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

Vaccine value profile for Chikungunya

Chikungunya virus (CHIKV) a mosquito-borne alphavirus is the causative agent of Chikungunya (CHIK), a disease with low mortality but high acute and chronic morbidity resulting in a high overall burden of disease. After the acute disease phase, chronic disease including persistent arthralgia is very common, and can cause fatigue and pain that is severe enough to limit normal activities. On average, around 40% of people infected with CHIKV will develop chronic arthritis, which may last for months or years. Recommendations for protection from CHIKV focus on infection control through preventing mosquito proliferation. There is currently no licensed antiviral drug or vaccine against CHIKV. Therefore, one of the most important public health impacts of vaccination would be to decrease burden of disease and economic losses in areas impacted by the virus, and prevent or reduce chronic morbidity associated with CHIK. This benefit would particularly be seen in Low and Middle Income Countries (LMIC) and socio-economically deprived areas, as they are more likely to have more infections and more severe outcomes. This 'Vaccine Value Profile' (VVP) for CHIK is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of vaccines in the development pipeline and vaccine-like products.This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations. All contributors have extensive expertise on various elements of the CHIK VVP and collectively aimed to identify current research and knowledge gaps.The VVP was developed using only existing and publicly available information.

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.

A bacterium against the tiger: further evidence of the potential of noninundative releases of males with manipulated Wolbachia infection in reducing fertility of Aedes albopictus field populations in Italy

BACKGROUND

Incompatible insect technique (IIT) is a population suppression approach based on the release of males with manipulated Wolbachia infection inducing egg inviability in wild females. We here present results of multiple field releases of incompatible ARwP males carried out in 2019 in a 2.7-ha green area within urban Rome (Italy) to assess the effect on Aedes albopictus egg viability. Data are compared with results obtained in 2018, when the approach was tested for the first time in Europe.

RESULTS

An average of 4674 ARwP males were released weekly for 7 weeks, resulting in a mean ARwP:wild male ratio of 1.1:1 (versus 0.7:1 in 2018). Egg-viability dynamics in ovitraps significantly varied between treated and control sites, with an estimated overall reduction of 35% (versus 15% in 2018). The estimated proportion of females classified as mated with ARwP males was 41.8% and the viability rate of eggs laid by these females (9.5%) was on average significantly lower than that of females only mated with wild males (87.8%); however, high variability in fertility was observed. Values of ARwP male competitiveness were 0.36 and 0.73 based on the overall viability rate of eggs in ovitraps and on female fertility, respectively; thus, well above the conventional 0.2 threshold for an effective suppressive impact in the field.

CONCLUSIONS

Results further support the potential of IIT as a tool to contribute to Ae. albopictus control in the urban context, stressing the need for larger field trials to evaluate the cost-efficacy of the approach in temperate regions. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

How habitat factors affect an Aedes mosquitoes driven outbreak at temperate latitudes: The case of the Chikungunya virus in Italy

BACKGROUND

Outbreaks of Aedes-borne diseases in temperate areas are not frequent, and limited in number of cases. We investigate the associations between habitat factors and temperature on individuals' risk of chikungunya (CHIKV) in a non-endemic area by spatially analyzing the data from the 2017 Italian outbreak.

METHODOLOGY/PRINCIPAL FINDINGS

We adopted a case-control study design to analyze the association between land-cover variables, temperature, and human population density with CHIKV cases. The observational unit was the area, at different scales, surrounding the residence of each CHIKV notified case. The statistical analysis was conducted considering the whole dataset and separately for the resort town of Anzio and the metropolitan city of Rome, which were the two main foci of the outbreak. In Rome, a higher probability for the occurrence of CHIKV cases is associated with lower temperature (OR = 0.72; 95% CI: 0.61-0.85) and with cells with higher vegetation coverage and human population density (OR = 1.03; 95% CI: 1.00-1.05). In Anzio, CHIKV case occurrence was positively associated with human population density (OR = 1.03; 95% CI: 1.00-1.06) but not with habitat factors or temperature.

