Training for health professionals. Module vector borne diseases

Transcription

1 Training for health professionals Module vector borne diseases

2 Introduction The incidence of vector-borne diseases (VBD) in Europe is much greater than is generally recognized As a result, diagnosis and treatment are often delayed Health authorities often fail to allocate funding for the surveillance and control 2

3 VBD & climate change in Europe Tick-borne Mosquito-borne Other insect-borne Lyme disease Chikungunya / Dengue* Leishmaniasis Tick-borne encephalitis Malaria* Chandipura virus Human ehrlichiosis West Nile virus Sicilian virus Tularaemia Tularaemia Tularaemia Crimean-Congo* Yellow fever* Toscana virus Sindbis viurs Tahyna virus * This disease is currently not present in Europe 3

4 Module vector-borne diseases Training topics Tick borne diseases West Nile fever (mosquito borne) Dengue fever (mosquito borne) Chikungunya fever (mosquito borne) Leishmaniasis (sandfly borne) 4

5 Outline training Objective Definitions Effect climate change on VBD Specific information for each VBD (top-5) Health effects Current situation Future situation Actions needed Summary 5

6 Training objective To learn how to be prepared for changes in public health due to climate change Take home message Health impact Mitigation and adaptation Preventive measures on individual & community level 6

7 Definitions [1] Mitigation = reducing the severity of climate change (reducing greenhouse gas concentrations) Adaptation = preparing for change (adjusting our systems to reduce harm from climate effects) 7

8 Definitions [2] Vector-borne disease (VBD) = an illness caused by an infectious microorganism (pathogen) that is transmitted to people by a vector, usually arthropods Arthropod = an invertebrate animal having an exoskeleton (e.g. insects or arachnids) 8

9 Definitions [3] Types of VBD transmission Anthroponotic infections Mosquitoes (Malaria), Ticks (Lyme disease) Zoonotic infections Rodents (plague), Birds (Q-fever) Animals Humans Vector Vector Vector Vector Humans Animals Humans 9

10 Definitions [4] Common (arthropod) vectors Ticks Mosquitoes Sandflies 10

11 VBD & climate change Climate change will affect the distribution of VBD in three ways: directly, by the effect on virus/parasite development and vector competence indirectly, by the effect on the range and abundance of the species that act as vectors indirectly, through socio-economic changes that affect the amount of human contact with the transmission cycles 11

12 VBD & climate change Most important climate factors Temperature Precipitation 12

13 Temperature effects Vector Survival decrease/increase depending on the species Changes in rate of vector population growth Changes in the susceptibility of vectors to some pathogens Changes in feeding rate and host contact 13

14 Temperature effects Example Summer: more days with high(er) temperature Longer lifespan Longer reproduction period Longer activity period Winter: less days with low temperature Benefits overwintering Shorter overwintering 14

15 Temperature effects Pathogen Decreased extrinsic incubation period of pathogen in vector at higher temperatures Changes in the transmission season Changes in geographical distribution Decreased viral replication 15

16 Precipitation effects Vector Survival: increased rain may increase larval habitat Excess rain can eliminate habitat by flooding Low rainfall can create habitat as rivers dry into pools (dry season mosquitoes) Decreased rain can increase containerbreeding mosquitoes by forcing increased water storage 16

17 Precipitation effects Vector (continued) Heavy rainfall events can synchronize vector host-seeking and virus transmission Increased humidity increases vector survival and vice-versa Pathogen Few direct effects but some data on humidity effects on parasite development 17

18 Summary effects climate change Climate change has the potential to Increase range or abundance of animal reservoirs and/or arthropod vectors Enhance transmission Increase importation of vectors or pathogens 18

19 Module vector borne diseases Tick-borne diseases

20 Tick-borne diseases Ticks are a distinct group of mites As blood feeding parasites, ticks are able to transmit a wide variety of pathogens This may cause tick-borne infections and diseases affecting Animals Humans 20

21 Tick-borne diseases Stages of the tick life-cycle 1. Egg 2. Larva 3. Nymph 4. Adult Ticks can transmit disease during the three last life-cycle stages. 21

