Health behaviors of the Sierra de Cádiz. Myths and beliefs?

INTRODUCTION: Throughout history, the practice and persistence of health behaviours and attitudes based on traditional medicine have been observed. OBJECTIVES: To determine whether there are health myths and beliefs in the study population, to describe these myths and beliefs, to determine whether they have persisted over time and to compile the most common myths and beliefs in Sierra de Cádiz. METHODOLOGY: This is a descriptive, observational, cross-sectional study. Our data collection tool was a questionnaire completed by 45 health care professionals in the study area. RESULTS: A total of 73.3% of the population had health-related myths or beliefs, of which 70% resorted to healers and the use of a herpes remedy. CONCLUSIONS: This study opens and motivates new research lines and highlights the need to develop educational campaigns and implement health-education programmes in which traditional medicine is involved.

Using (+)-Carvone to access novel derivatives of (+)-ent-Cannabidiol: the first asymmetric syntheses of (+)-ent-CBDP and (+)-ent-CBDV.

(-)-Cannabidiol [(-)-CBD] has recently gained prominence as a treatment for neuro-inflammation and other neurodegenerative disorders; interest is also developing in its synthetic enantiomer, (+)-CBD, which has a higher affinity to CB1 / CB2 receptors than the natural stereoisomer. We have developed an inexpensive, stereoselective route to access ent-CBD derivatives using (+)-carvone as a starting material. In addition to (+)-CBD, we report the first syntheses of (+)-cannabidivarin, (+)-cannabidiphorol as well as C-6 / C-8 homologues.

Evidence that Passerine Birds Act as Amplifying Hosts for Usutu Virus Circulation.

Environment determines the distribution and prevalence of vector-borne pathogens due to its direct and indirect effects on the hosts, vectors, and pathogens. To investigate the relationship between Usutu virus occurrence and host biodiversity and to characterize the nidus of infection, we used field-based measures of host diversity and density (all birds and only passerines), vector abundance, landscape and Usutu virus prevalence (mosquito infection rate), an emergent disease with a similar cycle to West Nile virus. We collected 908,237 female mosquitoes in an area of 54,984 ha in the Doñana National Park, southern Spain. We identified the mosquitoes and screened them for viruses, censused birds, characterized landscape and climatic variables, and then modeled the presence and infection rate of the virus in relation to host, vector, climatic, and landscape variables. Monthly Usutu presence, detected in Culex perexiguus, was positively related to Passeriformes richness and secondarily to NDVI in the previous month. Our results suggest that Usutu prevalence may be higher when and where host (passerine) richness was high, and thus challenging the conventional idea that host biodiversity reduces flavivirus amplification.

Survey of Crimean-Congo Hemorrhagic Fever Enzootic Focus, Spain, 2011-2015.

During 2011-2015, we conducted a Crimean-Congo hemorrhagic fever virus (CCHFV) survey in captured ticks that were feeding mainly on wild and domestic ungulates in Spain, where presence of this virus had been reported previously. We detected CCHFV RNA in Hyalomma lusitanicum and H. marginatum ticks for 3 of the 5 years. The rate of infected ticks was 2.78% (44/1,579), which was similar to those for other countries in Europe with endemic foci for CCHFV (Kosovo, Bulgaria, and Albania). These data confirm the established spread of CCHFV into western Europe. Phylogenetic study of the small RNA segment showed Africa-3 clade as the only genotype identified, although we observed cocirculation of genetic variants during 2011 and 2015. We could not rule out genetic reassortments because of lack of sequence data for the medium and large RNA segments of the virus genome.

First Evidence of Antibodies Against Lloviu Virus in Schreiber's Bent-Winged Insectivorous Bats Demonstrate a Wide Circulation of the Virus in Spain.

