Time trend of clinical cases of Lyme disease in two hospitals in Belgium, 2000-2013

BACKGROUND

As several studies indicated an increase in Lyme disease (LD), notably in neighbouring countries, concerns have arisen regarding the evolution of Lyme disease in Belgium. In order to confirm or infirm the increase of LD in Belgium, we focused on hospital admissions of patients diagnosed with LD between 2000 and 2013 based on hospital admission databases from two hospitals in Belgium.

METHODS

Hospital databases are a stable recording system. We did a retrospective analysis of the medical files of patients hospitalized with Lyme disease in two Belgian hospitals between 2000 and 2013.

RESULTS

The annual number of cases of LD for the two studied Belgian hospitals remained stable between 2000 and 2013, ranging from 1 for the Cliniques universitaires Saint-Luc to 15 for the the Clinique Saint-Pierre. No increasing trend were noted in the estimated annual incidence rate but the average estimated annual incidence rate was higher for the hospital Saint-Pierre (8.1 ± 3.7 per 100,000 inhabitants) than Saint-Luc (2.2 ± 1.5 per 100,000 inhabitants). The number of hospital cases of LD peaked between June and November.

CONCLUSIONS

Based on hospital admissions with LD, no increasing trend was observed for the period 2000-2013 in the two studied Belgian hospitals. This is in line with other studies carried out in Belgium.

The current status of resistance to alpha-cypermethrin, ivermectin, and amitraz of the cattle tick (Rhipicephalus microplus) in Ecuador

Rhipicephalus microplus is widely distributed in tropical and subtropical areas of the world where livestock is a principal activity with great veterinary and economic importance. In Ecuador, this hematophagous ectoparasite has been observed between 0 and 2600 masl. One of the main tick control measures is the use of acaricides, which have been indiscriminately used worldwide and in Ecuador. In this country, no studies on acaricide resistance in Rhipicephalus microplus have been published. The current study aims to characterise the level of resistance of R. microplus against three main acaricides commonly used in Ecuador i.e. amitraz, alpha-cypermethrin and ivermectin to determine the level and pattern of dose-responses for R. microplus in 12 field populations (farms). The level of acaricide resistance was evaluated using three different bioassays: adult immersion test (AIT), larval package test (LPT) and larval immersion test (LIT), as recommended by the FAO. The predictive dose-responses were analysed by binomial logistics regression of the larval survival rate (resistance). In general, we found resistance of 67% for amitraz; 50% for alpha-cypermethrin and from 25 to 42% for ivermectin in the twelve field populations analysed. Resistance levels were studied in larval and adult bioassays, respectively, which were slightly modified for this study. For larval bioassays based on corrected mortality i.e. high (above 51%), medium (21–50%) and low (11–20%) resistance, percentages less than 10% were considered as susceptible. For the adult test, two resistance levels were used i.e. high (more than 76%) and medium (51 to 75%) resistance. Percentages lower than 50% were considered as susceptible. In this context, for larval bioassays, amitraz showed 21%, 38% and 8% for high, medium and low resistance, respectively. Alpha-cypermethrin presented 8%, 4 and 38% for high, medium and low resistance, respectively. Ivermectin presented 8%, 25% and 8% for high, medium and low resistance, respectively. For adult tests with amitraz 50% and 17% of the field populations showed average and high resistance, with evidences of average resistance to alpha-cypermethrin in 50% of the samples and average resistance against ivermectin in 25% of the farms. No statistical difference amongst the three bioassays was found and acaricide resistance was confirmed by logistic regression analysis; hence resistance (dose-responses) in each field populations differed, depending on the choice of the acaricide, frequent usage, frequency of treatment and farm management. The effective estimated dose needed to eliminate 99% of ticks is higher than dose recommended by the manufacturer. In conclusion, amitraz showed the highest resistance followed by ivermectin and alpha-cypermethrin and reveals differences on resistance in each individual field population. This information is important in order to establish the monitoring of resistance on each farm individually, contributing to the rational use of acaricides included in an integrated control program for R. microplus.

