First case of imported chikungunya infection in Croatia, 2016

First Detection of West Nile Virus Lineage 2 in Culex pipiens Vectors in Croatia

The West Nile virus (WNV) has recently become more widespread, posing a threat to both human and animal health. In Western Europe, most outbreaks have been caused by WNV lineage 1, while in Eastern Europe, WNV lineage 2 has led to human and bird mortality. The ability to appropriately manage this threat is dependent on integrated surveillance and early detection. This study aimed to quantify the prevalence of WNV infection in mosquitoes and to identify the circulating viral lineage in eastern Croatia. Mosquito traps were set up in rural and urban areas during the 2021-2023 seasons, and the collected specimens were identified morphologically. Mosquito species Culex pipiens and Aedes albopictus were tested for Flaviviruses using conventional PCR in a heminested system. The positive samples were then subjected to a specific real-time PCR designed to detect WNV. A total of 385 mosquito pools were tested, and positive pools were found in samples from Osijek-Baranja and Vukovar-Srijem, both of which contained Cx. pipiens mosquitoes. Sequencing of amplicons revealed WNV lineage 2 partial NS5 gene sequences. Phylogenetic analysis suggests the Hungarian origin of strain, which complements birds' migratory routes. These findings indicate the first detection of WNV in mosquitoes in Croatia. This suggests that human cases in this region are likely due to infections with lineage 2 transmitted by local Culex mosquitoes.

Temporal Activity and Distribution of the Invasive Mosquitoes Aedes albopictus and Aedes japonicus in the Zagreb Area, Croatia

Aedes albopictus and Aedes japonicus are invasive mosquito species that are causing great public concern. Aedes albopictus have successfully spread in Croatia, established in both the coastal and continental parts of the country, while Aedes japonicus is invading temperate climate areas. The invasive Aedes species are particularly attracted to the black plastic water containers and flower vases in cemeteries where they oviposit their eggs. Therefore, monitoring of this species was carried out in 12 cemeteries in Zagreb, using ovitraps with masonite strips as a substrate for oviposition. The monitoring was carried out from 2017 to 2020. The traps were inspected and the substrate was replaced every two weeks. This study showed that these two invasive species were present and very abundant in the cemeteries. In the case of Ae. albopictus, a higher population density and a greater number of occupied cemeteries were detected. This species was identified in all 12 cemeteries. Aedes albopictus was identified as the dominant species at all study sites. The spread of Ae. japonicus increased during 2018 in comparison to the previous year. Although this species was present in approximately 9% of the ovitraps, the observed population remained consistent throughout the course of the study. The findings indicate that cemeteries can be considered as significant public health hotspots, as the invasive Aedes mosquitoes tend to develop and reproduce in such environments. Consequently, the mosquito population of these two invasive species may only be reduced by applying integrated mosquito management measures, focused on the education of citizens.

Current Status of Vector-Borne Diseases in Croatia: Challenges and Future Prospects

Different vector-borne pathogens are present or have (re-)emerged in Croatia. Flaviviruses tick-borne encephalitis (TBEV), West Nile (WNV), and Usutu (USUV) are widely distributed in continental regions, while Toscana virus (TOSV) and sandfly fever viruses are detected at the Croatian littoral. Recently, sporadic clinical cases of Tahyna orthobunyavirus (TAHV) and Bhanja bandavirus infection and seropositive individuals have been reported in continental Croatia. Acute infections and serologic evidence of WNV, TBEV, USUV, and TAHV were also confirmed in sentinel animals and vectors. Autochthonous dengue was reported in 2010 at the Croatian littoral. Lyme borreliosis is the most widely distributed vector-borne bacterial infection. The incidence is very high in northwestern and eastern regions, which correlates with numerous records of Ixodes ricinus ticks. Acute human Anaplasma phagocytophilum infections are reported sporadically, but there are many records of serologic evidence of anaplasmosis in animals. Mediterranean spotted fever (Rickettsia conorii) and murine typhus (Rickettsia typhi) are the main rickettsial infections in Croatia. Human leishmaniasis is notified sporadically, while serologic evidence of leishmaniasis was found in 11.4% of the Croatian population. After the official eradication of malaria in 1964, only imported cases were reported in Croatia. Since vector-borne diseases show a growing trend, continuous monitoring of vectors is required to protect the population from these infections.

