Autochthonous dengue fever, Tokyo, Japan, 2014

Assessing the impact of emergency measures in varied population density areas during a large dengue outbreak

Background

The patterns of dengue are affected by many factors, including population density and climate factors. Densely populated areas could play a role in dengue transmission due to increased human-mosquito contacts, the presence of more diverse and suitable vector habitats and breeding sites, and changes in land use. In addition to population densities, climatic factors such as temperature, relative humidity, and precipitation have been demonstrated to predict dengue patterns. To control dengue, emergency measures should focus on vector management. Most approaches to assessing emergency responses to dengue risks involve applying simulation models or describing emergency activities and the results of implementing those responses. Research using real-world data with analytical methods to evaluate emergency responses to dengue has been limited. This study investigated emergency control measures associated with dengue risks in areas with high and low population densities, considering their different control capacities.

Methodology

Data from the 2015 dengue outbreak in Kaohsiung City, Taiwan, were utilized. The government database provided information on confirmed dengue cases, emergency control measures, and climatic data. The study employed a distributed lag non-linear model (DLNM) to assess the effect of emergency control measures and their time lags on dengue risk.

Principal findings

The findings revealed that in areas with high population density, the absence of emergency measures significantly elevated the risks of dengue. However, implementing emergency measures, especially a higher number, was associated with lower risks. In contrast, in areas with low population density, the risks of dengue were only significantly elevated at the 1st week lag if no emergency control measures were implemented. When emergency activities were carried out, the risks of dengue significantly decreased only for the 1st week lag.

Conclusions

Our findings reveal distinct exposure-lag-response patterns in the associations between emergency control measures and dengue in areas with high and low population density. In regions with a high population density, implementing emergency activities during a significant dengue outbreak is crucial for reducing the risk. Conversely, in areas of low population density, the necessity of applying emergency activities may be less pronounced. The implications of this study on dengue management could provide valuable insights for health authorities dealing with limited resources.

The spread of Aedes albopictus (Diptera: Culicidae) in the islands of São Tomé and Príncipe

The mosquito Aedes albopictus (Diptera: Culicidae) is a vector species of the causal agents of Dengue, yellow fever, and Zika among other diseases pathogens. The species originated in Southeast Asia and has spread widely and rapidly in the last century. The species has been reported in localities from the Gulf of Guinea since the early 2000s, but systematic sampling has been scant. We sampled Ae. albopictus twice, in 2013 and 2023 across the altitudinal gradient in São Tomé and found that the species was present in all sampled years at altitudes up to 680 m. We also found some evidence of increases in proportional representation compared to Ae. aegypti over time. We report the presence of the species in Príncipe for the first time, suggesting that the range of Ae. albopictus is larger than previously thought. Finally, we use bioclimatic niche modeling to infer the potential range of Ae. albopictus and infer that the species has the potential to spread across a large portion of São Tomé and Príncipe. Our results suggest that Ae. albopictus has established itself as a resident species of the islands of the Gulf of Guinea and should be incorporated into the list of potential vectors that need to be surveyed and controlled.

The current status of neglected tropical diseases in Japan: A scoping review

Little attention has been paid to neglected tropical diseases (NTDs) in high-income countries and no literature provides an overview of NTDs in Japan. This scoping review aims to synthesize the latest evidence and information to understand epidemiology of and public health response to NTDs in Japan. Using three academic databases, we retrieved articles that mentioned NTDs in Japan, written in English or Japanese, and published between 2010 and 2020. Websites of key public health institutions and medical societies were also explored. From these sources of information, we extracted data that were relevant to answering our research questions. Our findings revealed the transmission of alveolar echinococcosis, Buruli ulcer, Chagas disease, dengue, foodborne trematodiases, mycetoma, scabies, and soil-transmitted helminthiasis as well as occurrence of snakebites within Japan. Other NTDs, such as chikungunya, cystic echinococcosis, cysticercosis, leishmaniasis, leprosy, lymphatic filariasis, rabies, and schistosomiasis, have been imported into the country. Government agencies tend to organize surveillance and control programs only for the NTDs targeted by the Infectious Disease Control Law, namely, echinococcosis, rabies, dengue, and chikungunya. At least one laboratory offers diagnostic testing for each NTD except for dracunculiasis, human African trypanosomiasis, onchocerciasis, and yaws. No medicine is approved for treatment of Chagas disease and fascioliasis and only off-label use drugs are available for cysticercosis, opisthorchiasis, human African trypanosomiasis, onchocerciasis, schistosomiasis, and yaws. Based on these findings, we developed disease-specific recommendations. In addition, three policy issues are discussed, such as lack of legal frameworks to organize responses to some NTDs, overreliance on researchers to procure some NTD products, and unaffordability of unapproved NTD medicines. Japan should recognize the presence of NTDs within the country and need to address them as a national effort. The implications of our findings extend beyond Japan, emphasizing the need to study, recognize, and address NTDs even in high-income countries.

Comparative analysis of the susceptibility of Aedes aegypti and Japanese Aedes albopictus to all dengue virus serotypes

BACKGROUND

Dengue fever, caused by the dengue virus (DENV), is the most common viral infection transmitted by Aedes mosquitoes (mainly Ae. aegypti and Ae. albopictus) worldwide. Aedes aegypti is not currently established in Japan, and Ae. albopictus is the primary vector mosquito for DENV in the country, but knowledge of its viral susceptibility is limited. Therefore, we aimed to clarify the status of DENV susceptibility by comparing the infection and dissemination dynamics of Japanese Ae. albopictus to all known DENV serotypes with those of Ae. aegypti.

METHODS

After propagation of each DENV serotype in Vero cells, the culture supernatants were mixed with defibrinated rabbit blood and adenosine triphosphate, and the mixture was artificially blood-sucked by two colonies of Ae. albopictus from Japan and one colony of Ae. aegypti from a dengue-endemic country (Vietnam). After 14 days of sucking, the mosquito body was divided into two parts (thorax/abdomen and head/wings/legs) and total RNA was extracted from each sample. DENV RNA was detected in these extracted RNA samples using a quantitative RT-PCR method specific for each DENV serotype, and infection and dissemination rates were analyzed.

RESULTS

The Japanese Ae. albopictus colonies were susceptible to all DENV serotypes. Its infection and dissemination rates were significantly lower than those of Ae. aegypti. However, the number of DENV RNA copies in Ae. albopictus was almost not significantly different from that in Ae. aegypti. Furthermore, Japanese Ae. albopictus differed widely in their susceptibility to each DENV serotype.

CONCLUSIONS

In Japanese Ae. albopictus, once DENV overcame the midgut infection barrier, the efficiency of subsequent propagation and dissemination of the virus in the mosquito body was comparable to that of Ae. aegypti. Based on the results of this study and previous dengue outbreak trends, Ae. albopictus is predicted to be highly compatible with DENV-1, suggesting that this serotype poses a high risk for future epidemics in Japan.

Role of air pollutants in dengue fever incidence: evidence from two southern cities in Taiwan

Air pollution may be involved in spreading dengue fever (DF) besides rainfalls and warmer temperatures. While particulate matter (PM), especially those with diameter of 10 μm (PM10) or 2.5 μm or less (PM25), and NO2 increase the risk of coronavirus 2 infection, their roles in triggering DF remain unclear. We explored if air pollution factors predict DF incidence in addition to the classic climate factors. Public databases and DF records of two southern cities in Taiwan were used in regression analyses. Month order, PM10 minimum, PM2.5 minimum, and precipitation days were retained in the enter mode model, and SO2 minimum, O3 maximum, and CO minimum were retained in the stepwise forward mode model in addition to month order, PM10 minimum, PM2.5 minimum, and precipitation days. While PM2.5 minimum showed a negative contribution to the monthly DF incidence, other variables showed the opposite effects. The sustain of month order, PM10 minimum, PM2.5 minimum, and precipitation days in both regression models confirms the role of classic climate factors and illustrates a potential biological role of the air pollutants in the life cycle of mosquito vectors and dengue virus and possibly human immune status. Future DF prevention should concern the contribution of air pollution besides the classic climate factors.

