission of SARS-CoV-2 in the west-
ern part of Denmark [7].
Cluster 5 variant
We identified 35 substitutions (excluding D614G
change) and four deletions in the spike protein of
SARS-CoV-2 among variants co-circulating in mink
and humans in Northern Jutland between June and
November 2020. A mink-associated SARS-CoV-2 vari-
ant with a combination of changes in the spike protein
(H69 and V70 deletion, Y453F, D614G, I692V, M1229I),
not previously observed, was named ‘cluster 5’ and
was found in 12 human cases and in mink on five mink
farms in Northern Jutland, from August to September
2020. Preliminary findings suggested that there might
be a lower capability of antibodies from convalescent
patients to neutralise this variant [5]. As at 1 February
2021, we assess that the cluster 5 variant is no longer
circulating among humans in Denmark.
Public health response
Denmark has followed a number of different strategies
in order to mitigate the spread of SARS-CoV-2 in mink
farms and to prevent spillover to the human population
www.eurosurveillance.org
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Table 1
Regional overview of human COVID-19 cases and cases caused by mink variant strains, Denmark, 10 August–29 November
2020
Total number of
confirmed human
COVID-19 cases (PCR)
Adjusted proportion
Number of
Total number
(%) of cases caused by
confirmed human
of sequenced
mink variant strainsb
cases caused by
samples (WGS)a
mink variant strains
%
95% CI
1,942
2,426
2,090
1,425
5,472
498
259
81
12
45
27
12
5
1
1
25–30
11–13
4–6
0–2
1–1
Cumulative incidence of human
COVID-19 cases caused by mink
variant strains per 100,000
populationc
Cases
239
117
40
10
15
95% CI
216–262
104–130
31–48
4–16
11–19
Region
North
Denmark
Central
Denmark
Southern
Denmark
Zealand
Capital
5,159
12,953
9,613
7,337
30,810
CI: confidence interval; COVID-19: coronavirus disease; WGS: whole genome sequencing.
 Samples for WGS were selected by convenience sampling among the total number of confirmed human COVID-19 cases. An analysis of
representativeness showed that the proportion of samples from human cases connected to mink production were similar to the population
in general at the regional level (chi-squared p > 0.66 for North, Central, Southern and Capital regions, and p = 0,176 for Zealand Region).
b
 Estimates of the proportions of COVID-19 cases with mink variant strains in the community were derived by sequencing SARS-CoV-2-positive
human samples to detect those with the mink variant strain. Proportions of cases with mink variants were calculated by week, and adjusted
for weekly variations, in the proportion of sequenced samples. WGS results were delivered on a weekly basis.
c
 Regional population size of the last quarter of 2020, Statistics Denmark.
a
Table 2
Summary of control measures to mitigate the spread of SARS-CoV-2 at the human–mink interface in Danish mink farms,
Denmark, June–November 2020
Period
(2020)
Surveillance and control measures in mink farms
Culling of mink in the first three farms with SARS-
CoV-2-positive mink, establishment of a surveillance
programme with sampling from dead mink on all farms
every 3 weeks, surveillance of PCR test results from
people connected to mink farms, and sampling from
mink in 125 randomly selected farms for PCR testing.
Containment strategy without culling, based on
enhanced biosecurity, use of personal protective
equipment in mink farms and enhanced surveillance of
dead mink.
Decision to cull mink in farms with infected mink as
well as mink in neighbouring (i.e. within a distance of
7.8 km) mink farms. Surveillance programme intensified
to comprise sampling of dead mink from herds within
the 7.8 km zones twice per week until culling.
Decision to cull all mink in Denmark and temporarily
halt mink production.
Comments
June
On a precautionary principle, and based on experiences from the
Netherlands, animals in the first three farms were culled.
July–
September
From 4 July to 11 August, no additional farms with SARS-CoV-2-
positive mink were detected by surveillance. The screening of 125
randomly sampled farms did not reveal farms with SARS-CoV-2-
positive mink, and no SARS-CoV-2-positive mink farm residents
were observed. From mid-August SARS-CoV-2 re-emerged in mink
farms.
In September, the number of farms with SARS-CoV-2-positive mink
showed a marked increase, and the incidence of human COVID-19
cases increased in parallel. The zone of 7.8 km was established
based on an analysis of minimum distance to the nearest farm with
SARS-CoV-2-positive mink [14]. These measures did not prevent
further spread to other mink farms and humans.
A risk assessment was issued by Statens Serum Institut on 3
November 2020. This assessment stated that during the COVID-19
pandemic, an ongoing production of mink represents a hazard to
human public health [7].
