Arbovirus outbreaks perspectives for Europeprepare.ersnet.org/lrmedia/2016/pdf/279.pdf · Outbreak...
16
08/03/2016 1 PREPAREing for (Re-)Emerging Arbovirus Infections in Europe Arbovirus outbreaks perspectives for Europe Herve Zeller, Emerging and vector-borne disease programme, ECDC, Stockholm, SE. Surveillance and control of vector-borne diseases ENVIRONMENT SUSCEPTIBLE HOST COMPETENT VECTOR PATHOGEN
Transcript of Arbovirus outbreaks perspectives for Europeprepare.ersnet.org/lrmedia/2016/pdf/279.pdf · Outbreak...
08032016
1
PREPAREing for (Re-)Emerging Arbovirus Infections in Europe
Arbovirus outbreaks perspectives for Europe
Herve Zeller Emerging and vector-borne disease programme ECDC Stockholm SE
Surveillance and control of vector-borne diseases
ENVIRONMENT
SUSCEPTIBLEHOST
COMPETENTVECTOR
PATHOGEN
08032016
2
Diseases under surveillancehellip
Vector-borne diseases
Malaria
West Nile fever Yellow fever Chikungunya Zikahellip
Viral haemorrhagic fevers (dengue Rift valley fever
Crimean-Congo Haemorrhagic fever)
Leishmaniasis sandfly fevers
Tick-borne encephalitis Lyme borreliosis
Rickettsiosis Mediterranean spotted fever (R conorii) anaplasmosis
Louse borne diseases LB relasping fever (Borrelia reccurentis)
Bartonella quintanatrench fever typhus
Plague
Zoonosis and others
Hantavirus Q fever tularaemia rabies
Viral haemorrhagic fevers (Ebola Marburg Lassa other arenaviruseshellip)
Poxviruses Bornavirus schistosomiasishellip
Other vector-borne viral threats
Bluetongue
Schmallenberg 2013
related to Akabane
Tinaroo Aino hellip
Culicoides
08032016
3
Understanding the diseases
Evidence based information (timelinessquality)
Support for early detection and response to outbreaks
Modelling approaches =gtto assess the risks
Predictive indicators which trigger outbreaks
Human behaviours
Prevention and Control
Preparedness plans (include communication)
Vector control new strategies expertise and training
Cost-effectiveness analysis of vector control to contain disease outbreaks
Arbovirus surveillance and control challenges
SurveillanceEarly warningPreparedness
bull Routine surveillancebullSyndromicsurveillancebullLaboratory surveillance
bull Epidemic Intelligencebull Rapid risk assessmentbull Event Assessmentbull Public Communication
bullThreat analysesbullVulnerability and gap analysesbullDetailed cross-sectoralplanningbullCrisis management and simulation exercisesbullMonitoring and evaluation of plans
Outbreak Response Assistance
RecoveryResponsePreparedness
Recovery
Crisis Mgt and Response Evaluation
Lessons identified -gt case studiesbull Outbreak
investigationbullCase-control studies
Prevention
bullRisk factor assessmentbullCohort studiesbullEpidemiological modellingbullEvidence-based medicine and systematic reviews
Prevention
Preparedness within public health
08032016
4
West Nile risk assessment tool
httpecdceuropaeuenhealthtopicswest_nile_feverWest-Nile-fever-mapspagesindexaspx
West Nile fever
Strengthening Preparedness
bull WN virus Risk Assessment tool Support Member States in defining criteria for
triggering an alert for potential WNV transmission to humans
defining an affected area withat risk for WNV transmission to humans
declaring a transmission zone lsquofreersquo of further viral transmission
bullWN fever mapping tool Provide Member States with
timely and accurate information to support deferral decision-making
about risks related to local transmission and returning travellers
(at the smallest spatial level to limit shortage of blood supplies)
bullEuropean Up-Front Risk Assessment tool (EUFRAT)
bullAid Member States quantifying the risk of transmission of emerging infectiousdiseases from blood transfusion during outbreak events
08032016
5
Madeira Dengue 1 outbreakOctober 2012-January 2013Attack rate 810100 000 no severe cases78 cases in mainland Europe
Cumulative incidence rate of probable and confirmed cases RAM 26 September 2012 ndash 03 March 2013 (n=2 090)
CIR cumulative Incidence Rate
Residents of RAM
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
2
Diseases under surveillancehellip
Vector-borne diseases
Malaria
West Nile fever Yellow fever Chikungunya Zikahellip
Viral haemorrhagic fevers (dengue Rift valley fever
Crimean-Congo Haemorrhagic fever)
Leishmaniasis sandfly fevers
Tick-borne encephalitis Lyme borreliosis
Rickettsiosis Mediterranean spotted fever (R conorii) anaplasmosis
Louse borne diseases LB relasping fever (Borrelia reccurentis)
Bartonella quintanatrench fever typhus
Plague
Zoonosis and others
Hantavirus Q fever tularaemia rabies
Viral haemorrhagic fevers (Ebola Marburg Lassa other arenaviruseshellip)
Poxviruses Bornavirus schistosomiasishellip
Other vector-borne viral threats
Bluetongue
Schmallenberg 2013
related to Akabane
Tinaroo Aino hellip
Culicoides
08032016
3
Understanding the diseases