22 Tick-borne diseases Tick-borne diseases to be aware of in Europe include: Lyme borreliosis (LB) Tick-borne encephalitis (TBE) Tick-borne relapsing fever (TBRF) Crimean-Congo haemorrhagic fever (CCHF) 22

23 Current situation - ticks In Europe, 90% to 95% of all tick bite incidences in humans are caused by Ixodes ricinus Ixodes persulcatus 23

24 Current situation Yearly number of cases in Europe Lyme borreliosis: ~ 85,000 Tick-borne encephalitis: ~5,000-8,000 Tick-borne relapsing fever: rare Crimean-Congo haemorrhagic fever: endemic in Bulgaria since 1950 ( 50-08: 1,568 cases; 17% mortality), recently new area s 24

25 Climate & ticks Climate suitability for the tick I. ricinus - Stable trends 25

26 Climate & ticks Climate suitability for the tick I. ricinus - Random trends 26

27 Future situation ticks Climate change Distribution to higher latitudes and altitudes Climate conditions Temperature During summer: temperature > 5-8 ºC During winter: high enough to continue life cycle Humidity Sufficient to prevent both eggs and ticks from drying out 27

28 Tick borne disease - Lyme borreliosis -

29 Lyme borreliosis (LB) Lyme borreliosis = a bacterial infection caused by member of the genus Borrelia Vector borne Bite by infected tick (B. burgdorferi) Tick species I. ricinus (Europe) Bacteria resevoir host many species of small mammals ground-feeding birds 29

30 LB health symptoms Health symptoms Local skin rash (80-90% of cases) Neuroborreliosis (main complication, 10%) Meningoencephalitis (less common) Risk groups All persons exposed to risk of tick bites are at risk of becoming infected. 30

31 LB geographical distribution In Europe, the mean prevalence of B. burgdorferi infected ticks is about 12% Regions with highest tick infection rates are located in central Europe Austria, Czech Republic, Southern Germany, Switzerland, Slovakia and Slovenia Nymphs > 10%, adults > 20% 31

32 LB - available warning systems Lyme borreliosis is not a notifiable disease in the European Union (in contrast to USA) No licensed vaccine is currently available Main methods of preventing infection are avoiding tick bites and early removal of attached ticks. 32

33 Tick borne disease - Tick-borne encephalitis -

34 Tick-borne encephalitis (TBE) Tick-borne encephalitis = disease caused by a virus of the Flaviviridae family Vector borne Bite by infected tick Tick species I. ricinus (Europe) Virus reservoir host Mainly small rodents Also insectivores and carnivores 34

35 TBE transmission mode Other transmission modes By consumption of infected unpasteurised dairy products. Not directly from human to human, apart from mother to the foetus Laboratory accidents (needle-stick injuries or aerosol infection) 35

36 TBE health symptoms Health symptoms Two third of human TBE virus infections is asymptomatic Clinical cases 1 st fase: nonspecific symptoms (fever, fatigue etc.) 2 nd fase: central nervous system affected Several TBE virus infection subtypes European, Far Eastern, Siberian 36

37 TBE health symptoms European subtype Milder compared to other subtypes 20-30% of patients experiencing the 2 nd phase Severe neurological sequelae in 10% of patients Mortality rate 0.5-2% Risk groups All persons exposed to risk of tick bites are at risk of becoming infected. 37

38 TBE geographical distribution TBE has become a growing public health challenge in Europe and other parts of the world The number of human cases of TBE in all endemic regions of Europe has increased by almost 400% in the last 30 years The risk areas have spread and new foci have been discovered 38

39 TBE geographical distribution TBE is present in Southern Scandinavia Central and Eastern Europe Risk of contracting the disease from a single bite is 1 in 600 in endemic regions 39

40 TBE - available warning systems Notifiable disease in 16 European countries, including 13 European Union (EU) Member States 3 non-eu Member States A vaccine is available People at high risk of an infection are vaccinated in Sweden and other countries 40

