The effects of climate change and globalization on mosquito vectors: evidence from Jeju Island, South Korea on the potential for Asian tiger mosquito (Aedes albopictus) influxes and survival from Vietnam rather than Japan

List of occupational diseases among farmers in Korea: a literature review

A comprehensive list of occupational diseases among farmers is crucial for both compensation and prevention efforts. In Korea, most farmers are self-employed, and some occupational diseases are compensated through farmer safety insurance. However, it is not harmonized with industrial accident compensation insurance and does not adequately reflect the true burden of occupational diseases among farmers. To address this gap, the authors compiled a list of occupational diseases tailored to Korean farmers by reviewing the International Labor Organization's list of occupational diseases, the Korean Industrial Accident Compensation Insurance List, the occupational disease lists of other countries, and relevant literature on farmers' work-related diseases.

Metabarcoding for the Monitoring of the Microbiome and Parasitome of Medically Important Mosquito Species in Two Urban and Semi-urban Areas of South Korea

Interactions between microbial communities and the host can modulate mosquito biology, including vector competence. Therefore, future vector biocontrol measures will utilize these interactions and require extensive monitoring of the mosquito microbiome. Metabarcoding strategies will be useful for conducting vector monitoring on a large scale. We used 16S and 18S rRNA gene metabarcoding through iSeq100 sequencing to characterize the microbiome and eukaryome of Aedes albopictus (Skuse 1894) and Culex pipiens (Linnaeus 1758), two globally important vectors present in South Korea. Mosquitoes were collected from an urban and a semi-urban location in South Korea. Bacterial alpha and beta diversities varied by population. Pseudomonadota dominated the microbiomes of both species. The microbiome composition varied by population and was dominated by different taxa. At the genus level, Wolbachia sp. was the most enriched genus in Cx. pipiens, followed by Aeromonas sp. In Ae. Albopictus, the most abundant group was Enterococcus sp. The gregarine parasite Ascogregarina taiwanensis was highly prevalent in Ae. Albopictus and its absence was marked by the presence of seven bacterial taxa. To our knowledge, this is the first characterization of the microbiome of Ae. albopictus and Cx. pipiens in these regions of South Korea and contributes to the current information on the microbiome of mosquito species, which can be used in further studies to assess pathogen-microbiome and microbiome-microbiome interactions.

Impact of climate change on dengue incidence in Singapore: time-series seasonal analysis

This study aimed to identify the meteorological factors that contribute to dengue epidemics. The monthly incidence of dengue was used as the outcome variable, while maximum temperature, humidity, precipitation, and sunshine hours were used as independent variables. The results showed a consistent increase in monthly dengue cases from 2013 to 2021, with seasonal patterns observed in stationary time-series data. The ARIMA (2, 1, 3) × seasonal (0, 1, 2)12 model was used based on its lowest Akaike Information Criterion (AIC) values. The analysis revealed that a 1-unit increase in rainfall was positively correlated with a small 0.062-unit increase in dengue cases, whereas a 1-unit increase in humidity was negatively associated, leading to a substantial reduction of approximately 16.34 cases. This study highlights the importance of incorporating weather data into national dengue prevention programs to enhance public awareness and to promote recommended safety measures.

A practical approach to multifaceted perspectives for sustainable international collaboration on mosquito-borne diseases in Southeast Asia

The coronavirus disease 2019 pandemic highlighted the necessity and limitations of scientific collaboration and equitable and effective international research partnerships. The spread of mosquito-borne diseases (MBDs) presents severe public health challenges, particularly in Southeast Asia. Addressing these threats requires establishing regional priorities, bridging research gaps, and strengthening long-term international collaboration. We propose a practical approach to multifaceted perspectives to enhance collaboration across Asia. This study examines MBD-related scientific publications from nine Southeast Asian countries between January 2017 and June 2024, utilizing bibliometric analysis and data visualization to identify research trends, research capacities, key institutions, and international collaborative partners. Thailand and Singapore led the dengue research, followed by Malaysia and Indonesia. Vietnam and the Philippines demonstrated moderate research capabilities, whereas Cambodia, Laos, and Myanmar had lower capacities. Relationships with high-income countries drove international collaboration, whereas intra-regional collaboration in Southeast Asia increased. Furthermore, we identified directions for cooperative opportunities between South Korea and other Southeast Asian countries by analyzing their relative research capacities for infectious MBDs. We propose a practical approach to bridge research-capacity gaps and strengthen collaboration between low- and middle-income countries. These findings provide fundamental information for developing future infectious-disease-response strategies and international-collaboration research partnerships and facilitate the implementation of effective global public health preparedness policies and evidence-based decision-making, such as knowledge-transfer and resource-sharing.

