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

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1 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. Health and Social Policies Romeo Bellini, Marco Carrieri, Alessandro Albieri Centro Agricoltura Ambiente G. Nicoli

2 Tiger mosquito surveillance system and the prevention of Chikungunya and Dengue Mosquito surveillance in rural areas and the risk of West Nile virus transmission

3 Chikungunya outbreak in Emilia-Romagna Summer 2007 Last update (16th Jan 08) Number of cases by lab results (July 4 th, 2007 September 28 th, 2007) Index case lab confirmed: 1 Lab confirmed: 7 Probable, drawing denied: 30 Lab negative: 89 A total of 247 probable/confirmed cases, from four provinces (Ravenna, Forlì-Cesena, Rimini, Bologna)

4 Quantitative monitoring of Aedes albopictus -2,700 ovitraps in the urban centres - density to achieve a precision D = checked every two weeks for 11 weeks/year - cost: 0,000 /year (~ 5% of the total plan cost)

6 Weeks No egg/trap/14 days

7 N.females/15 min Correlation between Human Landing Collection and number of eggs 4,5 4,0 Confidence 95% 3,5 3,0 2,5 2,0 1,5 1,0 R 2 =0.81, df=1.8, F=34., P< , N. eggs/ovitrap/14 days 7

8 Egg densities and R 0 at summer temperature 6 5 R 0 = 4 4 R 0 = 3 R 0 3 R 0 = 2 2 R 0 = 1 1 R 0 = N. eggs / ovitrap /14 days 8

9 41 % Municipalities with R 0>3 % Municipalities with average number of eggs supportive R0>3 % CHIK_M DEN II CHIK 30% % 20% 15% 10% 5% 0% Weeks

10 CHIK MUTATED CHIK DEN II By Provinces Piacenza Parma Reggio Emilia R Modena Bologna Ferrara R Ravenna Forlì-Cesena Rimini R Piacenza Parma Reggio Emilia R Modena Bologna Ferrara R Ravenna Forlì-Cesena Rimini R Piacenza Parma Reggio Emilia R Modena Bologna Ferrara R Ravenna Forlì-Cesena Rimini R0

11 Active sanitary surveillance system for the identification of Chik/Dengue imported cases in Emilia-Romagna Year Total report Chikungunya confirmed cases Dengue confirmed cases

12 References Bonilauri P. et al Chikungunya virus in Aedes albopictus, Italy. Emerg. Infect. Dis. 14(5): Angelini R. et al Chikungunya in north-eastern Italy: a summing up of the outbreak. Euro Surveill.; 12:E Albieri A. et al Quantitative monitoring of Aedes albopictus in Emilia-Romagna, Northern Italy: cluster investigation and geostatistical analysis. Bulletin of Insectology 63(2): Bellini R., et al The possible role of entomological surveillance in mosquito-borne disease prevention. Italian Journal of Tropical Medicine 16 (3-4): -47. Carrieri et al Surveillance of the chikungunya vector Aedes albopictus (Skuse) in Emilia- Romagna (northern Italy): organizational and technical aspects of a large scale monitoring system. J. Vector Ecol. 36(1): Bellini R., et al Impact of Chikungunya virus on Aedes albopictus females and possibility of vertical transmission using the actors of the 2007 outbreak in Italy. PLoS ONE 7(2): e doi:10.11/journal.pone Carrieri, M. et al Aedes albopictus (Diptera: Culicidae) population size survey in 2007 Chikungunya outbreak area in Italy. I: Characterization of breeding sites and evaluation of sampling methodologies. J. Med. Entomol. 48(6): (2011); Carrieri M. et al Aedes albopictus (Diptera: Culicidae) population size survey in the 2007 Chikungunya outbreak area in Italy. II: estimating epidemic thresholds. J. Med. Entomol. 49(2): 388-9; Carrieri et al. Bioecology of Aedes albopictus females (Diptera: Culicidae) and risk assessment for Chikungunya and Dengue viruses transmission in Northern Italy (in press)

13 Tiger mosquito surveillance system and the prevention of Chikungunya and Dengue Mosquito surveillance in rural areas and the risk of West Nile virus transmission

Culex pipiens Entomological surveillance gravid trap CO2

identified at species level and were pooled according to

individuals per pool Mosquito pools and bird samples were

14 Culex pipiens Entomological surveillance gravid trap CO2 trap Fortnightly collection Collected mosquitoes were identified at species level and were pooled according to date, location, and species, with a maximum number of 200 individuals per pool Mosquito pools and bird samples were tested by a real-time PCR, according to the method of Tang et al. (2006).