41 Tick borne disease - Tick-borne relapsing fever -

42 Tick-borne relapsing fever (TBRF) TBRF = a bacterial infection caused by member of the genus Borrelia Vector borne Bite by infected tick Tick species Ornithodoros Bacteria reservoir host Ticks Small mammals/birds/reptiles/bats 42

43 TBRF health symptoms Health symptoms High fever (> C) Other symptoms include Intensive asthenia, headache, arthralgia, myalgia, neck stiffness, stomach ache and nausea. Splenomegaly and hepatomegaly, usually associated with jaundice, and elevated pulse and blood pressure are common. Following the initial fever episode further relapses will occur 43

44 TBRF risk groups Two epidemiological types of TBRF have been described: Sporadic TBRF Observed in at-risk groups like soldiers, hunters, campers, field workers or travellers Developed countries Endemic TBRF Caused by rare but regular contact with infected ticks directly living in rural human dwellings Developing countries 44

45 TBRF geographical distribution The greatest endemic risk in Europe lies in the Iberian Peninsula, particularly in the Mediterranean part, and in Asia Minor Reports of imported TBRF cases have come from the UK, Belgium and France The number of cases is underestimated because most infections are benign, and no diagnosis is made 45

46 TBRF available warning systems TBRF is not a notifiable disease in the European Union No licensed vaccine is currently available Main methods of preventing infection are: Avoiding tick-infested areas Avoiding tick bites 46

47 TBRF available warning systems Main methods of preventing infection (continued) Removal or decreasing tick vectors and natural vertebrate reservoirs from buildings Chemical treatments Natural predators like domestic cats Limiting rodent-friendly environments inside and around buildings 47

48 Tick borne disease - Crimean-Congo haemorrhagic fever -

49 Crimean-Congo haemorrhagic fever (CCHF) CCHF = a viral infection caused by the genus Nairovirus, Bunyaviridae family Vector borne Bite by infected tick (nymph or adult) Tick species Hyalomma Virus resevoir host Immature ticks: hares and hedgehogs Mature ticks: domestic animals (cattle etc.) 49

50 CCHF transmission mode Other transmission mode: direct contact with infected blood or body fluids contaminated medical equipment or supply 50

51 CCHF- health symptoms Health symptoms A sudden onset of febrile illness with headache, myalgia, backache and joint pain, abdominal pain and vomiting. Frequently followed by: Haemorrhagic manifestations Necrotic hepatitis may occur Large ecchymosis and uncontrolled bleeding from venipuncture sites are common features. 51

52 CCHF health symptoms Mortality rate of CCHF is ~ 30% with death occuring in the 2 nd week of illness Risk groups Farmers, veterinarians and abattoir workers in endemic areas Healthcare workers (when nursing CCHF patients) Outdoor activities in endemic areas 52

53 CCHF - geographic distribution The geographic range of CCHF virus is known to be the most extensive of the tick borne viruses important to human health. In Europe, cases have been reported from Albania, Bulgaria, Kosovo, Turkey and the former Soviet Union In Greece, the first human case of CCHF infection was reported

54 CCHF available warning systems CCHF is not a notifiable disease on European Union level No validated specific antiviral therapy for CCHF. Main methods of preventing infection are: Avoiding tick-infested areas Avoiding tick bites 54

55 CCHF available warning systems Main methods of preventing infection (continued) Removal or decreasing tick vectors and natural vertebrate reservoirs from buildings Chemical treatments Natural predators like domestic cats Limiting rodent-friendly environments inside and around buildings 55

56 Summary tick borne diseases Tick borne disease & climate change Distribution to higher latitudes and altitudes Tick-borne diseases to be aware of in Europe Lyme borreliosis Tick-borne encephalitis Tick-borne relapsing fever Crimean-Congo haemorrhagic fever 56

57 What actions are needed? Public health surveillance at the European level (compulsory notification system in all countries) Educate the public on interventions against ticks Further research on tick distribution 57

58 Module vector borne diseases Mosquitoes borne diseases West Nile Dengue - Chikungunya

59 Mosquitoes-borne This training Culex mosquitoes West Nile fever Aedes mosquitoes Dengue fever Asian Tiger mosquitoes Chikungunya fever (Aedes albopictus) 59

