Green cities and vector-borne diseases: emerging concerns and opportunities.

Aligned with the Sustainable Development Goals, nature-based solutions such as urban greening e.g. public gardens, urban forests, parks and street trees, which aim to protect, sustainably manage or restore an ecosystem, have emerged as a promising tool for improving the health and well-being of an ever-increasing urban population. While urban greening efforts have undeniable benefits for human health and the biological communities inhabiting these green zones, disease vector populations may also be affected, possibly promoting greater pathogen transmission and the emergence of infectious diseases such as dengue, West Nile fever, malaria, leishmaniosis and tick-borne diseases. Evidence for the impact of urban green areas on vector-borne disease (VBD) transmission is scarce. Furthermore, because of vast disparities between cities, variation in green landscapes and differing scales of observation, findings are often contradictory; this calls for careful assessment of how urban greening affects VBD risk. Improved understanding of the effect of urban greening on VBDs would support planning, monitoring and management of green spaces in cities to sustainably mitigate VBD risks for surrounding urban populations.

Accessibility to rabies centers and human rabies post-exposure prophylaxis rates in Cambodia: A Bayesian spatio-temporal analysis to identify optimal locations for future centers.

Rabies is endemic in Cambodia. For exposed humans, post-exposure prophylaxis (PEP) is very effective in preventing this otherwise fatal disease. The Institut Pasteur du Cambodge (IPC) in Phnom Penh was the primary distributor of PEP in Cambodia until 2018. Since then, and to increase distribution of PEP, two new centers have been opened by IPC in the provinces of Battambang and Kampong Cham. Data on bitten patients, who sometimes bring the head of the biting animal for rabies analyses, have been recorded by IPC since 2000. However, human cases are not routinely recorded in Cambodia, making it difficult to establish a human burden of disease and generate a risk map of dog bites to inform the selection of future PEP center locations in high-risk areas. Our aim was to assess the impact of accessibility to rabies centers on the yearly rate of PEP patients in the population and generate a risk map to identify the locations where new centers would be the most beneficial to the Cambodian population. To accomplish this, we used spatio-temporal Bayesian regression models with the number of PEP patients as the outcome. The primary exposure variable considered was travel time to the nearest IPC center. Secondary exposure variables consisted of travel time to a provincial capital and urban proportion of the population. Between 2000 and 2016, a total of 293,955 PEP patient records were identified. Our results showed a significant negative association between travel time to IPC and the rate of PEP patients: an increase in one hour travel time from the living location to IPC PEP centers leads to a reduction in PEP rate of 70% to 80%. Five provinces were identified as the most efficient locations for future centers to maximize PEP accessibility: Banteay Meanchey, Siem Reap, Takeo, Kampot and Svay Rieng. Adding a PEP center in every provincial capital would increase the proportion of Cambodians living within 60 minutes of a PEP center from 26.6% to 64.9%, and living within 120 minutes from 52.8% to 93.3%, which could save hundreds of lives annually.

Monitoring insecticide resistance of adult and larval Aedes aegypti (Diptera: Culicidae) in Phnom Penh, Cambodia.

BACKGROUND: Dengue fever is a major public health concern in Cambodia, with thousands of cases every year in urban, suburban and rural areas of the country. The main vector of dengue fever in Cambodia is Aedes aegypti. The organophosphate larvicide temephos and adulticides belonging to the pyrethroid family have been widely used for decades by public health authorities to fight dengue vectors, but resistance of Ae. aegypti to these insecticides has been previously described for Cambodia. METHODS: In order to adapt the vector control strategy presently used in Cambodia, we tested 14 adulticides belonging to the carbamate, organochlorine, organophosphate, and pyrethroid insecticide families and three larvicides [temephos, spinosad and Bacillus thuringiensis ser. israelensis (Bti)] belonging to three different insecticide families (organophosphates, spinosyns and entomopathogenic bacteria). The standard procedures used here to test the adults and larvae of an Ae. aegypti population from Phnom Penh followed World Health Organization guidelines. RESULTS: For adults, high mortality rates were observed with carbamate, organophosphate and organochlorine (with the exception of dichlorodiphenyltrichloroethane) insecticides (i.e. between 87.6 and 100%), while low mortality rates were observed with all of the tested pyrethroid insecticides (i.e. between 1 and 35%). For larvae, no resistance against Bti was detected [resistance ratio (RR90 < 1.6)], but moderate resistance was observed for temephos and spinosad (RR90 < 5.6). CONCLUSIONS: The results of this study indicate that (i) Bti should be considered a serious alternative to temephos for the control of Ae. aegypti larvae; and (ii) the carbamate adulticides propoxur and bendiocarb should be employed instead of the widely used pyrethroid insecticides for the control of adult Ae. aegypti on land under mosaic farming and crop rotation in Cambodia, as the insects were found to be resistant to the latter types of insecticide. Research focusing on insecticide resistance and innovative and effective vector control strategies should be undertaken as a public health priority in Cambodia.