Individual and environmental factors associated with the seroprevalence of Borrelia burgdorferi in Belgian farmers and veterinarians

BACKGROUND

Lyme disease (LD) is a common tick-borne disease in Europe. Diverse factors at various scales determine the spatial distribution of Borrelia burgdorferi infection risk and a better understanding of those factors in a spatially explicit framework is needed for disease management and prevention. While the ecology of ticks and the landscape favoring their abundance have been extensively studied, the environmental conditions favoring an intense contact with susceptible humans, including groups at risk, are sparse. The aim of this study is to assess which individual and environmental factors can favor B. burgdorferi infection in a Belgian group professionally at risk.

METHODS

Serological results of 127 veterinarians and farmers enrolled in this study were analyzed, taking into account their municipality of residence. Using binary logistic regression and considering interaction terms, the joint effects of landscape composition and configuration, and forest and wildlife management were examined.

RESULTS

Seven of the 127 workers were seropositive for LD, leading to a seroprevalence of 5.51%. Seropositivity was higher in older persons. The proportion of forest and semi-natural habitats and wetland had a positive impact on LD seroprevalence while arable land-grassland ecotones had a negative one. Our results confirmed the need to consider complex interactions between landscape variables in order to model risk.

CONCLUSIONS

Our data show that LD has to be considered as a risk for farmers and veterinarians. Rather than focusing either on ecological aspects of tick and pathogen distribution or on purely epidemiological aspects such as individual risk factors, our model highlights the role of human-environment interactions in LD risk assessment.

Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples

To estimate the seroprevalence of Borrelia burgdorferi (Bb), Anaplasma phagocytophilum (Ap), and Francisella tularensis (Ft) in Belgium, we tested sera from three population-based samples in which exposure to pathogen is assumed to vary: 148 samples from workers professionally exposed, 209 samples from rural blood donors, and 193 samples from urban blood donors. Sera were tested using ELISA or the immunofluorescence assay test. The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors, which is similar to other studies. The fraction of negative results decreases significantly from urban blood donors and rural blood donors to workers. Regarding the seroprevalence of Ap, the cutoff titer of 1:64 recommended by the manufacturer may be set too low and produces artificially high seroprevalence rates. Using a cutoff titer of 1:128, the seroprevalence of Ap was estimated at 8.1% for workers professionally exposed, 6.2% for rural blood donors, and 5.7% for urban blood donors. Tularemia sera confirmed the presence of the pathogen in Belgium at 2.0% for workers and 0.5% for rural and urban blood donors. Our study is one of the few providing an estimation of the seroprevalences of Bb, Ap, and Ft in three different populations in Belgium, filling the gap in seroprevalence data among those groups. Our findings provide evidence that the entire Belgian population is exposed to Bb, Ap, and Ft infections, but a higher exposure is noticed for professionals at risk. Education on the risk factors for tick bites and preventive measures for both professionals exposed and the general population is needed.

Forest classes and tree cover gradient: tick habitat in encroached areas of southern Norway

Forest, in particular deciduous forest, is a key element in determining areas with a high probability of tick presence. The way forest is generally monitored may be ill suited to some landscapes where Ixodes ricinus is found, as forest is usually characterised using crisp land cover classes. However, tree vegetation can be found outside of forests and continuous gradations of tree density can be found in a variety of landscapes. In this paper we investigate the probability of tick presence in southern Norway using landscape description based both on land cover classes and continuous data describing the tree cover fraction. Both perspectives on the landscape are significant in the logistic model, indicating that the usual approach based solely on land cover classes may not be comprehensive enough in capturing tick habitat, and characterising the landscape with variables focused on single specific elements may be insufficient.