Measuring the effects of typhoon trajectories on dengue outbreaks in tropical regions of Taiwan: 1998-2019

Dengue fever is a rapidly spreading mosquito-borne contagion. However, the effects of extreme rainfall events on dengue occurrences have not been widely evaluated. With their immense precipitation and high winds, typhoons may have distinct effects on dengue occurrence from those during other heavy rain events. Frequented by typhoons and situated in the tropical climate zone, southern Taiwan is an appropriate study area due to its isolated geographic environment. Each subject to distinct orographic effects on typhoon structure and typhoon-induced precipitation, 9 typhoon trajectories around Taiwan have not been observed until now. This study analyzes typhoon-induced precipitation and examines historical typhoon events by trajectory to determine the effects of typhoons on dengue occurrences in different urban contexts of Tainan and Kaohsiung in high-epidemic southern Taiwan. We employed data from 1998 to 2019 and developed logistic regression models for modeling dengue occurrence while taking 28-day lag effects into account. We considered factors including typhoon trajectory, occurrence, and typhoon-induced precipitation to dengue occurrences. Our results indicate that typhoon trajectories are a significant risk factor for dengue occurrence. Typhoons affect dengue occurrence differently by trajectory. One out of four northbound (along the Taiwan Strait) and four out of five westbound (across Taiwan) typhoons were found to be positively correlated with dengue occurrences in southern Taiwan. We observe that typhoon-induced precipitation is not associated with dengue occurrence in southern Taiwan, which suggests that wind destruction during typhoon events may serve as the primary cause for their positive effects by leaving debris suitable for mosquito habitats. Our findings provide insights into the impact of typhoons by trajectory on dengue occurrence, which can improve the accuracy of future dengue forecasts in neighboring regions with similar climatic contexts.

Genetic Diversity of Dengue Vector Aedes albopictus Collected from South Korea, Japan, and Laos

Aedes albopictus is native to Southeast Asia and has emerged as a major vector for vector-borne diseases that are spreading rapidly worldwide. Recent studies have shown that Ae. albopictus populations have different genetic groups dependent on their thermal adaptations; however, studies on Korean populations are limited. In this study, we analyzed the genetic diversity and structure of two mitochondrial genes (COI and ND5) and sixteen microsatellites in mosquitoes inhabiting Korea, Japan, and Laos. The results indicate that the Korean population has low genetic diversity, with an independent cluster distinct from the Laos population. Mixed clusters have also been observed in the Korean population. On the basis of these findings, two hypotheses are proposed. First, certain Korean populations are native. Second, some subpopulations that descended from the metapopulation (East Asian countries) were introduced to Japan before migrating to Korea. Furthermore, we previously demonstrated that Ae. albopictus appears to have been imported to Korea. In conclusion, the dengue-virus-carrying mosquitoes could migrate to Korea from Southeast Asian epidemic regions, where they can survive during the severe winter months. The key findings can be used to establish an integrated pest management strategy based on population genetics for the Korean Ae. albopictus population.

Epidemiological and genomic analysis of dengue cases in Guangzhou, China, from 2010 to 2019

With a long epidemic history and a large number of dengue cases, Guangzhou is a key city for controlling dengue in China. The demographic information regarding dengue cases, and the genomic characteristics of the envelope gene of dengue viruses, as well as the associations between these factors were investigated from 2010 to 2019, to improve the understanding of the epidemiology of dengue in Guangzhou. Demographic data on 44,385 dengue cases reported to the Notifiable Infectious Disease Report System were analyzed using IBM SPSS Statistics v. 20. Dengue virus isolates from patient sera were sequenced, and phylogenetic trees were constructed using PhyML 3.1. There was no statistical difference in the risk of dengue infection between males and females. Unlike other areas in which dengue is endemic, the infection risk in Guangzhou increased with age. Surveillance identified four serotypes responsible for dengue infections in Guangzhou. Serotype 1 remained prevalent for most of the study period, whereas serotypes 3 and 4 were prevalent in 2012 and 2010, respectively. Different serotypes underwent genotype and sublineage shifts. The epidemiological characteristics and phylogeny of dengue in Guangzhou suggested that although it has circulated in Guangzhou for decades, it has not been endemic in Guangzhou. Meanwhile, shifts in genotypes, rather than in serotypes, might have caused dengue epidemics in Guangzhou.

Epidemiology of dengue reported in the World Health Organization's Western Pacific Region, 2013-2019

The global burden of dengue, an emerging and re-emerging mosquito-borne disease, increased during the 20-year period ending in 2019, with approximately 70% of cases estimated to have been in Asia. This report describes the epidemiology of dengue in the World Health Organization's Western Pacific Region during 2013-2019 using regional surveillance data reported from indicator-based surveillance systems from countries and areas in the Region, supplemented by publicly available dengue outbreak situation reports. The total reported annual number of dengue cases in the Region increased from 430 023 in 2013 to 1 050 285 in 2019, surpassing 1 million cases for the first time in 2019. The reported case-fatality ratio ranged from 0.19% (724/376 972 in 2014 and 2030/1 050 285 in 2019) to 0.30% (1380/458 843 in 2016). The introduction or reintroduction of serotypes to specific areas caused several outbreaks and rare occurrences of local transmission in places where dengue was not previously reported. This report reinforces the increased importance of dengue surveillance systems in monitoring dengue across the Region.

The Invasive Mosquitoes of Canada: An Entomological, Medical, and Veterinary Review

Several invasive mosquitoes have become established in Canada, including important pathogen vectors such as Aedes albopictus, Ae. japonicus, and Culex pipiens. Some species have been present for decades, while others are recent arrivals. Several species present new health concerns and may result in autochthonous seasonal outbreaks of pathogens, particularly in southern Canada, that were previously restricted to imported cases. This review provides an overview of current knowledge of the biological, medical, and veterinary perspectives of these invasive species and highlights the need for increased monitoring efforts and information sharing.

Yearly variations of the genetic structure of Aedes aegypti (Linnaeus) (Diptera: Culicidae) in the Philippines (2017-2019)

Dengue is the fastest emerging arboviral disease in the world, imposing a substantial health and economic burden in the tropics and subtropics. The mosquito, Aedes aegypti, is the primary vector of dengue in the Philippines. We examined the genetic structure of Ae. aegypti populations collected from the Philippine major islands (Luzon, Visayas and Mindanao), each with highland (Baguio city, Cebu city mountains and Maramag, Bukidnon, respectively) and lowland sites (Quezon city; Liloan, Cebu and Cagayan de Oro [CDO] city, respectively) during the wet (2017-2018 and 2018-2019) and dry seasons (2018 and 2019). Mosquitoes (n = 1800) were reared from field-collected eggs and immatures, and were analyzed using 12 microsatellite loci. Generalized linear model analyses revealed yearly variations between highlands and lowlands in the major islands as supported by Bayesian clustering analyses on: 1) stronger selection (inbreeding coefficient, F_IS = 0.52) in 2017-2018 than in 2018-2019 (F_IS = 0.32) as influenced by rainfall, 2) the number of non-neutral loci indicating selection, and 3) differences of effective population size although at p = 0.05. Across sites except Baguio and CDO cities: 1) F_IS varied seasonally as influenced by relative humidity (RH), and 2) the number of non-neutral loci varied as influenced by RH and rainfall indicating selection. Human-mediated activities and not isolation by distance influenced genetic differentiations of mosquito populations within (F_ST = 0.04) the major islands and across sites (global F_ST = 0.16). Gene flow (Nm) and potential first generation migrants among populations were observed between lowlands and highlands within and across major islands. Our results suggest that dengue control strategies in the epidemic wet season are to be changed into whole year-round approach, and water pipelines are to be installed in rural mountains to prevent the potential breeding sites of mosquitoes.

Imported Infectious Diseases, Tropical Diseases and Local Endemic Infectious Diseases in Japan

We aimed to describe the historical perspectives and the current epidemiology of tropical, imported and local endemic infectious diseases in Japan in this review. Public health legislation for infectious diseases and immigration statistics were overviewed to provide the background of the infectious disease situation in Japan. Many tropical diseases were successfully controlled and eliminated in the latter half of the 20th century and the majority of those diseases are imported today. The trend of the main 15 imported infectious diseases before the advent of COVID-19 was summarized as well as local endemic infectious diseases in Japan. Transmission risks of traditional cuisines, lifestyles and nature exposures in Japan are introduced to guide clinicians for travel advice to prevent those local infectious diseases.