Host Preferences and Impact of Climate on Blood Feeding in Anopheles funestus Group from South Africa

Anopheles vaneedeni and Anopheles parensis (members of the An. funestus group) are generally not considered malaria vectors. However, both species were recently identified as potential vectors in South Africa. A critical factor needed to determine their role in malaria transmission is their preference for human blood. The human blood index of An. vaneedeni and An. parensis and their potential role in the ongoing residual malaria transmission in South Africa is unknown. This study aimed to identify host blood meals from the wild-caught An. funestus group in a longitudinal study, and to establish the relationship between temperature, relative humidity, and precipitation on host feeding preferences. Anopheles leesoni, An. parensis, An. vaneedeni, and Anopheles rivulorum were collected, and females mainly fed on cattle. Climatic parameters did not influence the host feeding preferences of these four members of the An. funestus group, but impacted the proportion of females that took a blood meal. Significant changes in feeding proportions were driven by relative humidity, temperature, and precipitation. The role of these species in the ongoing residual malaria transmission in South Africa needs further investigation, as no human blood meals were identified. It is recommended that vector surveillance teams incorporate climatic monitoring and host blood meal identification into their routine activities. This information could provide the malaria vector control programmes with scientific evidence to evaluate the importance of the An. funestus group in residual malaria transmission.

Insights from multigene analysis: first report of a Southeast Asian Mosquito, Aedes (Mucidus) laniger (Diptera: Culicidae) on Jeju Island from Korea

BACKGROUND

Certain mosquitoes are known as dominant vectors worldwide, and transmit infectious diseases. The expansion of mosquito habitats due to climate change and increased human activities poses a significant health threat by facilitating the spread of various non-native infectious diseases. This study focused on the detection of the Southeast Asian mosquito species, Aedes (Mucidus) laniger (Wiedemann, 1820) on Jeju Island, the southernmost region of the Republic of Korea (ROK), highlighting the potential risks associated with the spread of vector-borne diseases, particularly emphasizing the elevated likelihood of invasion by Southeast Asian mosquitoes.

METHODS

Field surveys were conducted in August 2023 on Jeju Island. Adult mosquitoes were collected using BG-sentinel traps and identified to the species level using taxonomic keys. Morphological and molecular analyses were employed to confirm species designations. Molecular data, including mitochondrial and nuclear genes, were used for phylogenetic analysis, which was performed to compare and identify among recorded subgenera in ROK. Species distribution modeling for Ae. laniger was performed to predict potential habitats using R package 'BIOMOD2'.

RESULTS

The two specimens of Ae. laniger were collected for the first time on Jeju Island. Morphological and molecular analyses confirmed the identity of this species within the subgenus Mucidus and validated the first record of this species in the ROK. We employed a simple multigene phylogenetic analysis to confirm a new mosquito record at the genus and subgenus levels, finally validating the consistency between morphological identification and molecular phylogenetic outcomes. Furthermore, we have updated the taxonomic keys for the genus Aedes in the ROK, and revised mosquito lists for Jeju Island, incorporating the inclusion of Ae. laniger. On the basis of species distribution modeling, the area of suitable habitat for Ae. laniger is expected to expand due to climate change, but this change did not appear to be meaningful in East Asia.

CONCLUSIONS

This case offers the first report of the Southeast Asian mosquito, Ae. laniger, in the ROK. The detection of this species on Jeju Island suggests the potential establishment of a breeding population their habitat and raises concerns about further expansion into the Korean Peninsula. Considering the annual occurrence of mosquito-borne disease cases in the Southeast Asia, it is essential to conduct monitoring not only in Jeju Island, where Ae. laniger has been identified, but also across the entire Korean Peninsula.

The Comparative Field Evaluation of Four Different Traps for Mosquito Surveillance in the Republic of Korea

Monitoring mosquito populations is essential for controlling mosquito-borne diseases, and the selection of mosquito traps should be tailored to specific surveillance objectives. Here, we tested four mosquito traps for their efficiency and applicability: the Nozawa-style black light trap (BLT), BG-sentinel trap II (BGT), UV-LED Blackhole Plus Mosquito Buster trap (LED), and digital mosquito monitoring system (DMS). The traps were rotated weekly for a 24 h cycle at the same location for 13 weeks. Overall, 1649 female mosquitoes belonging to seven genera and sixteen species were collected by the traps. The traps exhibited differences in both the number of collected individuals and species composition. The BLT showed superior collection efficiency in terms of the number of collected individuals and species evenness, whereas the BGT showed the highest species diversity among all the traps. Thus, the BLT and BGT are the best choices for effective mosquito surveillance based on trap performance. Additionally, despite the relatively low efficiency of the LED and DMS observed in this study, the LED is known to be efficient when used for indoor conditions such as cowsheds, while the DMS has an advanced function that can automatically count the number of mosquitoes. Thus, our findings provide significant guidelines for planning new mosquito surveillance projects in the ROK.