Scouts, forests, and ticks: Impact of landscapes on human-tick contacts

Just as with forest workers or people practicing outdoor recreational activities, scouts are at high risk for tick bites and tick-borne infections. The risk of a tick bite is shaped not only by environmental and climatic factors but also by land management. The aim of this study was to assess which environmental conditions favour scout-tick contacts, and thus to better understand how these factors and their interactions influence the two components of risk: hazard (related to vector and host ecology) and exposure of humans to disease vectors. A survey was conducted in the summer of 2009 on the incidence of tick bites in scout camps taking place in southern Belgium. Joint effects of landscape composition and configuration, weather, climate, forest and wildlife management were examined using a multiple gamma regression with a log link. The landscape was characterized by buffers of varying sizes around the camps using a detailed land use map, and accounting for climate and weather variables. Landscape composition and configuration had a significant influence on scout-tick contacts: the risk was high when the camp was surrounded by a low proportion of arable land and situated in a complex and fragmented landscape. The distance to the nearest forest patch, the composition of the forest ecotone as well as weather and climatic factors were all significantly associated with scout-tick contacts. Both hazard- and exposure-related variables significantly contributed to the frequency of scout-tick contact. Our results show that environmental conditions favour scout-tick contacts. For example, we emphasize the impact of accessibility of environments suitable for ticks on the risk of contact. We also highlight the significant effect of both hazard and exposure. Our results are consistent with current knowledge, but further investigations on the effect of forest management, e.g. through its impact on forest structure, on the tick-host-pathogen system, and on humans exposure, is required.

High Resolution Spatial Analysis of Habitat Preference of Aedes Albopictus (Diptera: Culicidae) in an Urban Environment

Over the past decades, the Asian tiger mosquito (Aedes albopictus (Skuse, 1895)) has emerged in many countries, and it has colonized new environments, including urban areas. The species is a nuisance and a potential vector of several human pathogens, and a better understanding of the habitat preferences of the species is needed for help in successful prevention and control. So far, the habitat preference in urban environments has not been studied in Southern European cities. In this paper, spatial statistical models were used to evaluate the relationship between egg abundances and land cover types on the campus of Sapienza University in Rome, which is taken as an example of a European urban habitat. Predictor variables included land cover types, classified in detail on a high resolution image, as well as solar radiation and month of capture. The models account for repeated measures in the same trap and are adjusted for meteorological circumstances. Vegetation and solar radiation were found to be positively related to the number of eggs. More specifically, trees were positively related to the number of eggs and the relationship with grass was negative. These findings are consistent with the species' known preference for shaded areas. The unexpected positive relationship with solar radiation is amply discussed in the paper. This study represents a first step toward a better understanding of the spatial distribution of Ae. albopictus in urban environments.

Landscape and regional environmental analysis of the spatial distribution of hantavirus human cases in europe

Background: In Europe, the most prevalent hantavirus, Puumala virus, is transmitted by bank voles and causes nephropathia epidemica in human. The European spatial distribution of nephropathia epidemica is investigated here for the first time with a rich set of environmental variables.

Methods: The influence of variables at the landscape and regional level is studied through multilevel logistic regression, and further information on their effects across the different European ecoregions is obtained by comparing an overall niche model (boosted regression trees) with regressions by ecoregion.

Results: The presence of nephropathia epidemica is likely in populated regions with well-connected forests, more intense vegetation activity, low soil water content, mild summers, and cold winters. In these regions, landscapes with a higher proportion of built-up areas in forest ecotones and lower minimum temperature in winter are expected to be more at risk. Climate and forest connectivity have a stronger effect at the regional level. If variables are staying at their current values, the models predict that nephropathia epidemica may know intensification but should not spread (although southern Sweden, the Norwegian coast, and the Netherlands should be kept under watch).

Conclusion: Models indicate that large-scale modeling can lead to a very high predictive power. At large scale, the effect of one variable on disease may follow three response scenarios: the effect may be the same across the entire study area, the effect can change according to the variable value, and the effect can change depending on local specificities. Each of these scenarios impacts large-scale modeling differently.