Checklist of the mosquito fauna (Diptera, Culicidae) of Cambodia.

Between 2016 and 2020, the Medical and Veterinary Entomology unit of the Institut Pasteur du Cambodge collected over 230,000 mosquitoes. Based on this sampling effort, a checklist of 290 mosquito species in Cambodia is presented. This is the first attempt to list the Culicidae fauna of the country. We report 49 species for the first time in Cambodia. The 290 species belong to 20 genera: Aedeomyia (1 sp.), Aedes (55 spp.), Anopheles (53 spp.), Armigeres (26 spp.), Coquillettidia (3 spp.), Culex (57 spp.), Culiseta (1 sp.), Ficalbia (1 sp.), Heizmannia (10 spp.), Hodgesia (3 spp.), Lutzia (3 spp.), Malaya (2 spp.), Mansonia (5 spp.), Mimomyia (7 spp.), Orthopodomyia (3 spp.), Topomyia (4 spp.), Toxorhynchites (4 spp.), Tripteroides (6 spp.), Uranotaenia (27 spp.), and Verrallina (19 spp.). The Cambodian Culicidae fauna is discussed in its Southeast Asian context. Forty-three species are reported to be of medical importance, and are involved in the transmission of pathogens.

TITLE: Liste des moustiques (Diptera, Culicidae) du Cambodge. ABSTRACT: Entre 2016 et 2020, plus de 230 000 moustiques ont été capturés par l'Unité d'Entomologie Médicale et Vétérinaire de l'Institut Pasteur du Cambodge. Sur la base de ces collectes, une liste des 290 espèces de moustiques présentes au Cambodge est présentée. Il s'agit de la première tentative de répertorier la faune Culicidae du pays. Quarante-neuf espèces sont signalées pour la première fois au Cambodge. Les 290 espèces appartiennent à vingt genres : Aedeomyia (1 sp.), Aedes (55 spp.), Anopheles (53 spp.), Armigeres (26 spp.), Coquillettidia (3 spp.), Culex (57 spp.), Culiseta (1 sp.), Ficalbia (1 sp.), Heizmannia (10 spp.), Hodgesia (3 spp.), Lutzia (3 spp.), Malaya (2 spp.), Mansonia (5 spp.), Mimomyia (7 spp.), Orthopodomyia (3 spp.), Topomyia (4 spp.), Toxorhynchites (4 spp.), Tripteroides (6 spp.), Uranotaenia (27 spp.) et Verrallina (19 spp.). La faune des Culicidés cambodgiens est discutée dans son contexte sud-est asiatique. Quarante-trois espèces sont d'importance médicale et impliquées dans la transmission de pathogènes.

Host-Feeding Preference and Diel Activity of Mosquito Vectors of the Japanese Encephalitis Virus in Rural Cambodia.

Japanese Encephalitis (JE) is the most important cause of human encephalitis in Southeast Asia, and this zoonosis is mainly transmitted from pigs to human by mosquitoes. A better understanding of the host-feeding preference of Japanese encephalitis virus (JEV) major vectors is crucial for identifying risk areas, defining bridge vector species and targeting adapted vector control strategies. To assess host-feeding preference of JE vectors in a rural Cambodian area where JE is known to circulate, in 2017, we implemented four sessions of mosquito trapping (March, June, September, December), during five consecutive nights, collecting four times a night (6 p.m. to 6 a.m.), and using five baited traps simultaneously, i.e., cow, chicken, pig, human, and a blank one for control. In addition, blood meals of 157 engorged females trapped at the same location were opportunistically analyzed with polymerase chain reaction (PCR), using cow, pig, human, and dog blood primers. More than 95% of the 36,709 trapped mosquitoes were potential JE vectors. These vectors were trapped in large numbers throughout the year, including during the dry season, and from 6 p.m. to 6 a.m. Despite the apparent host-feeding preference of Culex vishnui, Cx. gelidus, and Cx. tritaenhyorhincus for cows, statistical analysis suggested that the primary target of these three mosquito species were pigs. Dog blood was detected in eight mosquitoes of the 157 tested, showing that mosquitoes also bite dogs, and suggesting that dogs may be used as proxy of the risk for human to get infected by JE virus.