Although Lloviu virus (LLOV) was discovered in the carcasses of insectivorous Schreiber's Bent-winged bats in the caves of Northern Spain in 2002, its infectivity and pathogenicity remain unclear. We examined the seroprevalence of LLOV in potentially exposed Schreiber's Bent-winged bats (n = 60), common serotine bats (n = 10) as controls, and humans (n = 22) using an immunoblot assay. We found antibodies against LLOV GP2 in all of Schreiber's Bent-winged bats serum pools, but not in any of the common serotine bats and human pools tested. To confirm this seroreactivity, 52 serums were individually tested using Domain Programmable Arrays (DPA), a phage display based-system serology technique for profiling filovirus epitopes. A serological signature against different LLOV proteins was obtained in 19/52 samples tested (36.5%). The immunodominant response was in the majority specific to LLOV-unique epitopes, confirming that the serological response detected was to LLOV. To our knowledge, this is the first serological evidence of LLOV exposure in live captured Schreiber's Bent-winged bats, dissociating LLOV circulation as the cause of the previously reported die-offs.

Identification of Novel Betaherpesviruses in Iberian Bats Reveals Parallel Evolution.

A thorough search for bat herpesviruses was carried out in oropharyngeal samples taken from most of the bat species present in the Iberian Peninsula from the Vespertilionidae, Miniopteridae, Molossidae and Rhinolophidae families, in addition to a colony of captive fruit bats from the Pteropodidae family. By using two degenerate consensus PCR methods targeting two conserved genes, distinct and previously unrecognized bat-hosted herpesviruses were identified for the most of the tested species. All together a total of 42 potentially novel bat herpesviruses were partially characterized. Thirty-two of them were tentatively assigned to the Betaherpesvirinae subfamily while the remaining 10 were allocated into the Gammaherpesvirinae subfamily. Significant diversity was observed among the novel sequences when compared with type herpesvirus species of the ICTV-approved genera. The inferred phylogenetic relationships showed that most of the betaherpesviruses sequences fell into a well-supported unique monophyletic clade and support the recognition of a new betaherpesvirus genus. This clade is subdivided into three major clades, corresponding to the families of bats studied. This supports the hypothesis of a species-specific parallel evolution process between the potentially new betaherpesviruses and their bat hosts. Interestingly, two of the betaherpesviruses' sequences detected in rhinolophid bats clustered together apart from the rest, closely related to viruses that belong to the Roseolovirus genus. This suggests a putative third roseolo lineage. On the contrary, no phylogenetic structure was detected among several potentially novel bat-hosted gammaherpesviruses found in the study. Remarkably, all of the possible novel bat herpesviruses described in this study are linked to a unique bat species.

Chikungunya virus infections among travellers returning to Spain, 2008 to 2014.

Since the first documented autochthonous transmission of chikungunya virus in the Caribbean island of Saint Martin in 2013, the infection has been reported within the Caribbean region as well as North, Central and South America. The risk of autochthonous transmission of chikungunya virus becoming established in Spain may be elevated due to the large numbers of travellers returning to Spain from countries affected by the 2013 epidemic in the Caribbean and South America, as well as the existence of the Aedes albopictus vector in certain parts of Spain. We retrospectively analysed the laboratory diagnostic database of the National Centre for Microbiology, Institute of Health Carlos III (CNM-ISCIII) from 2008 to 2014. During the study period, 264 confirmed cases, of 1,371 suspected cases, were diagnosed at the CNM-ISCIII. In 2014 alone, there were 234 confirmed cases. The highest number of confirmed cases were reported from the Dominican Republic (n = 136), Venezuela (n = 30) and Haiti (n = 11). Six cases were viraemic in areas of Spain where the vector is present. This report highlights the need for integrated active case and vector surveillance in Spain and other parts of Europe where chikungunya virus may be introduced by returning travellers.

Real time PCR assay for detection of all known lineages of West Nile virus.