Modeling the effect of rainfall changes to predict population dynamics of the Asian tiger mosquito Aedes albopictus under future climate conditions

The population dynamics of mosquitoes in temperate regions are not as well understood as those in tropical and subtropical regions, despite concerns that vector-borne diseases may be prevalent in future climates. Aedes albopictus, a vector mosquito in temperate regions, undergoes egg diapause while overwintering. To assess the prevalence of mosquito-borne diseases in the future, this study aimed to simulate and predict mosquito population dynamics under estimated future climatic conditions. In this study, we tailored the physiology-based climate-driven mosquito population (PCMP) model for temperate mosquitoes to incorporate egg diapauses for overwintering. We also investigated how the incorporation of the effect of rainfall on larval carrying capacity (into a model) changes the population dynamics of this species under future climate conditions. The PCMP model was constructed to simulate mosquito population dynamics, and the parameters of egg diapause and rainfall effects were estimated for each model to fit the observed data in Tokyo. We applied the global climate model data to the PCMP model and observed an increase in the mosquito population under future climate conditions. By applying the PCMP models (with or without the rainfall effect on the carrying capacity of the A. albopictus), our projections indicated that mosquito population dynamics in the future could experience changes in the patterns of their active season and population abundance. According to our results, the peak population number simulated using the highest CO₂ emission scenario, while incorporating the rainfall effect on the carrying capacity, was approximately 1.35 times larger than that predicted using the model that did not consider the rainfall effect. This implies that the inclusion of rainfall effects on mosquito population dynamics has a major impact on the risk assessments of mosquito-borne diseases in the future.

Changes in Container-Breeding Mosquito Diversity and Abundance Along an Urbanization Gradient are Associated With Dominance of Arboviral Vectors

Environmental conditions associated with urbanization are likely to influence the composition and abundance of mosquito (Diptera, Culicidae) assemblages through effects on juvenile stages, with important consequences for human disease risk. We present six years (2011-2016) of weekly juvenile mosquito data from distributed standardized ovitraps and evaluate how variation in impervious cover and temperature affect the composition and abundance of container-breeding mosquito species in Maryland, USA. Species richness and evenness were lowest at sites with high impervious cover (>60% in 100-m buffer). However, peak diversity was recorded at sites with intermediate impervious cover (28-35%). Four species were observed at all sites, including two recent invasives (Aedes albopictus Skuse, Ae. japonicus Theobald), an established resident (Culex pipiens L), and one native (Cx. restuans Theobald). All four are viral vectors in zoonotic or human transmission cycles. Temperature was a positive predictor of weekly larval abundance during the growing season for each species, as well as a positive predictor of rapid pupal development. Despite being observed at all sites, each species responded differently to impervious cover. Abundance of Ae. albopictus larvae was positively associated with impervious cover, emphasizing that this medically-important vector not only persists in the warmer, impervious urban landscape but is positively associated with it. Positive temperature effects in our models of larval abundance and pupae occurrence in container habitats suggest that these four vector species are likely to continue to be present and abundant in temperate cities under future temperature scenarios.

Temperature, season, and latitude influence development-related phenotypes of Philippine Aedes aegypti (Linnaeus): Implications for dengue control amidst global warming

Background

Dengue is endemic in the Philippines. Aedes aegypti is the primary vector. This study aimed to determine the hatching behavior and viability of Ae. aegypti first-generation (F1) eggs when exposed to temperature and photoperiod regimes under laboratory conditions.

Methods

Parental eggs were collected from selected highland and lowland sites in the Philippine big islands (Luzon, Visayas, and Mindanao) during the wet (2017–2018) and dry (2018) seasons. F1 egg cohorts were exposed separately in environmental chambers at 18, 25, and 38 °C with respective photoperiods for 6 weeks. Phenotypes (percent pharate larvae [PPL], hatch rates [HRs], and reproductive outputs [ROs]) were determined.

Results

Results of multivariate analyses of variance (MANOVA) between seasons showed significant main effects of temperature, season, and big island on all phenotypes across all sites. Significant interaction effects between seasons on all phenotypes across sites were shown between or among (1) season and big island, (2) season and temperature, (3) big island and temperature, (4) season, big island, and temperature, (5) big island, altitude, and temperature, and (6) season, big island, altitude, and temperature. Factors associated with the big islands might include their ecology, available breeding sites, and day lengths due to latitudinal differences, although they were not measured in the field. MANOVA results within each season on all phenotypes across sites showed (1) significant main effects of big island and temperature, and (2) significant interaction effects between big island and temperature within the wet season and (3) between temperature and photoperiod within the dry season. PPL were highest at 18 °C and were formed even at 38 °C in both seasons. Pharate larvae might play an adaptive role in global warming, expanded distribution to highlands, and preponderance to transmit human diseases. HRs in both seasons were highest at 25 °C and lowest at 38 °C. ROs were highest at 25 °C in the wet season and at 18 °C in the dry season.

Conclusions

Temperature and latitude of Philippine big islands influenced the development-related phenotypes of Ae. aegypti in both seasons. The two seasons influenced the phenotypes and their interaction effects with big island and/or temperature and/or altitude. Recommendations include year-round enhanced 4S control strategies for mosquito vectors and water pipeline installation in rural highlands.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05186-x.

A comparative study of dengue virus vectors in major parks and adjacent residential areas in Ho Chi Minh City, Vietnam

The primary dengue virus vectors, Aedes aegypti and Aedes albopictus, are primarily daytime biting mosquitoes. The risk of infection is suspected to be considerable in urban parks due to visitor traffic. Despite the importance of vector control for reducing dengue transmission, little information is available on vector populations in urban parks. The present study characterized mosquito habitats and estimated vector densities in the major urban parks in Ho Chi Minh City, Vietnam and compared them with those in adjacent residential areas. The prevalences of habitats where Aedes larvae were found were 43% and 9% for the parks and residential areas, respectively. The difference was statistically significant (prevalence ratio [PR]: 5.00, 95% CI: 3.85–6.49). The prevalences of positive larval habitats were significantly greater in the parks for both species than the residential areas (PR: 1.52, 95% CI: 1.04–2.22 for A. aegypti, PR: 10.10, 95% CI: 7.23–14.12 for A. albopictus). Larvae of both species were positively associated with discarded containers and planters. Aedes albopictus larvae were negatively associated with indoor habitats, but positively associated with vegetation shade. The adult density of A. aegypti was significantly less in the parks compared with the residential areas (rate ratio [RR]; 0.09, 95% CI: 0.05–0.16), while the density of A. albopictus was significantly higher in the parks (RR: 9.99, 95% CI: 6.85–14.59). When the species were combined, the density was significantly higher in the parks (RR: 2.50, 95% CI: 1.92–3.25). The urban parks provide suitable environment for Aedes mosquitoes, and A. albopictus in particular. Virus vectors are abundant in the urban parks, and the current vector control programs need to have greater consideration of urban parks.

The primary dengue virus vectors, Aedes aegypti and Aedes albopictus, are primarily daytime biting mosquitoes and therefore the risk of infection may be considerable in urban parks due to human foot traffic. Prior to the present study little information was available on vector populations in urban parks. Here we describe that larvae of both species were positively associated with discarded containers and planters. Aedes albopictus larvae were negatively associated with indoor habitats, but positively associated with vegetation shade. Aedes albopictus was predominant in the urban parks while A. aegypti was predominant in adjacent residential areas. When the species were combined the density of vectors was greater in the urban parks. The current vector control programs need to take into consideration vector intensity within urban parks.

Pathogens and disease vectors/hosts monitoring in aquatic environments: Potential of using eDNA/eRNA based approach

Infectious diseases are spreading in to previously unreported geographical regions, and are reappeared in regions 75 or 100 years after their last reported case, as a result of environmental changes caused by anthropogenic activities. A pathogen, vector/host monitoring methodology is therefore indispensable in identifying potential transmission sites, providing early warnings and evaluating the human health risks of these infectious diseases in a given area. Recently, environmental DNA (eDNA) and environmental RNA approach (eRNA) have become widespread in monitoring organisms in the environment due to advantages like lower cost, time, and labour requirements. However, eDNA/eRNA based monitoring of pathogens and vectors/hosts using aquatic samples is limited to very few studies. In this review, we summarized the currently available eDNA/eRNA based human and non-human pathogens and vectors/hosts detection studies in aquatic samples. Species-specific shedding, transport, and decay of eDNA/eRNA in aquatic environments which is essential in estimating the abundance of pathogen, vectors/host in focus is also summarized. We also suggest the usage of eDNA/eRNA approach in urban aquatic samples like runoff in identifying the disease vectors/hosts inhabiting in locations which are not accessible easily.