Emerging and Neglected Viruses of Zoonotic Importance in Croatia

Several arboviruses have emerged in Croatia in recent years. Tick-borne encephalitis is endemic in continental counties; however, new natural micro-foci have been detected. Two autochthonous dengue cases were reported in 2010. West Nile virus emerged in 2012, followed by emergence of Usutu virus in 2013. Although high seroprevalence rates of Toscana virus have been detected among residents of Croatian littoral, the virus remains neglected, with only a few clinical cases of neuroinvasive infections reported. Lymphocytic choriomeningitis virus is a neglected neuroinvasive rodent-borne virus. So far, there are no reports on human clinical cases; however, the seroprevalence studies indicate the virus presence in the Croatian mainland. Puumala and Dobrava hantaviruses are widely distributing rodent-borne viruses with sporadic and epidemic occurrence. Hepatitis E virus is an emerging food-borne virus in Croatia. After the emergence in 2012, cases were regularly recorded. Seropositivity varies greatly by region and population group. Rotaviruses represent a significant healthcare burden since rotavirus vaccination is not included in the Croatian national immunization program. Additionally, rotaviruses are widely distributed in the Croatian ecosystem. A novel coronavirus, SARS-CoV-2, emerged in February 2020 and spread rapidly throughout the country. This review focuses on emerging and neglected viruses of zoonotic importance detected in Croatia.

Estimating Spatio-Temporal Dynamics of Aedes Albopictus Dispersal to Guide Control Interventions in Case of Exotic Arboviruses in Temperate Regions

The increasing number of exotic arbovirus cases imported in Europe and the 2017 chikungunya outbreak in central/southern Italy highlight the urgency of evidence-based outbreak management plans to predict, prevent or interrupt spreading of these arboviruses to non-endemic countries in temperate regions. We here present the results of three mark-release-recapture experiments conducted in a peri-urban area of North-East Italy to estimate the spatio-temporal dynamics of the dispersal of Aedes albopictus females looking for oviposition sites. The Flight Range of 90% of the mosquito population (FR₉₀) was found to exceed 200 m, consistently with data obtained from a previous study conducted in a highly urbanised area in Rome (Central Italy). Modelling results showed that dispersal can be so rapid that insecticide spraying within a 200m-radius around a potential infected case leaves >10% probability that a potentially infected mosquito escapes the treatment, even if this is carried out after only 2–3 days since the importation of a viremic case. These data provide evidence in favour of an update of guidelines for the control of exotic autochthonous arbovirus transmission in temperate areas and highlight the need of effective surveillance approaches and rapid response to contain the risks associated to imported viremic cases.

Zika virus: epidemiology, clinical aspects, diagnosis, and control of infection

Zika virus (ZIKV) is an emerging pathogen of huge public health significance to human beings. Although majority of infections are benign with self-limiting symptoms, the recent outbreak has established an association with the increased incidence of some congenital anomalies such as microcephaly. In other words, due to the large extent of the virus and mosquito vectors, the infection has become a thoughtful health problem for human societies, though now, there are no antiviral therapies or vaccines against this virus. In spite of extensive research carried out by scientists, not so much information has been gathered about this viral infection. In the current review, we prepared an overview of the remarkable progress made in understanding about the epidemiology, immunology, clinical presentation, and diagnosis methods of ZIKV infection.

Clinical Spectrum of Chikungunya in Pakistan

Background

Chikungunya fever is a pandemic disease caused by an arthropod-borne chikungunya virus (CHIKV). The virus spreads through mosquitoes. This mosquito induced viral illness is clinically suspected on symptoms from fever and severe polyarthralgia. The recent outbreak of chikungunya was reported in November 2016 in the metropolitan city Karachi, Pakistan. We emphasis on the awareness of the etiology and vector control to prevent serious consequences.

Method

A total number of 1275 patients were included in this cross-sectional study. These patients were enrolled based on clinical findings described by Centers for Disease Control and Prevention (CDC). Our exclusion criteria were patients with missing data or having co-infection with dengue or malaria. The patients were tested for chikungunya antibodies, malaria, and dengue. The patients were followed for three months.

Results

Out of 1275 consenting patients from the emergency department, 564 tested positive for chikungunya antibodies and out of these 564 patients 365 had co-infection of dengue and malaria. So based on exclusion criteria, 199 patients had isolated chikungunya infection and were studied for the frequency of clinical symptoms. The most common finding was joint pain and fever on presentation and joint pain was the only chronic finding which persisted.

Conclusion

Our study demonstrated the frequency of clinical findings in chikungunya infection. It also signifies the importance of testing for antibodies because it helped in excluding patients with false positive clinical findings and differentiating co-infection with malaria and dengue. It also gauged patient's view about the cause of this disease.