Two contiguous outbreaks of dengue type 2 in north Queensland

The epidemiology of imported and locally acquired dengue in Australia, 2012-2022

BACKGROUND

Dengue is the most important arboviral disease globally and poses ongoing challenges for control including in non-endemic countries with competent mosquito vectors at risk of local transmission through imported cases. We examined recent epidemiological trends in imported and locally acquired dengue in Australia, where the Wolbachia mosquito population replacement method was implemented throughout dengue-prone areas of northern Queensland between 2011 and 2019.

METHODS

We analysed dengue cases reported to the Australian National Notifiable Disease Surveillance System between January 2012 and December 2022, and Australian traveller movement data.

RESULTS

Between 2012 and 2022, 13 343 dengue cases were reported in Australia (median 1466 annual cases); 12 568 cases (94.2%) were imported, 584 (4.4%) were locally acquired and 191 (1.4%) had no origin recorded. Locally acquired cases decreased from a peak in 2013 (n = 236) to zero in 2021-22. Annual incidence of imported dengue ranged from 8.29/100 000 (n = 917 cases) to 22.10/100 000 (n = 2203) annual traveller movements between 2012 and 2019, decreased in 2020 (6.74/100 000 traveller movements; n = 191) and 2021 (3.32/100 000 traveller movements; n = 10) during COVID-19-related border closures, then rose to 34.79/100 000 traveller movements (n = 504) in 2022. Imported cases were primarily acquired in Southeast Asia (n = 9323; 74%), Southern and Central Asia (n = 1555; 12%) and Oceania (n = 1341; 11%). Indonesia (n = 5778; 46%) and Thailand (n = 1483; 12%) were top acquisition countries. DENV-2 (n = 2147; 42%) and DENV-1 (n = 1526; 30%) were predominant serotypes.

CONCLUSION

Our analysis highlights Australia's successful control of locally acquired dengue with Wolbachia. Imported dengue trends reflect both Australian travel destinations and patterns and local epidemiology in endemic countries.

Timely surveillance and temporal calibration of disease response against human infectious diseases

Background

Disease surveillance and response are critical components of epidemic preparedness. The disease response, in most cases, is a set of reactive measures that follow the outcomes of the disease surveillance. Hence, timely surveillance is a prerequisite for an effective response.

Methodology/principal findings

We apply epidemiological soundness criteria in combination with the Latent Influence Point Process and time-to-event models to construct a disease spread network. The network implicitly quantifies the fertility (whether a case leads to secondary cases) and reproduction (number of secondary cases per infectious case) of the cases as well as the size and generations (of the infection chain) of the outbreaks. We test our approach by applying it to historic dengue case data from Australia. Using the data, we empirically confirm that high morbidity relates positively with delay in disease response. Moreover, we identify what constitutes timely surveillance by applying various thresholds of disease response delay to the network and report their impact on case fertility, reproduction, number of generations and ultimately, outbreak size. We observe that enforcing a response delay threshold of 5 days leads to a large average reduction across all parameters (occurrence 87%, reproduction 83%, outbreak size 80% and outbreak generations 47%), whereas extending the threshold to 10 days, in comparison, significantly limits the effectiveness of the response actions. Lastly, we identify the components of the disease surveillance system that can be calibrated to achieve the identified thresholds.

Conclusion

We identify practically achievable, timely surveillance thresholds (on temporal scale) that lead to an effective response and identify how they can be satisfied. Our approach can be utilized to provide guidelines on spatially and demographically targeted resource allocation for public awareness campaigns as well as to improve diagnostic abilities and turn-around times for the doctors and laboratories involved.

Bio-Efficacy of Commercially Available Residual Insecticides for the Control of Aedes aegypti in Mexico

Commercial aerosolized insecticides can be implemented as a community-based approach to targeted indoor residual spraying against Aedes aegypti, but their efficacy on pyrethroid-resistant mosquitoes has not yet been evaluated. Two commercial aerosolized products (H24 Poder Fulminante Ultra Eficaz^®, carbamate, and Baygon Ultra Verde^®, pyrethroid) were sprayed on common indoor surfaces e.g., cement, plywood, and cloth, and tested for their residual efficacy on susceptible and field-derived pyrethroid-resistant Ae. aegypti strains using the WHO cone bioassays. Overall, ≥80% 24-h mortality was observed for both products for at least 4 wk regardless of the mosquito strain or surface type used. H24 Poder Fulminante Ultra Eficaz showed the highest residual potency, sustaining >80% mortality for 7-wk posttreatment regardless of mosquito strain and surface type. For Baygon Ultra Verde, the mean mortality of female Ae. aegypti remained >80% for a shorter period (4-6 wk). Nonpyrethroid commercial aerosolized formulations can provide a lasting residual effect indoors compatible with the need for rapid and lasting mosquito control during outbreaks and may be suitable for community-based targeted indoor residual spraying.

Impact of population displacement and forced movements on the transmission and outbreaks of Aedes-borne viral diseases: Dengue as a model

Population displacement and other forced movement patterns following natural disasters, armed conflicts or due to socioeconomic reasons contribute to the global emergence of Aedes-borne viral disease epidemics. In particular, dengue epidemiology is critically affected by situations of displacement and forced movement patterns, particularly within and across borders. In this respect, waves of human movements have been a major driver for the changing epidemiology and outbreaks of the disease on local, regional and global scales. Both emerging dengue autochthonous transmission and outbreaks in countries known to be non-endemic and co-circulation and hyperendemicity with multiple dengue virus serotypes have led to the emergence of severe disease forms such as dengue hemorrhagic fever and dengue shock syndrome. This paper reviews the emergence of dengue outbreaks driven by population displacement and forced movements following natural disasters and conflicts within the context of regional and sub-regional groupings.

Dominance of the tiger: The displacement of Aedes aegypti by Aedes albopictus in parts of the Torres Strait, Australia

Most of the inhabited islands in the Torres Strait region of Australia have experienced dengue outbreaks transmitted by Aedes aegypti at various times since at least the 1890s. However, another potential dengue vector, Aedes albopictus, the Asian tiger mosquito, was detected for the first time in 2005 and it expanded across most of the Torres Strait within a few years. In 2016, a survey of container-inhabiting mosquitoes was conducted in all island communities and Ae. aegypti was undetectable on most of the islands which the species had previously occupied, and had been replaced by Ae. albopictus. It is suspected that competitive displacement was responsible for the changes in species distribution. Aedes aegypti was only detected on Boigu Island and Thursday Island. Recent dengue outbreaks in the Torres Strait have apparently been driven by both Ae. albopictus and Ae. aegypti. The findings have major implications on management of dengue outbreaks in the region.

From Incriminating Stegomyia fasciata to Releasing Wolbachia pipientis: Australian Research on the Dengue Virus Vector, Aedes aegypti, and Development of Novel Strategies for Its Surveillance and Control

Globally, the dengue viruses (DENVs) infect approximately 300 million people annually. Australia has a history of epidemic dengue, with outbreaks in the early decades of the twentieth century responsible for tens of thousands of cases. Seminal experiments conducted by Australian scientists during these outbreaks were the first to incriminate Aedes aegypti as a major vector of dengue viruses. One hundred years later, Australian scientists are playing a lead role in the development of surveillance and suppression strategies that target this mosquito species. Surveillance of Ae. aegypti populations and their associated dengue risk was greatly improved by understanding the contribution of key premises, key containers, and cryptic larval habitats to mosquito productivity, and, more recently, the development of novel adult traps. In terms of mosquito control, targeted indoor residual pyrethroid spraying and community-based biological control utilizing predatory copepods can significantly reduce Ae. aegypti populations. The release of Ae. aegypti transinfected with the virus-blocking bacterium, Wolbachia, provides a promising strategy for limiting DENV transmission. These diverse strategies developed by Australian scientists have the potential to alleviate the burden of dengue in the future, whether it is at the local level or as part of a country-wide program.