Evidence based information (timelinessquality)
Support for early detection and response to outbreaks
Modelling approaches =gtto assess the risks
Predictive indicators which trigger outbreaks
Human behaviours
Prevention and Control
Preparedness plans (include communication)
Vector control new strategies expertise and training
Cost-effectiveness analysis of vector control to contain disease outbreaks
Arbovirus surveillance and control challenges
SurveillanceEarly warningPreparedness
bull Routine surveillancebullSyndromicsurveillancebullLaboratory surveillance
bull Epidemic Intelligencebull Rapid risk assessmentbull Event Assessmentbull Public Communication
bullThreat analysesbullVulnerability and gap analysesbullDetailed cross-sectoralplanningbullCrisis management and simulation exercisesbullMonitoring and evaluation of plans
Outbreak Response Assistance
RecoveryResponsePreparedness
Recovery
Crisis Mgt and Response Evaluation
Lessons identified -gt case studiesbull Outbreak
investigationbullCase-control studies
Prevention
bullRisk factor assessmentbullCohort studiesbullEpidemiological modellingbullEvidence-based medicine and systematic reviews
Prevention
Preparedness within public health
08032016
4
West Nile risk assessment tool
httpecdceuropaeuenhealthtopicswest_nile_feverWest-Nile-fever-mapspagesindexaspx
West Nile fever
Strengthening Preparedness
bull WN virus Risk Assessment tool Support Member States in defining criteria for
triggering an alert for potential WNV transmission to humans
defining an affected area withat risk for WNV transmission to humans
declaring a transmission zone lsquofreersquo of further viral transmission
bullWN fever mapping tool Provide Member States with
timely and accurate information to support deferral decision-making
about risks related to local transmission and returning travellers
(at the smallest spatial level to limit shortage of blood supplies)
bullEuropean Up-Front Risk Assessment tool (EUFRAT)
bullAid Member States quantifying the risk of transmission of emerging infectiousdiseases from blood transfusion during outbreak events
08032016
5
Madeira Dengue 1 outbreakOctober 2012-January 2013Attack rate 810100 000 no severe cases78 cases in mainland Europe
Cumulative incidence rate of probable and confirmed cases RAM 26 September 2012 ndash 03 March 2013 (n=2 090)
CIR cumulative Incidence Rate
Residents of RAM
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
3
Understanding the diseases
Evidence based information (timelinessquality)
Support for early detection and response to outbreaks
Modelling approaches =gtto assess the risks
Predictive indicators which trigger outbreaks
Human behaviours
Prevention and Control
Preparedness plans (include communication)
Vector control new strategies expertise and training
Cost-effectiveness analysis of vector control to contain disease outbreaks
Arbovirus surveillance and control challenges
SurveillanceEarly warningPreparedness
bull Routine surveillancebullSyndromicsurveillancebullLaboratory surveillance
bull Epidemic Intelligencebull Rapid risk assessmentbull Event Assessmentbull Public Communication
bullThreat analysesbullVulnerability and gap analysesbullDetailed cross-sectoralplanningbullCrisis management and simulation exercisesbullMonitoring and evaluation of plans
Outbreak Response Assistance
RecoveryResponsePreparedness
Recovery
Crisis Mgt and Response Evaluation
Lessons identified -gt case studiesbull Outbreak
investigationbullCase-control studies
Prevention
bullRisk factor assessmentbullCohort studiesbullEpidemiological modellingbullEvidence-based medicine and systematic reviews
Prevention
Preparedness within public health
08032016
4
West Nile risk assessment tool
httpecdceuropaeuenhealthtopicswest_nile_feverWest-Nile-fever-mapspagesindexaspx
West Nile fever
Strengthening Preparedness
bull WN virus Risk Assessment tool Support Member States in defining criteria for
triggering an alert for potential WNV transmission to humans
defining an affected area withat risk for WNV transmission to humans
declaring a transmission zone lsquofreersquo of further viral transmission
bullWN fever mapping tool Provide Member States with
timely and accurate information to support deferral decision-making
about risks related to local transmission and returning travellers
(at the smallest spatial level to limit shortage of blood supplies)
bullEuropean Up-Front Risk Assessment tool (EUFRAT)
bullAid Member States quantifying the risk of transmission of emerging infectiousdiseases from blood transfusion during outbreak events
08032016
5
Madeira Dengue 1 outbreakOctober 2012-January 2013Attack rate 810100 000 no severe cases78 cases in mainland Europe
Cumulative incidence rate of probable and confirmed cases RAM 26 September 2012 ndash 03 March 2013 (n=2 090)
CIR cumulative Incidence Rate
Residents of RAM