Understanding the role of arthropod vectors in the emergence and spread of plant, animal and human diseases. A chronicle of epidemics foretold in South of France.

Southern France, like the rest of the world, is facing the emergence of diseases affecting plants, animals and humans, of which causative agents (viruses, parasites, bacteria) are transmitted by arthropod vectors. Global changes are accelerating the emergence and spread of these diseases. After presenting some examples related to vectors of yellow fever and dengue viruses (Aedes aegypti and Ae. albopictus), Crimean-Congo hemorrhagic fever (Hyalomma marginatum), Bluetongue (Culicoides sp.), and the phytopathogen Xylella fastidiosa (Hemiptera spp.), we will discuss what are the intrinsic and extrinsic factors that make an arthropod a vector in a given place and at a given time. We also propose some thoughts regarding these emergences, possible scenarios for their evolution and some recommendations for the future.

Le sud de la France, comme le reste du monde, est confronté à l'émergence de maladies affectant les plantes, les animaux et les populations humaines, dont les agents étiologiques (virus, parasites, bactéries) sont transmis par des arthropodes vecteurs. Les changements globaux auxquels nous faisons face accélèrent l'apparition et la diffusion de ces pathologies. Après avoir pris quelques exemples concernant les vecteurs des virus de la fièvre jaune et de la dengue (Aedes aegypti et Ae. albopictus), de la fièvre de Crimée-Congo (Hyalomma marginatum), de la fièvre catarrhale ovine (Culicoides sp.) et de la bactérie phytopathogène Xylella fastidiosa (Hemiptera spp.), nous verrons quels sont les facteurs intrinsèques et extrinsèques qui font qu'un arthropode devient un vecteur en un lieu et à un moment donné. Nous proposons des pistes de réflexion sur ces émergences et le possible devenir des maladies transmises par arthropodes. Nous concluons par quelques recommandations pour mieux anticiper les émergences.

Strategic Approach, Advances, and Challenges in the Development and Application of the SIT for Area-Wide Control of Aedes albopictus Mosquitoes in Reunion Island.

The global expansion of Aedes albopictus, together with the absence of specific treatment and vaccines for most of the arboviruses it transmits, has stimulated the development of more sustainable and ecologically acceptable methods for control of disease transmission through the suppression of natural vector populations. The sterile insect technique (SIT) is rapidly evolving as an additional tool for mosquito control, offering an efficient and more environment-friendly alternative to the use of insecticides. Following the devastating chikungunya outbreak, which affected 38% of the population on Reunion Island (a French overseas territory in the southwest of the Indian Ocean), there has been strong interest and political will to develop effective alternatives to the existing vector control strategies. Over the past 10 years, the French Research and Development Institute (IRD) has established an SIT feasibility program against Ae. albopictus on Reunion Island in collaboration with national and international partners. This program aimed to determine whether the SIT based on the release of radiation-sterilized males is scientifically and technically feasible, and socially acceptable as part of a control strategy targeting the local Ae. albopictus population. This paper provides a review of a multi-year and a particularly broad scoping process of establishing the scientific and technological feasibility of the SIT against Ae. albopictus on Reunion Island. It also draws attention to some prerequisites of the decision-making process, through awareness campaigns to enhance public understanding and support, social adoption, and regulatory validation of the SIT pilot tests.

Population Genetics of Phlebotomus papatasi from Endemic and Nonendemic Areas for Zoonotic Cutaneous Leishmaniasis in Morocco, as Revealed by Cytochrome Oxidase Gene Subunit I Sequencing.

Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major Yakimoff & Shokhor and transmitted by Phlebotomus papatasi (Scopoli) is a public health concern in Morocco. The disease is endemic mainly in pre-Saharan regions on the southern slope of the High Atlas Mountains. The northern slope of the High Atlas Mountains and the arid plains of central Morocco remain non-endemic and are currently considered high risk for ZCL. Here we investigate and compare the population genetic structure of P. papatasi populations sampled in various habitats in historical foci and non-endemic ZCL areas. A fragment of the mtDNA cytochrome oxidase I (CO1) gene was amplified and sequenced in 59 individuals from 10 P. papatasi populations. Haplotype diversity was probed, a median-joining network was generated (FST) and molecular variance (AMOVA) were analyzed. Overall, we identified 28 haplotypes with 32 distinct segregating sites, of which seven are parsimony informative. The rate of private haplotypes was high; 20 haplotypes (71.4%) are private ones and exclusive to a single population. The phylogenetic tree and the network reconstructed highlight a genetic structuration of these populations in two well defined groups: Ouarzazate (or endemic areas) and Non-Ouarzazate (or nonendemic areas). These groups are separated by the High Atlas Mountains. Overall, our study highlights differences in terms of population genetics between ZCL endemic and non-endemic areas. To what extent such differences would impact the transmission of L. major by natural P. papatasi population remains to be investigated.

High diversity of mosquito vectors in Cambodian primary schools and consequences for arbovirus transmission.

Only few data exist in Cambodia on mosquito diversity and their potential role as vectors. Many arboviruses, such as dengue and Japanese encephalitis, are endemic and mostly affect children in the country. This research sets out to evaluate vector relative abundance and diversity in primary schools in Cambodia in an attempt to explain the apparent burden of dengue fever, severe dengue (DEN), Japanese encephalitis (JE), other arboviral diseases and malaria among children, 15 years and under, attending selected primary schools through vector surveys. Entomological surveys were implemented in primary schools in two provinces of Cambodia to assess the potential risk of exposure of schoolchildren to mosquito vector species. Light traps and BG traps were used to collect adult mosquitoes in 24 schools during the rainy and dry seasons of 2017 and 2018 in Kampong Cham and Tboung Khmum provinces. A total of 61 species were described, including Aedes, Culex and Anopheles species. The relative abundance and biodiversity of mosquito species were dependent on the month and school. Of the 37,725 mosquitoes caught during the study, three species accounted for three-quarters of the relative abundance: Culex vishnui, Anopheles indefinitus and Culex quinquefasciatus. More importantly, nearly 90% of the mosquitoes caught in the schools were identified as potential vectors of pathogens including Japanese encephalitis, dengue, and malaria parasites. Our results showed that schools in Cambodia represent a risk for vector-borne disease transmission and highlight the importance of implementing vector control in schools in Cambodia to decrease the risk of transmission.

From Anonymous to Public Enemy: How Does a Mosquito Become a Feared Arbovirus Vector?

The past few decades have seen the emergence of several worldwide arbovirus epidemics (chikungunya, Zika), the expansion or recrudescence of historical arboviruses (dengue, yellow fever), and the modification of the distribution area of major vector mosquitoes such as Aedes aegypti and Ae. albopictus, raising questions about the risk of appearance of new vectors and new epidemics. In this opinion piece, we review the factors that led to the emergence of yellow fever in the Americas, define the conditions for a mosquito to become a vector, analyse the recent example of the new status of Aedes albopictus from neglected mosquito to major vector, and propose some scenarios for the future.

Predicting Dengue Outbreaks in Cambodia.

In Cambodia, dengue outbreaks occur each rainy season (May-October) but vary in magnitude. Using national surveillance data, we designed a tool that can predict 90% of the variance in peak magnitude by April, when typically <10% of dengue cases have been reported. This prediction may help hospitals anticipate excess patients.

How much does direct transmission between pigs contribute to Japanese Encephalitis virus circulation? A modelling approach in Cambodia.

Japanese Encephalitis (JE) is the most important cause of human encephalitis throughout Asia and the Pacific. Although JE is a vector-borne disease, it has been demonstrated experimentally that transmission between pigs can occur through direct contact. Whether pig-to-pig transmission plays a role in the natural epidemiological cycle of JE remains unknown. To assess whether direct transmission between pigs may occur under field conditions, we built two mathematical models of JE transmission incorporating vector-borne transmission alone or a combination of vector-borne and direct transmission. We used Markov Chain Monte Carlo (MCMC) techniques to estimate the parameters of the models. We fitted the models to (i) two serological datasets collected longitudinally from two pig cohorts (C1 and C2) during two periods of four months on a farm on the outskirts of Phnom-Penh, Cambodia and to (ii) a cross-sectional (CS) serological survey dataset collected from 505 swine coming from eight different provinces of Cambodia. In both cases, the model incorporating both vector-borne and direct transmission better explained the data. We computed the value of the basic reproduction number R0 (2.93 for C1, 2.66 for C2 and 2.27 for CS), as well as the vector-borne reproduction number Rpv and the direct transmission reproduction number Rpp. We then determined the contribution of direct transmission on R0 (11.90% for C1, 11.62% for C2 and 7.51% for CS). According to our results, the existence of pig-to-pig transmission is consistent with our swine serological data. Thus, direct transmission may contribute to the epidemiological cycle of JE in Cambodia. These results need to be confirmed in other eco-climatic settings, in particular in temperate areas where pig-to-pig transmission may facilitate the persistence of JE virus (JEV) during cold seasons when there are no or few mosquitoes.

