Diffuse maculopapular rash: A family cluster during the last Chikungunya virus epidemic in Italy

Public Perceptions on Non-Pharmaceutical Interventions for West Nile Virus Infections: A Survey from an Endemic Area in Northern Italy

During the last decade, cases of West Nile Virus (WNV) have occurred in the Emilia Romagna Region (ERR). Even though the notification rates remain relatively low, ranging from 0.06 to 1.83 cases/100,000 inhabitants, the persistent pathogen's circulation in settings characterized by favorable environmental characteristics suggests that WNV is becoming endemic to the Po River Valley. This study assesses knowledge, attitudes, and preventive practices toward WNV prevention among residents from 10 high-risk municipalities from the provinces of Parma and Reggio Emilia (total population: 82,317 inhabitants, census 2020). A web-based survey, based on the health belief model, was performed during the month of January 2021, with a convenience sampling of 469 participants from a series of closed discussion groups on social media (i.e., 2.1% of the potential responders). A total of 243 participants knew the meaning of WNV: Of them, 61.3% were aware of previous WNV infections in ERR, 76.5% acknowledged WNV infection as a severe one, but only 31.3% expressed any worry about WNV. Our results irregularly report preventive practices, either collective (e.g., draining standing water from items and the environment, 50.7%; spraying pesticides around the home, 33.0%) or individual (e.g., use of skin repellants when going outdoors, 42.6%). In a multivariate analysis, performed through binary logistic regression, participants reporting any worry towards WNV were more likely to characterize WNV as a severe disease (adjusted odds ratio [aOR] = 20.288, 95% confidence interval [CI] = 5.083-80.972). On the contrary, respondents supporting community mosquito control programs were more likely among people working with animals/livestock (aOR = 13.948, 95%CI = 2.793-69.653), and supporting tax exemptions for mosquito control programs (aOR = 4.069, 95%CI 2.098-7.893). In conclusion, our results suggest that future interventions promoting WNV prevention among residents in ERR should focus on perceptions of vulnerability to WNV, emphasizing the benefits of personal protective behaviors.

A comparative analysis of the 2007 and 2017 Italian chikungunya outbreaks and implication for public health response

Chikungunya virus (CHIKV) is a mosquito-borne infection that is emerging in temperate areas of Europe, following the expansion of one of its vector species, Aedes albopictus. Although CHIKV fever is a self-limiting disease, with a clinical syndrome often resolving within few days, it can also cause severe sequelae, including chronic polyarthralgia lasting up to 5 years. Additionally, CHIKV outbreaks may limit blood bank donations, adding economic burden on the health system. Public health authorities in Europe need to increase their preparedness against this emerging threat. Two large CHIKV outbreaks occurred in Italy in 2007 and 2017, with hundreds of cases and significant geographical spread. The aim of this paper is to review and compare the 2 Italian outbreaks in terms of available estimates of key epidemiological features, patient clinical presentation, virus and immunological characteristics, and public health response. Recommendations for public health and future directions for research are also discussed and highlighted.

In Europe, vector-borne diseases have been increasing during the last decades. CHIKV is an example of a neglected emerging disease transmitted by the alien mosquitoes Ae. albopictus that caused 2 large outbreaks in Italy in 2007 and 2017. It is important to compare the main epidemiological, clinical, virological, and immunological features, as well as the public health responses, to increase preparedness to face future outbreaks.

Chikungunya in Indonesia: Epidemiology and diagnostic challenges

BACKGROUND

Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed.

METHODOLOGY/PRINCIPAL FINDINGS

Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI.

CONCLUSIONS/SIGNIFICANCE

CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.

Mosquito-Borne Diseases Emergence/Resurgence and How to Effectively Control It Biologically

Deadly pathogens and parasites are transmitted by vectors and the mosquito is considered the most threatening vector in public health, transmitting these pathogens to humans and animals. We are currently witnessing the emergence/resurgence in new regions/populations of the most important mosquito-borne diseases, such as arboviruses and malaria. This resurgence may be the consequence of numerous complex parameters, but the major cause remains the mismanagement of insecticide use and the emergence of resistance. Biological control programmes have rendered promising results but several highly effective techniques, such as genetic manipulation, remain insufficiently considered as a control mechanism. Currently, new strategies based on attractive toxic sugar baits and new agents, such as Wolbachia and Asaia, are being intensively studied for potential use as alternatives to chemicals. Research into new insecticides, Insect Growth Regulators, and repellent compounds is pressing, and the improvement of biological strategies may provide key solutions to prevent outbreaks, decrease the danger to at-risk populations, and mitigate resistance.