60 Mosquito borne disease - West Nile fever -

61 West Nile mosquito borne West Nile fever = disease caused by a virus of the Flaviviridae family (West Nile virus, WNV) Vector borne Bites of infected mosquitoes Culex mosquitoes species Virus reservoir host Birds 61

62 West Nile transmission mode Direct transmission between animals has been seen experimentally Infected humans and horses do not seem to spread the virus to other mammals Person-to-person transmission has not been reported In rare cases, the virus has been spread by blood transfusions, organ transplants, and transplacental transmission 62

63 West Nile health effects Asymptomatic infections (~80%) Clinical symptoms Mild Flu-like symptoms, including fever, headache and body aches. Most uncomplicated infections resolve in 3-6 days Severe clinical cases Neuro-invasive disease: there may be signs of encephalitis, meningo-encephalitis or meningitis. 63

64 West Nile health effects An estimated 1 out of infections results in meningitis or encephalitis. The case fatality rate in patients with neuro-invasive illness ranges from 4% to 14%; it can reach 15 29% in patients over 70 years old. Concurrent disorders such as diabetes or immunosuppression increases the risk of death. 64

65 West Nile mosquito borne Culex species (Cx. spp.) Large number of spp. world wide (> 700) About 20 spp. are present in Europe Infection and transmission rates are variable Example: mosquitoes from the Rhone delta, France Cx. modestus Cx. pipiens Infection rate: 89.2% 38.5% Transmission rate: 54.5% 15.8% 65

66 Current situation Worldwide distribution Cx. mosquitoes Distributed worldwide They can be found in tropical and temperate climate zones on all continents except Antarctica Europe distribution Cx. mosquitoes Wetland areas of high biodiversity Cx. pipiens spp. urban/city dweller 66

67 Current distribution - mosquito Distribution of the Culex pipiens complex and its sibling species Source: Smith

68 West Nile health impact West Nile Fever worldwide West Nile Fever is distributed worldwide Outbreaks may occur in humans, birds, and horses in Africa, Europe, Russia, India, and Australia West Nile Fever Europe Erratic and spatially and temporally limited phenomena Occurring quite unpredictably, even if all conditions appear to be present in a definite place 68

69 West Nile health impact Risk groups People over 50 years old are at higher risk of developing severe neurological disease and should take special care to avoid mosquito bites. 69

70 Current distribution West Nile 70

71 Available warning systems Country Control measures Greece Romania Turkey Enhanced surveillance for human cases Adulticiding (ultra-low volume spraying) of mosquitoes in villages with human cases Public education campaigns for personal protection Education and guidance to school teachers and health care personnel Seasonal surveillance for human cases Blood safety measures Improved surveillance (active and passive) for human cases Inclusion of WNV as a notifiable disease for 2011 season 71

72 Available warning systems West Nile fever is a notifiable disease in the European Union The ECDC is responsible for the surveillance of infectious diseases in the European Union. 72

73 Future situation Current situation Europe Autochthonous WNV infections in several countries during the transmission season Future situation & climate change The dynamics of transmission of WNV are complex difficult to predict the situation for Europe in the coming years Data indicate that the epidemiology of WNV in Europe is changing 73

74 What actions are needed? [1] Development of a vaccine Need for integrated multidisciplinary surveillance systems and response plans Raising the awareness of clinicians and veterinarians of the clinical presentation of WNV disease in humans and horses Particularly during the mosquito season from June to October Primarily in areas considered as at major risk surrounding (irrigated areas and river deltas) 74

75 What actions are needed? [2] More research to Suitable habitats for birds that would increase the bird-mosquito-human interface Competent vector species Establish limits around WNV affected areas Identify potential new at-risk areas Study the cycle of transmission and the maintenance of WNV in the environment over the years 75

76 Mosquito borne disease - Chikungunya fever - - Dengue fever -

77 Chikungunya & Dengue Chikungunya fever = disease caused by a virus of the Togaviridae family (CHIKV) Dengue fever = disease caused by a virus of the Flaviviridae family (dengue virus; DENV) Vector borne Transmitted from human to human by bites of infected mosquitoes 77