Species distribution modelling for Rhipicephalus microplus (Acari: Ixodidae) in Benin, West Africa: comparing datasets and modelling algorithms

Rhipicephalus microplus is one of the most widely distributed and economically important ticks, transmitting Babesia bigemina, B. bovis and Anaplasma marginale. It was recently introduced to West Africa on live animals originating from Brazil. Knowing the precise environmental suitability for the tick would allow veterinary health officials to draft vector control strategies for different regions of the country. To test the performance of modelling algorithms and different sets of environmental explanatory variables, species distribution models for this tick species in Benin were developed using generalized linear models, linear discriminant analysis and random forests. The training data for these models were a dataset containing reported absence or presence in 104 farms, randomly selected across Benin. These farms were sampled at the end of the rainy season, which corresponds with an annual peak in tick abundance. Two environmental datasets for the country of Benin were compared: one based on interpolated climate data (WorldClim) and one based on remotely sensed images (MODIS). The pixel size for both environmental datasets was 1 km. Highly suitable areas occurred mainly along the warmer and humid coast extending northwards to central Benin. The northern hot and drier areas were found to be unsuitable. The models developed and tested on data from the entire country were generally found to perform well, having an AUC value greater than 0.92. Although statistically significant, only small differences in accuracy measures were found between the modelling algorithms, or between the environmental datasets. The resulting risk maps differed nonetheless. Models based on interpolated climate suggested gradual variations in habitat suitability, while those based on remotely sensed data indicated a sharper contrast between suitable and unsuitable areas, and a patchy distribution of the suitable areas. Remotely sensed data yielded more spatial detail in the predictions. When computing accuracy measures on a subset of data along the invasion front, the modelling technique Random Forest outperformed the other modelling approaches, and results with MODIS-derived variables were better than those using WorldClim data. The high environmental suitability for R. microplus in the southern half of Benin raises concern at the regional level for animal health, including its potential to substantially alter transmission risk of Babesia bovis. The northern part of Benin appeared overall of low environmental suitability. Continuous surveillance in the transition zone however remains relevant, in relation to important cattle movements in the region, and to the invasive character of R. microplus.

Towards a resource-based habitat approach for spatial modelling of vector-borne disease risks

Given the veterinary and public health impact of vector-borne diseases, there is a clear need to assess the suitability of landscapes for the emergence and spread of these diseases. Current approaches for predicting disease risks neglect key features of the landscape as components of the functional habitat of vectors or hosts, and hence of the pathogen. Empirical-statistical methods do not explicitly incorporate biological mechanisms, whereas current mechanistic models are rarely spatially explicit; both methods ignore the way animals use the landscape (i.e. movement ecology). We argue that applying a functional concept for habitat, i.e. the resource-based habitat concept (RBHC), can solve these issues. The RBHC offers a framework to identify systematically the different ecological resources that are necessary for the completion of the transmission cycle and to relate these resources to (combinations of) landscape features and other environmental factors. The potential of the RBHC as a framework for identifying suitable habitats for vector-borne pathogens is explored and illustrated with the case of bluetongue virus, a midge-transmitted virus affecting ruminants. The concept facilitates the study of functional habitats of the interacting species (vectors as well as hosts) and provides new insight into spatial and temporal variation in transmission opportunities and exposure that ultimately determine disease risks. It may help to identify knowledge gaps and control options arising from changes in the spatial configuration of key resources across the landscape. The RBHC framework may act as a bridge between existing mechanistic and statistical modelling approaches.

Shaping zoonosis risk: landscape ecology vs. landscape attractiveness for people, the case of tick-borne encephalitis in Sweden

BACKGROUND

In this paper, the hazard and exposure concepts from risk assessment are applied in an innovative approach to understand zoonotic disease risk. Hazard is here related to the landscape ecology determining where the hosts, vectors and pathogens are and, exposure is defined as the attractiveness and accessibility to hazardous areas. Tick-borne encephalitis in Sweden was used as a case study.

METHODS

Three boosted regression tree models are compared: a hazard model, an exposure model and a global model which combines the two approaches.

RESULTS

The global model offers the best predictive power and the most accurate modelling. The highest probabilities were found in easy-to-reach places with high landscape diversity, holiday houses, waterbodies and, well-connected forests of oak, birch or pine, with open-area in their ecotones, a complex shape, numerous clear-cuts and, a variation in tree height.

CONCLUSION

While conditions for access and use of hazardous areas are quite specific to Scandinavia, this study offers promising perspectives to improve our understanding of the distribution of zoonotic and vector-borne diseases in diverse contexts.