Identification of breeding habitats and kdr mutations in Anopheles spp. in South Korea

BACKGROUND

Malaria is still endemic in South Korea. However, limited information is available on the current Anopheles breeding sites and the occurrence of insecticide resistance-associated genetic mutations and their distribution needed to control the malaria vector efficiently.

METHODS

This study explored breeding sites of Anopheline adults in Gimpo-si, near the demilitarized zone (DMZ) in Gyeonggi-do province, South Korea, from 2022 to 2023. Genetic diversity was investigated based on the internal transcribed spacer (ITS2), cytochrome c oxidase subunit I (COI), and knockdown resistance (kdr) genes of Anopheles mosquitoes. A natural environment associated with the seasonal abundance of Anopheles larvae was characterized.

RESULTS

Two breeding sites of Anopheles larvae and adults were found at a stream margin or shallow freshwater near the forest in Wolgot-myeon in Gimpo-si without cattle shed within 1 km and in Naega-myeon in Ganghwa-gun with cow shed within 100 m in 2022 and 2023, respectively. Both sites were located between the newly cultivated lands and the forest. Besides, both breeding sites were in the valley at a slight elevation of 60-70 m from ground lands and maintained the shadow all day. Overall, the Wolgot-myeon breeding site showed various Anopheles spp. larvae, including Anopheles sinensis. Naega-myeon, an additional breeding site found in 2023, had Anopheles sineroides larvae, and approximately 59.7% (89/149) of An. sinensis adults inhabited within a 100-m distance. The total collection, including larvae and adults, revealed that An. sinensis, Anopheles pullus, Anopheles kleini, An. sineroides, Anopheles belenrae, and Anopheles lindesayi accounted for 44.2% (118/267), 0.7% (2/267), 0.7% (2/267), 22.1% (59/267), 1.9% (5/267), and 30.3% (81/267), respectively. Furthermore, various kdr mutant genotypes (F/F, C/C, L/F, L/C and F/C) in An. sinensis, and the first kdr allele mutant (L/F1014) in An. belenrae were identified in South Korea.

CONCLUSIONS

Two breeding sites of Anopheles larvae were studied in Wolgot-myeon and Naega-myeon. Various Anopheles spp. larvae were detected in both habitats, but overall, An. sinensis was the most prevalent adults in both study sites. The occurrence of kdr allele mutant of An. belenrae in South Korea was reported. Rigorous larvae monitoring of Anopheles spp., continuously updating information on Anopheles breeding sites, and understanding the environmental conditions of Anopheles habitats are required to develop an effective malaria control programme in South Korea.

Future land-use change predictions using Dyna-Clue to support mosquito-borne disease risk assessment

Mosquitoes are known vectors for viral diseases in Canada, and their distribution is driven by climate and land use. Despite that, future land-use changes have not yet been used as a driver in mosquito distribution models in North America. In this paper, we developed land-use change projections designed to address mosquito-borne disease (MBD) prediction in a 38 761 km2 area of Eastern Ontario. The landscape in the study area is marked by urbanization and intensive agriculture and hosts a diverse mosquito community. The Dyna-CLUE model was used to project land-use for three time horizons (2030, 2050, and 2070) based on historical trends (from 2014 to 2020) for water, forest, agriculture, and urban land uses. Five scenarios were generated to reflect urbanization, agricultural expansion, and natural areas. An ensemble of thirty simulations per scenario was run to account for land-use conversion uncertainty. The simulation closest to the average map generated was selected to represent the scenario. A concordance matrix generated using map pair analysis showed a good agreement between the simulated 2020 maps and 2020 observed map. By 2050, the most significant changes are predicted to occur mainly in the southeastern region's rural and forested areas. By 2070, high deforestation is expected in the central west. These results will be integrated into risk models predicting mosquito distribution to study the possibility of humans' increased exposure risk to MBDs.

Genetic Diversity of Dengue Vector Aedes albopictus Collected from South Korea, Japan, and Laos

Aedes albopictus is native to Southeast Asia and has emerged as a major vector for vector-borne diseases that are spreading rapidly worldwide. Recent studies have shown that Ae. albopictus populations have different genetic groups dependent on their thermal adaptations; however, studies on Korean populations are limited. In this study, we analyzed the genetic diversity and structure of two mitochondrial genes (COI and ND5) and sixteen microsatellites in mosquitoes inhabiting Korea, Japan, and Laos. The results indicate that the Korean population has low genetic diversity, with an independent cluster distinct from the Laos population. Mixed clusters have also been observed in the Korean population. On the basis of these findings, two hypotheses are proposed. First, certain Korean populations are native. Second, some subpopulations that descended from the metapopulation (East Asian countries) were introduced to Japan before migrating to Korea. Furthermore, we previously demonstrated that Ae. albopictus appears to have been imported to Korea. In conclusion, the dengue-virus-carrying mosquitoes could migrate to Korea from Southeast Asian epidemic regions, where they can survive during the severe winter months. The key findings can be used to establish an integrated pest management strategy based on population genetics for the Korean Ae. albopictus population.