The origins of dengue outbreaks in northern Queensland, Australia, 1990–2017

Dengue is one of the world's major infectious mosquito-borne diseases and although not endemic in Australia, is a significant public health concern. Queensland is vulnerable to outbreaks of dengue viruses (DENVs) and indeed, due to endemic populations of the mosquito vector Aedes aeypti, has been the only state since the 1950s to record local transmission. Determining DENV outbreak origins, and monitoring strain movement and diversity greatly assists outbreak management. It also confirms epidemiological links and potentially identifies incursions of rare or highly pathogenic viruses. There have been 73 DENV outbreaks recorded in northern Queensland within the past three decades and it has been the role of Public Health Virology, Department of Health, Queensland Government, to provide DENV genotyping and characterisation to facilitate this essential surveillance. This review summarises the likely origins of the recent northern Queensland outbreaks and describes the complex dynamics of DENV genotypic diversity that have characterised local transmission events.

Dengue viruses in Papua New Guinea: evidence of endemicity and phylogenetic variation, including the evolution of new genetic lineages

Dengue is the most common cause of mosquito-borne viral disease in humans, and is endemic in more than 100 tropical and subtropical countries. Periodic outbreaks of dengue have been reported in Papua New Guinea (PNG), but there is only limited knowledge of its endemicity and disease burden. To help elucidate the status of the dengue viruses (DENVs) in PNG, we performed envelope (E) gene sequencing of DENV serotypes 1-4 (DENV 1-4) obtained from infected patients who traveled to Australia or from patients diagnosed during local DENV transmission events between 2001 and 2016. Phylogenetic analysis and comparison with globally available DENV sequences revealed new endemic PNG lineages for DENV 1-3 which have emerged within the last decade. We also identified another possible PNG lineage for DENV-4 from 2016. The DENV-1 and 3 PNG lineages were most closely related to recent lineages circulating on Pacific island nations while the DENV-2 lineage and putative DENV-4 PNG lineage were most similar to Indonesian sequences. This study has demonstrated for the first time the co-circulation of DENV 1-4 strains in PNG and provided molecular evidence of endemic DENV transmission. Our results provide an important platform for improved surveillance and monitoring of DENVs in PNG and broaden the global understanding of DENV genetic diversity.

Field Comparisons of the Gravid Aedes Trap (GAT) and BG-Sentinel Trap for Monitoring Aedes albopictus (Diptera: Culicidae) Populations and Notes on Indoor GAT Collections in Vietnam

We report on the use of the Gravid Aedes Trap (GAT) as a surveillance device for Aedes albopictus (Skuse) relative to the BG-Sentinel (BGS) trap in field studies conducted in Trenton, NJ, and on Hammond Island, Queensland, Australia. A parallel study conducted in Nha Trang, Vietnam, assessed the use of the GAT as an indoor surveillance device as well as the use of canola oil as a noninsecticide killing agent. In Trenton and Hammond Island, the GAT collected fewer male (0.40 ± 0.12 and 0.43 ± 0.30, respectively) and female (3.05 ± 0.67 and 2.7 ± 2.3, respectively) Ae. albopictus than the BGS trap (males: 3.54 ± 1.26 and 3.75 ± 0.83; females: 4.66 ± 1.18 and 3.9 ± 0.23) over their respective sampling periods (i.e., 24 h for the BGS and 1 wk for the GAT). Despite differences in capture rates, the percentage of traps positive for female Ae. albopictus was similar between the BGS and GAT (Trenton: 60.1 ± 6.3% and 64.4 ± 4.1%; Hammond: 87.5 ± 6.9% and 80.0 ± 8.2%). In Nha Trang, the GAT was equally effective indoors and outdoors with (10 g hay or 3 g fish food) and without (water or empty) infusion. Additionally, no significant decrease in collections was observed between GATs set with canola oil or long-lasting insecticidal net. In summary, both traps were successful in monitoring female Ae. albopictus over their respective trapping intervals, but would be best used to complement each other to monitor both sexes and all physiological stages of female Ae. albopictus. However, the versatility and low-cost of the GAT makes it an attractive alternative to the more expensive BGS trap.

Holding back the tiger: Successful control program protects Australia from Aedes albopictus expansion

Background

The Asian tiger mosquito, Aedes albopictus, is an important vector of dengue, chikungunya and Zika viruses and is a highly invasive and aggressive biter. Established populations of this species were first recognised in Australia in 2005 when they were discovered on islands in the Torres Strait, between mainland Australia and Papua New Guinea. A control program was implemented with the original goal of eliminating Ae. albopictus from the Torres Strait. We describe the evolution of management strategies that provide a template for Ae. albopictus control that can be adopted elsewhere.

Methodology / Principal findings

The control strategy implemented between 2005 and 2008 targeted larval habitats using source reduction, insect-growth regulator and pyrethroid insecticide to control larvae and adults in the containers. However, the infrequency of insecticide reapplication, the continual accumulation and replacement of containers, and imminent re-introduction of mosquitoes through people’s movement from elsewhere compromised the program. Consequently, in 2009 the objective of the program changed from elimination to quarantine, with the goal of preventing Ae albopictus from infesting Thursday and Horn islands, which are the transport hubs connecting the Torres Strait to mainland Australia. However, larval control strategies did not prevent the species establishing on these islands in 2010. Thereafter, an additional strategy adopted by the quarantine program in early 2011 was harborage spraying, whereby the vegetated, well shaded resting sites of adult Ae. albopictus were treated with a residual pyrethroid insecticide. Inclusion of this additional measure led to a 97% decline in Ae. albopictus numbers within two years. In addition, the frequency of container treatment was increased to five weeks between treatments, compared to an average of 8 weeks that occurred in the earlier iterations of the program. By 2015 and 2016, Ae. albopictus populations on the two islands were undetectable in 70–90% of surveys conducted. Importantly, a comprehensive surveillance network in selected strategic areas has not identified established populations of this species on the Australian mainland.

Conclusions / Significance

The program has successfully reduced Ae. albopictus populations on Thursday Island and Horn Island to levels where it is undetectable in up to 90% of surveys, and has largely removed the risk of mainland establishment via that route. The vector management strategies adopted in the later years of the program have been demonstrably successful and provide a practical management framework for dengue, chikungunya or Zika virus outbreaks vectored by Ae. albopictus. As of June 2016, Ae. albopictus had not established on the Australian mainland and this program has likely contributed significantly to this outcome.

Aedes albopictus is a disease vector and biting nuisance of major public health concern. Established populations of Ae. albopictus were first recognised in Australia in 2005 after they were discovered on islands in the Torres Strait. Consequently, a control program was established in the same year to eliminate Ae. albopictus populations in the Torres Strait in order to reduce the risk of disease, as well as to prevent the mosquito from spreading to the mainland of Australia. In 2009, the goal of the program changed from elimination to quarantine (cordon sanitaire) focusing mainly on the inner islands of Thursday Island and Horn Island, which are the major population, administrative and transport centres linking the Torres Strait region to the Australian mainland. The cordon sanitaire strategy involved an integrated approach composed of harborage spraying, source reduction, insecticide treatment of containers, lethal tire piles, mosquito population monitoring and public awareness campaigns. Strategic improvements in management techniques led to a 97% decline in Ae. albopictus numbers on the two islands between 2011 and 2012. By 2015, the program had successfully reduced Ae. albopictus populations on Thursday Island and Horn Island to levels where the species was frequently undetectable, and had largely removed the risk of mainland incursion via that route. In 2016 the improved management strategies were also adopted to successfully control a dengue outbreak in which Ae. albopictus was the implicated vector on two outer islands of the Torres Strait.

Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies

Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens’ engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.

Land Use Influences Mosquito Communities and Disease Risk on Remote Tropical Islands: A Case Study Using a Novel Sampling Technique

Land use changes, such as deforestation and urbanization, can influence interactions between vectors, hosts, and pathogens. The consequences may result in the appearance and rise of mosquito-borne diseases, especially in remote tropical regions. Tropical regions can be the hotspots for the emergence of diseases due to high biological diversity and complex species interactions. Furthermore, frontier areas are often haphazardly surveyed as a result of inadequate or expensive sampling techniques, which limit early detection and medical intervention. We trialed a novel sampling technique of nonpowered traps and a carbon dioxide attractant derived from yeast and sugar to explore how land use influences mosquito communities on four remote, tropical islands in the Australian Torres Strait. Using this technique, we collected > 11,000 mosquitoes from urban and sylvan habitats. We found that human land use significantly affected mosquito communities. Mosquito abundances and diversity were higher in sylvan habitats compared with urban areas, resulting in significantly different community compositions between the two habitats. An important outcome of our study was determining that there were greater numbers of disease-vectoring species associated with human habitations. On the basis of these findings, we believe that our novel sampling technique is a realistic tool for assessing mosquito communities in remote regions.

A spatial simulation model for dengue virus infection in urban areas

Background

The World Health Organization estimates that the global number of dengue infections range between 80–100 million per year, with some studies estimating approximately three times higher numbers. Furthermore, the geographic range of dengue virus transmission is extending with the disease now occurring more frequently in areas such as southern Europe. Ae. aegypti, one of the most prominent dengue vectors, is endemic to the far north-east of Australia and the city of Cairns frequently experiences dengue outbreaks which sometimes lead to large epidemics.

Method

A spatially-explicit, individual-based mathematical model that accounts for the spread of dengue infection as a result of human movement and mosquito dispersion is presented. The model closely couples the four key sub-models necessary for representing the overall dynamics of the physical system, namely those describing mosquito population dynamics, human movement, virus transmission and vector control. Important features are the use of high quality outbreak data and mosquito trapping data for calibration and validation and a strategy to derive local mosquito abundance based on vegetation coverage and census data.

Results

The model has been calibrated using detailed 2003 dengue outbreak data from Cairns, together with census and mosquito trapping data, and is shown to realistically reproduce a further dengue outbreak. The simulation results replicating the 2008/2009 Cairns epidemic support several hypotheses (formulated previously) aimed at explaining the large-scale epidemic which occurred in 2008/2009; specifically, while warmer weather and increased human movement had only a small effect on the spread of the virus, a shorter virus strain-specific extrinsic incubation time can explain the observed explosive outbreak of 2008/2009.

Conclusion

The proof-of-concept simulation model described in this study has potential as a tool for understanding factors contributing to dengue spread as well as planning and optimizing dengue control, including reducing the Ae. aegypti vector population and for estimating the effectiveness and cost-effectiveness of future vaccination programmes. This model could also be applied to other vector borne viral diseases such as chikungunya, also spread by Ae. aegypti and, by re-parameterisation of the vector sub-model, to dengue and chikungunya viruses spread by Aedes albopictus.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-447) contains supplementary material, which is available to authorized users.

Epidemiology of dengue in a high-income country: a case study in Queensland, Australia

Background

Australia is one of the few high-income countries where dengue transmission regularly occurs. Dengue is a major health threat in North Queensland (NQ), where the vector Aedes aegypti is present. Whether NQ should be considered as a dengue endemic or epidemic region is an ongoing debate. To help address this issue, we analysed the characteristics of locally-acquired (LA) and imported dengue cases in NQ through time and space. We describe the epidemiology of dengue in NQ from 1995 to 2011, to identify areas to target interventions. We also investigated the timeliness of notification and identified high-risk areas.

Methods

Data sets of notified cases and viraemic arrivals from overseas were analysed. We developed a time series based on the LA cases and performed an analysis to capture the relationship between incidence rate and demographic factors. Spatial analysis was used to visualise incidence rates through space and time.

Results

Between 1995 and 2011, 93.9% of reported dengue cases were LA, mainly in the ‘Cairns and Hinterland’ district; 49.7% were males, and the mean age was 38.0 years old. The sources of imported cases (6.1%) were Indonesia (24.6%), Papua New Guinea (23.2%), Thailand (13.4%), East Timor (8.9%) and the Philippines (6.7%), consistent with national data. Travellers importing dengue were predominantly in the age groups 30–34 and 45–49 years old, whereas the age range of patients who acquired dengue locally was larger. The number of LA cases correlated with the number of viraemic importations. Duration of viraemia of public health importance was positively correlated with the delay in notification. Dengue incidence varied over the year and was typically highest in summer and autumn. However, dengue activity has been reported in winter, and a number of outbreaks resulted in transmission year-round.

Conclusions

This study emphasizes the importance of delay in notification and consequent duration of viraemia of public health importance for dengue outbreak duration. It also highlights the need for targeted vector control programmes and surveillance of travellers at airports as well as regularly affected local areas. Given the likely increase in dengue transmission with climate change, endemicity in NQ may become a very real possibility.

Electronic supplementary material

The online version of this article (doi:10.1186/1756-3305-7-379) contains supplementary material, which is available to authorized users.

Field validation of the gravid Aedes trap (GAT) for collection of Aedes aegypti (Diptera: Culicidae)

Current surveillance methods for adult Aedes aegypti (L.) are expensive, require electrical power (e.g., the BG-Sentinel trap, BGS), are labor intensive (aspirators), or require difficult to use and costly adhesives (sticky ovitraps). Field trials were conducted in Cairns (Australia) to compare the efficacy of the newly designed Gravid Aedes Trap (GAT) against existing sticky ovitraps (MosquiTRAP and double sticky ovitrap) and the BGS. Latin square design trials confirmed that alarge GAT using a 9.2-liters bucket treated with Mortein Barrier Outdoor Surface Spray ([AI] 0.3 g/kg imiprothrin and 0.6 g/kg deltamethrin) outperformed a smaller 1.2-liters GAT and collected, on average, 3.7x and 2.4X more female Ae. aegypti than the MosquiTRAP and double sticky ovitrap, respectively. Field trials showed that the GAT collected 10-50% less female Ae. aegypti than the BGS trap but 30% more gravid mosquitoes than the BGS. Trials using the BGS and the GAT indicated that there was no difference in capture rates between female Ae. aegypti uninfected and infected with the wMel strain of Wolbachia, and wMel infection rates were nearly identical at >90% to field captured Ae. aegypti. The potential for the GAT to be used for dengue virus surveillance was also demonstrated with dengue virus type 3 RNA detected in five-sixths and six-sixths pools ofAe. aegypti stored in a GAT held at 28 degreeC and 60% relative humidity for 7 and 14 d, respectively. Mosquito knock down in GATs treated with Mortein surface spray set in 30, 70, and 99% shade was comparable for up to 2 mo, with only approximately 10% of adults escaping. The GAT is therefore a useful tool for capturing adult Ae. aegypti and may be suitable for other container-inhabiting species such as Aedes albopictus (Skuse) and Culex quinquefasciatus Say. The low cost and practicality of operation make the GAT suitable for vector surveillance and projects requiring monitoring of mosquitoes for Wolbachia and arboviruses, especially in developing countries.