Physico-chemical and biological characterization of anopheline mosquito larval habitats (Diptera: Culicidae): implications for malaria control

BACKGROUND

A fundamental understanding of the spatial distribution and ecology of mosquito larvae is essential for effective vector control intervention strategies. In this study, data-driven decision tree models, generalized linear models and ordination analysis were used to identify the most important biotic and abiotic factors that affect the occurrence and abundance of mosquito larvae in Southwest Ethiopia.

METHODS

In total, 220 samples were taken at 180 sampling locations during the years 2010 and 2012. Sampling sites were characterized based on physical, chemical and biological attributes. The predictive performance of decision tree models was evaluated based on correctly classified instances (CCI), Cohen's kappa statistic (κ) and the determination coefficient (R2). A conditional analysis was performed on the regression tree models to test the relation between key environmental and biological parameters and the abundance of mosquito larvae.

RESULTS

The decision tree model developed for anopheline larvae showed a good model performance (CCI = 84 ± 2%, and κ = 0.66 ± 0.04), indicating that the genus has clear habitat requirements. Anopheline mosquito larvae showed a widespread distribution and especially occurred in small human-made aquatic habitats. Water temperature, canopy cover, emergent vegetation cover, and presence of predators and competitors were found to be the main variables determining the abundance and distribution of anopheline larvae. In contrast, anopheline mosquito larvae were found to be less prominently present in permanent larval habitats. This could be attributed to the high abundance and diversity of natural predators and competitors suppressing the mosquito population densities.

CONCLUSIONS

The findings of this study suggest that targeting smaller human-made aquatic habitats could result in effective larval control of anopheline mosquitoes in the study area. Controlling the occurrence of mosquito larvae via drainage of permanent wetlands may not be a good management strategy as it negatively affects the occurrence and abundance of mosquito predators and competitors and promotes an increase in anopheline population densities.

An update on distribution models for Rhipicephalus microplus in West Africa

The cattle tick, Rhipicephalus microplus, which reached the West African region approximately 8 years ago, has established viable populations in Côte d'Ivoire and Benin and spread rapidly from the assumed points of introduction. However, existing maps of its distribution range do not agree on the areas at risk, most probably due to suboptimal modelling approaches. Therefore, we undertook a re-investigation of the potential distribution range based on a high-quality dataset from West Africa that includes information on 104 farms located all over Benin. Focussing on climate suitability and applying advanced modelling, a subset of representative and uncorrelated climate variables was selected and fed into Maxent software to obtain an estimate of climate suitability for West Africa. The resulting map was validated using an independent dataset of 13 farms along the apparent distribution edge. The entire southern part of West Africa (covering southern Nigeria, Benin, Togo and Ghana) features high climate suitability for R. microplus. All of Côte d'Ivoire is inside the distribution range of this tick and the southern rim of Burkina Faso is expected to be suitable for the establishment of R. microplus populations. The validation of the distribution, dated one year after the initial field visit, confirmed the predicted distribution range, although a small number of individuals of R. microplus were found north of the predicted limit. These low numbers might indicate that the climate is not suitable for the establishment of a viable tick population. An alternative explanation is the recent introduction by nomadic cattle herds passing through this location. In this region of the world, it is quite common for cattle owners to lead their livestock over distances of more than 500 km in search of food and water.

Geographic distribution of the invasive cattle tick Rhipicephalus microplus, a country-wide survey in Benin

The cattle tick Rhipicephalus microplus is currently invading the West African region, and little information is available on the spread of this exotic tick in this region. We set out a country-wide field survey to determine its current distribution in Benin. Ticks were collected on cattle from 106 farms selected by random sampling covering all regions of the country. Rhipicephalus annulatus was found on 70 % of all farms, R. decoloratus on 42 %, R. geigyi on 58 %, and R. microplus on 49 %. There is a clear geographic separation between the indigenous Rhipicephalus species and R. microplus. Rhipicephalus annulatus occurs mainly in the northern departments, but it was also observed in lower numbers in locations in the south. The presence of R. decoloratus is limited to the northern region, and in most locations, this tick makes up a small proportion of the collected ticks. The tick R. geigyi tends to be dominant, but occurs only in the four northern departments. The observations concerning R. microplus are entirely different, this species occurs in the southern and central region. The results of this survey confirm the invasive character and displacement properties of R. microplus, since in less than a decade it has colonized more than half of the country and has displaced indigenous ticks of the same genus in many of the sampled locations.