78 Chikungunya & Dengue Vector borne (continued) Aedes mosquitoes species (both CHIKV and DENV) Virus reservoir host Humans 78

79 Transmission mode Bites of infected mosquitoes Direct contact with infected blood or body fluids Contaminated medical equipment or supply Can be transmitted from mother to child 79

80 Climate change & Aedes mosquitoes - Chikungunya fever - - Dengue fever -

81 Chikungunya & Dengue Aedes mosquito species Ae. aegypti Diurnal biting habits Once endemic in Europe, disappeared after WWII Ae. albopictus (Asian tiger mosquito) Not host-specific Present in southern Europe 81 Aegypti Albopictus

82 Current situation Worldwide distribution Aedes mosquitoes Climate conditions Overwintering conditions: 0 C January isotherm with 500 mm annual rainfall Development: monthly mean temperature 10 C Transmission: monthly mean temperature 20 C Risk zones Chikungunya/Dengue fever Originally, Africa, Southeast Asia, Indian subcontinent and islands in the Indian Ocean Increasing presence of Aedes mosquitoes in Southern Europe new risk zone? 82

83 Current distribution - mosquito Ae. aegypti Ae. albopictus 83

84 Future situation minimum impact Year 2030 Year 2030 Climate change & long term impact on Ae. Albopictus distribution 84

85 Future situation maximum impact Year 2030 Year 2030 Climate change & long term impact on Ae. Albopictus distribution 85

86 Future situation Maps show the risk of establishment of Aedes albopictus The maps do not report the risk of transmitting exotic viruses, nor can one extrapolate from them to assess any such risk Analysing this risk would require a significant number of additional datasets, e.g. vector capacity in the given eco-climatic settings which are currently not available 86

87 Mosquito borne disease - Chikungunya -

88 Chikungunya health effects Clinical symptoms Incubation time of 4-7 days (range 1-12) Sudden onset of high fever (>38.5 C) Other (flu-like) symptoms: Headache, backpain, myalgia, arthralgia, rash Similar to Dengue fever Treatment Symptoms generally resolve within 7-10 days No vaccine or medication currently available 88

89 Chikungunya health effects Possible complications Gastro-intestinal complications, cardiovascular decompensation or meningoencephalitis Fatalities have been reported mainly in aged patients or where the patient s immune system was weakened by underlying conditions 89

90 Chikungunya health impact World wide 52: Tanzania 60s: Southeast Asia: India ~ 1.39 million cases 80s: Small outbreaks: Thailand < 12,000 cases 01-07: Major outbreaks islands Indian Ocean ( 1 / 3 of population) and India ~ 1.42 million cases Europe 07: outbreak in Italy 247 cases 90

91 Chikungunya health impact Risk groups There are no particular risk groups: anyone exposed to the infected vector may become infected with the virus Vulnerable population for severe illness Pregnant women Children under 12 years old People with immune disorders or server chronic illnesses 91

92 Current distribution Chikungunya 92

93 Available warning systems Chikungunya is not a notifiable disease in most of the European countries. There is no commercial chikungunya vaccine Prevention of chikungunya is currently based on individual protection against mosquito bites 93

94 Mosquito borne disease - Dengue fever-

95 Dengue health effects Asymptomatic infections (40-80%) Clinical symptoms Mild fever Classic dengue fever Server flu-like symptoms: high fever, severe headache, pain behind the eyes, muscle and joint pains and rash Dengue haemorrhagic fever / Dengue shock <5 % of all cases, mostly children and adolescents Increase of vascular permeability that can lead to life-threatening hypovolemic shock 95

96 Dengue health impact World wide 2.5 billion people (two fifths of the world's population) are now at risk from dengue WHO estimates there may be 50 million dengue infections every year Europe Last endemic was in in Greece However, imported cases frequently reported (travellers that have visited endemic areas) 96

97 Dengue health impact Risk groups There are no particular risk groups: anyone exposed to the infected vector may become infected with the virus Since there are four virus serotypes, it is possible to get dengue multiple times within a lifetime 97