West Nile virus (WNV) is one of the most widespread arbovirus and a large variety of WNV strains and lineages have been described. The molecular methods for the diagnosis of WNV target mainly lineages 1 and 2, which have caused outbreaks in humans, equines and birds. But the last few years new and putative WNV lineages of unknown pathogenicity have been described. Here we describe a new sensitive and specific real-time PCR assay for the detection and quantification of all the WNV lineages described until now. Primers and probe were designed in the 3'-untranslated region (3'-UTR) of the WNV genome and were designed to match all sequenced WNV strains perfectly. The sensitivity of the assay ranged from 1,5 to 15 copies per reaction depending on the WNV lineage tested. The method was validated for WNV diagnosis using different viral strains, human samples (cerebrospinal fluid, biopsies, serum and plasma) and mosquito pools. The assay did not amplify any other phylogenetically or symptomatically related viruses. All of the above make it a very suitable tool for the diagnosis of WNV and for surveillance studies.

Concurrent Infection With Dengue Type 4 and Plasmodium falciparum Acquired in Haiti.

We report one laboratory-confirmed coinfection by dengue type 4 and Plasmodium falciparum imported to Spain from Haiti. Diagnosis was made by real-time polymerase chain reaction (RT-PCR), serology, quantitative buffy coat, and thick blood smear. In areas where both infections are present, diagnosis of both diseases should be considered because a delay in the treatment of malaria could be fatal.

Early detection of dengue virus by use of reverse transcription-recombinase polymerase amplification.

A method for the rapid diagnosis of early dengue virus (DENV) infection is highly needed. Here, a prototype reverse transcription-recombinase polymerase amplification (RT-RPA) assay was developed. The assay detected DENV RNA in <20 min without the need for thermocycling amplification. The assay enabled the detection of as few as 10 copies of DENV RNA. The designed RT-RPA primers and exo probe detected the DENV genome of at least 12 genotypes of DENV circulating globally without cross-reacting with other arboviruses. We assessed the diagnostic performance of the RT-RPA assay for the detection of DENV RNA in 203 serum samples of patients with clinically suspected dengue. The sera were simultaneously tested for DENV using a reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay, quantitative RT-PCR (qRT-PCR), and IgM- and IgG-capture enzyme-linked immunosorbent assays (ELISA). Acute DENV infection was confirmed in 130 samples and 61 of the samples (46.9%) were classified as viremic with qRT-PCR. The RT-RPA assay showed good concordance (κ of ≥0.723) with the RT-LAMP and qRT-PCR assays in detecting the dengue viremic samples. When used in combination with ELISA, both the RT-RPA and RT-LAMP assays increased the detection of acute DENV infection to ≥95.7% (≥45/47) in samples obtained within 5 days of illness. The results from the study suggest that the RT-RPA assay is the most rapid molecular diagnostic tool available for the detection of DENV. Hence, it is possible to use the RT-RPA assay in a laboratory to complement routine serology testing for dengue.

Wide detection of Aedes flavivirus in north-eastern Italy--a European hotspot of emerging mosquito-borne diseases.

The pattern of flavivirus infection in mosquitoes belonging to the genera Aedes and Culex collected in two regions of north-eastern Italy (Trentino and Veneto) was assessed. Mosquitoes were collected during 2012 and screened for flaviviruses using a generic reverse transcription-nested-PCR targeted on a region of the non-structural NS5 gene. The phylogenetic analysis was performed on a fragment of ~1000 bp. Virus isolation was attempted in C6/36 insect cell lines and the infected cell cultures were studied by electron microscopy. We detected a wide distribution of Aedes flavivirus (AeFV) in Aedes albopictus, with higher infection prevalence in Trentino than in Veneto. In Culex pipiens collected in Veneto, we detected a new sequence of an insect-specific flavivirus and one of Usutu virus. Interestingly, we detected AeFV in C. pipiens, for the first time to our knowledge, in both regions. Viral isolation in cell culture was successful for AeFV. AeFV sequences found in Veneto showed a high percentage of similarity to those detected in Trentino and to those previously reported in other areas of northern Italy. Co-infections with different flaviviruses were not detected.

Genetic and evolutionary characterization of Venezuelan equine encephalitis virus isolates from Argentina.

