Do you like needles?

Marienhamn harbour at midnight, July 2006.

Ahvenamaa or Åland (as the locals prefer to call it, or rather them) is a bit of a historical geo-political oddity.  An archipelago of more than 6000 islands and skerries, although only 35 inhabited, it is inhabited around 26,ooo Swedish speaking people in an autonomous Finnish kunta (Commune). The Swedish Krona freely circulates (although the Euro is the official currency), they have their own flag and the Finnish defence forces are forbidden (it was made a demilitarised zone after the first world war).  Lying between Turku and Stockholm, handily for the locals all the big ferries stop at it's capital Marienhamn (Maarianhamina) albeit in the middle of the night, in order to take advantage of it being outside the EU-customs zone; but in the process adding an annoying couple of extra hours to the Helsinki-Stockholm journey time (unless you're just on the boat for the booze, fags and karaoke, in which case who cares). It has probably the best summer weather in Finland, (but the worst winter weather if you like skiing) and some beautiful archipelagic scenery. And, to get a bit closer to the point of this post, it's also reputed as a great place for cycling and camping holidays.

So as you might guess we are planning a cycling/camping holiday in Åland (I'm going to use the local names for everything from now on as I am writing in English and to annoy Konna who insists on using the Finnish versions), for a week this summer and as well as the usual logistical issues of transport, equipment, food, routes and accommodation to resolve (as we are not doing a pre-packaged deal) we also need to think about something I associate with visiting exotic destinations like Africa or the far east father than cartographical inksplashes in the Baltic. Vaccinations.

Now to get right up close and personal with the point of the post, Åland also is home to something other than a bunch of people with a long standing identity crisis (Finns, Swedes, Ålanders...). Ixodes ricinus ticks. Yum, look tasty don't they? Unfortunately as well as being as fugly as hell, and liking to latch on to wayfarers and do impressions of blood-filled coffee beans, punkki are tricky to remove.  Then you discover they potentially carry two even more unwanted guests: the bacterium Borrelia burghdor feri, which causes Lyme disease; and even worse, the virus for Tick Borne Encephalitis (TBE) in 1:200 to 1:1000 ticks.  Åland is considered endemic for TBE in Finland (although maybe not according to UK NaTHNaC), which is un-curable after contracting it, and it has a 1-2% fatality rate. For this reason the advice seems to be that at-risks groups (which include cyclists and campers you-know-where) should consider having the vaccination course. 

So that's three shots at €40 a shot; €120 each to add to what was supposed to be a cheap holiday. Money well spent? Well it's hard to judge the risks on this sort of thing (just ask Ben Goldacre if you don't believe me) - trying to put it in perspective even taking the worst case: say 1 in 200 x 2% x say 50% chance of getting bitten/latched onto by a tick in a week (that last is a complete guess by the way) = 1 in 20,000 chance of death.  Which compares to something like a 1 in 94,000 chance of dying cycling in the first place. [A direct comparison of those figures is statistically completely wrong, as different things were being measured in each case - so please don't imagine that means 5x more likely!!!] 

Maybe we will end up going to the punkkibussi after all, too much knowledge is a worrying thing for Konna at least ... or am I being complacent when we can fix it with a needle or three?