Comparison of the dynamics of Japanese encephalitis virus circulation in sentinel pigs between a rural and a peri-urban setting in Cambodia.

Japanese encephalitis is mainly considered a rural disease, but there is growing evidence of a peri-urban and urban transmission in several countries, including Cambodia. We, therefore, compared the epidemiologic dynamic of Japanese encephalitis between a rural and a peri-urban setting in Cambodia. We monitored two cohorts of 15 pigs and determined the force of infection-rate at which seronegative pigs become positive-in two study farms located in a peri-urban and rural area, respectively. We also studied the mosquito abundance and diversity in proximity of the pigs, as well as the host densities in both areas. All the pigs seroconverted before the age of 6 months. The force of infection was 0.061 per day (95% confidence interval = 0.034-0.098) in the peri-urban cohort and 0.069 per day (95% confidence interval = 0.047-0.099) in the rural cohort. Several differences in the epidemiologic dynamic of Japanese encephalitis between both study sites were highlighted. The later virus amplification in the rural cohort may be linked to the later waning of maternal antibodies, but also to the higher pig density in direct proximity of the studied pigs, which could have led to a dilution of mosquito bites at the farm level. The force of infection was almost identical in both the peri-urban and the rural farms studied, which shifts the classic epidemiologic cycle of the virus. This study is a first step in improving our understanding of Japanese encephalitis virus ecology in different environments with distinct landscapes, human and animal densities.

Resistance of Aedes aegypti (Diptera: Culicidae) Populations to Deltamethrin, Permethrin, and Temephos in Cambodia.

Dengue fever is a major public health concern, including 185,000 annual cases in Cambodia. Aedes aegypti is the primary vector for dengue transmission and is targeted with insecticide treatments. This study characterized the insecticide resistance status of Ae aegypti from rural and urban locations. The susceptibility to temephos, permethrin, and deltamethrin of Ae aegypti was evaluated in accordance with World Health Organization instructions. All the field populations showed lower mortality rate to temephos compared with the sensitive strain with resistance ratio 50 (RR50) varying from 3.3 to 33.78 and RR90 from 4.2 to 47 compared with the sensitive strain, demonstrating a generalized resistance of larvae to the temephos in Cambodia. Ae aegypti adult populations were highly resistant to permethrin regardless of province or rural/urban classification with an average mortality of 0.02%. Seven of the 8 field populations showed resistance to deltamethrin. These results are alarming for dengue vector control, as widespread resistance may compromise the entomological impact of larval control operations. Innovative vector control tools are needed to replace ineffective pesticides in Cambodia.

Massive Iatrogenic Outbreak of Human Immunodeficiency Virus Type 1 in Rural Cambodia, 2014-2015.

Background: In 2014-2015, 242 individuals aged 2-89 years were newly diagnosed with human immunodeficiency virus type 1 (HIV-1) in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods: We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C virus (HCV) and hepatitis B virus (HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV. We performed amplification, sequencing, and evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed healthcare practitioner were obtained from 193 cases and 1499 controls during interviews. Results: Cases were coinfected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (<130 days) HIV infections. Phylogeny of 202 HIV env C2V3 sequences showed a 198-sample CRF01_AE strains cluster, with time to most recent common ancestor (tMRCA) in September 2013 (95% highest posterior density, August 2012-July 2014), and a peak of 15 infections/day in September 2014. Three geospatial HIV hotspots were discernible in Roka and correlated with high exposure to the practitioner (P = .04). Fifty-nine of 153 (38.6%) tested cases showed recent (<180 days) HCV infections. Ninety HCV NS5B sequences formed 3 main clades, 1 containing 34 subtypes 1b with tMRCA in 2012, and 2 with 51 subtypes 6e and tMRCAs in 2002-2003. Conclusions: Unsafe injections in Cambodia most likely led to an explosive iatrogenic spreading of HIV, associated with a long-standing and more genetically diverse HCV propagation.