Emerging and Re-emerging Vector-Borne Infectious Diseases and the Challenges for Control: A Review

Vector-borne emerging and re-emerging diseases pose considerable public health problem worldwide. Some of these diseases are emerging and/or re-emerging at increasing rates and appeared in new regions in the past two decades. Studies emphasized that the interactions among pathogens, hosts, and the environment play a key role for the emergence or re-emergence of these diseases. Furthermore, social and demographic factors such as human population growth, urbanization, globalization, trade exchange and travel and close interactions with livestock have significantly been linked with the emergence and/or re-emergence of vector-borne diseases. Other studies emphasize the ongoing evolution of pathogens, proliferation of reservoir populations, and antimicrobial drug use to be the principal exacerbating forces for emergence and re-emergence of vector-borne infectious diseases. Still other studies equivocally claim that climate change has been associated with appearance and resurgence of vector-borne infectious diseases. Despite the fact that many important emerging and re-emerging vector-borne infectious diseases are becoming better controlled, our success in stopping the many new appearing and resurging vector-borne infectious diseases that may happen in the future seems to be uncertain. Hence, this paper reviews and synthesizes the existing literature to explore global patterns of emerging and re-emerging vector-borne infections and the challenges for their control. It also attempts to give insights to the epidemiological profile of major vector-borne diseases including Zika fever, dengue, West Nile fever, Crimean-Congo hemorrhagic fever, Chikungunya, Yellow fever, and Rift Valley fever.

Analysis of international traveler mobility patterns in Tokyo to identify geographic foci of dengue fever risk

Travelers play a role in triggering epidemics of imported dengue fever because they can carry the virus to other countries during the incubation period. If a traveler carrying dengue virus visits open green space and is bitten by mosquitoes, a local outbreak can ensue. In the present study, we aimed to understand the movement patterns of international travelers in Tokyo using mobile phone data, with the goal of identifying geographical foci of dengue transmission. We analyzed datasets based on mobile phone access to WiFi systems and measured the spatial distribution of international visitors in Tokyo on two specific dates (one weekday in July 2017 and another weekday in August 2017). Mobile phone users were classified by nationality into three groups according to risk of dengue transmission. Sixteen national parks were selected based on their involvement in a 2014 dengue outbreak and abundance of Aedes mosquitoes. We found that not all national parks were visited by international travelers and that visits to cemeteries were very infrequent. We also found that travelers from countries with high dengue prevalence were less likely to visit national parks compared with travelers from dengue-free countries. Travelers from countries with sporadic dengue cases and countries with regional transmission tended to visit common destinations. By contrast, the travel footprints of visitors from countries with continuous dengue transmission were focused on non-green spaces. Entomological surveillance in Tokyo has been restricted to national parks since the 2014 dengue outbreak. However, our results indicate that areas subject to surveillance should include both public and private green spaces near tourist sites.

Molecular Characterization of Imported and Autochthonous Dengue in Northeastern Spain

Dengue is the most significant arbovirus worldwide and a public health threat to non-endemic areas in which Aedes vectors are present. Autochthonous dengue transmission has been reported in several European countries in the last decade. Infected travelers from endemic regions arriving to areas colonized by Aedes albopictus in Europe need to be monitored in surveillance and control programs. We aimed to perform molecular characterization of RT-PCR-positive dengue cases detected in Catalonia, northeastern Spain, from 2013 to 2018. The basic demographic information and the geographical regions of importation were also analyzed. One-hundred four dengue cases were studied (103 imported infections and the first autochthonous case in our region). The dengue virus strains detected were serotyped and genotyped using molecular methods, and phylogenetic analyses were conducted. All four dengue serotypes were detected in travelers, including up to 10 different genotypes, reflecting the global circulation of dengue in endemic areas. The primary travel-related case of the 2018 autochthonous transmission was not identified, but the molecular analysis revealed dengue serotype 1, genotype I of Asian origin. Our results highlight the diversity of imported dengue virus strains and the role of molecular epidemiology in supporting arbovirus surveillance programs.

Zika Virus Potential Vectors among Aedes Mosquitoes from Hokkaido, Northern Japan: Implications for Potential Emergence of Zika Disease

The Zika virus (ZIKV) is a rapidly expanding mosquito-borne virus that causes febrile illness in humans. Aedes aegypti and Ae. albopictus are the primary ZIKV vectors; however, the potential vector competence of other Aedes mosquitoes distributed in northern Japan (Palearctic ecozone) are not yet known. In this study, the susceptibility to Zika virus infection of three Aedes mosquitoes distributed in the main city of the northern Japan and their capacities as vectors for ZIKV were evaluated. Field-collected mosquitoes were fed ad libitum an infectious blood meal containing the ZIKV PRVABC59. The Zika virus was detected in the abdomen of Ae. galloisi and Ae. japonicus at 2–10 days post infection (PI), and from the thorax and head of Ae. galloisi at 10 days PI, resulting in 17.6% and 5.9% infection rates, respectively. The Zika virus was not detected from Ae. punctor at any time. Some northern Japanese Aedes could be suspected as vectors of ZIKV but the risk may be low when compared with major ZIKV vectors.

Comparative analyses on epidemiological characteristics of dengue fever in Guangdong and Yunnan, China, 2004-2018

Background

In China, Guangdong and Yunnan are the two most dengue-affected provinces. This study aimed to compare the epidemiological characteristics of dengue fever in Guangdong and Yunnan during 2004–2018.

Methods

Descriptive analyses were used to explore the temporal, spatial, and demographic distribution of dengue fever.

Results

Of the 73,761 dengue cases reported in mainland China during 2004–2018, 93.7% indigenous and 65.9% imported cases occurred in Guangdong and Yunnan, respectively. A total of 55,970 and 5938 indigenous cases occurred in 108 Guangdong and 8 Yunnan counties, respectively during 2004–2018. Whereas 1146 and 3050 imported cases occurred in 84 Guangdong and 72 Yunnan counties, respectively during 2004–2018. Guangdong had a much higher average yearly indigenous incidence rate (3.65 (1/100000) vs 0.86 (1/100000)), but a much lower average yearly imported incidence rate (0.07 (1/100000) vs 0.44(1/100000)) compared with Yunnan in 2004–2018. Furthermore, dengue fever occurred more widely in space and more frequently in time in Guangdong. Guangdong and Yunnan had similar seasonal characteristics for dengue fever, but Guangdong had a longer peak period. Most dengue cases were clustered in the south-western border of Yunnan and the Pearl River Delta region in Guangdong. Most of the imported cases (93.9%) in Guangdong and Yunnan were from 9 Southeast Asian countries. Thailand, Cambodia, and Malaysia imported mainly into Guangdong while Myanmar and Laos imported into Yunnan. There was a strong male predominance among imported cases and an almost equal gender distribution among indigenous cases. Most dengue cases occurred in individuals aged 21–50 years, accounting for 57.3% (Guangdong) vs. 62.8% (Yunnan) of indigenous and 83.2% (Guangdong) vs. 62.6% (Yunnan) of imported cases. The associated major occupations (house worker or unemployed, retiree, and businessman, for indigenous cases; and businessman, for imported cases), were similar. However, farmers accounted for a larger proportion of dengue cases in Yunnan.

Conclusions

Identifying the different epidemiological characteristics of dengue fever in Guangdong and Yunnan can be helpful to formulate targeted, strategic plans, and implement effective public health prevention measures in China.