Venezuelan equine encephalitis viruses (VEEV) are emerging pathogens of medical and veterinary importance circulating in America. Argentina is a country free from epizootic VEEV activity, with circulation of enzootic strains belonging to Rio Negro virus (RNV; VEEV subtype VI) and Pixuna virus (PIXV, VEEV subtype IV). In this work, we aim to report the sequencing and phylogenetic analyses of all Argentinean VEE viruses, including 7 strains previously isolated from mosquitoes in 1980, 5 sequences obtained from rodents in 1991 and 11 sequences amplified from mosquitoes between 2003 and 2005. Two genomic regions, corresponding to the non-structural protein 4 (nsP4) and the protein E3/E2 (PE2) genes were analyzed, but only 8 samples could be amplified in the last one (longer and more variable fragment of 702 bp). For both genomic fragments, phylogenetic trees showed the absence of lineages within RNV group, and a close genetic relationship between Argentinean strains and the prototype strain BeAr35645 for PIXV clade. The analysis of nsP4 gene opens the possibility to propose a possible geographic clustering of strains within PIXV group (Argentina and Brazil). Coalescent analysis performed on RNV sequences suggested a common ancestor of 58.3 years (with a 95% highest posterior density [HPD] interval of 16.4-345.7) prior to 1991 and inferred a substitution rate of 9.8×10(-5)substitutions/site/year, slightly lower than other enzootic VEE viruses. These results provide, for the first time, information about genetic features and variability of all VEEVs detected in Argentina, creating a database that will be useful for future detections in our country. This is particularly important for RNV, which has indigenous circulation.

Diagnosis of west nile virus human infections: overview and proposal of diagnostic protocols considering the results of external quality assessment studies.

West Nile virus, genus Flavivirus, is transmitted between birds and occasionally other animals by ornithophilic mosquitoes. This virus also infects humans causing asymptomatic infections in about 85% of cases and <1% of clinical cases progress to severe neuroinvasive disease. The virus also presents a threat since most infections remain unapparent. However, the virus contained in blood and organs from asymptomatically infected donors can be transmitted to recipients of these infectious tissues. This paper reviews the presently available methods to achieve the laboratory diagnosis of West Nile virus infections in humans, discussing the most prominent advantages and disadvantages of each in light of the results obtained during four different External Quality Assessment studies carried out by the European Network for 'Imported' Viral Diseases (ENIVD).

Desarrollo de un método de transcripción inversa seguida de reacción en cadena de la polimerasa para la detección del virus de la fiebre amarilla / Development of a reverse transcription polymerase chain reaction method for yellow fever virus detection

Introduction. Yellow fever is considered a re-emerging disease and is endemic in tropical regions of Africa and South America. At present, there are no standardized or commercialized kits available for yellow fever virus detection. Therefore, diagnosis must be made by time-consuming routine techniques, and sometimes, the virus or its proteins are not detected. Furthermore, co-circulation with other flaviviruses, including dengue virus, increases the difficulty of diagnosis. Objective. To develop a specific reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR-based assay to improve the detection and diagnosis of yellow fever virus using both serum and fresh tissue samples. Materials and methods. RT-PCR primers were designed to amplify a short fragment of all yellow fever virus genotypes reported. A second set of primers was used in a nested PCR to increase sensitivity. Thirty-three clinical samples were tested with the standardized reaction. Results. The expected amplicon was obtained in 25 out of 33 samples analyzed using this approach, and 2 more samples tested positive after a subsequent nested PCR approach. Conclusion. This improved technique not only ensures the specific detection of a wide range of yellow fever virus genotypes but also may increase the sensitivity of detection by introducing a second round of amplification, allowing a rapid differential diagnosis between dengue and yellow fever infection, which is required for effective surveillance and opportune epidemiologic measures.

