EU Parliament Office for Science and Technology- AVIESAN Work shop
Brussels, 19 June 2012
Arboviral diseases and the threats for Europe
Herve ZellerEmerging and vector-borne disease programme
Biological transmissionViremic natural hostCompetent vectorSensitive host
Mechanical transmission
Arthropod-borne diseases
Blood and
tissue donation
Public concer
nLimited
knowledge
Disease:
Increase
Why do we bother?
Outbreaks: media attention
Sensitive issue
Control issues
Some examples of emergence in Europe
Chikungunya feverItaly 2007 France 2010
West Nile feverItaly 2008, Greece Turkey 2010
Crimean Congo hemorrhagic feverTurkey 2002, Greece 2008India 2009, Spain 2011
Bluetongue2006-2007 multi-
countries Schmallenberg2011 multi-countries
Dengue France 2010
Vector-borne diseases
Situation Disease* Pathogen Vector
1 2 X 3 X X 4 X X
5 X X X: present; X: absent; *Acquired through local (autochthonous) transmission
Braks et al. (2011) Towards an integrated approach in surveillance of vector-borne diseases in Europe. Parasites & Vectors 04:192
• Arbovirosis in tropical/subtropical regions (Asia, Americas)• Expansion in Africa, Middle-East• 1st cause of hospitalisation of children in South East Asia • Emerging /reemerging disease (WHO, 1993)
Dengue
Source: http://www.pdvi.org/about_dengue/GBD.asp
908 15497122174
295554
479848
925896
12796681451083
2204516
0
500000
1000000
1500000
2000000
2500000
55-59 60-69 70-79 80-89 90-99 00-07 2008 2009 2010
Period or year
Num
ber o
f cas
es
Dengue Population at risk 3.6 billion
Endemic countries 125
Infections /year 70- 500 millions
Severe Cases 2.1 millionsDeaths/ year 21,000
Source: http://www.pdvi.org/about_dengue/GBD.asp
Average number of Dengue cases reported to WHO per year
Global Dengue Risk map 2012
Simmons CP et al. N Engl J Med 2012;366:1423-1432
O Schwartz, Pasteur Institute 100 nm
Chikungunya
TogaviridaeAlphavirus
«which bends up»
in Makonde dialect
Febrile illness witharthralgia +++(long lasting)
Chikungunya outbreak 2005-2006 La Reunion
2006
2005
Population: 750 000
Emergence of a virus with a mutation that increases the rate of transmission by the local mosquito vectors
Þmajor outbreak infection of 35% population
Chikungunya outbreak in Italy, Aug 2007: Location of the outbreak
Emilia-Romagna region
1995 2000
2005 2011
Mosquito vector spread distribution
Are Aedes albopictus or other mosquito speciesfrom northern Italy competent to sustain newarboviral outbreaks? Medical and Veterinary Entomology (2010) 24, 83–87 Talbalhi S et al
Invasive mosquito species in EuropeAe. aegyptiAe. albopictusAe. japonicusAe. koreicus
West Nile fever
Natural cycle between birds and mosquitoes
Human infection• Asymptomatic infections (>70%)• Mild febrile illness• Neuro-invasive illness in 1 out of
150-300 cases (mostly in elderly) with fatalities
Country 2010No cases No areas
2011No cases No areas
Greece 262* 11 69 (101)
11
Hungary 17 13 3 3Italy 3 2 14 7Romania 52 19 10 5Spain 2 1
Albania 2 1FYROM 4 1Ukraine 8 3Russian Federation 519 8 153 6Turkey 47 15 3 3Israel 88 5 34 4Tunisia 3 1
Affected countries/areas in 2011 (/2010)
* Case fatality rate among patients with neuroinvasive illness: 18% (elderly)
Risk of transmissio
n through blood donations
Cases in horses:
Spain, Italy, Greece…
Tick-Borne EncephalitisAnnually 2,000–3,000 TBE-cases reported from the European countries. 6,000–8,000 cases reported from Russia
Vaccine available
Average number of cases per 100.000 inhabitants
Level of endemicity
Will be notifiable in 2013
Crimean Congo Haemorrhagic fever
EID 2010, 16, No. 8 • August 2010 K Zakhashvili et al
Hyalomma marginatum
Clinical description: Crimea 1944-45
Virus isolation : 1956: human in Congo 1967: ticks in Crimea, Russia
CFR 5=30% Nosocomial infections, BSL 4 virusNo disease in animals
Crimean-Congo Hemorrhagic fever: a Re-emerging disease in Europe
Nosocomial infections
• Kosovo 2001 • Bulgaria 2008• Turkey 2008
• Bulgaria 2009
www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18952 ; 18845; 18953
2008
• Greece • Bulgaria• Turkey• Russia
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
250
500
750
1000
1250
1500
17
133249 266
438
717
1315
1318
868
6 13 13 27 33 6361
Number of cases of CCHF reported in Turkey 2001-2010
Fatal cases
Year
Num
ber o
f cas
es
Distribution of Crimean-Congo Hemorrhagic Fever virus
CCHFV isolation Serology + Hyaloma vectors
Hyaloma vectors
Adapted from Bray, 2007 and Ergonul, 2007
ECDC mission
• Identify, assess and communicate current and emerging threats to human health from communicable diseases.
Addedvalue forEurope
Provides Member States with access to expertise, topical assessments of disease risks and decision support tools with the latest scientific knowledge
ECDC’s role in shaping the EU research agenda
Surveillance and control of vector-borne diseases
ENVIRONMENT
SUSCEPTIBLEHOST COMPETEN
TVECTOR
PATHOGEN
SURVEILLANCE
PREVENTION
CONTROL
Conclusions
Vector-borne diseases are a growing concern in Europe Orphan diseases, lack of knowledgeSurveillance not uniform in EU, not always mandatoryDiagnostic tools to improveControl issues: Development of more effective tools to prevent and control outbreaksNew developments for antiviral drugs and vaccines
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
Thank for your attention