An explosive epidemic of DENV-3 in Cairns, Australia

From November 2008-May 2009 Cairns Queensland Australia was struck by an explosive epidemic of DENV-3 that exceeded the capacity of highly skilled dengue control team to control it. We describe the environmental, virological and entomological factors associated with this outbreak to better understand the circumstances leading to its occurrence. Patient interviews, serological results and viral sequencing strongly suggest that the imported index case was infected in Kalimantan, Indonesia. A delay in notification of 27 days from importation of the index case until Queensland Health was notified of dengue transmission allowed the virus to amplify and spread unchecked through November 2008. Unseasonably warm weather, with daily mean temperatures exceeding 30°C, occurred in late November and would have shortened the extrinsic incubation period of the virus and enhanced transmission. Analysis of case movements early in the outbreak indicated that the total incubation period was as low as 9–11 days. This was supported by laboratory vector competence studies that found transmission by Aedes aegypti occurred within 5 days post exposure at 28°C. Effective vector competence rates calculated from these transmission studies indicate that early transmission contributed to the explosive dengue transmission observed in this outbreak. Collections from BG sentinel traps and double sticky ovitraps showed that large populations of the vector Ae. aegypti occurred in the transmission areas from November – December 2008. Finally, the seasonal movement of people around the Christmas holiday season enhanced the spread of DENV-3. These results suggest that a strain of DENV-3 with an unusually rapid transmission cycle was able to outpace vector control efforts, especially those reliant upon delayed action control such as lethal ovitraps.

Novel estimates of Aedes aegypti (Diptera: Culicidae) population size and adult survival based on Wolbachia releases

The size of Aedes aegypti (L.) mosquito populations and adult survival rates have proven difficult to estimate because of a lack of consistent quantitative measures to equate sampling methods, such as adult trapping, to actual population size. However, such estimates are critical for devising control methods and for modeling the transmission of dengue and other infectious agents carried by this species. Here we take advantage of recent releases of Wolbachia-infected Ae. aegypti coupled with the results of ongoing monitoring to estimate the size of adult Ae. aegypti populations around Cairns in far north Queensland, Australia. Based on the association between released adults infected with Wolbachia and data from Biogents Sentinel traps, we show that data from two locations are consistent with population estimates of approximately 5-10 females per house and daily survival rates of 0.7-0.9 for the released Wolbachia-infected females. Moreover, we estimate that networks of Biogents Sentinel traps at a density of one per 15 houses capture around 5-10% of the adult population per week, and provide a rapid estimate of the absolute population size of Ae. aegypti. These data are discussed with respect to release rates and monitoring in future Wolbachia releases and also the levels of suppression required to reduce dengue transmission.

Weather-driven variation in dengue activity in Australia examined using a process-based modeling approach

The impact of weather variation on dengue transmission in Cairns, Australia, was determined by applying a process-based dengue simulation model (DENSiM) that incorporated local meteorologic, entomologic, and demographic data. Analysis showed that inter-annual weather variation is one of the significant determinants of dengue outbreak receptivity. Cross-correlation analyses showed that DENSiM simulated epidemics of similar relative magnitude and timing to those historically recorded in reported dengue cases in Cairns during 1991-2009, (r = 0.372, P < 0.01). The DENSiM model can now be used to study the potential impacts of future climate change on dengue transmission. Understanding the impact of climate variation on the geographic range, seasonality, and magnitude of dengue transmission will enhance development of adaptation strategies to minimize future disease burden in Australia.

Cooling off health security hot spots: getting on top of it down under

Australia is free of many diseases, pests and weeds found elsewhere in the world due to its geographical isolation and relatively good health security practices. However, its health security is under increasing pressure due to a number of ecological, climatic, demographic and behavioural changes occurring globally. North Queensland is a high risk area (a health security hot spot) for Australia, due in part to its connection to neighbouring countries via the Torres Strait and the Indo-Papuan conduit, its high diversity of wildlife reservoirs and its environmental characteristics. Major outbreaks of exotic diseases, pests and weeds in Australia can cost in excess of $1 billion; however, most expenditure on health security is reactive apart from preventive measures undertaken for a few high profile diseases, pests and weeds. Large gains in health security could therefore be made by spending more on pre-emptive approaches to reduce the risk of outbreaks, invasion/spread and establishment, despite these gains being difficult to quantify. Although biosecurity threats may initially have regional impacts (e.g. Hendra virus), a break down in security in health security hot spots can have national and international consequences, as has been seen recently in other regions with the emergence of SARS and pandemic avian influenza. Novel approaches should be driven by building research and management capacity, particularly in the regions where threats arise, a model that is applicable both in Australia and in other regions of the world that value and therefore aim to improve their strategies for maintaining health security.

Incidence of dengue virus infection among Japanese travellers, 2006 to 2010

INTRODUCTION

Dengue continues to be a global public health concern. In Japan, although dengue cases are currently seen only among travellers returning from endemic areas, the number of reported cases is rising according to the national case-based surveillance system. We evaluated the characteristics of dengue cases imported into Japan and the relationship between the incidence of infection and season of travel to popular destinations.

METHODS

Dengue cases reported to the national surveillance system were retrospectively examined. The number of reported cases per number of Japanese travellers to a dengue-endemic country was calculated to estimate the country-specific incidence of imported dengue virus infection. The incidence of dengue infection among Japanese travellers was compared between dengue high season and low season in each country using relative risk (RR) and associated 95% confidence intervals (CI).

RESULTS

Among 540 Japanese residents who were reported as dengue cases from 2006 to 2010, the majority had travelled to Indonesia, India, the Philippines and Thailand. The RR of dengue infection among Japanese travellers during dengue high season versus low season was 4.92 (95% CI: 3.01-8.04) for the Philippines, 2.76 (95% CI: 1.67-4.54) for Thailand and 0.37 (95% CI: 0.15-0.92) for Indonesia.

DISCUSSION

Overall, higher incidence of imported cases appeared to be related to historic dengue high seasons. Travellers planning to visit dengue-endemic countries should be aware of historic dengue seasonality and the current dengue situation.

The impacts of low-cost treatment options upon scale formation potential in remote communities reliant on hard groundwaters. A case study: Northern Territory, Australia

The majority of small, remote communities within the Northern Territory (NT) in Central Australia are reliant on groundwater as their primary supply of domestic, potable water. Saturation indices for a variety of relevant minerals were calculated using available thermodynamic speciation codes on collected groundwater data across the NT. These saturation indices were used to assess the theoretical formation of problematic mineral-scale, which manifests itself by forming stubborn coatings on domestic appliances and fixtures. The results of this research show that 63% of the measured sites within the NT have the potential to form calcium carbonate (CaCO(3)) scale, increasing to 91% in arid, central regions. The data also suggests that all groundwaters are over-saturated with respect to amorphous calcium-bridged ferric-silica polymers, based on the crystalline mineral index (Ca(3)Fe(2)Si(3)O(12)), although the quantitative impact of this scale is limited by low iron concentrations. An assessment of possible low-cost/low-technology management options was made, including; lowering the temperature of hot-water systems, diluting groundwater with rainwater and modifying the pH of the source water. Source water pH modification (generally a reduction to pH 7.0) was shown to clearly alleviate potential carbonate-based scale formation, over and above the other two options, albeit at a greater technical and capital expense. Although low-cost/low-technology treatment options are unlikely to remove severe scale-related issues, their place in small, remote communities with minor scale problems should be investigated further, owing to the social, technical and capital barriers involved with installing advanced treatment plants (e.g. reverse osmosis) in such locations.