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
4
West Nile risk assessment tool
httpecdceuropaeuenhealthtopicswest_nile_feverWest-Nile-fever-mapspagesindexaspx
West Nile fever
Strengthening Preparedness
bull WN virus Risk Assessment tool Support Member States in defining criteria for
triggering an alert for potential WNV transmission to humans
defining an affected area withat risk for WNV transmission to humans
declaring a transmission zone lsquofreersquo of further viral transmission
bullWN fever mapping tool Provide Member States with
timely and accurate information to support deferral decision-making
about risks related to local transmission and returning travellers
(at the smallest spatial level to limit shortage of blood supplies)
bullEuropean Up-Front Risk Assessment tool (EUFRAT)
bullAid Member States quantifying the risk of transmission of emerging infectiousdiseases from blood transfusion during outbreak events
08032016
5
Madeira Dengue 1 outbreakOctober 2012-January 2013Attack rate 810100 000 no severe cases78 cases in mainland Europe
Cumulative incidence rate of probable and confirmed cases RAM 26 September 2012 ndash 03 March 2013 (n=2 090)
CIR cumulative Incidence Rate
Residents of RAM
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
5
Madeira Dengue 1 outbreakOctober 2012-January 2013Attack rate 810100 000 no severe cases78 cases in mainland Europe
Cumulative incidence rate of probable and confirmed cases RAM 26 September 2012 ndash 03 March 2013 (n=2 090)
CIR cumulative Incidence Rate
Residents of RAM
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
6
DA Focks et al J Med Entomol 1993
Temperature and Ae aegypti population
MJ Hopp et al Climatic Change 2001
New generations of Ae aegypti
Survival of Ae aegypti
Temp gt 22oC
Temp gt 13oC
Temp gt 18oC
2007 2008 2009 2010 2011 2012 2013 2014
Dengue and Chikungunyaautochthonous transmission in the EU
Italy
Dengue
France France
France Croatia France France
MadeiraPortugal
Chikungunya
France 2014
4 autochthonous dengue cases
443 confirmed imported chikungunya cases
11 autochthonous chikungunya casesSept-October (one neighbourhood)
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
7
Seasonality dengue fever
0
50
100
150
200
250
300
350
400
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Nu
mb
er
of
case
s2008
2009
2010
2011
2012
2013
TESSy data
Airport-level final destination of international travellers from dengue affected areas (endemic and epidemic) by quarter for 2010 overlaid with the presence of Ae albopictus 2010
Semenza JC et al (2014) PlosS Negl Trop Dis 8(12) e3278
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
8
Dengue a concern in the EU
Strengthening surveillance and reporting of human cases
bull Harmonized EU case definition
bull Early reporting
bull Laboratory capacity building (EQAhellip)
Strengthening Aedes mosquito surveillance and control programmes
bull For prevention of introduction and establishment of invasive mosquitoes
bull For reduction of the risk of transmission in areas where invasive mosquitoes have become established
Importance of predictive models for preparedness
Challenges
Sustainability of vector surveillance programmes
Vector control tools (=gtneeds for assessments of control measures)
httpecdceuropaeuenhealthtopicsvectorsvector-mapsPagesVBORNET_mapsaspx
Harmonization of surveillance protocols and training
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
9
Available online at wwwecdceuropaeu
wwwparasitesandvectorscom
httpwwweurowhointenhealth-topicscommunicable-diseasesvector-borne-and-parasitic-diseasespublications2013regional-framework-for-surveillance-and-control-of-invasive-mosquito-vectors-and-re-emerging-vector-borne-diseases-20142020_recache
ECDC Guidelines for the surveillance of invasive and native mosquitoes
WHO Framework for surveillance
10
E3 European Environment and Epidemiology network
Inte-grate
Inter-pret
AnalyseMerge
Epidemic intelligence
and surveillance(ECDC WHO)
Environmental and land-use
data(eg EEA
SEIS EDEN)
Demographic and
socio-economic data
(Eurostat)
Semenza JC Menne B Lancet ID 20099365-75
to promote geospatial infectious disease modelling in Europe and its integration in Public health
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
10
European Environmental Agency
httprstbroyalsocietypublishingorgcontentroyptbsuppl20130130rstb20120250DC1rstb20120250supp1pdf
Modelled length of transmission season
for Chikungunya in Europe
(dynamic preview)
Set of key information for risk assessment about Public Health threat in Europe
Data depository
European Environment Epidemiology
22httpse3geoportalecdceuropaeuSitePagesHomeaspx
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
11
Tick vectors of CCHF
Flying ticks anciently evolved associations that constitute a risk of infectious disease spread de la Fuente et al Parasit Vectors 2015 Oct 158538 doi 101186s13071-015-1154-1