Introducción. La fiebre amarilla se considera una enfermedad reemergente y endémica en regiones tropicales de África y Suramérica. Actualmente, no existen estuches estandarizados o comerciales disponibles para la detección del virus de la fiebre amarilla y, por lo tanto, el diagnóstico debe hacerse mediante técnicas de rutina que consumen mucho tiempo y algunas veces no garantizan la detección del virus o de sus proteínas. Además, la cocirculación con otros flavivirus, incluyendo el del dengue, hacen el diagnóstico más complicado. Objetivo. Desarrollar un ensayo específico de amplificación basado en transcripción inversa seguida de reacción en cadena de la polimerasa, con el fin de mejorar la detección y el diagnóstico de la fiebre amarilla, tanto a partir de suero como de tejido fresco. Materiales y métodos. Se diseñaron iniciadores específicos para amplificar un fragmento conservado del virus de la fiebre amarilla. Un segundo par de iniciadores se usó en una reacción de amplificación anidada para incrementar la sensibilidad. Se probaron 33 muestras clínicas con la técnica estandarizada. Resultados. El amplímero esperado se obtuvo en 25 de las 33 muestras analizadas usando este método y 2 más resultaron positivas después de la reacción anidada. Conclusión. Esta técnica mejorada garantiza la detección de todos los genotipos virales de fiebre amarilla y puede incrementar la sensibilidad del ensayo introduciendo una segunda etapa de amplificación, lo cual permite el diagnóstico diferencial con infección por dengue y otros flavivirus, lo cual es de gran importancia para la vigilancia y la toma de medidas epidemiológicas oportunas.

San Juan de Dios, la implementación de una cultura de cuidados / S. João de Deus, a implementação de uma cultura da care / San Juan de Dios, implementationa culture of care

A lo largo de este trabajo analizaremos la influencia de San Juan de Dios en la sanidad, ya que en diferentes y múltiples bases de datos aparecen publicaciones donde se manifiesta y menciona al Santo de San Juan de Dios como un contribuidor de los cuidados a enfermos. Objetivo: Describir las aportaciones y repercusiones de San Juan de Dios en los cuidados de los enfermos, realizando para ello una reflexión analítica sobre los mismos y valorando si existe un paralelismo con la realidad actual sanitaria. Metodología: Realización de una revisión bibliográfica mediante una búsqueda sistemática de los términos: San Juan de Dios, Cuidados, Cultura y Enfermo, en las bases de datos: Enfispo, Dialnet, PubMed, Cuiden, Cochrane Plus, Scielo y Biblioteca Virtual del Sistema Sanitario Público Andaluz, y posterior análisis reflexivo de la investigación documental existente. Conclusiones: Las contribuciones aportadas por San Juan de Dios suponen la implementación de una nueva cultura de cuidados, referentes tanto a organización como a cambios en las formas de concebir la enfermedad, que aún hoy en día en la actualidad siguen vigente (AU)

Throughout this paper we analyze the influence of St. John of God in healing, because in different and multiple databases appear manifest and publications which mentioned the Holy of St. John of God as a contributor to the care of the sick. Objective: Describe the contributions and impact of San Juan de Dios in the care of the sick, it made for an analytical reflection on them and evaluating whether there is a parallel with the current reality health. Methodology: Performing a literature review through a systematic search of the terms: St. John of God, Care, Culture and Sick in databases: ENFISPO, Dialnet, PubMed, Cochrane Library SciELO and Virtual Andalusian Public Health System, and subsequent reflective analysis of existing documentary research. Conclusions: The contributions of San Juan de Dios involve the implementation of a new culture of care, concerning both organization and to changes in the ways of conceiving the disease, which even today still existing today (AU)

Ao longo deste trabalho, analisar a influência de S. João de Deus na cura, porque em bancos de dados diferentes e múltiplas aparecer manifesto e publicações que mencionaram o Santo de São João de Deus, como um contribuinte para o cuidado dos doentes. Objetivo: Descrever as contribuições e impacto de San Juan de Dios no cuidado dos enfermos, feita para uma reflexão analítica sobre eles e avaliar se existe um paralelo com a atual realidade da saúde. Metodologia: Realizar uma revisão bibliográfica através de uma pesquisa sistemática dos termos: São João de Deus, Cuidado, Cultura e Doentes das bases de dados: ENFISPO, Dialnet, PubMed, SciELO e Cochrane Biblioteca Virtual da Andaluzia Sistema Único de Saúde, e posterior análise reflexiva de pesquisa documental existente. Conclusões: As contribuições de San Juan de Dios envolvem a implementação de uma nova cultura de atendimento, tanto em termos de organização e às mudanças nas formas de conceber a doença, que ainda hoje existente hoje (AU)

Toscana virus infection in Catalonia (Spain).