Geographic distribution of the invasive cattle tick Rhipicephalus microplus, a country-wide survey in Benin

The cattle tick Rhipicephalus microplus is currently invading the West African region, and little information is available on the spread of this exotic tick in this region. We set out a country-wide field survey to determine its current distribution in Benin. Ticks were collected on cattle from 106 farms selected by random sampling covering all regions of the country. Rhipicephalus annulatus was found on 70 % of all farms, R. decoloratus on 42 %, R. geigyi on 58 %, and R. microplus on 49 %. There is a clear geographic separation between the indigenous Rhipicephalus species and R. microplus. Rhipicephalus annulatus occurs mainly in the northern departments, but it was also observed in lower numbers in locations in the south. The presence of R. decoloratus is limited to the northern region, and in most locations, this tick makes up a small proportion of the collected ticks. The tick R. geigyi tends to be dominant, but occurs only in the four northern departments. The observations concerning R. microplus are entirely different, this species occurs in the southern and central region. The results of this survey confirm the invasive character and displacement properties of R. microplus, since in less than a decade it has colonized more than half of the country and has displaced indigenous ticks of the same genus in many of the sampled locations.

Modelling zoonotic diseases in humans: comparison of methods for hantavirus in Sweden

Because their distribution usually depends on the presence of more than one species, modelling zoonotic diseases in humans differs from modelling individual species distribution even though the data are similar in nature. Three approaches can be used to model spatial distributions recorded by points: based on presence/absence, presence/available or presence data. Here, we compared one or two of several existing methods for each of these approaches. Human cases of hantavirus infection reported by place of infection between 1991 and 1998 in Sweden were used as a case study. Puumala virus (PUUV), the most common hantavirus in Europe, circulates among bank voles (Myodes glareolus). In northern Sweden, it causes nephropathia epidemica (NE) in humans, a mild form of hemorrhagic fever with renal syndrome.Logistic binomial regression and boosted regression trees were used to model presence and absence data. Presence and available sites (where the disease may occur) were modelled using cross-validated logistic regression. Finally, the ecological niche model MaxEnt, based on presence-only data, was used.In our study, logistic regression had the best predictive power, followed by boosted regression trees, MaxEnt and cross-validated logistic regression. It is also the most statistically reliable but requires absence data. The cross-validated method partly avoids the issue of absence data but requires fastidious calculations. MaxEnt accounts for non-linear responses but the estimators can be complex. The advantages and disadvantages of each method are reviewed.

A multi-level analysis of the relationship between environmental factors and questing Ixodes ricinus dynamics in Belgium

Background

Ticks are the most important pathogen vectors in Europe. They are known to be influenced by environmental factors, but these links are usually studied at specific temporal or spatial scales. Focusing on Ixodes ricinus in Belgium, we attempt to bridge the gap between current “single-sided” studies that focus on temporal or spatial variation only. Here, spatial and temporal patterns of ticks are modelled together.

Methods

A multi-level analysis of the Ixodes ricinus patterns in Belgium was performed. Joint effects of weather, habitat quality and hunting on field sampled tick abundance were examined at two levels, namely, sampling level, which is associated with temporal dynamics, and site level, which is related to spatial dynamics. Independent variables were collected from standard weather station records, game management data and remote sensing-based land cover data.

Results

At sampling level, only a marginally significant effect of daily relative humidity and temperature on the abundance of questing nymphs was identified. Average wind speed of seven days prior to the sampling day was found important to both questing nymphs and adults. At site level, a group of landscape-level forest fragmentation indices were highlighted for both questing nymph and adult abundance, including the nearest-neighbour distance, the shape and the aggregation level of forest patches. No cross-level effects or spatial autocorrelation were found.

Conclusions

Nymphal and adult ticks responded differently to environmental variables at different spatial and temporal scales. Our results can advise spatio-temporal extents of environment data collection for continuing empirical investigations and potential parameters for biological tick models.