TICKS
Modelling the candidate areas where active surveys should be performed to check for changes in the tickrsquos population status
Estrada-Pentildea A et al The Impact of Climate Trends on a Tick Affecting Public Health A Retrospective ModelingApproach for Hyalomma marginatum (Ixodidae) PLoS One 2015 May 810(5)e0125760 doi 101371journalpone0125760 eCollection 2015
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
12
Map of West Nile fever outbreaks by year Europe
and neighbouring countries between 2002 and 2011
number of WNF presence notification by year over the study period (2002ndash2011)
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Map of predicted probability of WNV infection based on environmental predictors 2012 2013
Tran AL International Journal of Health Geographics 2014 1326 doi1011861476-072X-13-26
Reported human cases in 2012 and 2013
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
13
ECDC ndash E3 -EPOC ndash Dengue and Mosquitoes project 2010-2011Suitability map based on environmental variable
Aedes albopictus
No prediction
Non-linear discriminant analysis (average of 100 bootstrap models) Done with eRiskMapper version 114 (produced by the Tala research group David Morley David Rogers and Luigi Sedda University of Oxford Dept of Zoology)
Most of Europe is predicted unsuitable for dengue but the red areas here major towns and cities indicate suitability for dengue
Predictions mainly driven by both high human population densities in cities and thermal conditions that coincide with other places globally where dengue occurs
Rogers DJ et al Acta Tropica 129 (2014) 1ndash 14
2014
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
14
Challenges for surveillance and controlof diseases transmitted by Aedes invasive species
bull Areas under surveillance
bull Critical period
bull Clinicians awareness
bull Laboratory capacity
bull Communication
bull Vector control measures
Risk matrix of scenarios for Zika virus in Europe
Probability
High
- Increased frequency of sporadic entry of Zika infected travellers
Medium
-Sporadic autochthonous sexual Zika transmission
-Sporadic autochthonous transmission of Zika by Aedes albopictus
LowLarge autochthonous transmission of Zika by Aedes albopictus
Low MediumImpact
High
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
15
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Scenario Description
Zika outbreak plateaus in Americas but increased frequency of travel to the Americas leads to increased importation of Zika-infected cases
European citizens with no travel history to the Americas acquire sexually-transmitted Zika virus infection
Sporadic autochthonous Zika transmission in Europe in area of high Ae albopictusabundance
High vector abundance and vector capacity in conjunction with permissive climate leading to large outbreak of autochthonous transmission
Risk drivers for monitoring assessment
Epidemic curve in Americas
Air traffic passenger data from Zika outbreak regions
Number of Zika infected patients in Europe
Time windows for Zika sexual transmission
Anticipated vector abundance (based on climate forecasts)
Monitor new scientific developments on vector competencecapacity
Role of asymptomatics in Zika transmission
Vector resistance to biocides
Description of scenarios
Increased frequency of sporadicimportation of Zika cases
Sporadicautochthonous sexual Zika transmission
Sporadic autochthonous transmission of Zika by Aedes albopictus
Large autochthonous transmission of Zika by Aedes albopictus
Media and publicattention
Moderate the plight of
specific travellers raises concern about safety of travellers and the efficiency of healthcare systems for treating them
High concern about
sexual Zika transmission (eg whether asymptomaticscan also transmit)
High (primarily in areas with active mosquito) bull questions about
impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
Very High(primarily in areas with active mosquito) bull potential negative
impact on tourism to European areas with Ae albopictus
bull questions about impact on pregnant women and how to protect citizens
bull questions on vector distribution and control
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
08032016
16
Conclusions
Vector-borne diseases limited knowledge and growing concern Surveillance not uniform in EU not always mandatory
Diagnostic tools to improve
Treatmentvaccine to develop
Control issues needs for more effective tools to prevent and control outbreaks
Monitoring drivers of infectious diseases can help predict vector-borne disease threats
Promote integrated approaches for a better understanding and
knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats targeted preventive measures and control activities
