Chikungunya virus outbreak in Sint Maarten: Long-term arthralgia after a 15-month period.

BACKGROUND & OBJECTIVES: The first chikungunya (CHIK) epidemic in the Americas was reported in December 2013. Chikungunya virus (CHIKV) causes an acute febrile illness and is transmitted to humans by Aedes mosquitoes. Although earlier studies have described long-term clinical manifestations of CHIK patients infected with the East/Central/South African (ECSA) genotype, little is known about persistent manifestations in the Caribbean region, for which the Asian genotype is responsible. The objective of this study was to describe the presence of persisting clinical manifestations, specifically arthralgia, in CHIKV-infected patients on the Caribbean Island, Sint Maarten, 15 months after onset of the disease. METHODS: This retrospective cohort study included confirmed CHIK patients that were recorded by the participating general practitioners (GPs) during the chikungunya outbreak in 2014 in Sint Maarten. Between March and July 2015, 15 months after the onset of disease, patients were interviewed via telephone about the presence, duration and impact of clinical CHIKV manifestations. RESULTS: In total, 56 patients were interviewed (median age 47 yr), of which 30 (54%) were females. Out of the total interviewed patients, 52 (93%) reported arthralgia for the first three months after the disease onset, of which 23 (44%) patients reported to have persistent arthralgia, 15 months after the disease onset. Pain intensity of persistent arthralgia was perceived as mild in the majority of patients (n = 14; 60%), moderate in 7 (30%) patients and severe in 2 (9%) patients. During the acute phase of disease, most patients had to miss school or work (n = 39; 72%) due to clinical CHIKV manifestations and reported a negative impact on daily activities (n = 36; 57%). INTERPRETATION & CONCLUSION: Results suggested that persisting arthralgia is a frequent complication in CHIK patients included in the study. Future research on strain-specific clinical long-term manifestations and on their impact on daily life of patients, in the form of a comparative study between patients and controls, is recommended.

Louse-borne relapsing fever (Borrelia recurrentis) in asylum seekers from Eritrea, the Netherlands, July 2015.

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by Borrelia recurrentis was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients. Physicians should be aware of the possibility of B. recurrentis infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

No evidence for the persistence of Schmallenberg virus in overwintering mosquitoes.

In 2011, Schmallenberg virus (SBV), a novel member of the Simbu serogroup, genus Orthobunyavirus, was identified as the causative agent of a disease in ruminants in Europe. Based on the current knowledge on arthropods involved in the transmission of Simbu group viruses, a role of both midges and mosquitoes in the SBV transmission cycle cannot be excluded beforehand. The persistence of SBV in mosquitoes overwintering at SBV-affected farms in the Netherlands was investigated. No evidence for the presence of SBV in 868 hibernating mosquitoes (Culex, Anopheles, and Culiseta spp., collected from January to March 2012) was found. This suggests that mosquitoes do not play an important role, if any, in the persistence of SBV during the winter months in northwestern Europe.

Risk assessment of vector-borne diseases for public health governance.

OBJECTIVES: In the context of public health, risk governance (or risk analysis) is a framework for the assessment and subsequent management and/or control of the danger posed by an identified disease threat. Generic frameworks in which to carry out risk assessment have been developed by various agencies. These include monitoring, data collection, statistical analysis and dissemination. Due to the inherent complexity of disease systems, however, the generic approach must be modified for individual, disease-specific risk assessment frameworks. STUDY DESIGN: The analysis was based on the review of the current risk assessments of vector-borne diseases adopted by the main Public Health organisations (OIE, WHO, ECDC, FAO, CDC etc…). METHODS: Literature, legislation and statistical assessment of the risk analysis frameworks. RESULTS: This review outlines the need for the development of a general public health risk assessment method for vector-borne diseases, in order to guarantee that sufficient information is gathered to apply robust models of risk assessment. Stochastic (especially spatial) methods, often in Bayesian frameworks are now gaining prominence in standard risk assessment procedures because of their ability to assess accurately model uncertainties. CONCLUSIONS: Risk assessment needs to be addressed quantitatively wherever possible, and submitted with its quality assessment in order to enable successful public health measures to be adopted. In terms of current practice, often a series of different models and analyses are applied to the same problem, with results and outcomes that are difficult to compare because of the unknown model and data uncertainties. Therefore, the risk assessment areas in need of further research are identified in this article.

Introduction and control of three invasive mosquito species in the Netherlands, July-October 2010.

In July 2010, during routine mosquito surveillance inspections at companies that import used tires, three invasive species were found at five locations in the Netherlands: the yellow fever mosquito (Aedes aegypti), the Asian tiger mosquito (Ae. albopictus), and the American rock-pool mosquito (Ae. atropalpus). This is the first time that Ae. aegypti is reported from the Netherlands. Mosquito control was initiated one week after the first invasive mosquito was found, using adulticides and larvicides. The available data suggest that the implemented control measures have been effective for this season.

First report of a North American invasive mosquito species Ochlerotatus atropalpus (Coquillett) in the Netherlands, 2009.