CONCLUSION/SIGNIFICANCE

Using temperature, human population density and vegetation coverage data as drives for CHIKV transmission, our estimates could be instrumental in assessing spatial heterogeneity in the risk of experiencing arboviral diseases in non-endemic temperate areas.

Mosquito-borne viruses causing human disease in Fennoscandia—Past, current, and future perspectives

Five different mosquito-borne viruses (moboviruses) significant to human disease are known to be endemic to Fennoscandia (Sindbis virus, Inkoo virus, Tahyna virus, Chatanga virus, and Batai virus). However, the incidence of mosquito-borne virus infections in Fennoscandia is unknown, largely due to underdiagnosing and lack of surveillance efforts. The Fennoscandian moboviruses are difficult to prevent due to their method of transmission, and often difficult to diagnose due to a lack of clear case definition criteria. Thus, many cases are likely to be mis-diagnosed, or even not diagnosed at all. Significant long-term effects, often in the form of malaise, rashes, and arthralgia have been found for some of these infections. Research into mobovirus disease is ongoing, though mainly focused on a few pathogens, with many others neglected. With moboviruses found as far north as the 69th parallel, studying mosquito-borne disease occurring in the tropics is only a small part of the whole picture. This review is written with the objective of summarizing current medically relevant knowledge of moboviruses occurring in Fennoscandia, while highlighting what is yet unknown and possibly overlooked.

Spatial Analysis of Mosquito-Borne Diseases in Europe: A Scoping Review

Mosquito-borne infections are increasing in endemic areas and previously unaffected regions. In 2020, the notification rate for Dengue was 0.5 cases per 100,000 population, and for Chikungunya <0.1/100,000. In 2019, the rate for Malaria was 1.3/100,000, and for West Nile Virus, 0.1/100,000. Spatial analysis is increasingly used in surveillance and epidemiological investigation, but reviews about their use in this research topic are scarce. We identify and describe the methodological approaches used to investigate the distribution and ecological determinants of mosquito-borne infections in Europe. Relevant literature was extracted from PubMed, Scopus, and Web of Science from inception until October 2021 and analysed according to PRISMA-ScR protocol. We identified 110 studies. Most used geographical correlation analysis (n = 50), mainly applying generalised linear models, and the remaining used spatial cluster detection (n = 30) and disease mapping (n = 30), mainly conducted using frequentist approaches. The most studied infections were Dengue (n = 32), Malaria (n = 26), Chikungunya (n = 26), and West Nile Virus (n = 24), and the most studied ecological determinants were temperature (n = 39), precipitation (n = 24), water bodies (n = 14), and vegetation (n = 11). Results from this review may support public health programs for mosquito-borne disease prevention and may help guide future research, as we recommended various good practices for spatial epidemiological studies.

AIMSurv: First pan-European harmonized surveillance of Aedes invasive mosquito species of relevance for human vector-borne diseases

Human and animal vector-borne diseases, particularly mosquito-borne diseases, are emerging or re-emerging worldwide. Six Aedes invasive mosquito (AIM) species were introduced to Europe since the 1970s: Aedes aegypti, Ae. albopictus, Ae. japonicus, Ae. koreicus, Ae. atropalpus and Ae. triseriatus. Here, we report the results of AIMSurv2020, the first pan-European surveillance effort for AIMs. Implemented by 42 volunteer teams from 24 countries. And presented in the form of a dataset named "AIMSurv Aedes Invasive Mosquito species harmonized surveillance in Europe. AIM-COST Action. Project ID: CA17108". AIMSurv2020 harmonizes field surveillance methodologies for sampling different AIMs life stages, frequency and minimum length of sampling period, and data reporting. Data include minimum requirements for sample types and recommended requirements for those teams with more resources. Data are published as a Darwin Core archive in the Global Biodiversity Information Facility- Spain, comprising a core file with 19,130 records (EventID) and an occurrences file with 19,743 records (OccurrenceID). AIM species recorded in AIMSurv2020 were Ae. albopictus, Ae. japonicus and Ae. koreicus, as well as native mosquito species.