Toscana virus (TOSV), an arthropod-borne phlebovirus, is an important agent of acute meningitis and meningoencephalitis in the Mediterranean area. The epidemiology of the infection in humans in Catalonia is at present unknown. In this study, we found a seroprevalence of infection of 6%, and 2 clinical cases were detected by serology and/or PCR.

Development of a reverse transcription polymerase chain reaction method for yellow fever virus detection.

INTRODUCTION: Yellow fever is considered a re-emerging disease and is endemic in tropical regions of Africa and South America. At present, there are no standardized or commercialized kits available for yellow fever virus detection. Therefore, diagnosis must be made by time-consuming routine techniques, and sometimes, the virus or its proteins are not detected. Furthermore, co-circulation with other flaviviruses, including dengue virus, increases the difficulty of diagnosis. OBJECTIVE: To develop a specific reverse transcriptase-polymerase chain reaction (RT-PCR) and nested PCR-based assay to improve the detection and diagnosis of yellow fever virus using both serum and fresh tissue samples. MATERIALS AND METHODS: RT-PCR primers were designed to amplify a short fragment of all yellow fever virus genotypes reported. A second set of primers was used in a nested PCR to increase sensitivity. Thirty-three clinical samples were tested with the standardized reaction. RESULTS: The expected amplicon was obtained in 25 out of 33 samples analyzed using this approach, and 2 more samples tested positive after a subsequent nested PCR approach. CONCLUSION: This improved technique not only ensures the specific detection of a wide range of yellow fever virus genotypes but also may increase the sensitivity of detection by introducing a second round of amplification, allowing a rapid differential diagnosis between dengue and yellow fever infection, which is required for effective surveillance and opportune epidemiologic measures.

Detection of a new insect flavivirus and isolation of Aedes flavivirus in Northern Italy.

BACKGROUND: During recent years, numerous novel 'insect flaviviruses' have been discovered in natural mosquito populations. In a previous study we described the presence of flavivirus DNA sequences integrated in Aedes albopictus (Asian tiger mosquito) populations from Northern Italy in 2007. METHODS: During 2008 we collected and tested Aedes females for flavivirus presence and developed phylogenetic analysis, virus isolation, electron microscopy studies and RNAse treatments. RESULTS: We detected a high prevalence of flavivirus in Ae. albopictus (77.5%). The phylogenetic analysis identified the insect flavivirus sequences as Aedes flavivirus (AEFV) recently described in Japan, and that may have been introduced in Italy travelling with the tiger mosquito. Some of these pools grew in C6/36 cells, producing cytopathic effects, and the RNase treatment results showed the presence of the detected sequences in RNA forms. Furthermore, we detected a new insect flavivirus in one pool of Aedes cinereus/geminus mosquitoes. Phylogenetic analysis of this virus shows that it forms a distinct cluster within the clade of insect flavivirus. CONCLUSIONS: This is the first study to report a high prevalence, to describe the seasonal activity and an isolation of the insect flavivirus Aedes flavivirus in Europe. Moreover we describe the detection of a new insect flavivirus detected from Ae. cinereus mosquitoes from Italy. These flavivirus may be common, ubiquitous and diverse in nature and we discuss the implications of the insect flavivirus group in virus evolution and transmission.