Spatial patterns and socioecological drivers of dengue fever transmission in Queensland, Australia

BACKGROUND

Understanding how socioecological factors affect the transmission of dengue fever (DF) may help to develop an early warning system of DF.

OBJECTIVES

We examined the impact of socioecological factors on the transmission of DF and assessed potential predictors of locally acquired and overseas-acquired cases of DF in Queensland, Australia.

METHODS

We obtained data from Queensland Health on the numbers of notified DF cases by local government area (LGA) in Queensland for the period 1 January 2002 through 31 December 2005. Data on weather and the socioeconomic index were obtained from the Australian Bureau of Meteorology and the Australian Bureau of Statistics, respectively. A Bayesian spatial conditional autoregressive model was fitted at the LGA level to quantify the relationship between DF and socioecological factors.

RESULTS

Our estimates suggest an increase in locally acquired DF of 6% [95% credible interval (CI): 2%, 11%] and 61% (95% CI: 2%, 241%) in association with a 1-mm increase in average monthly rainfall and a 1°C increase in average monthly maximum temperature between 2002 and 2005, respectively. By contrast, overseas-acquired DF cases increased by 1% (95% CI: 0%, 3%) and by 1% (95% CI: 0%, 2%) in association with a 1-mm increase in average monthly rainfall and a 1-unit increase in average socioeconomic index, respectively.

CONCLUSIONS

Socioecological factors appear to influence the transmission of DF in Queensland, but the drivers of locally acquired and overseas-acquired DF may differ. DF risk is spatially clustered with different patterns for locally acquired and overseas-acquired cases.

Epidemiologic update of dengue in the Western Pacific Region, 2010

Dengue is an emerging vectorborne infectious disease that is a major public health concern in the Asia Pacific region. Official dengue surveillance data for 2010 provided by ministries of health were summarized as part of routine activities of the World Health Organization Regional Office for the Western Pacific. Based on reported data, dengue has continued to show an increasing trend in the Western Pacific Region. In 2010, countries and areas reported a total of 353 907 dengue cases, of which 1073 died, for a case fatality ratio of 0.30%. More than 1000 cases were reported each from Australia (North Queensland), Cambodia, the Lao People's Democratic Republic, Malaysia, the Philippines, Singapore and Viet Nam. With the exception of Australia, the number of reported cases in 2010 was greater than that reported in 2009 for these countries. The elevated number of cases reported in 2010 in some countries, such as the Philippines, is likely due to several factors, such as enhanced reporting and continued epidemic activity. However, increases in reported number of cases in other areas, such as Singapore and Malaysia, appear to indicate sustained epidemic activity in those countries. The continued epidemic dengue activity in the Region highlights the need for timely and routine regional sharing of information.

Quantifying the spatial dimension of dengue virus epidemic spread within a tropical urban environment

Background

Dengue infection spread in naive populations occurs in an explosive and widespread fashion primarily due to the absence of population herd immunity, the population dynamics and dispersal of Ae. aegypti, and the movement of individuals within the urban space. Knowledge on the relative contribution of such factors to the spatial dimension of dengue virus spread has been limited. In the present study we analyzed the spatio-temporal pattern of a large dengue virus-2 (DENV-2) outbreak that affected the Australian city of Cairns (north Queensland) in 2003, quantified the relationship between dengue transmission and distance to the epidemic's index case (IC), evaluated the effects of indoor residual spraying (IRS) on the odds of dengue infection, and generated recommendations for city-wide dengue surveillance and control.

Methods and Findings

We retrospectively analyzed data from 383 DENV-2 confirmed cases and 1,163 IRS applications performed during the 25-week epidemic period. Spatial (local k-function, angular wavelets) and space-time (Knox test) analyses quantified the intensity and directionality of clustering of dengue cases, whereas a semi-parametric Bayesian space-time regression assessed the impact of IRS and spatial autocorrelation in the odds of weekly dengue infection. About 63% of the cases clustered up to 800 m around the IC's house. Most cases were distributed in the NW-SE axis as a consequence of the spatial arrangement of blocks within the city and, possibly, the prevailing winds. Space-time analysis showed that DENV-2 infection spread rapidly, generating 18 clusters (comprising 65% of all cases), and that these clusters varied in extent as a function of their distance to the IC's residence. IRS applications had a significant protective effect in the further occurrence of dengue cases, but only when they reached coverage of 60% or more of the neighboring premises of a house.

Conclusion

By applying sound statistical analysis to a very detailed dataset from one of the largest outbreaks that affected the city of Cairns in recent times, we not only described the spread of dengue virus with high detail but also quantified the spatio-temporal dimension of dengue virus transmission within this complex urban environment. In areas susceptible to non-periodic dengue epidemics, effective disease prevention and control would depend on the prompt response to introduced cases. We foresee that some of the results and recommendations derived from our study may also be applicable to other areas currently affected or potentially subject to dengue epidemics.

Global trends in population growth and human redistribution and movement have reshaped the map of dengue transmission risk, exposing a significant proportion of the world's population to the threat of dengue epidemics. Knowledge on the relative contribution of vector and human movement to the widespread and explosive nature of dengue epidemic spread within an urban environment is limited. By analyzing a very detailed dataset of a dengue epidemic that affected the Australian city of Cairns we performed a comprehensive quantification of the spatio-temporal dimensions of dengue virus epidemic transmission and propagation within a complex urban environment. Space and space-time analysis and models allowed derivation of detailed information on the pattern of introduction and epidemic spread of dengue infection within the urban space. We foresee that some of the results and recommendations derived from our study may also be applicable to many other areas currently affected or potentially subject to dengue epidemics.

Vector competence of Australian mosquitoes for chikungunya virus

Chikungunya virus (CHIKV) is a globally emerging arbovirus responsible for unprecedented outbreaks in the western Indian Ocean, the Indian subcontinent and Italy. To assess the receptivity of Australia to CHIKV, we exposed 10 Australian mosquito species to a 2006 strain of CHIKV isolated from a viremic traveler from Mauritius. In susceptibility trials, the infectious dose required to infect 50% of the mosquitoes was 10(0.6) cell culture infectious dose (CCID)(50)/mosquito for Aedes procax, 10(1.7) CCID(50)/mosquito for Aedes albopictus, 10(2.1) CCID(50)/mosquito for Aedes vigilax, and 10(2.6) CCID(50)/mosquito for Aedes aegypti and Aedes notoscriptus. When exposed to blood meals containing between 10(3.5) and 10(4.1) CCID(50)/mosquito of CHIKV, infection rates in these five species, plus Coquillettidia linealis, were >or=81%. Subsequent transmission rates ranged between 20% for Ae. notoscriptus and 76% for Ae. vigilax. In contrast, Culex spp. were poor laboratory vectors, with infection and dissemination rates <or=20% and <or=12%, respectively. Although Australia has efficient laboratory vectors, the role a mosquito species plays in potential CHIKV transmission cycles will also depend on its geographical and temporal abundance, longevity, and association with humans.

