Outbreak of Chikungunya fever in the Province of Ravenna:

Size: px

Start display at page:

Download "Outbreak of Chikungunya fever in the Province of Ravenna:"

Jane Ball
5 years ago
Views:

1 Outbreak of Chikungunya fever in the Province of Ravenna: social and operational aspects Séance commune Société de Pathologie Exotique Società Italiana di Medicina Tropicale 21 Avril 2008 HIA du Val-de-Grâce (Amphithéâtre Rouvillois), Paris LUCIANO VENTURI, DVM R Angelini 1, P Angelini 2, AC Finarelli 2, P Macini 2 and L Venturi 1 1 Department of Public Health, Local Health Unit, Ravenna, Italy 2 Public Health Service, Regione Emilia-Romagna, Italy

2 Botticelli, S. ( ) Canto XIX of Dante s Inferno Gore s Fever and Dante s Inferno: Chikungunya Reaches Ravenna Weissmann G., The FASEB Journal, Vol. 22, March 2008.

3 Ravenna province Km Population: Emilia-Romagna region Km Population:

4 Savio river embankment: dividing Castiglione di Cervia (left) from Castiglione di Ravenna (right)

5 Epidemiological data: update Nov. 21 th, 2007 Confirmed Prob., abs. of blood samples August 14 th Cases list (47) August 9 th first alert August 18 th First disinfestation August 31 th Chik virus detected (PCR) on mosquito samples (Castiglione di C. e Castiglione di R.) IZSLER August 29 th RegionaI surveillance system start Chik virus confirmed ISS August 23 th -27 th large scale disinfestation

6 Cases map and disinfestation areas

8 Epidemic clusters Last update Nov 11,

9 Chikungunya outbreak in Emilia-Romagna Summer 2007 Last update (16 th Jan 08) Number of cases by lab results Emilia-Romagna (July 4 th, 2007 September 28 th, 2007) Index case lab confirmed: 1 Lab confirmed: 217 Probable, drawing denied: 30 Lab negative: 89 In total, 247 probable/confirmed cases, from four provinces (Ravenna, Forlì/Cesena, Rimini, Bologna) Lab confirmed in the province of Ravenna: 170

10 REGIONAL PROGRAMME FOR THE CONTROL OF TIGER MOSQUITO AND THE PREVENTION OF CHIKUNGUNYA AND DENGUE FEVER 2008

11 CHIK - DENGUE Regional programme (an integrated strategy) Community communication Epidemiological Surveillance Prevention actions Entomological control Regional laboratory Assistance

12 Prevention of Chigungunya and Dengue in Emilia Romagna: why? Vector-borne diseases as a public health emergence Aedes albopictus diffusion in Emilia Romagna Medium/high probability that a viremic person (tourists, workers, displaced persons, refugees, soldiers. ) enter in the regional territory Clinical connection beetween Chik and Dengue added to an useful synergy of a mutual surveillance system

13 Chikungunya and Dengue joint Programme surveillance goals 1. Timely detection of every Chikungunya and Dengue cases 2. Well-timed differentiation of imported cases from autochthonous ones 3. Assessment of the registered cases and its organization into a regional monitoring system

14 Sanitary surveillance features - Standing surveillance Rapid signalling system Well-timed epidemiological investigation Prompt laboratory diagnosis - Active surveillance Scheduled contacts between Public Health Departments and National Health Service doctors : General practitioners and Pediathrics: weekly Permanent assistance field doctors, First aid, daily

15 Control Programme balance Minus: Absence of a national surveillance system A complicated plot between administrative and technical institutions.. Plus: Solid experience rised from last year epidemic A well-established practice in surveillance of communicable diseases: rapid signalling system running since 2006 A Regional Health System based on an high cohesion of all its components

16 Scenario Phase 0 no cases or imported cases only Phase 1 one authochtonous case or one small cluster (< 30 cases) Phase 2 one big outbreak (> 30 cases) or many small clusters Phase 3 many big outbreaks or registred epidemic

Ae. Albopictus is present on the 80% of the regional territory: A zone (white): no Tiger Mosquito B zone (yellow): Tiger Mosquito, but no cases C zone (red): area with two or more autochtonous cases

17 Ae. Albopictus is present on the 80% of the regional territory: A zone (white): no Tiger Mosquito B zone (yellow): Tiger Mosquito, but no cases C zone (red): area with two or more autochtonous cases in This area is identified with administrative territories (Municipality, neighbourhood, hamlet.) D zone (red): area where local transmission of viruses is registred in 2008, it is iditenfied with one or more municipal territory