98 Current distribution - Dengue 98

99 Available warning systems Dengue is not a notifiable disease on European Union level There is no dengue vaccine, but this is an active field of research Prevention of dengue is currently based on individual protection against mosquito bites 99

100 Future situation - Chikungunya fever - - Dengue fever -

101 Future situation Current situation Europe Mosquito biting activity is highest in midafternoon. Incidental, travellers that visited endemic areas Future situation & climate change At present, no good prediction models available 101

102 What actions are needed? [1] Short term Providing information to all people traveling from the affected areas with high disease incidence Providing dengue/chikungunya virus fact sheets to physicians, as returning travelers may present with the disease, Reminding medical staff of the need to follow universally accepted precautions when handling samples from all patients Advising European Union member states on blood donation policies Assessing the capability and capacity of laboratories in Europe to diagnose dengue/chikungunya fever 102

103 What actions are needed? [2] Long term Further studies and documentation of vector competence and capacity of Ae. albopictus would be useful in areas in Europe where these vectors are known to be present. Areas at risk of vector establishment need to be identified and regularly monitored, and vector surveillance implemented or strengthened in these areas. Measures to prevent the introduction of Ae. albopictus through the used tyre trade and plants transported in water (e.g. Dracaena species) should be considered. 103

104 Summary mosquito borne [1] Aedes species (dengue and chikungunya virus) It can be concluded that the temperate strains of Aedes albopictus are here to stay and that they will spread (Southern Europe) New Aedes populations may become established in other parts of Europe Culex species (West Nile virus) Autochthonous transmission of West Nile fever in several European countries Data indicate that the epidemiology of WNV in Europe is changing 104

105 Summary mosquito borne [2] Actions Surveillance of the introduction and spread of this vector, in particular in areas at risk, is important in order to be prepared for the mosquito s role in the transmission of diseases Education of public (risk areas and travelers) and health professionals Preventive measures Health effects Treatment Advising European Union member states on blood donation policies 105

106 Module vector borne diseases Leishmaniasis sandfly borne

107 Leishmaniasis sandfly borne Leishmaniasis = disease caused by Leishmaniasis parasite Vector borne zoonotic or anthroponotic usually by the bite of a phlebotomine sandfly species Parasite reservoir hosts Wild animals (fox, rodents, wolves etc.) Domestic animals (dogs) 107

108 Transmission mode Bite by an infected sandfly Can be transmitted from mother to child Contaminated medical equipment or supply (shared syringes) 108

109 Leishmaniasis health effects Asymptomatic leishmania infections Forms of leishmaniasis CL: Cutaneous (most common) ML: Mucocutaneous VL: Visceral (most severe, affecting organs) Canine leishmaniasis (dogs) 109

110 Leishmaniasis sandfly borne 500 phlebotomine species, but only about 30 transmit leishmaniasis Only the female sandfly transmits the parasites 8 medically important in Europe 110

111 Current situation Worldwide distribution of parasite & sandflies Areas that have at least one month with a mean temperature of 20 C European distribution of parasite & sandflies South of latitude 45 o N and less than 800 m above sea level Recent data suggest that the area has been expanded 111

112 Current distribution sandfly P. papatasi P. perfiliewi P. ariasi P. neglectus/syriacus 112

113 Current distribution sandfly P. tobbi P. perniciosus P. sergenti P. similis 113

114 Leishmaniasis health impact World wide An estimated 12 million people are infected 2 million estimated new cases/year Europe Incidence of leishmaniasis in humans is relatively low ( /100,000) 700 estimated new cases/year for Southern European countries (3,950 if Turkey is included) 114

115 Leishmaniasis health impact Risk groups leishmania infections There are no specific risk groups for leishmania infections Risk groups leishmaniasis HIV-positive people (visceral leishmaniasis) Intravenous drug users who share syringes 115

116 Current distribution Leishmaniasis 116

117 MS1 Current distribution Leishmaniasis Source: Dujardin

118 Dia 117 MS1 Wellicht andere afbeelding gebruiken van WHO. Want dan dezelfde plaatjes (lay-out) als voor andere VBD. Maaike Steenhof;