October
November
COVID-19: coronavirus disease; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
4
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On 5 November 2020, a partial lockdown was intro-
duced in the seven municipalities with the highest num-
ber of farms with SARS-CoV-2-positive mink in Northern
Jutland, and a mass-testing of the human population
was initiated. On 19 November 2020, restrictions were
lifted due to decreased incidence and the absence of
new cases of the cluster 5 variant.
By 25 November 2020, mink on all 290 farms with
SARS-CoV-2-positive mink, and mink on farms within
an assigned zone of 7.8 km from the nearest infected
farm, had been culled. The few remaining animals were
culled during December and January when legisla-
tion was passed and enforced to ban mink farming in
Denmark until 31 December 2021, including import and
export of live mink.
(290/1,147) of the Danish farms had infected mink
before the culling ended, corresponding to ca 3–4 mil-
lion infected animals compared with less than 300,000
humans being infected, based on serological stud-
ies (3.1% positive blood donors as of first week of
December 2020 [13]). A massive and susceptible animal
population serves as a threat for infection and trans-
mission, and for viral adaptation and potential immune
escape that may spill back into the human population.
The Danish experiences are unique because of the
magnitude of the Danish mink production. However,
other countries with farmed mink may well experience
similar risks.
The Danish experience calls for a global and coordi-
nated One-Health approach to understand and miti-
gate the risk that farmed mink may pose for the control
of the pandemic and to act accordingly.
Discussion
Spread of SARS-CoV-2 in mink farms and at the human–
animal and/or animal–human interface has been
reported from several countries, including Canada,
France, Greece, Italy, Lithuania, the Netherlands,
Spain, Sweden and the United States [8-10].
In the current study, people in households located
on Danish mink farms have been identified as hav-
ing an occupational risk for SARS-CoV-2 due to direct
or indirect exposure in the farm environment. It can
be assumed that at least one member of a mink farm
household had regular access to the animals and farm
area. Moreover, from our surveillance data, the occur-
rence of SARS-CoV-2 in people connected to mink
farms seemed to be closely related to the occurrence
of the virus in mink. It should be noted, however, that
it was not possible to identify employees living outside
a mink farm. These factors may have led to an under-
estimation of the occupational risk of mink farming in
areas with SARS-CoV-2-positive mink.
In addition, we observed from June 2020 the emer-
gence of the mink variant of SARS-CoV-2, with trans-
mission of this both in mink and people connected to
mink farms. These strains also spread further in the
community [1]. At least 90 human cases were linked to
the June outbreak caused by the mink variant, including
residents and staff at a nursing home and participants
in a bus trip to Bornholm [11,12]. In the second wave,
starting in August, community spread of the mink vari-
ant was seen in the municipalities with highest num-
bers of farms with SARS-CoV-2-positive mink, and at
the peak of the epidemic more than half of the strains
sequenced from human samples in North Denmark
Region were mink-associated. This spread was of sub-
stantial public health concern, since it contributed to
the emergence of SARS-CoV-2 in an area of Denmark
that hitherto had very few COVID-19-cases, relative to
urban areas of Denmark.
Until June 2020, Denmark accounted for ca 40% of the
world production of mink furs and had a mink popu-
lation of some 17 million animals. Approximately 25%
Acknowledgements
Danny Haimes at the Danish Patient Safety Authority is
thanked for discussions, ideas and for contributing to the
identification of infected farms by the reporting of PCR-
positive results from human cases connected to mink
production.
Funding statement: No particular funding was obtained for
this work, which was a part of national health response to
the COVID-19 pandemic.
Conflict of interest
None declared.
Authors’ contributions
Study design, practical set-up and daily maintenance of
surveillance: Helle Daugaard Larsen, Tinna Ravnholt Urth,
Ute Wolff Sönksen, Manon Chaine, Karina Lauenborg
Møller, Ann-Sofie Nicole Berthelsen, Tine Dalby, Frederikke
Kristensen Lomholt, Thomas Bruun Rasmussen, Louise
Lohse, Bertel Strandbygaard, Anette Bøtner, Jannik Fonager,
Anne Sofie Hammer, Anette Boklund, Brian Kristensen, Tyra
Grove Krause, Sten Mortensen, Kåre Mølbak.
Surveillance, data collection, processing, and validation: All
authors, including Sarah Kristine Nørgaard (data processing
and statistical methods validation).
Virology and sequencing: Thomas Bruun Rasmussen, Jannik
Fonager, Anette Bøtner, Bertel Strandbygaard, Louise Lohse,
Morten Rasmussen, Ria Lassaunière, Anders Fomsgaard,
Graham J. Belsham.
Writing and editing: All authors have been very active in criti-
cal editing.
Manuscript: Kåre Mølbak, Helle Daugaard Larsen, Frederikke
Kristensen Lomholt, Tine Dalby, and Guido Benedetti.
www.eurosurveillance.org
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