Diversity of West Nile and Usutu virus strains in mosquitoes at an international airport in Austria

Increased globalization and international transportation have resulted in the inadvertent introduction of exotic mosquitoes and new mosquito‐borne diseases. International airports are among the possible points of entry for mosquitoes and their pathogens. We established a mosquito and mosquito‐borne diseases monitoring programme at the largest international airport in Austria and report the results for the first two years, 2018 and 2019. This included weekly monitoring and sampling of adult mosquitoes, and screening them for the presence of viral nucleic acids by standard molecular diagnostic techniques. Additionally, we surveyed the avian community at the airport, as birds are potentially amplifying hosts. In 2018, West Nile virus (WNV) was detected in 14 pools and Usutu virus (USUV) was detected in another 14 pools of mosquitoes (minimum infection rate [MIR] of 6.8 for each virus). Of these 28 pools, 26 consisted of female Culex pipiens/torrentium, and two contained male Culex sp. mosquitoes. Cx. pipiens/torrentium mosquitoes were the most frequently captured mosquito species at the airport. The detected WNV strains belonged to five sub‐clusters within the sub‐lineage 2d‐1, and all detected USUV strains were grouped to at least seven sub‐clusters among the cluster Europe 2; all strains were previously shown to be endemic in Austria. In 2019, all mosquito pools were negative for any viral nucleic acids tested. Our study suggests that airports may serve as foci of arbovirus activity, particularly during epidemic years, and should be considered when designing mosquito control and arbovirus monitoring programmes.

Challenges to Mitigating the Urban Health Burden of Mosquito-Borne Diseases in the Face of Climate Change

Cities worldwide are facing ever-increasing pressure to develop mitigation strategies for all sectors to deal with the impacts of climate change. Cities are expected to house 70% of the world's population by 2050, and developing related resilient health systems is a significant challenge. Because of their physical nature, cities' surface temperatures are often substantially higher than that of the surrounding rural areas, generating the so-called Urban Heat Island (UHI) effect. Whilst considerable emphasis has been placed on strategies to mitigate against the UHI-associated negative health effects of heat and pollution in cities, mosquito-borne diseases have largely been ignored. However, the World Health Organization estimates that one of the main consequences of global warming will be an increased burden of mosquito-borne diseases, many of which have an urban facet to their epidemiology and thus the global population exposed to these pathogens will steadily increase. Current health mitigation strategies for heat and pollution, for example, may, however, be detrimental for mosquito-borne diseases. Implementation of multi-sectoral strategies that can benefit many sectors (such as water, labor, and health) do exist or can be envisaged and would enable optimal use of the meagre resources available. Discussion among multi-sectoral stakeholders should be actively encouraged.

Determining vector competence of Aedes aegypti from Ghana in transmitting dengue virus serotypes 1 and 2

Background

Dengue virus (DENV) is a mosquito-borne arbovirus transmitted by Aedes mosquitoes, but is not endemic in all areas where this vector is found. For example, the relatively sparse distribution of cases in West Africa is generally attributed to the refractory nature of West African Aedes aegypti (Ae. aegypti) to DENV infection, and particularly the forest-dwelling Ae. aegypti formosus. However, recent studies have shown these mosquitoes to be competent vectors within some West African countries that have suffered outbreaks in the past, such as Senegal. There is however little information on the vector competence of the Ae. aegypti in West African countries such as Ghana with no reported outbreaks.

Methods

This study examined the vector competence of 4 Ae. aegypti colonies from urban, semi-urban, and two rural locations in Ghana in transmitting DENV serotypes 1 and 2, using a single colony from Vietnam as control. Midgut infection and virus dissemination were determined by quantitative reverse transcription polymerase chain reaction (qRT-PCR), while the presence and concentration of DENV in the saliva of infectious mosquitoes was determined by the focus forming assay.

Results

There were significant differences in the colonies’ susceptibility to virus infection, dissemination, and transmission. All examined Ghanaian mosquitoes were refractory to infection by DENV serotype 2, while some colonies exhibited potential to transmit DENV serotype 1. None of the tested colonies were as competent as the control group colony.

Conclusions

These findings give insight into the possible risk of outbreaks, particularly in the urban areas in the south of Ghana, and highlight the need for continuous surveillance to determine the transmission status and outbreak risk. This study also highlights the need to prevent importation of different DENV strains and potential invasion of new highly vector-competent Ae. aegypti strains, particularly around the ports of entry.

Graphic Abstract

Progress of public health policy regarding global infectious diseases over the past decade in Japan

This article aims to examine progress of public health policy regarding global infectious diseases over the past decade in Japan.

A narrative review was conducted, overviewing items of the Infectious Disease Committee and the Tuberculosis Committee of the Ministry of Health, Labour and Welfare between 2010 and 2019.

The mean value of items discussed in each meeting were 9.7 items. Among these items, these committees have discussed about countermeasures in terms of reduced burden of indigenous infectious diseases such as measles, rubella and pertussis, and increased risk of imported infectious diseases such as Ebola virus disease, Middle East Respiratory Syndrome, plague, avian influenza, pandemic influenza and tuberculosis.

These changes regarding infectious diseases lead to loss of target population, difficulty of early detection, and market failure in old and new antibiotics and others, which requires challenge to scattered at-risk targets, effort to training and awareness, and creation of novel public health policy for research and development as well as production and supply. Over the past decade, public health policy regarding global infectious diseases have been one of the key targets under the triangle of global infectious disease, and recent experience of Coronavirus disease 2019 will further prioritize it in Japan. However, the principles of public health policy are globally vulnerable in the Post-Corona era, which can lead to the collapse of democratic way. To combat global infectious diseases without going off the road, we need to learn about the past history of public health policy.

Travel medicine facilities: The first nationwide cross-sectional questionnaire survey in Japan

INTRODUCTION

Travel medicine has gained importance in recent years; however, there is little data regarding travel medicine departments in Japanese hospitals.

METHODS

This cross-sectional study contacted 488 hospitals designated by either the Japanese government or major Japanese associations. A questionnaire comprising 11 questions pertaining to the availability of pre-travel consultation, out-of-hours service for travel-related patients, number of medical doctors engaged in travel medicine and infectious disease specialists, and the number of negative pressure rooms available for inpatients and outpatients was distributed. It also asked about the facilities available to combat specific diseases like malaria, dengue, and post-exposure prophylaxis for rabies as these are most common diseases affecting returning travelers.

RESULTS

Of the 263 hospitals (58.7%) that responded to our questionnaire, 82 hospitals (31.2%) provided pre-travel consulting, 188 hospitals (72.0%) accepted travel-related patients out-of-hours, median (interquartile range [IQR]) number of medical doctors involved in travel medicine was 1 (0-3), and median (IQR) number of patients accepted for admission was 2 (1-4). Only 106 (41%) hospitals could diagnose malaria at any time, 56 hospitals (21%) could immediately provide oral anti-malarial medicines; rapid diagnostic test for dengue was available in 99 hospitals (39%), while 67 hospitals (26%) could immediately administer post-exposure prophylaxis for rabies.

CONCLUSIONS

Japan's medical care system is concerned about illnesses-especially malaria, dengue and rabies in returned travelers. We suggest construction of a medical care system centered on designated medical facilities for category I and II infectious diseases to build capacity for early diagnosis and treatment of common tropical infectious diseases.

Epidemiological trends of imported infectious diseases in Japan: Analysis of imported 2-year infectious disease registry data

INTRODUCTION

The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information.

METHODS

J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis.

RESULTS

Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers' diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever.

CONCLUSIONS

We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.

The 2014 autochthonous dengue fever outbreak in Tokyo: A case series study and assessment of the causes and preventive measures

Objective

In 2014, an autochthonous dengue fever outbreak occurred around the Yoyogi Park in Japan for the first time in 70 years. Despite no local cases reported since then, the risk of another outbreak remains high. This study reviews the autochthonous dengue fever cases of the outbreak, investigates its causes, and delineates preventive measures against autochthonous dengue epidemics.

Methods

We conducted a case series study of 15 patients who visited our institution during the 2014 outbreak. We collected and evaluated data on the surveillance of vector mosquitoes, weather, pest control, travelers’ origins and destinations, and imported dengue fever cases using reports made by public institutions.

Results

All patients recovered with supportive treatments and none met the diagnostic criteria for severe dengue infection. Twelve patients with positive real-time polymerase chain reactions were confirmed as having dengue virus-1 infections. We found no obvious associations between the number of mosquitoes and the weather, or between the number of imported dengue fever cases and that of travelers. Insect growth regulator (IGR) against vector mosquitoes has been used since 2014 for pest control, but the number of larvae has not declined in the Yoyogi Park, although that of imagoes has been relatively suppressed.

Conclusion

The 2014 outbreak emerged without particularly favorable climate conditions for vector mosquitoes. We found no obvious associations between the number of travelers or the imported dengue fever cases and the outbreak, but the increasing number of travelers may contribute to another outbreak. Pest control, including IGR, remains essential for infection control.