119 Available warning systems Compulsory notification system Portugal: compulsory for VL Spain: compulsory for VL in 12/17 autonomous communities Greece: compulsory for VL and CL Cyprus: compulsory for VL and CL Turkey: compulsory for VL and CL 118

120 Future situation Current situation Europe Sandfly biting activity is strongly seasonal, restricted to summer months in most areas Southern Europe, below 800m above sea level Future situation & climate change Prolonged activity periods and shorter diapause periods (overwintering) Extend northwards and into higher altitudes At present, no good prediction models available 119

121 What actions are needed? Public health surveillance at the European level (compulsory notification system in all countries)? Educate the public on interventions against sandflies Further research 120

122 What actions are needed? Interventions against sandflies Insect repellents such as DEET Insecticides Use of insecticide impregnated nets and bed nets Dog: topical applications and deltamethrinimpregnated collars 121

123 What actions are needed? Further research on Alternative modes of transmission Effective vaccine for human leishmaniasis immunisation strategy for Mediterranean populations Effective vaccine for canine leishmaniasis to control the infections in vector reservoir dogs Better predictive modelling of disease transmission 122

124 Summary sandfly borne [1] Currently, Leishmaniasis infected sandflies are present in Southern Europe (max. 800m above sea level) Climate change may extend this risk area northwards and into higher altitudes Actions Surveillance of the introduction and spread of this vector 123

125 Summary sandfly borne [2] Actions (continued) Education of public (risk areas and travelers) and health professionals Preventive measures Health effects Treatment 124

126 Module vector borne diseases SUMMARY

127 Training objective To learn how to be prepared for changes in public health due to climate change Take home message Health impact Mitigation and adaptation Preventive measures on individual & community level 126

128 Summary module VBD [1] Health impact climate change Tick borne disease highest tick infection rates in central Europe may spread to northern areas Mosquito borne disease West Nile virus spatially and temporally limited. However, autochthonous transmissions. Chikungunya outbreak in Italy in In future, Southern Europe may be at risk. 127

129 Summary module VBD [2] Health impact climate change (continued) Mosquito borne disease Dengue currently not present in Europe. In future, Southern Europe may be at risk. Sandfly borne disease Leishmaniasis is endemic in Southern Europe. In future, risk area may extend northwards and into higher altitudes 128

130 Summary module VBD [3] Adaptation Surveillance of the introduction and spread of the vector, in particular in areas at risk Providing information to all people traveling from the affected areas with high disease incidence Providing fact sheets to physicians Reminding medical staff of the need to follow universally accepted precautions when handling samples from all patients 129

131 Summary module VBD [4] Adaptation (continued) Advising European Union member states on blood donation policies Assessing the capability and capacity of laboratories in Europe to diagnose vector borne disease Development of vaccines 130

132 Summary module VBD [5] Preventive measures on individual level Avoiding risk areas (if possible) When staying in affected areas Wear long-sleeved shirts and long trousers, and trousers tucked into socks Use insect repellents such as DEET If possible, sleep under bed nets pre-treated with insecticides If possible, set the air conditioning to a low temperature at night 131

133 Summary module VBD [6] When staying in affected areas (continued) Good screens on windows and doors Remove tick within 24 hours (hard ticks) 132

134 Summary module VBD [7] Preventive measures on community level Blood donation restrictions have to be considered in areas where a vector borne virus is circulating Limiting vector friendly environments (next slides) 133

135 Summary module VBD [8] Ticks Chemical treatment Natural predators like domestic cats Limiting rodent-friendly environments inside and around buildings Acaricides may be useful on domestic animals to control CCHF virus-infected ticks if used days prior to slaughter or to export of animals from enzootic regions 134

136 Summary module VBD [9] Mosquitoes Insecticides Removal of breeding sites around buildings: emptying stagnant water in and around the houses on a weekly basis Limiting vector friendly environments - sandflies Dog: topical applications and deltamethrin impregnated collars 135

137 More information Websites