Dissecting functional components of reproductive isolation among closely related sympatric species of the Anopheles gambiae complex.

Explaining how and why reproductive isolation evolves and determining which forms of reproductive isolation have the largest impact on the process of population divergence are major goals in the study of speciation. By studying recent adaptive radiations in incompletely isolated taxa, it is possible to identify barriers involved at early divergence before other confounding barriers emerge after speciation is complete. Sibling species of the Anopheles gambiae complex offer opportunities to provide insights into speciation mechanisms. Here, we studied patterns of reproductive isolation among three taxa, Anopheles coluzzii, An. gambiae s.s. and Anopheles arabiensis, to compare its strength at different spatial scales, to dissect the relative contribution of pre- versus postmating isolation, and to infer the involvement of ecological divergence on hybridization. Because F1 hybrids are viable, fertile and not uncommon, understanding the dynamics of hybridization in this trio of major malaria vectors has important implications for how adaptations arise and spread across the group, and in planning studies of the safety and efficacy of gene drive as a means of malaria control. We first performed a systematic review and meta-analysis of published surveys reporting on hybrid prevalence, showing strong reproductive isolation at a continental scale despite geographically restricted exceptions. Second, we exploited our own extensive field data sets collected at a regional scale in two contrasting environmental settings, to assess: (i) levels of premating isolation; (ii) spatio/temporal and frequency-dependent dynamics of hybridization, (iii) relationship between reproductive isolation and ecological divergence and (iv) hybrid viability penalty. Results are in accordance with ecological speciation theory predicting a positive association between the strength of reproductive isolation and degree of ecological divergence, and indicate that postmating isolation does contribute to reproductive isolation among these species. Specifically, only postmating isolation was positively associated with ecological divergence, whereas premating isolation was correlated with phylogenetic distance.

No evidence for manipulation of Anopheles gambiae, An. coluzzii and An. arabiensis host preference by Plasmodium falciparum.

Whether malaria parasites can manipulate mosquito host choice in ways that enhance parasite transmission toward suitable hosts and/or reduce mosquito attraction to unsuitable hosts (i.e. specific manipulation) is unknown. To address this question, we experimentally infected three species of mosquito vectors with wild isolates of the human malaria parasite Plasmodium falciparum, and examined the effects of immature and mature infections on mosquito behavioural responses to combinations of calf odour, human odour and outdoor air using a dual-port olfactometer. Regardless of parasite developmental stage and mosquito species, P. falciparum infection did not alter mosquito activation rate or their choice for human odours. The overall expression pattern of host choice of all three mosquito species was consistent with a high degree of anthropophily, with infected and uninfected individuals showing higher attraction toward human odour over calf odour, human odour over outdoor air, and outdoor air over calf odour. Our results suggest that, in this system, the parasite may not be able to manipulate the early long-range behavioural steps involved in the mosquito host-feeding process. Future studies are required to test whether malaria parasites can modify their mosquito host choice at a shorter range to enhance transmission.

An ecological and digital epidemiology analysis on the role of human behavior on the 2014 Chikungunya outbreak in Martinique.

Understanding the spatio-temporal dynamics of endemic infections is of critical importance for a deeper understanding of pathogen transmission, and for the design of more efficient public health strategies. However, very few studies in this domain have focused on emerging infections, generating a gap of knowledge that hampers epidemiological response planning. Here, we analyze the case of a Chikungunya outbreak that occurred in Martinique in 2014. Using time series estimates from a network of sentinel practitioners covering the entire island, we first analyze the spatio-temporal dynamics and show that the largest city has served as the epicenter of this epidemic. We further show that the epidemic spread from there through two different propagation waves moving northwards and southwards, probably by individuals moving along the road network. We then develop a mathematical model to explore the drivers of the temporal dynamics of this mosquito-borne virus. Finally, we show that human behavior, inferred by a textual analysis of messages published on the social network Twitter, is required to explain the epidemiological dynamics over time. Overall, our results suggest that human behavior has been a key component of the outbreak propagation, and we argue that such results can lead to more efficient public health strategies specifically targeting the propagation process.