Spatial analysis of notified dengue fever infections

This study aimed to investigate the spatial clustering and dynamic dispersion of dengue incidence in Queensland, Australia. We used Moran's I statistic to assess the spatial autocorrelation of reported dengue cases. Spatial empirical Bayes smoothing estimates were used to display the spatial distribution of dengue in postal areas throughout Queensland. Local indicators of spatial association (LISA) maps and logistic regression models were used to identify spatial clusters and examine the spatio-temporal patterns of the spread of dengue. The results indicate that the spatial distribution of dengue was clustered during each of the three periods of 1993-1996, 1997-2000 and 2001-2004. The high-incidence clusters of dengue were primarily concentrated in the north of Queensland and low-incidence clusters occurred in the south-east of Queensland. The study concludes that the geographical range of notified dengue cases has significantly expanded in Queensland over recent years.

Global spread of epidemic dengue: the influence of environmental change

Dengue/dengue hemorrhagic fever is the most important vector-borne viral disease globally, with over half of the world’s population living in areas at risk of infection. Frequent and cyclical epidemics are reported throughout the tropical world, with regular importation of the virus via viremic travelers into both endemic and nonendemic countries. These events coincide with the recently observed global warming that is associated with climate change. Whether these events are coincidental is examined in this article. The history of dengue emergence is traced to determine the major drivers responsible for the spread of both the viruses and mosquito vectors to new geographic regions. We conclude that demographic- and anthropogenic-driven environmental changes, combined with globalization and inefficient public health measures rather than climate change, are the principal driving forces for the re-emergence and spread of epidemic dengue in the past 40 years. These trends are likely to continue given the global trends projected by the United Nations.

The risk of dengue transmission by blood during a 2004 outbreak in Cairns, Australia

BACKGROUND

Dengue virus (DENV) is a Flavivirus transmitted by the Aedes mosquito. The related arbovirus, West Nile virus, has been shown to be transfusion transmitted, which, added to the four recorded dengue transfusion-associated cases, indicates that DENV is also transfusion transmitted. The purpose of this study was to assess the risk of transfusion-transmitted DENV during a 2004 outbreak in the Australian city of Cairns.

STUDY DESIGN AND METHODS

A mathematical model was constructed to estimate the risk of transfusion-transmitted dengue. The model's central premise is that the transmission risk is proportional to the frequency of dengue-viremic donations and correlates with the incidence of asymptomatic dengue viremia among the population at large.

RESULTS

The modeling predicted that the total number of DENV infections (clinical plus subclinical) among the population at large during the entire outbreak ranged from 156 to 569 with the epidemic peak occurring between February 8 and March 6, 2004. The overall transmission risk during the entire outbreak was estimated as 1 in 19,759 (range, 1 in 3404 to 75,486) peaking at 1 in 5968 (range 1 in 1028 to 22,800).

CONCLUSION

By use of the most conservative estimates for key variables, the risk of collecting a viremic donation could have been as high as 1 in 1028 during the peak of the 2004 outbreak. The model can be used to determine transfusion transmission risk levels during DENV outbreaks and inform decisions as to when fresh component restriction measures are required to minimize transfusion transmission risk.

Influence of hosts on the ecology of arboviral transmission: potential mechanisms influencing dengue, Murray Valley encephalitis, and Ross River virus in Australia

Ecological interactions are fundamental to the transmission of infectious disease. Arboviruses are particularly elegant examples, where rich arrays of mechanisms influence transmission between vectors and hosts. Research on host contributions to the ecology of arboviral diseases has been undertaken within multiple subdisciplines, but significant gaps in knowledge remain and multidisciplinary approaches are needed. Through our multidisciplinary review of the literature we have identified five broad areas where hosts may influence the ecology of arboviral transmission: host immunity; cross-protective immunity and antibody-dependent enhancement; host abundance; host diversity; and pathogen spillover and dispersal. Herein we discuss the known and theoretical roles of hosts within these topics and then apply this knowledge to three epidemiologically important mosquito-borne arboviruses that occur in Australia: dengue virus (DENV), Murray Valley encephalitis virus (MVEV), and Ross River virus (RRV). We argue that the underlying mechanisms by which hosts influence arboviral activity are numerous and attempts to delineate these mechanisms further are needed. Investigations that focus on hosts of vector-borne diseases are likely to be rewarding, particularly where the ecology of vectors is relatively well understood. From an applied perspective, enhanced knowledge of host influences upon vector-borne disease transmission is likely to enable better management of disease burden. Finally, we suggest a framework that may be useful to identify and determine host contributions to the ecology of arboviruses.

Infection and dissemination of dengue virus type 2 in Aedes aegypti, Aedes albopictus, and Aedes scutellaris from the Torres Strait, Australia

To determine their relative roles in transmission of dengue virus (DENV) in the Torres Strait region of northern Australia, we examined infection and dissemination of a sympatric strain of dengue virus type 2 (DENV-2) in Aedes scutellaris, Ae. albopictus, and Ae. aegypti. In experiments using membrane feeders for virus exposure, infection rates were 83% and 43% for Ae. scutellaris and Ae. aegypti, respectively. Salivary gland infection rates for both species were 43%. In experiments using pledgets for virus exposure, infection rates for Ae. aegypti, Ae. scutellaris, and Ae. albopictus were 68%, 55%, and 37%, respectively. Aedes albopictus exhibited the greatest barriers to infection with only 7% tested developing a salivary gland infection, compared to 42% and 24% of Ae. aegypti and Ae. scutellaris, respectively. These results suggest that Ae. scutellaris may have been responsible for DENV transmission on Torres Strait islands, where Ae. aegypti does not occur. In contrast, Ae. albopictus may not be an important vector of DENV-2 from the Torres Strait.

Environmental factors and incidence of dengue fever and dengue haemorrhagic fever in an urban area, Southern Thailand

Using the enumeration district (ED) block level this study looked at the incidence of dengue fever and dengue haemorrhagic fever (DF/DHF) within the Songkhla municipality in Thailand. Each of the 146 blocks in this area were considered as study units and surveyed for their environmental characteristics. A total of 287 cases of DH/DHF occurring in the year 1998 were selected for this study and the location of their homes mapped. Clustering analysis showed point clustering of the homes (P<0.0001) which was probably due to high density habitation, without any actual prevalence of case clustering. There was no evidence of clustering of the ED blocks with an incidence of DF/DHF (P=0.32). DF/DHF incidence for each block was strongly associated with the percentages of shop-houses, brick-made houses and houses with poor garbage disposal (all P<0.01). DF/DHF control should be emphasized for the areas which have a predominance of these housing types.

Discovery of a widespread infestation of Aedes albopictus in the Torres Strait, Australia

Aedes albopictus is a container-breeding Stegomyia mosquito that has dispersed widely from its origins in Southeast Asia. Because Ae. albopictus is a known dengue vector and a potential vector of a variety of arboviruses and it can tolerate cooler climates than Aedes aegypti, Australian quarantine and health authorities have strategies to detect and eliminate it from international ports. Following the detection of 42 adult Ae. albopictus in BG-Sentinel traps set on Yorke island in the Torres Strait of Australia in April 2005, extensive surveys were conducted to determine the distribution of Ae. albopictus in the Torres Strait and adjoining Cape York Peninsula. A total of 17 islands and the northern peninsula area of Cape York Peninsula were surveyed by collection of larvae and pupae from flooded containers and human bait collections of adult mosquitoes with aspirators and sweep nets. Aedes albopictus was detected on 10 islands and comprised 100% of the day-biting container-breeding mosquitoes on Yorke and Stephens Islands. No Ae. albopictus were detected in the mainland sites on Cape York. Retrospective genetic analysis of larvae collected in April 2004 and April 2005 on Yorke Island indicated that Ae. albopictus was present in low densities in 2004 and that there were 3 genetically distinct mitochondrial haplotypes on Yorke Island in April 2005. Additionally, on Yorke Island there is evidence that Ae. albopictus is displacing Aedes scutellaris.