Mosquito alert: leveraging citizen science to create a GBIF mosquito occurrence dataset

The Mosquito Alert dataset includes occurrence records of adult mosquitoes collected worldwide in 2014-2020 through Mosquito Alert, a citizen science system for investigating and managing disease-carrying mosquitoes. Records are linked to citizen science-submitted photographs and validated by entomologists to determine the presence of five targeted European mosquito vectors: Aedes albopictus, Ae. aegypti, Ae. japonicus, Ae. koreicus, and Culex pipiens. Most records are from Spain, reflecting Spanish national and regional funding, but since autumn 2020 substantial records from other European countries are included, thanks to volunteer entomologists coordinated by the AIM-COST Action, and to technological developments to increase scalability. Among other applications, the Mosquito Alert dataset will help develop citizen science-based early warning systems for mosquito-borne disease risk. It can also be reused for modelling vector exposure risk, or to train machine-learning detection and classification routines on the linked images, to assist with data validation and establishing automated alert systems.

Molecular and biological characterization of an Asian-American isolate of Chikungunya virus

Chikungunya virus is an arthropod-transmitted virus that causes chikungunya fever, a disease characterized by severe muscle and joint pain. In 2013, the virus was introduced to the Americas and caused approximately 2.7 million cases of infection during the subsequent two years. The lack of knowledge regarding the biological behavior of the viral strains circulating during the outbreak motivated the characterization of an isolate from the Colombian outbreak, starting from analysis of the complete genome to the biological behavior in vitro. The full genome was retrieved using next-generation sequencing. The infective and replicative capacities were evaluated in HEK293T, Huh-7, and MRC-5 cell lines. The infection rates were determined by flow cytometry, and the cytopathic effect was assessed by a resazurin fluorescent metabolic assay. The viral yield was quantified using the virus plaque formation assay, while the viral proteins and genomic RNA kinetics were subsequently evaluated by western-blot and RT-qPCR. The COL7624 isolate clustered with other American and Caribbean sequences in the Asian American lineage. The T669A substitution in E2 protein distinguished it from other Colombian sequences reported in 2014. After 48 h post infection (hpi), the three cell lines analyzed reached infection percentages exceeding 65%, generating a high load of infectious viral progeny. The infection kinetics indicated that the replication peak of this CHIKV isolate is around 24 hpi, although gRNA is detectable in the culture supernatant from 4 hpi onwards. The infection caused the overexpression of interferon and pro-inflammatory cytokines, such as IL-1β, TNF-α, and IL-8. The COL7624 CHIKV isolate exhibited a high infective and replicative capacity as well as activation of cellular immune responses, similar to isolates belonging to the other genotypes.

An unwanted companion reaches the country: the first record of the alien mosquito Aedes japonicus japonicus (Theobald, 1901) in Slovakia

BACKGROUND

Invasive mosquitoes of the genus Aedes are quickly spreading around the world. The presence of these alien species is concerning for both their impact on the native biodiversity and their high vector competence. The surveillance of Aedes invasive mosquito (AIM) species is one of the most important steps in vector-borne disease control and prevention.

METHODS

In 2020, the monitoring of AIM species was conducted in five areas (Bratislava, Zvolen, Banská Bystrica, Prešov, Košice) of Slovakia. The sites were located at points of entry (border crossings with Austria and Hungary) and in the urban and rural zones of cities and their surroundings. Ovitraps were used at the majority of sites as a standard method of monitoring. The collected specimens were identified morphologically, with subsequent molecular identification by conventional PCR (cox1) and Sanger sequencing. The phylogenetic relatedness of the obtained sequences was inferred by the maximum likelihood (ML) method. The nucleotide heterogeneity of the Slovak sequences was analysed by the index of disparity.

