Low to medium-low risk perception for dengue, chikungunya and Zika outbreaks by infectious diseases physicians in France, Western Europe

Reporting delays of chikungunya cases during the 2017 outbreak in Lazio region, Italy

BACKGROUND

Emerging arboviral diseases in Europe pose a challenge due to difficulties in detecting and diagnosing cases during the initial circulation of the pathogen. Early outbreak detection enables public health authorities to take effective actions to reduce disease transmission. Quantification of the reporting delays of cases is vital to plan and assess surveillance and control strategies. Here, we provide estimates of reporting delays during an emerging arboviral outbreak and indications on how delays may have impacted onward transmission.

METHODOLOGY/PRINCIPAL FINDINGS

Using descriptive statistics and Kaplan-Meyer curves we analyzed case reporting delays (the period between the date of symptom onset and the date of notification to the public health authorities) during the 2017 Italian chikungunya outbreak. We further investigated the effect of outbreak detection on reporting delays by means of a Cox proportional hazard model. We estimated that the overall median reporting delay was 15.5 days, but this was reduced to 8 days after the notification of the first case. Cases with symptom onset after outbreak detection had about a 3.5 times higher reporting rate, however only 3.6% were notified within 24h from symptom onset. Remarkably, we found that 45.9% of identified cases developed symptoms before the detection of the outbreak.

CONCLUSIONS/SIGNIFICANCE

These results suggest that efforts should be undertaken to improve the early detection and identification of arboviral cases, as well as the management of vector species to mitigate the impact of long reporting delays.

How do attitudes shape protective practices against the Asian tiger mosquito in community gardens in a nonendemic country?

BACKGROUND

The Asian tiger mosquito Aedes albopictus is responsible for the transmission of many arboviruses worldwide and is well adapted to thrive in urban environments. In mainland France, a nonendemic area, this mosquito is responsible for several autochthonous and imported cases of chikungunya and dengue each year. Better management and prevention of mosquito-borne disease transmission in nonendemic areas is thus of global concern. In this context, the aim of this study was to provide a better understanding of mosquito-human interactions as well as human behavior and beliefs in regard to this mosquito species in urban areas.

METHODS

We focused on people who participate in community gardens, which are increasingly popular initiatives in metropolitan France and are conducive to the development of tiger mosquitoes. To evaluate community gardeners' knowledge and practices in relation to mosquito management and control, we conducted a knowledge, attitude, and practice (KAP) survey.

RESULTS

In contrast to previous KAP studies, we showed that attitudes, more than knowledge, influence the practices of community gardeners in relation to mosquitoes. Interestingly, all gardeners who participated in the survey were concerned about the Asian tiger mosquito and were motivated to incorporate mosquito control methods in their gardens. Moreover, mosquitoes were perceived as nuisances rather than disease vector species. A change in community gardeners' perceptions could facilitate more appropriate behavior to control this species.

CONCLUSIONS

This survey reveals the lack of knowledge and awareness of good practices for the efficient control of the Asian tiger mosquito in green urban areas.

Has Zika Been Forgotten? Findings From Nationwide Survey on Knowledge, Attitudes, and Mosquito Preventive Practices in Malaysia

OBJECTIVE

The aim of this study is to assess knowledge and attitudes toward Zika virus disease (ZVD) as well as mosquito prevention practices in Malaysia at a nationwide level.

METHODS

Computer-assisted telephone interviews (CATI) were conducted between June 2019 and February 2020.

RESULTS

There are gaps in knowledge about the symptoms, mode of transmission, and risk of microcephaly. The mean for the Zika-related knowledge score was 5.9 (SD ± 4.4) out of a possible score of 14. The majority perceived little or no risk of getting ZVD (75.0%) and 75.5% were a little or not at all worried about ZVD. A high proportion reported the use of insect sprays or mosquito coils to prevent mosquito bites; however, a relatively lower proportion of people reported fixing mosquito netting on doors and windows, and using mosquito bed nets. The mean for the mosquito prevention practices score was 11.9 (SD ± 4.7) out of a possible score of 27. Important factors influencing mosquito prevention practices include household income, environment factors, risk perception, and Zika-related knowledge.