18 Autochthonous cases prevention - Phase 0 no cases or inported cases only Tiger Mosquito control Sanitary surveillance A zone B zone C zone Surveillance only Standing surveillance Routine action Standing surveillance Extraordinary action (in areas identified starting from cases of 2007) Active surveillance (from april to june) Autochthonous cases prevention - Phase 1 one autochthnous case or a small outbreak of autochthnous cases Tiger Mosquito control Sanitary surveillance A zone B zone D zone Surveillance only Standing surveillance Routine action Standing surveillance Extraordinary action (within a radius of 300 mt. around every case) Active surveillance (from april to october)

19 Autochthonous cases prevention - Phase 2 one large scale outbreak (> 30 cases) or many small outbreaks Tiger Mosquito control Sanitary surveillance A zone B zone C zone Surveillance only Standing surveillance Routine action Active surveillance (from ap. to oct.) Extraordinary action (within a radius of 300 mt. around every case) Active surveillance (from april to october) Autochthonous cases prevention - Phase 3 many large outbreaks or epidemic vith high attack rate Tiger Mosquito control Sanitary surveillance A zone B zone C zone Surveillance only Standing surveillance Extraordinary action ( other interventions!?!) Active surveillance (from ap. to oct.) Extraordinary action (within a radius of 300 mt. around every case + other interventions!?!) Active surveillance (from april to october)

20 Regional surveillance system of Tiger Mosquito infestation The monitoring of the Tiger Mosquito s eggs is an indirect method of surveillance that helps to obtain information on the development of the population of Adults

21 Regional surveillance system of Tiger Mosquito infestation Based on ovitraps Activated some years ago in many Municipalities It has been organized as regional system since 2006 All Provinces included

22 Ovitraps positioning: by experts of the Public Health Department and Municipalities: in consideration of the need for homogeneous distribution after assessing the microclimate conditions of the selected site Samples are collected weekly, and are analysed by the laboratory network of the Regional Environmental Agency (ARPA) Data are published every week on the website

23 In the Emilia-Romagna Region were positionated 1664 ovitraps for Tiger Mosquito in 2007

24 Distribution of ovitrap for Tiger Mosquito in Emilia Romagna pre-chikungunya

25 Distribution of ovitrap for Tiger Mosquito in Emilia Romagna post-chikungunya

26 Regional surveillance system of TM infestation: 2763 improvements Increase of ovitraps number to obtain comparable and locally representative estimates at provincial level for Municipality with an urbanized area above 600 ha

27 To obtain comparable and representative estimates at provincial level Tot 1640

28 In the Emilia-Romagna Region, for Tiger Mosquito in 2008, are going to be positionated: 2763 ovitraps the optimal number of ovitraps is: 1640

29 Goals CHIK and animals? DSP-AUSL RA / INRA / IZSLER Data collection on a possible (!) role of domestic and wild animals as reservoirs of Chik-V Research target Domestic animals (dogs and poultry) living in the epidemic area of Castiglione di Cervia Wild and free animals (free pigeons and coypus) captured in the environs of Castiglione di Cervia and Castiglione di Ravenna

30 Methods Sampling data (March April 2008) 120 free pigeons 10/15 coypus (nutria) 60 dogs from epidemic area and 30 dogs from a disease free area (control samples) 10/20 poultry places (80/120 chickens, minimum) an anamnestic sheet for every sampling site

31 Lab/Epi investigations IZSLER headquarter, Brescia (I): celisa Samples sent also to the Institut National de la Recherche Agronomique (INRA), St. Genès Champanelle (F): seroneutralisation Epidemiological data elaboration ( field sheets)

32 When they told us it was Chikungunya, it was not a problem for Ravenna any more. But I thought: this is a big problem for Europe. R Angelini (Director of Public Health, Ravenna). New York Times, Dec. 23, 2007

UNDERSTANDING THE ENVIRONMENTAL DRIVERS INFLUENCING THE EPIDEMIOLOGICAL RISK OF VECTOR BORNE DISEASES

UNDERSTANDING THE ENVIRONMENTAL DRIVERS INFLUENCING THE EPIDEMIOLOGICAL RISK OF VECTOR BORNE DISEASES Paola Angelini, Alba Carola Finarelli, Andrea Mattivi, Roberto Cagarelli Public Health Department D.G.