Epidemiología molecular de los virus Dengue / Molecular epidemiology of Dengue virus

El dengue es la enfermedad viral más importante transmitida por mosquitos a humanos por su alta morbimortalidad y el potencial de diseminación de su vector Aedes aegypti. Además, la falta de una vacuna y medicamentos antivirales específicos, así como el incremento progresivo de las infecciones secundarias y la hiperendemicidad en diferentes países, hacen de esta enfermedad un problema de salud pública. Existen cuatro serotipos del virus del dengue (DENV), dentro de cada serotipo se han descrito varios genotipos, constituidos a su vez por diferentes linajes o clados. La epidemiología molecular combina los análisis filogenéticos de los DENV detectados en un área geográfica, en un tiempo definido, con la información clínica y epidemiológica disponible. El objetivo de estos estudios es tratar de establecer asociaciones entre genotipos o linajes virales con el origen (ancestros), procedencia geográfica, ruta de transmisión viral, severidad de la enfermedad, grupos poblacionales afectados, y la intensidad y extensión de los brotes epidémicos. La epidemiología molecular ha generado información relevante como la etiología del DENV genotipo Asiático en los casos graves de dengue de la epidemia ocurrida en Venezuela en 1989, y la identificación de cambios nucleotídicos puntuales en el genoma viral asociados a propiedades biológicas fundamentales. En la actualidad se hace necesario realizar análisis exhaustivos del genoma viral completo, conjuntamente con el análisis bioinformático, biológico, clínico y epidemiológico de los cuatro serotipos circulantes en los países endémicos, así como instaurar en los laboratorios adscritos a los sistemas de vigilancia epidemiológica del dengue, la vigilancia molecular para la identificación de genotipos (o linajes) circulantes, lo que contribuiría entre otros aspectos al control efectivo de la enfermedad por DENV.

Dengue is the most important viral disease transmitted by mosquitoes to humans in tropical and subtropical regions of the world. This is the result of its high morbidity and mortality, the spread potential of the vector Aedes aegypti, the lack of effective vaccines and specific antiviral drugs, the gradual increase in secondary infections and hyperendemicity differences in distinct countries. There are four serotypes of dengue virus which are phylogenetically grouped in genotypes and subdivided in lineages or clades. Molecular epidemiology combines phylogenetic analysis of DENV detected in particular geographic areas within a defined time with the available clinical and epidemiologic information. The objective of these studies is to look for relationships between genotypes or lineages, viral origin, geographical spreading and routes of viral transmission, disease severity, population groups affected, and the intensity, speed and extent of outbreaks. Also, molecular epidemiology has generated relevant information such as the Asian genotype DENV etiology in cases of the severe dengue epidemic in Venezuela in 1989, and the identification of specific nucleotide changes in the viral genome associated with its fundamental biological properties. However, analysis of the complete viral genome, together with bioinformatic, biological, clinical and epidemiological analysis corresponding to the four serotypes circulating in endemic countries should be performed. Molecular surveillance for the identification of genotypes (or strains) circulating should be implemented in the laboratories responsible for the epidemiological surveillance of dengue, which would improve the effective control of DENV.

Blood meal analysis, flavivirus screening, and influence of meteorological variables on the dynamics of potential mosquito vectors of West Nile virus in northern Italy.

An extended area of northern Italy has experienced several West Nile virus (WNV) outbreaks and the emergence of Usutu virus (USUV) during previous years. Our aim was to study some of the factors that could explain disease patterns in the Trentino region, where circulation was detected in human sera and sentinel chickens, but no human or equine cases were reported. We collected Culex species (Diptera: Culicidae) in peridomestic environments. The collected specimens were analyzed for feeding behavior, the influence of temperature and rainfall on the abundance of mosquitoes, and the occurrence of flaviviruses. Analysis of blood meals showed that Culex pipiens fed mainly on blackbirds (Turdus merula) and house sparrows (Passer domesticus), while Culex hortensis fed strictly on lizards. The abundance of Cx. pipiens females correlated positively with mean temperature and negatively with rainfall (one to four weeks before capture). This negative relationship could be due to the direct effect of the flushing of habitats together with an indirect effect of oviposition repellency. The mean weekly temperature influenced the abundance of Cx. hortensis. No flaviviruses were detected in the analyzed Culex mosquitoes. These data suggest a silent cycle at low enzootic transmission levels in the area. Furthermore, we present the first contribution to understanding the transmission role of Cx. pipiens mosquitoes in Italy by identifying vertebrate hosts to species level.