Multiple outbreaks of dengue serotype 2 in north Queensland, 2003/04

OBJECTIVES

To describe the various investigations and responses to multiple outbreaks of dengue serotype 2 that occurred in north Queensland in 2003/04.

METHODS

Details about each case were collated so as to target mosquito-control responses including control of mosquito breeding sites, interior spraying of selected premises, and a novel 'lure and kill' approach using lethal ovitraps. Phylogenetic analyses were undertaken to determine the genetic relatedness of viruses isolated during the outbreaks.

RESULTS

Except for a two-month hiatus in mid-2003, the outbreaks continued for 16 months and included approximately 900 confirmed cases, with three severe cases and one death. The available evidence suggests that the mosquito-control measures were effective, but delays in recognising the outbreaks in Cairns and the Torres Strait coupled with intense mosquito breeding contributed to the extensive nature of the outbreaks. Phylogenetic analyses showed that there had been only two major outbreaks, one that spread from Cairns to Townsville, the other from the Torres Strait to Cairns; both were initiated by viraemic travellers from Papua New Guinea.

CONCLUSIONS

Phylogenetic analyses were essential in understanding how the outbreaks were related to each other, and in demonstrating that dengue had not become endemic. Further innovative approaches to dengue surveillance and mosquito control in north Queensland are necessary.

IMPLICATIONS

Dengue outbreaks have become more frequent and more severe in north Queensland in recent years, raising the possibility that dengue viruses could become endemic in the region leading to outbreaks of dengue haemorrhagic fever.

Repellents: past, present, and future

The use of repellents in protecting people against vector-borne diseases is predicated on the assertion that reducing human/vector contact will reduce the incidence of disease. The methods that have been used in developing countries have been simple to apply and relatively cheap. This article will discuss the use of repellents for protection against vector-borne disease in Southeast Asia and the Southwest Pacific region.

Deaths associated with dengue haemorrhagic fever: the first in Australia in over a century

A dengue fever epidemic was recognised in the Torres Strait Islands of Queensland in late 2003. Two fatal cases of dengue haemorrhagic fever occurred in early 2004. This severe manifestation is more common when a patient is infected a second time, with a different virus serotype to the first infection. These are the first fatalities related to dengue fever in Australia in over a century.

Sucrose density gradient centrifugation and cross-flow filtration methods for the production of arbovirus antigens inactivated by binary ethylenimine

BACKGROUND

Sucrose density gradient centrifugation and cross-flow filtration methods have been developed and standardised for the safe and reproducible production of inactivated arbovirus antigens which are appropriate for use in diagnostic serological applications.

METHODS

To optimise the maximum titre of growth during the propagation of arboviruses, the multiplicity of infection and choice of cell line were investigated using stocks of Ross River virus and Barmah Forest virus grown in both mosquito and mammalian cell lines. To standardise and improve the efficacy of the inactivation of arboviral suspensions, stocks of Ross River virus, Barmah Forest virus, Japanese encephalitis virus, Murray Valley encephalitis virus and Alfuy virus were chemically inactivated using binary ethylenimine at a final concentration of 3 mM. Aliquots were then taken at hourly intervals and crude inactivation rates were determined for each virus using a plaque assay. To ensure complete inactivation, the same aliquots were each passaged 3 times in Aedes albopictus C6/36 cells and the presence of viral growth was detected using an immunofluorescent assay. For larger quantities of viral suspensions, centrifugation on an isopycnic sucrose density gradient or cross-flow filtration was used to produce concentrated, pure antigens or partially concentrated, semi-purified antigens respectively.

RESULTS

The results of the propagation experiments suggested that the maximum viral titres obtained for both Ross River virus and Barmah Forest virus were affected by the incubation period and choice of cell line, rather than the use of different multiplicity of infection values. Results of the binary ethylenimine inactivation trial suggested that standardised periods of 5 or 8 hours would be suitable to ensure effective and complete inactivation for a number of different arboviral antigens.

CONCLUSION

Two methods used to prepare inactivated arbovirus antigens have been standardised to minimise production failure and expenditure and to provide reagents that conform to the highest quality and safety requirements of a diagnostic serology laboratory. The antigens are suitable for use in either enzyme linked immunosorbent assays or haemagglutination inhibition assays and the optimised protocols can be directly applied to produce antigens from new or emerging arboviral pathogens.

Enhanced vector competence of Aedes aegypti (Diptera: Culicidae) from the Torres Strait compared with mainland Australia for dengue 2 and 4 viruses

Australian Aedes aegypti (L.) mosquitoes colonized from the Torres Strait and three mainland localities (Charters Towers, Townsville, and Cairns) were fed on blood suspensions containing dengue virus type 2 (DEN-2) or dengue virus type 4 (DEN-4). Variation was found in oral susceptibility to DEN-2 (59 -99% infection) and DEN-4 (28-79% infection) among Ae. aegypti assayed for virus at 8, 12, 16, or 20 d after ingestion of infected blood. Torres Strait Ae. aegypti were the most susceptible to DEN-2 and were significantly more efficient in transmission to capillary tube at 16 d (76% transmission) than mainland Ae. aegypti populations (20-28% transmission). Torres Strait Ae. aegypti were also the most susceptible to DEN-4, although transmission did not vary significantly from mainland populations at 16 d (12% compared with 0-4%) or 20 d (16% compared with 4-16%). Disseminated infection (i.e., leg infection) with either DEN-2 or DEN-4 was not an accurate predictor of transmission potential. This study demonstrates differences among Australian Ae. aegypti populations in vector competence for DEN-2 and DEN-4. Torres Strait Ae. aegypti were more frequently infected and able to transmit DEN-2 at higher rates than mainland populations. These data indicate that the Torres Strait region is potentially more receptive to dengue transmission than mainland localities, a finding discussed with respect to past outbreaks.

Health advice given by general practitioners for travellers from Australia

OBJECTIVES

To investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia.

DESIGN AND SETTING

A postal questionnaire was sent to general practitioners (GPs).

PARTICIPANTS

433 GPs were randomly selected from the register of the Medical Directory of Australia from the areas of western Sydney and Townville.

RESULTS

Two hundred and thirteen questionnaires (49.2%) were returned. Approximately two-thirds of the sample was male (133/207,64.3%) and one-third female (74/207,35.7%). The mean age of the GPs was 46.7 (SD+/-12.1) years. The GPs reportedly saw an average of 3.9 (SD+/-11.8) travellers per week. Most GPs (160/202,79.2%) reported that they spent between 5-25 min for pre-travel consultations. GPs generally reported giving advice to travellers on travel vaccines, malaria prophylaxis, personal protective measures against insect bites, geographic diseases, clothing, and sexually transmitted infections. The majority of GPs did not routinely give information on travel insurance, unsafe sex, barotrauma, in-flight exercise, jet lag or first aid knowledge. Most GPs reported not routinely giving written documentation in the form of written travel health advice, a doctor's letter or a travellers' vaccination record.

CONCLUSIONS

GPs report seeking core information needed for formulating travel health advice. GPs also provided travellers with health advice on most of the areas, which need to be covered in the pre-travel consultation. More GPs may wish to consider advising travellers about the importance of travel insurance and managing common maladies of travellers, such as motion sickness, barotrauma, and jet lag. With limited time in general practice to advise travellers, more GPs should consider providing written advice and documentation for travel, including a travellers' vaccination record.