Consequences of landscape fragmentation on Lyme disease risk: a cellular automata approach

The abundance of infected Ixodid ticks is an important component of human risk of Lyme disease, and various empirical studies have shown that this is associated, at least in part, to landscape fragmentation. In this study, we aimed at exploring how varying woodland fragmentation patterns affect the risk of Lyme disease, through infected tick abundance. A cellular automata model was developed, incorporating a heterogeneous landscape with three interactive components: an age-structured tick population, a classical disease transmission function, and hosts. A set of simplifying assumptions were adopted with respect to the study objective and field data limitations. In the model, the landscape influences both tick survival and host movement. The validation of the model was performed with an empirical study. Scenarios of various landscape configurations (focusing on woodland fragmentation) were simulated and compared. Lyme disease risk indices (density and infection prevalence of nymphs) differed considerably between scenarios: (i) the risk could be higher in highly fragmented woodlands, which is supported by a number of recently published empirical studies, and (ii) grassland could reduce the risk in adjacent woodland, which suggests landscape fragmentation studies of zoonotic diseases should not focus on the patch-level woodland patterns only, but also on landscape-level adjacent land cover patterns. Further analysis of the simulation results indicated strong correlations between Lyme disease risk indices and the density, shape and aggregation level of woodland patches. These findings highlight the strong effect of the spatial patterns of local host population and movement on the spatial dynamics of Lyme disease risks, which can be shaped by woodland fragmentation. In conclusion, using a cellular automata approach is beneficial for modelling complex zoonotic transmission systems as it can be combined with either real world landscapes for exploring direct spatial effects or artificial representations for outlining possible empirical investigations.

Spatially disaggregated disease transmission risk: land cover, land use and risk of dengue transmission on the island of Oahu

Vector-borne diseases persist in transmission systems that usually comprise heterogeneously distributed vectors and hosts leading to a highly heterogeneous case distribution. In this study, we build on principles of classical mathematical epidemiology to investigate spatial heterogeneity of disease risk for vector-borne diseases. Land cover delineates habitat suitability for vectors, and land use determines the spatial distribution of humans. We focus on the risk of exposure for dengue transmission on the Hawaiian island of Oahu, where the vector Aedes albopictus is well established and areas of dense human population exist. In Hawai'i, dengue virus is generally absent, but occasionally flares up when introduced. It is therefore relevant to investigate risk, but difficult to do based on disease incidence data. Based on publicly available data (land cover, land use, census data, surveillance mosquito trapping), we map the spatial distribution of vectors and human hosts and finally overlay them to produce a vector-to-host ratio map. The resulting high-resolution maps indicate a high spatial variability in vector-to-host ratio suggesting that risk of exposure is spatially heterogeneous and varies according to land cover and land use.

Pathogenic landscapes: interactions between land, people, disease vectors, and their animal hosts

BACKGROUND

Landscape attributes influence spatial variations in disease risk or incidence. We present a review of the key findings from eight case studies that we conducted in Europe and West Africa on the impact of land changes on emerging or re-emerging vector-borne diseases and/or zoonoses. The case studies concern West Nile virus transmission in Senegal, tick-borne encephalitis incidence in Latvia, sandfly abundance in the French Pyrenees, Rift Valley Fever in the Ferlo (Senegal), West Nile Fever and the risk of malaria re-emergence in the Camargue, and rodent-borne Puumala hantavirus and Lyme borreliosis in Belgium.

RESULTS

We identified general principles governing landscape epidemiology in these diverse disease systems and geographic regions. We formulated ten propositions that are related to landscape attributes, spatial patterns and habitat connectivity, pathways of pathogen transmission between vectors and hosts, scale issues, land use and ownership, and human behaviour associated with transmission cycles.

CONCLUSIONS

A static view of the "pathogenecity" of landscapes overlays maps of the spatial distribution of vectors and their habitats, animal hosts carrying specific pathogens and their habitat, and susceptible human hosts and their land use. A more dynamic view emphasizing the spatial and temporal interactions between these agents at multiple scales is more appropriate. We also highlight the complementarity of the modelling approaches used in our case studies. Integrated analyses at the landscape scale allows a better understanding of interactions between changes in ecosystems and climate, land use and human behaviour, and the ecology of vectors and animal hosts of infectious agents.