•

We studied 15 patients with autochthonous dengue fever during a local outbreak.

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This outbreak emerged without favorable climate conditions for mosquitoes.

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There were no increased number of travelers or imported dengue cases.

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Pest control using insect growth regulator can be effective for infection control.

Seroprevalence of Jamestown Canyon virus in the Japanese general population

Background

Jamestown Canyon virus (JCV) is a mosquito-borne orthobunyavirus that causes acute febrile illness, meningitis, and meningoencephalitis, mainly among adults. JCV is widely distributed in North America and the number of JCV cases in the U.S. has increased in recent years. Therefore, the central nervous system disease caused by JCV can be considered a potentially re-emerging viral disease. However, the seroprevalence of JCV is unknown in Japan. The purpose of this study is to evaluate the seroprevalence of JCV in the Japanese population.

Methods

We used an IgG enzyme-linked immunosorbent assay (IgG-ELISA) with JCV-infected cell-lysates and/or a neutralizing (NT) antibody assay. The cut-off value of IgG-ELISA was determined using IgG-ELISA to analyze serum specimens from 37 healthy Japanese donors. IgG-ELISA was validated by assessing its sensitivity and specificity, using 38 human serum samples previously tested for the presence or absence of antibodies against JCV and snowshoe hare virus (SSHV), in an in-house NT antibody assay conducted by the Public Health Agency of Canada. The seroepidemiological study was performed using IgG-ELISA and NT antibody assay to analyze 246 human serum samples from the serum bank of the National Institute of Infectious Diseases (NIID) in Japan.

Results

The cut-off value of IgG-ELISA was determined at 0.20, based on the mean (− 0.075) and standard deviation (0.092) values using Japanese donors’ sera. The sensitivity and the specificity of IgG-ELISA determined using 25 JCV-positive and 4 JCV-negative serum samples were 96 and 100%, respectively. Analysis of the 246 Japanese serum samples revealed that no specimen showed a higher value than the cut-off value of IgG-ELISA, and no sample tested positive by the NT antibody assay.

Conclusions

Our results showed that JCV is not circulating significantly in Japan. To the best of our knowledge, this is the first report to demonstrate the seroprevalence of JCV in the general population in Japan.

Aedes albopictus and Aedes flavopictus (Diptera: Culicidae) pre-imaginal abundance patterns are associated with different environmental factors along an altitudinal gradient

Aedes (Stegomyia) albopictus (Skuse) is a major global invasive mosquito species that, in Japan, co-occurs with Aedes (Stegomyia) flavopictus Yamada, a closely related species recently intercepted in Europe. Here, we present results of a detailed 25-month long study where we biweekly sampled pupae and fourth instar larvae of these two species from ovitraps set along Mt. Konpira, Nagasaki, Japan. This setting allowed us to ask whether these species had different responses to changes in environmental variables along the altitudinal gradient of an urban hill. We found that spatially Ae. albopictus abundance decreased, while Ae. flavopictus abundance increased, the further away from urban land. Ae. flavopictus also was more abundant than Ae. albopictus in locations with homogenous vegetation growth with a high mean Enhanced Vegetation Index (EVI), platykurtic EVI, and low SD in canopy cover, while Ae. albopictus was more abundant than Ae. flavopictus in areas with more variable (high SD) canopy cover. Moreover, Ae. flavopictus abundance negatively impacted the spatial abundance of Ae. albopictus. Temporally we found that Ae. flavopictus was more likely to be present in Mt. Konpira at lower temperatures than Ae. albopictus. Our results suggest that spatial and temporal abundance patterns of these two mosquito species are partially driven by their different response to environmental factors.

Patient and National Economic Burden of Dengue in Japan: Results from Japanese National Claims Database

Dengue fever is a predominantly imported infectious disease in Japan. However, domestic dengue infections were found in 2014. The economic burden of dengue is informative to formulate a policy toward its control. We estimated patient and societal economic burden of dengue infections in Japan from the restricted societal perspective. The direct medical cost was estimated from the national claims database between 2011 and 2015, and the indirect cost was estimated by multiplying the treatment days with the average wage. The average number of dengue patients per year was 274. The economic burden per dengue patient was $1,364.90 (direct medical cost: $1,213.80 and indirect cost: $151.10); the average economic burden for dengue in Japan per year was $433,217 (direct cost: $329,557, indirect cost: $41,298, and nonmedical cost: $62,362). We estimated the economic burden of dengue per patient and year in Japan from 2011 to 2015. The economic burden per year was not huge. It may not be necessary to formulate the National Prevention Plan for dengue. However, domestic dengue outbreak might occur again in the future. Preventive action should be taken with considering cost-effectiveness or budget impact. The findings in this study may be of use for these health economic analyses for planning prevention strategy for not only dengue but also other mosquito-borne diseases.

A Two-Patch Mathematical Model for Temperature-Dependent Dengue Transmission Dynamics

Dengue fever has been a threat to public health not only in tropical regions but non-tropical regions due to recent climate change. Motivated by a recent dengue outbreak in Japan, we develop a two-patch model for dengue transmission associated with temperature-dependent parameters. The two patches represent a park area where mosquitoes prevail and a residential area where people live. Based on climate change scenarios, we investigate the dengue transmission dynamics between the patches. We employ an optimal control method to implement proper control measures in the two-patch model. We find that blockage between two patches for a short-term period is effective in a certain degree for the disease control, but to obtain a significant control effect of the disease, a long-term blockage should be implemented. Moreover, the control strategies such as vector control and transmission control are very effective, if they are implemented right before the summer outbreak. We also investigate the cost-effectiveness of control strategies such as vaccination, vector control and virus transmission control. We find that vector control and virus transmission control are more cost-effective than vaccination in case of Korea.

First detection of a Vssc allele V1016G conferring a high level of insecticide resistance in Aedes albopictus collected from Europe (Italy) and Asia (Vietnam), 2016: a new emerging threat to controlling arboviral diseases

Introduction

Aedes albopictus (Skuse) is an important vector of arboviral diseases, including dengue, chikungunya and Zika virus disease. Monitoring insecticide resistance and mechanisms by which the mosquito develops resistance is crucial to minimise disease transmission.

Aim

To determine insecticide resistance status and mechanisms in Ae. albopictus from different geographical regions.

Methods

We sampled 33 populations of Ae. albopictus from Asia, Europe and South America, and tested these for susceptibility to permethrin, a pyrethroid insecticide. In resistant populations, the target site for pyrethroids, a voltage-sensitive sodium channel (Vssc) was genotyped. Three resistant sub-strains, each harbouring a resistance allele homozygously, were established and susceptibilities to three different pyrethroids (with and without a cytochrome P450 inhibitor) were assayed.

Results

Most populations of Ae. albopictus tested were highly susceptible to permethrin but a few from Italy and Vietnam (4/33), exhibited high-level resistance. Genotyping studies detected a knockdown resistance (kdr) allele V1016G in Vssc for the first time in Ae. albopictus. Two previously reported kdr alleles, F1534C and F1534S, were also detected. The bioassays indicated that the strain homozygous for the V1016G allele showed much greater levels of pyrethroid resistance than other strains harbouring F1534C or F1534S.

Conclusion

The V1016G allele was detected in bothAsian and Italian Ae. albopictus populations, thus a spread of this allele beyond Italy in Europe cannot be ruled out. This study emphasises the necessity to frequently and regularly monitor the V1016G allele in Ae. albopictus, particularly where this mosquito species is the main vector of arboviruses.

Entomological Investigation Detects Dengue Virus Type 1 in Aedes (Stegomyia) albopictus (Skuse) during the 2015-16 Outbreak in Hawaii

A dengue outbreak occurred on Hawaii Island between September 2015 and March 2016. Entomological investigations were undertaken between December 2015 and February 2016 to determine which Aedes mosquito species were responsible for the outbreak. A total of 3,259 mosquitoes were collected using a combination of CDC autocidal gravid ovitraps, Biogents BG-Sentinel traps, and hand-nets; immature mosquitoes were collected during environmental surveys. The composition of species was Aedes albopictus (58%), Aedes aegypti (25%), Wyeomyia mitchelli (7%), Aedes vexans (5%), Culex quinquefasciatus (4%), and Aedes japonicus (1%). Adult mosquitoes were analyzed by real-time reverse transcription polymerase chain reaction (PCR) for the presence of dengue virus (DENV) RNA. Of the 185 pools of female mosquitoes tested, 15 containing Ae. albopictus were positive for the presence of DENV type 1 RNA. No virus was detected in pools of the remaining species. Phylogenetic analysis showed the virus strain belonged to genotype I and was closely related to strains that were circulating in the Pacific between 2008 and 2014. This is the first report of detection of DENV in Ae. albopictus from Hawaii.

