Bureau des risques infectieux émergents et des vigilances Sous-direction de la Veille et de la Sécurité Sanitaire Direction générale de la Santé

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1 Bureau des risques infectieux émergents et des vigilances Sous-direction de la Veille et de la Sécurité Sanitaire Direction générale de la Santé Ministère des Affaires Sociales et de la Santé

2 Two different situations: overseas departments and those of mainland France: Overseas = Epidemic Situation and endemic presence of established and active vectors. Metropolitan France = No epidemic nor endemic situation, but a vector settled permanently in the south of France. 2

3 French overseas departments Dengue Chikungunya Malaria Zika 3

4 French overseas departments in America (French Caribbean Islands and French Guiana) Hyperendemicity of dengue 2014 Chikungunya : clinically presumed cases 2016 Zika : clinically presumed cases Major issue regarding vector control : insecticide resistance 4

5 French overseas departments (French Indian Ocean islands: La Réunion, Mayotte) Chikungunya emerged in 2005 and 2006, affecting 38 % of the local population. This first major epidemic caused severe morbidity and mortality. 5

6 French overseas departments SISMIP Diseases surveillance épidemiology network Public mosquito control 6

7 French overseas departments Vector control measures: Mostly based on social mobilization Indoor and outdoor fogging in emerging cluster Fogging stopped when epidemic is declared Distribution of impregnated bednets for pregnant women 7

8 Mainland France 8

9 Départments where Aedes albopictus is present 9

10 Départments where Aedes albopictus is present 10

11 Départments where Aedes albopictus is present 11

12 Départments where Aedes albopictus is present 12

13 Départments where Aedes albopictus is present 13

14 Départments where Aedes albopictus is present 14

15 Départments where Aedes albopictus is present 15

16 Départments where Aedes albopictus is present 16

17 Départments where Aedes albopictus is present 17

18 Two situations: Entomological surveillance Human surveillance and vector control 18

19 Mainland France surveillance and response plan

20 Vector control plan: 5 levels 0a: No Aedes albopictus 0b: Controlled presence of Aedes albopictus (May 1 to November 30) 1: Aedes albopictus implanted and active (30 departments in 2015) 2: A. albopictus implanted, active plus one native human case confirmed 3: A. albopictus implanted, active with native human cases plus one confirmed outbreak (at least 2 cases grouped) 4: A. albopictus implanted, active plus several distinct foci of native human cases 5: Epidemics situation of Aedes albopictus 5a: diffuse distribution of native human cases 5b: epidemic over a wide area and high attack rate requiring adaptive management and monitoring 20

21 Mainland France Departments albopictus 0a et 0b Entomological surveillance system 21

22 Albopictus 0 area First step: Define areas where A. albopictus is present 1/ Ovitrap network (collected monthly) 2/ Surveillance of main tires importers and established entrance points 3/ Citizens' reporting tools o Website o Mobile app i Moustique 22

23 1/ Ovitrap network 23 23

24 Albopictus 0 area First step: Define areas were Ae. albopictus is present 1/ Ovitrap network (collected monthly) 2/ Surveillance of main tires importers and established entrance points 3/ Citizens' reporting tools o Website o Mobile app i Moustique

25 2/ Surveillance of main tires importers and established entrance points 27 tires importers in

26 2/ Surveillance of main tires importers and established entrance points 26

27 Albopictus 0 area First step: Define areas were Ae. albopictus is present 1/ Ovitrap network (collected monthly) 2/ Surveillance of main tires importers and established entrance points 3/ Citizens reporting tools o Website o Mobile app i Moustique 27

28 Albopictus 0 area First step: Define areas were Ae. albopictus is present 3/ Website and mobile app - citizens report suspect A. Albopictus for identification Pre-identification online (size, color) Specimen sent to experts for confirmation - Mobile app i Moustique citizens report suspect insects for identification 28

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31 Flowchart of the reporting process. Source : 31

32 Mainland France Citizen Public mosquito control Specimen sent to experts for confirmation 32

33 Citizen Public mosquito control If Ae. albopictus Others Public mosquito control 33 33

34 864 citizens reports 71 Ae. albopictus 34 34

35 Results : : notifications via website, and among those, 438 Aedes albopictus 95 municipalities (not known to be colonized previously) involved in 2014, and 159 in 2015 Ovitrap network and web portal: passive surveillance is still efficient at long distances from the colonized area The website also contributed to the detection of A. japonicus in four municipalities of Eastern France. 35

36 reporting forms received via from municipalities already colonized from non colonized municipalities X2 RHONE- ALPES 7% PACA 43% X4 ALSACE 1% X4 AQUITAINE 5% CORSE IDF 1% 3% X2 M-P 10% X4 L-R 30% 100% 80% 60% 40% 20% Total ZNC Source détections signalement Réseau et signalement Réseau piège 0% SLM 67 36

37 Mainland France Departments albopictus 1 Vector control measures 37

38 Mainland France surveillance and response plan In areas where A. albopictus is implanted: Surveillance of virus carriers coming from endemic areas Vector control measures Host (naïve): Humans Virus: Infected host Vectors Cap. Need for an early detection of imported cases Coordinated, complementary and adapted responses to the risk for each entomological/epidemiological situation defined by risks lvl 0 to 5 38

39 760 cases Or places 39

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41 Vector control process All suspected or confirmed dengue/chikungunya/zika cases Notification to health surveillance agency by physicians or labs Epidemiological investigation (symptoms, travel, possible beginning/end of viraemia, ) Alert of the vector control operator Entomological investigation and treatments if necessary Assessment of the efficacy, new treatment if necessary 41

42 Mainland France Departments albopictus 1 VOOZARBO Diseases surveillance épidemiology network Public mosquito control 42

43 First step Entomological investigation 43

44 Second step if vector is présent Vector control process Notification of a suspect case potentially viremic - Validation of the address(es) - Definition of the perimeter(s) (150m radius or more, depending on the cluster size) - Definition of the treatment routes (vehicle and pedestrian)

45 Municipality is informed afterwards: Geolocation Obtaining access permission (keys, codes, ) Investigation inside the perimeter Breeding sites removal or larviciding when necessary (mostly Bti) Information of the neighbourhood: date and hour of treatment, safety measures about insecticides

46 Vector control process Imagocide treatment obetween 4 A.M. and 5 A.M.: truckmounted ULV spraying (cold fogging) inside the perimeter (Aqua-Kothrine EW ) owhen necessary: thermal fogging for inaccessible nesting sites (Aqua- Kothrine EW )

47 Nombre de moustique moyen Is Vector Control efficient? Data Chikungunya, France 2014 From 242 (before) to 8 (after) Aedes albopictus / day (8 BGs traps) 1 pool CHIKV+ after 1st ULV treatment -> ULV control must be repeated oct 17-oct 20-oct 21-oct 23-oct 24-oct 27-oct 28-oct Temps (dates)

48 Is Vector Control efficient? Dengue, France 2015

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