RESULTS

A bush mosquito, Aedes japonicus japonicus, was found and confirmed by molecular methods in three geographically distant areas of Slovakia-Bratislava, Zvolen and Prešov. The presence of AIM species is also likely in Košice; however, the material was not subjected to molecular identification. The nucleotide sequences of some Slovak strains confirm their significant heterogeneity. They were placed in several clusters on the ML phylogenetic tree. Moreover, Ae. j. japonicus was discovered in regions of Slovakia that are not close to a point of entry, where the mosquitoes could find favourable habitats in dendrothelms in city parks or forests.

CONCLUSION

Despite being a first record of the Ae. j. japonicus in Slovakia, our study indicates that the established populations already exist across the country, underlining the urgent need for intensified surveillance of AIM species as well as mosquito-borne pathogens.

Flavivirus Persistence in Wildlife Populations

A substantial number of humans are at risk for infection by vector-borne flaviviruses, resulting in considerable morbidity and mortality worldwide. These viruses also infect wildlife at a considerable rate, persistently cycling between ticks/mosquitoes and small mammals and reptiles and non-human primates and humans. Substantially increasing evidence of viral persistence in wildlife continues to be reported. In addition to in humans, viral persistence has been shown to establish in mammalian, reptile, arachnid, and mosquito systems, as well as insect cell lines. Although a considerable amount of research has centered on the potential roles of defective virus particles, autophagy and/or apoptosis-induced evasion of the immune response, and the precise mechanism of these features in flavivirus persistence have yet to be elucidated. In this review, we present findings that aid in understanding how vector-borne flavivirus persistence is established in wildlife. Research studies to be discussed include determining the critical roles universal flavivirus non-structural proteins played in flaviviral persistence, the advancement of animal models of viral persistence, and studying host factors that allow vector-borne flavivirus replication without destructive effects on infected cells. These findings underscore the viral–host relationships in wildlife animals and could be used to elucidate the underlying mechanisms responsible for the establishment of viral persistence in these animals.

Potential for online crowdsourced biological recording data to complement surveillance for arthropod vectors

Voluntary contributions by citizen scientists can gather large datasets covering wide geographical areas, and are increasingly utilized by researchers for multiple applications, including arthropod vector surveillance. Online platforms such as iNaturalist accumulate crowdsourced biological observations from around the world and these data could also be useful for monitoring vectors. The aim of this study was to explore the availability of observations of important vector taxa on the iNaturalist platform and examine the utility of these data to complement existing vector surveillance activities. Of ten vector taxa investigated, records were most numerous for mosquitoes (Culicidae; 23,018 records, 222 species) and ticks (Ixodida; 16,214 records, 87 species), with most data from 2019–2020. Case studies were performed to assess whether images associated with records were of sufficient quality to identify species and compare iNaturalist observations of vector species to the known situation at the state, national and regional level based on existing published data. Firstly, tick data collected at the national (United Kingdom) or state (Minnesota, USA) level were sufficient to determine seasonal occurrence and distribution patterns of important tick species, and were able to corroborate and complement known trends in tick distribution. Importantly, tick species with expanding distributions (Haemaphysalis punctata in the UK, and Amblyomma americanum in Minnesota) were also detected. Secondly, using iNaturalist data to monitor expanding tick species in Europe (Hyalomma spp.) and the USA (Haemaphysalis longicornis), and invasive Aedes mosquitoes in Europe, showed potential for tracking these species within their known range as well as identifying possible areas of expansion. Despite known limitations associated with crowdsourced data, this study shows that iNaturalist can be a valuable source of information on vector distribution and seasonality that could be used to supplement existing vector surveillance data, especially at a time when many surveillance programs may have been interrupted by COVID-19 restrictions.