CONCLUSION

Zika prevention measures should be targeted in priority toward residents in lower socioeconomic neighborhoods. Campaigns should focus on messages highlighting the high risk of getting dengue.

European expert network on rare communicable diseases and other rare diseases linked to mobility and globalisation focused on health care provision (EURaDMoG): a feasibility study

INTRODUCTION

In the current mobility and globalization context, there is a growing need to identify potential changes on the pattern of diseases in the European Union (EU)/European Economic Area (EEA) and provide accurate diagnosis and treatment for the population. The pattern of rare communicable diseases that can affect people returning to EU/EEA from travel abroad, visiting EU/EEA or establishing in the EU/EEA is of special relevance. The objective of this manuscript is to give an overview about the EURaDMoG study and discuss the feasibility of establishing a European network on rare communicable diseases and other rare conditions linked to mobility and globalization.

METHODS

We undertook a three-steps process where we first conducted a narrative review to estimate the prevalence and incidence and to list rare communicable and non-communicable diseases linked to mobility and globalization in the EU/EEA; second, we organized an international consultation workshop with experts in the diseases previously selected; and finally, the feasibility study analysed how successful a European expert network on rare diseases linked to mobility and globalization focused on health care provision would be, accounting for different operational and also sustainability criteria.

RESULTS

First, considering the areas or topics that the network should cover, it was concluded that communicable and non-communicable rare diseases linked to mobility and globalization should be differentiated. Second, since all non-communicable rare diseases linked to mobility and globalization identified are already covered by different European Reference Networks (ERNs), there is no need for them to be included in a new European network. Three scenarios were considered for establishing a potential European network for rare communicable diseases linked to Mobility and Globalisation with a focus on Health Care provision: 1) To maintain the current situation "Status Quo" scenario; 2) to create a specific European expert network (EEN) on rare communicable diseases linked to mobility and globalisation; 3) to develop a new ERN on communicable rare diseases linked to mobility and globalisation.

CONCLUSIONS

Since the focus is the provision of health care, an ERN could have the potential to better boost the quality of care being facilitated by technological tools and online platforms that permit the safe and ethically acceptable exchange of data. However, this potential new network should not eclipse current existing networks and they should be complementary.

The Ecology of Protective Behaviors: A Study in New Risk Areas for Mosquito-Borne Diseases

During the last decade, tiger mosquitoes have rapidly colonized a large number of European countries, increasing the risk of infection with mosquito-borne diseases (MBDs), and constituting an emerging health threat in the region. The objectives of the present study were to prospectively investigate changes in Self-protective Behaviors, beliefs and attitudes regarding MBDs in Mediterranean France, and to assess the influence of social and cognitive time-varying covariates on behaviors. Data were collected using the same computer-assisted telephone survey in 2012, 2013 and 2014 among respondents residing in French Mediterranean regions. Weighted estimates in multivariate analysis were computed using the generalized estimating equation technique, with Self-protective Behaviors as a repeated outcome. Perceived exposure to tiger mosquitoes and knowledge about MBDs increased significantly between 2012 and 2014. Most respondents suffered from mosquito bites over the same period, but only 4 in 10 adopted Self-protective Behaviors. These behaviors were mostly related to the frequency of mosquito bites, perceived exposure to tiger mosquitoes, and to higher perceived vulnerability to MBDs. In conclusion, French Mediterranean residents are increasingly knowledgeable about MBDs and the proximity of tiger mosquitoes. However, self-protection was predominantly related to the frequency of mosquito bites and higher perceived vulnerability. These results suggest that Self-protective Behaviors are being shaped more in new risk areas by environmental cues to which people are exposed than by other common personal determinants of health behaviors.