Molecular and evolutionary analysis of dengue virus serotype 2 isolates from Korean travelers in 2015

In Korea, dengue infection has been frequently reported in travelers to tropical and subtropical countries. Global warming increases the probability of autochthonous dengue outbreaks in Korea. In this report, the molecular and evolutionary properties of four dengue virus (DENV) type 2 isolates from Korean overseas travelers were examined. Three of these isolates were classified as Cosmopolitan genotypes and further divided into sublineages 1 (43,253, 43,254) and 2 (43,248), while the other isolate (KBPV-VR29) was related to American genotypes. The variable amino acid motifs related to virulence and replication were identified in the structural and non-structural proteins. A negative selection mechanism was clearly verified in all of the DENV proteins. Potential recombination events were identified in the NS5 protein of the XSBN10 strain. The substitution rate (5.32 × 10⁻⁴ substitutions per site) and the time of the most recent common ancestor (TMRCA) for each evolutionary group were determined by the Bayesian skyline coalescent method. This study shows that DENV type 2 strains with distinct phylogenetic, evolutionary, and virulence characteristics have been introduced into Korea by overseas travelers and have the potential to trigger autochthonous dengue outbreaks.

Characterization of the first autochthonous dengue outbreak in Spain (August-September 2018)

On October 3rd 2018, dengue virus (DENV) infection was confirmed in three family members (symptoms onset between August 18th and 27th) without travel history outside of Spain. They had been together in the Autonomous Communities (AC) of Murcia and Andalusia. By the end of October, a second cluster of two dengue cases (symptoms onset on September 27th and 30th) was confirmed in the AC of Murcia. DENV type 1 sequence was identical to the first cluster, and the epidemiological link was a visit from a case of the first cluster to a fruit-farm neighboring the small village of residence of the second cluster. The entomological investigation found Aedes albopictus activity in this area although all mosquitoes were PCR-negative for DENV. This is the first autochthonous dengue outbreak identified in Spain. This outbreak highlights challenges to timely detect and respond to DENV transmission and opens questions on dengue dynamics in a non-endemic context.

Genetic analysis of Aedes aegypti captured at two international airports serving to the Greater Tokyo Area during 2012-2015

The introduction of exotic disease vectors into a new habitat can drastically change the local epidemiological situation. During 2012–2015, larvae and an adult of the yellow-fever mosquito, Aedes aegypti, were captured alive at two international airports serving the Greater Tokyo Area, Japan. Because this species does not naturally distribute in this country, those mosquitoes were considered to be introduced from overseas via air-transportation. To infer the places of origin of those mosquitoes, we genotyped the 12 microsatellite loci for which the most comprehensive population genetic reference is currently available. Although clustering by Bayesian and multivariate methods both suggested that all those mosquitoes captured at the airports in Japan belonged to the Asia/Pacific populations, they were not clustered into a single cluster. Moreover, there was variation in mitochondrial cytochrome oxidase I gene (CoxI) haplotypes among mosquitoes collected in different incidents of discovery which indicated the existence of multiple maternal origins. We conclude there is little evidence to support the overwintering of Ae. aegypti at the airports; nevertheless, special attention is still needed to prevent the invasion of this prominent arbovirus vector.

Non-Human Primate Models of Dengue Virus Infection: A Comparison of Viremia Levels and Antibody Responses during Primary and Secondary Infection among Old World and New World Monkeys

Due to the global burden of dengue disease, a vaccine is urgently needed. One of the key points in vaccine development is the development of a robust and reliable animal model of dengue virus infection. Characteristics including the ability to sustain viral replication, demonstration of clinical signs, and immune response that resemble those of human dengue virus infection are vital in animal models. Preclinical studies in vaccine development usually include parameters such as safety evaluation, induction of viremia and antigenemia, immunogenicity, and vaccine effectiveness. Although mice have been used as a model, non-human primates have an advantage over mice because of their relative similarity to humans in their genetic composition and immune responses. This review compares the viremia kinetics and antibody responses of cynomolgus macaques (Macaca fasicularis), common marmosets (Callithrix jacchus), and tamarins (Saguinus midas and Saguinus labitus) and summarize the perspectives and the usefulness along with challenges in dengue vaccine development.

A potential global surveillance tool for effective, low-cost sampling of invasive Aedes mosquito eggs from tyres using adhesive tape

BACKGROUND

The international movement of used tyres is a major factor responsible for global introductions of Aedes invasive mosquitoes (AIMs) (Diptera: Culicidae) that are major disease vectors (e.g. dengue, Zika, chikungunya and yellow fever). Surveillance methods are restricted by expense, availability and efficiency to detect all life stages. Currently, no tested method exists to screen imported used tyres for eggs in diapause, the life stage most at risk from accidental introduction. Here we test the efficiency of adhesive tape as an affordable and readily available material to screen tyres for eggs, testing its effect on hatch rate, larval development, DNA amplification and structural damage on the egg surface.

RESULTS

We demonstrated that the properties of adhesive tape can influence pick up of dormant eggs attached to dry surfaces. Tapes with high levels of adhesion, such as duct tape, removed eggs with high levels of efficiency (97% ± 3.14). Egg numbers collected from cleaned used tyres were found to explain larval hatch rate success well, particularly in subsequent larval to adult emergence experiments. The strength of this relationship decreased when we tested dirty tyres. Damage to the exochorion was observed following scanning electron microscopy (SEM), possibly resulting in the high variance in the observed model. We found that five days was the optimal time for eggs to remain on all tested tapes for maximum return on hatch rate success. Tape type did not inhibit amplification of DNA of eggs from three, five or ten days of exposure. Using this DNA, genotyping of AIMs was possible using species-specific markers.

CONCLUSIONS

We demonstrated for the first time that adhesive tapes are effective at removing AIM eggs from tyres. We propose that this method could be a standardised tool for surveillance to provide public health authorities and researchers with an additional method to screen tyre cargo. We provide a screening protocol for this purpose. This method has a global applicability and in turn can lead to increased predictability of introductions and improve screening methods at high risk entry points.

The Global Expansion of Dengue: How Aedes aegypti Mosquitoes Enabled the First Pandemic Arbovirus

Dengue is an emerging viral disease principally transmitted by the Aedes (Stegomyia) aegypti mosquito. It is one of the fastest-growing global infectious diseases, with 100-400 million new infections a year, and is now entrenched in a growing number of tropical megacities. Behind this rapid rise is the simple adaptation of Ae. aegypti to a new entomological niche carved out by human habitation. This review describes the expansion of dengue and explores how key changes in the ecology of Ae. aegypti allowed it to become a successful invasive species and highly efficient disease vector. We argue that characterizing geographic heterogeneity in mosquito bionomics will be a key research priority that will enable us to better understand future dengue risk and design control strategies to reverse its global spread.

Emerging and re-emerging infectious diseases in Japan: epidemiology and infection prevention measures

In recent years, emerging and re-emerging infectious diseases, such as the Ebola virus disease and Middle East Respiratory Syndrome (MERS), have been frequently reported. In this review, we summarize the representative outbreaks of emerging and re-emerging infectious diseases since 2000 and outbreaks of various infectious diseases that have occurred around the world and in Japan. Moreover, the emerging and re-emerging infectious diseases that could develop in Japan are also summarized. Especially, for mosquito-borne infectious diseases, viral hemorrhagic fever and severe fever with thrombocytopenia syndrome, and avian Influenza and MERS, the disease features, routes of infection, and infection prevention measures are reviewed in this article. Healthcare workers are at high risk of infection, and therefore, a sufficient understanding of disease features and routes of infection and the appropriate infection prevention measures are needed to increase self-protection.