Spatio-Temporal Distribution of Aedes Albopictus and Culex Pipiens along an Urban-Natural Gradient in the Ventotene Island, Italy

The distribution of mosquitos and their corresponding hosts is critical in public health to determine the risk of transmission for vector-borne diseases. In this pilot study conducted in the small Mediterranean island of Ventotene, a known stopover site for migratory birds, the spatio-temporal distribution of two major mosquito vectors is analyzed from the natural to urban environment. The results show that Aedes albopictus aggregates mostly near areas with a human presence and the urban landscape, while Culex pipiens is more spatio-temporally spread, as it can also be found in wilder and less anthropized areas where the availability of human hosts is limited. Culex pipiens is also active earlier in the year. From a microgeographical perspective, our results confirm the anthropophilic spatial distribution of Ae. Albopictus, while suggesting that the circulation of bird zoonosis, such as West Nile, could be favored by the Cx. pipiens distribution. The results highlight the different ecology of the vectors and the interplay with their hosts, even at a small scale. The current evidence may help in forecasting the risk of pathogen transmission and surveillance planning.

ZanzaMapp: A Scalable Citizen Science Tool to Monitor Perception of Mosquito Abundance and Nuisance in Italy and Beyond

Mosquitoes represent a considerable nuisance and are actual/potential vectors of human diseases in Europe. Costly and labour-intensive entomological monitoring is needed to correct planning of interventions aimed at reducing nuisance and the risk of pathogen transmission. The widespread availability of mobile phones and of massive Internet connections opens the way to the contribution of citizen in complementing entomological monitoring. ZanzaMapp is the first mobile “mosquito” application for smartphones specifically designed to assess citizens’ perception of mosquito abundance and nuisance in Italy. Differently from other applications targeting mosquitoes, ZanzaMapp prioritizes the number of records over their scientific authentication by requesting users to answer four simple questions on perceived mosquito presence/abundance/nuisance and geo-localizing the records. The paper analyses 36,867 ZanzaMapp records sent by 13,669 devices from 2016 to 2018 and discusses the results with reference to either citizens’ exploitation and appreciation of the app and to the consistency of the results obtained with the known biology of main mosquito species in Italy. In addition, we provide a first small-scale validation of ZanzaMapp data as predictors of Aedes albopictus biting females and examples of spatial analyses and maps which could be exploited by public institutions and administrations involved in mosquito and mosquito-borne pathogen monitoring and control.

Spatial modes for transmission of chikungunya virus during a large chikungunya outbreak in Italy: a modeling analysis

BACKGROUND

The spatial spread of many mosquito-borne diseases occurs by focal spread at the scale of a few hundred meters and over longer distances due to human mobility. The relative contributions of different spatial scales for transmission of chikungunya virus require definition to improve outbreak vector control recommendations.

METHODS

We analyzed data from a large chikungunya outbreak mediated by the mosquito Aedes albopictus in the Lazio region, Italy, consisting of 414 reported human cases between June and November 2017. Using dates of symptom onset, geographic coordinates of residence, and information from epidemiological questionnaires, we reconstructed transmission chains related to that outbreak.

RESULTS

Focal spread (within 1 km) accounted for 54.9% of all cases, 15.8% were transmitted at a local scale (1-15 km) and the remaining 29.3% were exported from the main areas of chikungunya circulation in Lazio to longer distances such as Rome and other geographical areas. Seventy percent of focal infections (corresponding to 38% of the total 414 cases) were transmitted within a distance of 200 m (the buffer distance adopted by the national guidelines for insecticide spraying). Two main epidemic clusters were identified, with a radius expanding at a rate of 300-600 m per month. The majority of exported cases resulted in either sporadic or no further transmission in the region.

CONCLUSIONS

Evidence suggest that human mobility contributes to seeding a relevant number of secondary cases and new foci of transmission over several kilometers. Reactive vector control based on current guidelines might allow a significant number of secondary clusters in untreated areas, especially if the outbreak is not detected early. Existing policies and guidelines for control during outbreaks should recommend the prioritization of preventive measures in neighboring territories with known mobility flows to the main areas of transmission.