In late August and early September 2009, numerous larvae, pupae, and actively flying adult specimens of Ochlerotatus atropalpus were discovered in the Province of Brabant, southern Netherlands, during surveillance activities for Aedes albopictus at two trading companies that import used tires. No Ae. albopictus were found. Both companies mainly import used tires from countries in Europe, but also from North America. Oc. atropalpus is endemic to North America and has so far only been found outside of its endemic range in Europe, namely France and Italy, where it was subsequently eradicated. A preliminary modelling study shows that the weather conditions in the Netherlands are unlikely to prevent establishment of Oc. atropalpus. This species has so far only been shown to serve as a vector for virus transmission under laboratory conditions. Studies on potential human and veterinary health risks, as well as possible control strategies are currently ongoing.

Short report: Influence of centers for disease control light trap position, relative to a human-baited bed net, on catches of Anopheles gambiae and Culex quinquefasciatus in Tanzania.

The best position for Centers for Disease Control (Atlanta, GA) light traps, in relation to human-occupied bed nets for trapping of host-seeking Anopheles gambiae Giles and Culex quinquefasciatus Say mosquitoes, was determined in Tanzania. Significantly higher catches were recorded for both species when the trap was positioned at the foot end of the bed, near the top of the net. Parity rates were significantly higher near the top of the net than at the level of the host. Since trap position affects the catch size and the proportion of infectious mosquitoes therein, standardized use of this sampling technique for estimating entomologic inoculation rates (i.e., the number of potentially infectious bites received over a certain period of time) is recommended.

Innate preference for host-odor blends modulates degree of anthropophagy of Anopheles gambiae sensu lato (Diptera: Culicidae).

In field studies, Anopheles gambiae Giles sensu stricto obtains most blood meals from humans, whereas Anopheles quadriannulatus Theobald bites predominantly bovids. We investigated whether host odors modulate the host preference of these mosquito species. In a dual-choice olfactometer, mosquitoes were given a choice between clean air and putative host-specific odor blends. An. gambiae chose 'human odor' over clean air and clean air over cow odor.' Although Anopheles quadriannulatus did not choose cow odor over clean air, it chose clean air over human odor. Cheese odor, which attracted An. gambiae, did not result in higher trap catch of An. quadriannulatus. We conclude that the degree of anthropophagy of An. gambiae s.l. has an innate olfactory basis.

Superior reproductive success on human blood without sugar is not limited to highly anthropophilic mosquito species.

Anthropophilic mosquitoes such as Aedes aegypti L. (Diptera: Culicidae) have been shown to have superior reproductive success on human blood when sugar is not available. Life-table experiments were conducted with Aedes albopictus Skuse and Ae. aegypti to compare the effects of sugar availability on age-specific survivorship, lifetime and daily fecundity, and blood-feeding frequency when offered human blood daily. There were no significant interactions between the effects of sugar availability and mosquito species for these four variables, indicating similar effects of sugar availability for both species. Lifetime fecundity was not significantly affected by sugar availability, but sugar-deprived females had significantly reduced age-specific survivorship than did sugar-fed females. In absence of sugar, females took bloodmeals twice as often, resulting in a higher daily fecundity. The results indicate that superior reproductive success on human blood without sugar does not seem to be limited to highly anthropophilic mosquito species, such as Ae. aegypti. We conclude that evolution of a highly anthropophilic feeding strategy is not an inevitable result of the ability to thrive on human blood alone.

Olfactory receptors on the antennae of the malaria mosquito Anopheles gambiae are sensitive to ammonia and other sweat-borne components.

Electrophysiological studies on female An. gambiae s.s. mosquitoes revealed a receptor neuron within a subpopulation of the antennal grooved-peg sensilla sensitive to the odour of incubated sweat, but not responding to fresh sweat. This receptor neuron was sensitive to ammonia as well, a sweat-borne component which attracts female An. gambiae in a windtunnel bioassay. Neurons innervating a different subpopulation of grooved-peg sensilla did not show a response to incubated sweat. In the latter sensilla, however, one type of neuron responded to water or water containing solutions, while another receptor neuron was inhibited when stimulated with dry air, ether or ethanol. Neurons innervating sensilla trichodea, a more abundant antennal type of olfactory sensillum, did not respond to fresh or incubated sweat at the doses offered. However, receptor neurons within the sensilla trichodea responded with excitation to several sweat-borne components. A subpopulation of the sensilla trichodea was innervated by neurons sensitive to geranyl acetone. A second subpopulation housed receptor neurons sensitive to indole. 3-Methyl-1-butanol and 6-methyl-5-hepten-2-one evoked excitation of receptor neurons within both subpopulations of sensilla trichodea. Neurons were most sensitive to indole and geranyl acetone with a threshold of 0.01%. These findings are discussed in the context of host-seeking behaviour.

Infochemicals in mosquito host selection: human skin microflora and Plasmodium parasites.

The interaction between the African malaria vector Anopheles gambiae and its human host has traditionally been viewed within a bitrophic context, considering only the human and the mosquito. Recently, the influence of the Plasmodium parasite on the interaction has been recognized, because it affects the physiology and/or behaviour of humans and mosquitoes. However, studies on odour-mediated host-seeking behaviour of An. gambiae and other Diptera have provided evidence that a fourth group of organisms should be taken into consideration. Human skin microflora play a role in the production of odorous compounds that might function as kairomones for mosquitoes. Here, Marieta Braks, Rob Anderson and Bart Knols introduce the role of human microflora into the process of odour-mediated host selection and review the interaction in a multipartite context so as to identify research avenues that will enhance our limited knowledge of this aspect of malaria transmission.