Clinical and epidemiological characteristics of imported dengue fever among inbound passengers: Infrared thermometer-based active surveillance at an international airport

BACKGROUND

Dengue fever is endemic in tropical and subtropical areas, especially Southeast Asia. International air travel facilitates the spread of dengue across and within borders. To date, no predictive factors have been established for assessing risk of dengue among febrile travelers.

METHODS

Since 2006, Taiwan has operated a program of infrared thermometer-based non-contact active surveillance at Taoyuan International Airport (TPE). All inbound passengers from dengue-endemic countries who are febrile (tympanic temperature ≥38°C) undergo routine laboratory testing for dengue. We analyzed clinical and epidemiological characteristics of all tested passengers entering Taiwan via TPE in 2011 to identify the predictive factors of dengue infection.

RESULTS

In 2011, of the 3,719 febrile passengers from dengue-endemic countries, 74 (2.0%) had laboratory-confirmed dengue infection. Multivariable logistic regression analysis revealed that those who were aged ≥60 years (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 2.6-29.6) and had self-reported fever (aOR, 2.5; 95% CI, 1.5-4.1), skin rashes (aOR, 11.0; 95% CI, 3.4-35.1), or a tympanic temperature ≥39°C (aOR, 2.9; 95% CI, 1.7-4.9) were significantly more likely to have dengue (all p values < 0.05). Compared with travelers who stayed in dengue-endemic countries for ≤7 days, those who traveled 8-14, 15-21, 22-28, and ≥29 days were also more likely to be infected (aORs of 10.2, 14.9, 39.0 and 12.0, respectively).

CONCLUSION

These clinical and epidemiological features can facilitate timely recognition and diagnosis of imported dengue in febrile inbound passengers and therefore help prevent domestic transmission of dengue virus.

High-throughput genotyping of a full voltage-gated sodium channel gene via genomic DNA using target capture sequencing and analytical pipeline MoNaS to discover novel insecticide resistance mutations

In insects, the voltage-gated sodium channel (VGSC) is the primary target site of pyrethroid insecticides. Various amino acid substitutions in the VGSC protein, which are selected under insecticide pressure, are known to confer insecticide resistance. In the genome, the VGSC gene consists of more than 30 exons sparsely distributed across a large genomic region, which often exceeds 100 kbp. Due to this complex genomic structure, it is often challenging to genotype full coding nucleotide sequences (CDSs) of VGSC from individual genomic DNA (gDNA). In this study, we designed biotinylated oligonucleotide probes from CDSs of VGSC of Asian tiger mosquito, Aedes albopictus. The probe set effectively concentrated (>80,000-fold) all targeted regions of gene VGSC from pooled barcoded Illumina libraries each constructed from individual A. albopictus gDNAs. The probe set also captured all orthologous VGSC CDSs, except some tiny exons, from the gDNA of other Culicinae mosquitos, A. aegypti and Culex pipiens complex, with comparable efficiency as a result of the high nucleotide-level conservation of VGSC. To improve efficiency of the downstream bioinformatic process, we developed an automated pipeline-MoNaS (Mosquito Na+ channel mutation Search)-which calls amino acid substitutions in the VGSC from NGS reads and compares those to known resistance mutations. The proposed method and our bioinformatic tool should facilitate the discovery of novel amino acid variants conferring insecticide resistance on VGSC and population genetic studies on resistance alleles (with respect to the origin, selection, and migration etc.) in both clinically and agriculturally important insect pests.

A notorious vector-borne disease: Dengue fever, its evolution as public health threat

Dengue fever, the most notorious of vector borne diseases is under global resurgence. Incidence has increased 30 fold with global expansion. It is thus imperative to review the origin, history and current epidemiology of dengue, its transmission, factors responsible for resurgence, surveillance and the treatment options available. India being hyperendemic, national level comprehensive studies to estimate the true burden of dengue along with its geographical mapping is the need of the hour. Through integrated and combined efforts from various sectors and policy makers, prevention of dengue must be identified and intensified to control further disease transmission as there is no specific antiviral treatment or vaccine against dengue is available in India.

Exploring Epidemiological Characteristics of Domestic Imported Dengue Fever in Mainland China, 2014-2018

Epidemiological characteristics of domestic imported dengue fever in mainland China, 2014-2018, including time-series, spatial mobility and crowd features, were analyzed. There existed seasonal characteristics from August to November. The 872 domestic imported cases from 8 provinces, located in the southeastern, southwestern and southern coastal or border areas, were imported to 267 counties in 20 provinces of mainland China, located in the outer areas along the southwest-northeast line. The 628 domestic imported cases were still imported to the adjacent counties in the provinces themselves, 234 domestic imported cases were imported to 12 other provinces except the 8 original exported provinces, 493 cases in 2014 reached the peak, and 816 domestic imported cases were from Guangdong (675) and Yunnan (141). Domestic imported cases from Guangdong were imported to 218 counties, and 475 cases from Guangdong were imported to the adjacent counties in Guangdong itself. There were more male cases than female cases except in 2016. Domestic imported cases were clustered from 21 to 50 years old. The top three cases were from farmer, worker and housework or unemployed. The findings are helpful to formulate targeted, strategic plans and implement effective public health prevention and control measures.

Two Cases of Dengue Virus Type 2 (DENV-2) Infection in a Japanese Couple Returning from the Maldives during the 2018 Dengue Outbreak

Annually, more than 1.2 million travelers from other countries visit the Maldives for sightseeing, business, and honeymoon. In 2018, the largest dengue fever outbreak occurred, affecting more than 3,200 people. During this outbreak, we encountered a newly married Japanese couple returning from the Maldives on their honeymoon in October 2018, both were infected by the dengue virus type 2 during the travel. The number of imported dengue fever cases from the Maldives may increase; hence, physicians should stay up to date on dengue outbreak information worldwide.

The threat of climate change to non-dengue-endemic countries: increasing risk of dengue transmission potential using climate and non-climate datasets

Background

Dengue is a major public health problem in the tropics and sub-tropics, but the disease is less known to non-dengue-endemic countries including in Northeast Asia. However, an unexpected dengue outbreak occurred in 2014 in Japan. Given that autochthonous (domestic) dengue cases had not been reported for the past 70 years in Japan, this outbreak was highly unusual and suggests that several environmental factors might have changed in a way that favors vector mosquitoes in the Northeast Asian region.

Methods

A Climate Risk Factor (CRF) index, as validated in previous work, was constructed using climate and non-climate factors. This CRF index was compared to the number of reported dengue cases in Tokyo, Japan where the outbreak was observed in 2014. In order to identify high-risk areas, the CRF index was further estimated at the 5 km by 5 km resolution and mapped for Japan and South Korea.

Results

The high-risk areas determined by the CRF index corresponded well to the provinces where a high number of autochthonous cases were reported during the outbreak in Japan. At the provincial-level, high-risk areas for dengue fever were the Eastern part of Tokyo and Kanakawa, the South-Eastern part of Saitama, and the North-Western part of Chiba. While a relatively small number of high-risk areas were identified in South Korea compared with Japan, the high-risk areas in South Korea include popular tourist destinations where international visitors have been increasing.

Conclusion

The recent dengue outbreak in Japan may signal that the two adjacent non-dengue-endemic countries are also exposed to the risk of temporal and sporadic behavior of dengue fever. It is critical to understand potential high-risk areas for future outbreaks and to set up appropriate prevention activities at the governmental-level.

The use of air travel data for predicting dengue importation to China: A modelling study

BACKGROUND

Dengue virus importation from abroad is still the main driver of dengue incidence in China. Using global flight data to model importation may improve our understanding and prediction of dengue virus importation and onward transmission.

METHODS

A retrospective analysis was performed of surveillance cases of dengue infections imported to China and volume of air traffic to China for the years 2005 through 2014, inclusive. The data were aggregated by year, destination province, and source country. Descriptive statistics were calculated, and a random effects negative binomial model was created to predict the number of imported cases based on the volume of travelers from dengue-endemic countries.

RESULTS

There were 1,822 cases of imported dengue infections over the study period. Most imported cases are from a small number of high-incidence countries with a large volume of travel to China, most notably Myanmar (22% of cases). The number of imported cases of dengue infections increased by 5.9% for every 10% increase in travel volume from dengue-endemic countries.

CONCLUSION

Patterns of air travel have a measurable impact on the importation of dengue to China. Modelling dengue importation risk may be a useful strategy to direct public health surveillance and interventions.