Landscape predictors of tick-borne encephalitis in Latvia: land cover, land use, and land ownership

Although the presence of tick-borne encephalitis (TBE) virus circulating in tick populations depends on large-scale patterns of climate, and the local density of infected ticks depends on the abundance of mammalian hosts, the risk of human infection depends on the access and use by human populations of tick-infested habitats, particularly forests, at the landscape level. We investigated the incidence of reported TBE cases in rural parishes (i.e., municipalities) in Latvia. The following major characteristics of parishes were considered: whether their environment is suitable for tick and tick-host populations (depending on land cover); whether the local human population is likely to enter the forest on a regular base (depending on land use); and whether the spatial distributions of these two aspects are likely to intersect, through access rules (as a function of land ownership). The results indicated that all three aspects are important in explaining and predicting the spatial distribution of TBE cases in the rural areas of Latvia. The concept of landscape is here given new depth by consideration of its physical structure, its use by human populations, and its accessibility as modulated by ownership.

Distribution and density of tsetse flies (Glossinidae: Diptera) at the game/people/livestock interface of the Nkhotakota Game Reserve human sleeping sickness focus in Malawi

In large parts sub-Saharan Africa, tsetse flies, the vectors of African human or animal trypanosomiasis, are, or will in the foreseeable future, be confined to protected areas such as game or national parks. Challenge of people and livestock is likely to occur at the game/livestock/people interface of such infested areas. Since tsetse control in protected areas is difficult, management of trypanosomiasis in people and/or livestock requires a good understanding of tsetse population dynamics along such interfaces. The Nkhotakota Game Reserve, an important focus of human trypanosomiasis in Malawi, is a tsetse-infested protected area surrounded by a virtually tsetse-free zone. The abundance of tsetse (Glossina morsitans morsitans) along the interface, within and outside the game reserve, was monitored over 15 months using epsilon traps. A land cover map described the vegetation surrounding the traps. Few flies were captured outside the reserve. Inside, the abundance of tsetse at the interface was low but increased away from the boundary. This uneven distribution of tsetse inside the reserve is attributed to the uneven distribution of wildlife, the main host of tsetse, being concentrated deeper inside the reserve. Challenge of people and livestock at the interface is thus expected to be low, and cases of trypanosomiasis are likely due to people and/or livestock entering the reserve. Effective control of trypanosomiasis in people and livestock could be achieved by increasing the awareness among people of dangers associated with entering the reserve.

Determinants of the geographic distribution of Puumala virus and Lyme borreliosis infections in Belgium

BACKGROUND

Vector-borne and zoonotic diseases generally display clear spatial patterns due to different space-dependent factors. Land cover and land use influence disease transmission by controlling both the spatial distribution of vectors or hosts, and the probability of contact with susceptible human populations. The objective of this study was to combine environmental and socio-economic factors to explain the spatial distribution of two emerging human diseases in Belgium, Puumala virus (PUUV) and Lyme borreliosis. Municipalities were taken as units of analysis.

RESULTS

Negative binomial regressions including a correction for spatial endogeneity show that the spatial distribution of PUUV and Lyme borreliosis infections are associated with a combination of factors linked to the vector and host populations, to human behaviours, and to landscape attributes. Both diseases are associated with the presence of forests, which are the preferred habitat for vector or host populations. The PUUV infection risk is higher in remote forest areas, where the level of urbanisation is low, and among low-income populations. The Lyme borreliosis transmission risk is higher in mixed landscapes with forests and spatially dispersed houses, mostly in wealthy peri-urban areas. The spatial dependence resulting from a combination of endogenous and exogenous processes could be accounted for in the model on PUUV but not for Lyme borreliosis.

CONCLUSION

A large part of the spatial variation in disease risk can be explained by environmental and socio-economic factors. The two diseases not only are most prevalent in different regions but also affect different groups of people. Combining these two criteria may increase the efficiency of information campaigns through appropriate targeting.