Importation of dengue by soldiers returning from East Timor to north Queensland, Australia

BACKGROUND

Soldiers based in Townsville, Australia, returned from East Timor following peacekeeping operations during the wet season of 1999 to 2000. This represented the potential to import dengue virus into north Queensland, a dengue receptive area of Australia. This article seeks to outline the measures taken by the Australian Defence Force (ADF) to prevent local transmission and to present the outcomes.

METHODS

Soldiers returning to north Queensland were provided with education on dengue fever and in the fortnight before return, their living areas were subjected to intensive vector control measures, in order to reduce the risk of acquisition of dengue. They were further encouraged to present early with any febrile illness following their return to Townsville. Provisionally diagnosed dengue cases were notified to the state public health authorities immediately and cases were isolated until suitable vector control programs were implemented or the potentially viremic period exceeded. Serologic and virologic investigations were undertaken to identify the passage and probable serotype or confirm the presence and serotype of dengue virus.

RESULTS

Nine serologically confirmed cases of dengue were identified as viremic in north Queensland. Six cases were identified as arising from dengue serotype 2, two were from serotype 3, and one case was ill defined. No dengue cases have been reported in the local population 4 months following these ADF cases.

CONCLUSIONS

Local outbreaks of dengue fever have occurred in north Queensland following the importation of dengue virus in returned travelers. The successful prevention of local transmission in these circumstances was contributed to by early notification of cases and prevention of transmission through isolation of cases and collaboration between ADF and state and local public health authorities in vector control. The management of potentially viremic returning service personnel represents a future challenge for the ADF.

Flavivirus susceptibility in Aedes aegypti

Aedes aegypti is the primary vector of yellow fever (YF) and dengue fever (DF) flaviviruses worldwide. In this review we focus on past and present research on genetic components and environmental factors in Aedes aegypti that appear to control flavivirus transmission. We review genetic relationships among Ae. aegypti populations throughout the world and discuss how variation in vector competence is correlated with overall genetic differences among populations. We describe current research into how genetic and environmental factors jointly affect distribution of vector competence in natural populations. Based on this information, we propose a population genetic model for vector competence and discuss our recent progress in testing this model. We end with a discussion of approaches being taken to identify the genes that may control flavivirus susceptibility in Ae. aegypti.

Single rapid TaqMan fluorogenic probe based PCR assay that detects all four dengue serotypes

Public health laboratories require rapid diagnosis of dengue outbreaks for application of measures such as vector control. We have developed a rapid single fluorogenic probe-based polymerase chain reaction assay for the detection of all four dengue serotypes (FUDRT-PCR). The method employs primers and probe that are complementary to the evolutionarily conserved 3' untranslated region of the dengue genome. The assay detected viral RNA of strains of all four dengue serotypes but not of the flaviviruses Japanese encephalitis virus, Murray Valley encephalitis virus, Kunjin, Stratford, West Nile, Alfuy or Yellow fever. When compared to an existing nested-PCR assay for the detection of dengue on clinical samples, FUDRT-PCR detected dengue 1 (100%, n=14), dengue 2 (85%, n=13), dengue 3 (64%, n=14) and dengue 4 (100%, n=3) with the indicated sensitivities. FUDRT-PCR enables diagnosis of acute dengue infection in four hours from sample receipt. In addition, a single-test procedure should result in a reduction in the number of tests performed with considerable cost savings for diagnostic laboratories.

An epidemic of dengue 3 in far north Queensland, 1997-1999

OBJECTIVES

To describe an epidemic of dengue type 3 that occurred in far north Queensland in 1997-1999 and its influence on the further development of dengue prevention and control strategies.

DESIGN

Epidemiological and laboratory investigation of cases, entomological surveys and phylogenetic analysis of dengue virus isolates.

MAIN OUTCOME MEASURES

Numbers and characteristics of confirmed cases; Breteau Index (BI; number of containers breeding Aedes aegypti per 100 premises); effect of control measures on mosquito populations; genetic homology of epidemic virus with other dengue virus isolates.

RESULTS

The epidemic lasted 70 weeks and comprised 498 confirmed cases in three towns (Cairns, Port Douglas and Mossman); 101 patients (20%) were admitted to hospital. Median interval between symptom onset and notification was seven days (range, 0-53 days), and cumulative duration of viraemia of public health significance was 2,072 days. BIs in affected areas were high, particularly in Mossman (45) and Port Douglas (31). Control measures significantly reduced mosquito populations (assessed as number of ovitraps containing Ae. aegypti eggs and mean number of eggs per trap [P< 0.05 for both]). However, transmission persisted in several foci, in part due to undetected waterfilled containers breeding Ae. aegypti. The epidemic virus belonged to serotype 3; phylogenetic analysis suggested it was imported from Thailand.

CONCLUSIONS

The epidemic had greater morbidity than other recent Queensland epidemics of dengue and was harder to control, necessitating substantial revision of the Dengue Fever Management Plan for North Queensland. The epidemic's severity supports the hypothesis that dengue viruses from South East Asia are more virulent than others.

The importance of subterranean mosquito habitat to arbovirus vector control strategies in north Queensland, Australia

In north Queensland, 14 localities were surveyed for mosquito larvae (third and fourth instar) during summer/autumn and winter from 1996 to 1999. Absolute population numbers in subterranean habitats, mainly service manholes and pits (97%) but also some wells, septic tanks, storm drains, and sumps, were expressed as a proportion of total numbers in these sites plus surface sites within a 100-m radius. When correction factors were applied to subterranean samples, the 472,477 larvae mainly of Aedes tremulus (Theobald) group, Aedes notoscriptus (Skuse), and Aedes aegypti (L.) comprised 78% of the total population. In relation to the proportion of the overall immature mosquito population from subterranean habitats (propsub), linear regression coefficients for minimum temperature, relative humidity, and Mesocyclops copepod prevalence were significant for winter data; but for summer, only relative humidity was significant. Linear regression coefficients for Mesocyclops prevalence approached significance (P = 0.061) in summer. When multiple linear regression was used to model propsub, 68% of the variation was accounted for by relative humidity and the prevalence of Mesocyclops. In the drier and cooler towns, increased use of subterranean sites during winter was caused by reduced availability of surface oviposition sites because of the dry season. In the wetter coastal towns, no such restrictions applied and ambient conditions remained more equitable all year round. Mesocyclops were surprisingly common, particularly in these coastal towns. Release of known numbers of Mesocyclops indicated that 3-sweep netting in service manholes was sensitive down to densities of one Mesocyclops per 10 liters, and overall recovery varied from 1 to 4%. In relation to control, service manholes represent a stable habitat for mosquito (7% positive overall) and Mesocyclops populations. If they remained wet, service manholes positive for mosquito immatures or Mesocyclops during summer/autumn had 96% and 85% chance, respectively, of being positive the following winter. Even allowing for the effect of drying, a mosquito-positive manhole had a 79% chance of remaining positive the following winter. In view of the importance of these sites as refuges from adverse ambient conditions, it is proposed that a winter control strategy using Mesocyclops presents a cost-effective control option to reduce the recolonization of surface sites when conditions become more suitable.

Arboviruses associated with human disease in Australia

Mosquito-borne arboviruses are an important public health issue in Australia. The alphaviruses Ross River and Barmah Forest virus are widespread and active annually, and cause debilitating polyarthritis. The flaviviruses Murray Valley encephalitis, Kunjin and Japanese encephalitis virus are restricted in distribution and activity but may cause life-threatening illness, and dengue viruses are active in some areas.