15 Distribution of mosquito traps in CO2 traps + 16 gravid traps

16 Total number of mosquito pools sampled in 2013 for every species

17 Entomological surveillance results 2013 data Province First human case date WNND onset date WNF onset date First WNV positive mosquito pool Anticipation days of mosquito viral circulation respect to human onset date MO 03 Aug 14 Aug 3 Jul FE 06 Aug 13 Sep 17 Jul 20 BO 15 Aug 24 Aug 17 Jul RE 16 Aug - 17 Jul 30 PR 11Sep 01 Sep 19 Jul 54 RA Jul PC Aug FC - - Aug Entomological surveillance showed viral circulation on average 32,5 days before the first human case

18 Human cases of WNV Human cases of WNV and Cx.pipiens density Human cases WNV PROV. WNF WNND Total BO FE MO PR RE Total Human cases and KDE of WNV circulation Human cases and NLDA of WNV circulation

19 Vector Index Vector Index VI i species NiPi N number of Culex pipiens for traps for night P infected mosquitoes (MLE/1000) 1,000 0,900 0,800 0,700 0,600 0,500 0,400 0,300 0,200 0,100 0,000 BO FE MO PC PR RE V.I. = settimane Season 2013

20 Vector Index Medio (28- sett) Vector Index Max Province Cases/ * Mean Vector Index (28-^ week) Max Vector Index Reggio Emilia 1, ,81 Modena 1, ,94 Ferrara 1, ,87 Parma 0, ,55 Bologna 0, ,63 In each Province, we found a strong correlation between reported human case number and Vector Index (mean and maximum value). Piacenza , Ravenna , Forlì-Cesena Rimini * Population considered: Residents in Municipality under 100 mt a.s.l y = 0.85x R 2 = y = 1.40x + 0. R 2 = Log (1+casi per ab) Log (1+casi per ab)

21 19 AGO 04 SET 14 AGO 28 AGO 19 SET SCENARIO A - HYPOTETICAL STARTING BLOOD DONATION SCREENING AFTER FIRST WNND CASE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER PIACENZA PARMA REGGIO EMILIA MODENA BOLOGNA FERRARA LEGENDA START OF BLOOD DONATION SCREENING (HYPOTETICAL) WNND CONFIRMED CASE ALERT (NOTIFICATION) DATE TOTAL NUMBER OF TESTED DONATIONS IN HYPOTETICAL SCENARIO

22 17 LUG 17 LUG LUG 08 AGO 19 AGO 26 LUG LUG 04 SET 03 LUG 17 LUG LUG 14 AGO 17 LUG 26 LUG 08 AGO 28 AGO 19 LUG LUG 14 AGO 19 SET 13 AGO AGO 26 AGO SCENARIO B REAL SITUATION STARTING BLOOD DONATION SCREENING AFTER FIRST ENTOMOLOGICAL EVIDENCE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER PIACENZA PARMA REGGIO EMILIA MODENA BOLOGNA FERRARA LEGENDA WNND CONFIRMED CASE ALERT DATE START OF BLOOD DONATION SCREENING (REAL) POSITIVE MOSQUITOES POOL DATE POSITIVE MOSQUITOES POOL COMMUNICATION DATE

23 17 LUG 17 LUG LUG 08 AGO 19 AGO 26 LUG LUG 04 SET 03 LUG 17 LUG LUG 03 AGO 07 AGO 14 AGO 17 LUG 26 LUG 08 AGO 28 AGO 19 LUG LUG 14 AGO 13 SET 19 SET 13 AGO AGO 26 AGO 08 SET SCENARIO B REAL SITUATION + «INTERCEPTED» STARTING BLOOD DONATION SCREENING AFTER FIRST ENTOMOLOGICAL EVIDENCE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER PIACENZA PARMA REGGIO EMILIA MODENA BOLOGNA FERRARA LEGENDA WNND CONFIRMED CASE ALERT START OF BLOOD DONATION SCREENING (REAL) POSITIVE MOSQUITOES POOL DATE POSITIVE MOSQUITOES POOL COMMUNICATION DATE IDENTIFIED DONOR BEFORE FIRST WNND CASE («INTERCEPTED») IDENTIFIED DONOR BEFORE FIRST WNND CASE. NOT CLASSIFIED AS «INTERCEPTED» BECAUSE RESIDENT IN MANTOVA, WHERE BLOOD CONTROL WAS ALREADY ACTIVE AT THE TIME.

24 References Angelini P. et al West Nile virus circulation in Emilia-Romagna, Italy: the integrated surveillance system Euro Surveill. 2010;15(16):pii=19547; Calzolai M, et al Evidence of Simultaneous Circulation of West Nile and Usutu Viruses in Mosquitoes Sampled in Emilia Romagna Region (Italy) in PLoS ONE 5(12): e doi:10.11/journal.pone Calzolari M. et al Arboviral survey of mosquitoes in two Northern Italian regions in 2007 and Vector-Borne and Zoonotic Diseases DOI: =vbz Calzolari M, et al Mosquito, Bird and Human Surveillance of West Nile and Usutu Viruses in Emilia-Romagna Region (Italy) in PLoS ONE 7(5): e doi:10.11/journal.pone Calzolari M et al Usutu Virus Persistence and West Nile Virus Inactivity in the Emilia-Romagna Region (Italy) in PLoS ONE 8(5): e678. doi:10.11/journal.pone Bellini R, Zeller H, Van Bortel W A review of the vector management methods to prevent and control West Nile virus outbreaks in Europe. Parasites and Vectors. 2014; (accepted) Bellini et al. The experience of West Nile virus integrated surveillance system in the Emilia-Romagna region: 5 years of implementation. Submitted

WNV, Italian approach. Simonetta Pupella

WNV, Italian approach. Simonetta Pupella WNV, Italian approach Simonetta Pupella I, the undersigned speaker, declare that in carrying out the function stated above at this event, I do not have any personal or third-party commercial interests,