Trans-Generational Symbiont Transmission Reduced at High Temperatures in a West Nile Virus Vector Mosquito Culex quinquefasciatus

The influence of environmental factors on the efficacy of the endosymbiont Wolbachia used in mosquito and pathogen control are poorly characterized and may be critical for disease control. We studied the vector mosquito Culex pipiens quinquefasciatus (Say) to determine the effect of temperature on the composition of the relative abundance of Wolbachia spp. and the microbiome, as well as key immune genes of interest in the Toll and IMD pathways. 16S barcode sequencing was used to determine the microbiome composition and qPCR was used to determine the relative abundance of Wolbachia spp. based on the highly utilized marker Wolbachia surface protein (wsp) gene. We found no effect of temperature within a single generation on the relative abundance of Wolbachia or immune gene expression, nor on the alpha or beta diversity of the microbiome. However, there was a significant difference in the abundance of Wolbachia between generations at high temperatures (≥ 28°C), but not at lower temperatures (≤ 23°C). These results support the idea that Wolbachia are reduced at higher temperatures between generations, which has an influence on the establishment of pathogens including West Nile Virus (WNV). Modulation of the Toll or IMD mosquito immune pathways was not indicated. Wolbachia endosymbiosis and trans-generation transmission appears especially sensitive to high temperatures, which may have implications for Wolbachia-based vector control strategies under climate change scenarios.

Weather Factors Associated with Reduced Risk of Dengue Transmission in an Urbanized Tropical City

This study assessed the impact of weather factors, including novel predictors-pollutant standards index (PSI) and wind speed-on dengue incidence in Singapore between 2012 and 2019. Autoregressive integrated moving average (ARIMA) model was fitted to explore the autocorrelation in time series and quasi-Poisson model with a distributed lag non-linear term (DLNM) was set up to assess any non-linear association between climatic factors and dengue incidence. In DLNM, a PSI level of up to 111 was positively associated with dengue incidence; incidence reduced as PSI level increased to 160. A slight rainfall increase of up to 7 mm per week gave rise to higher dengue risk. On the contrary, heavier rainfall was protective against dengue. An increase in mean temperature under around 28.0 °C corresponded with increased dengue cases whereas the association became negative beyond 28.0 °C; the minimum temperature was significantly positively associated with dengue incidence at around 23-25 °C, and the relationship reversed when temperature exceed 27 °C. An overall positive association, albeit insignificant, was observed between maximum temperature and dengue incidence. Wind speed was associated with decreasing relative risk (RR). Beyond prevailing conclusions on temperature, this study observed that extremely poor air quality, high wind speed, minimum temperature ≥27 °C, and rainfall volume beyond 12 mm per week reduced the risk of dengue transmission in an urbanized tropical environment.

Factors influencing healthcare seeking in patients with dengue: systematic review

OBJECTIVE

Delays in seeking healthcare for dengue are associated with poor health outcomes. Despite this, the factors influencing such delays remain unclear, rendering interventions to improve healthcare seeking for dengue ineffective. This systematic review aimed to synthesise the factors influencing healthcare seeking of patients with dengue and form a comprehensive framework.

METHODS

This review included both qualitative and quantitative studies. Studies were obtained by searching five databases, contacting field experts and performing backward reference searches. The best-fit meta-synthesis approach was used during data synthesis, where extracted data were fitted into the social-ecological model. Sub-analyses were conducted to identify the commonly reported factors and their level of statistical significance.

RESULTS

Twenty studies were selected for meta-synthesis. Eighteen factors influencing healthcare seeking in dengue were identified and categorised under four domains: individual (11 factors), interpersonal (one factor), organisational (four factors) and community (two factors). The most reported factors were knowledge of dengue, access to healthcare, quality of health service and resource availability. Overall, more barriers to dengue health seeking than facilitators were found. History of dengue infection and having knowledge of dengue were found to be ambiguous as they both facilitated and hindered dengue healthcare seeking. Contrary to common belief, women were less likely to seek help for dengue than men.

CONCLUSIONS

The factors affecting dengue healthcare-seeking behaviour are diverse, can be ambiguous and are found across multiple social-ecological levels. Understanding these complexities is essential for the development of effective interventions to improve dengue healthcare-seeking behaviour.

Genetic Diversity of Dengue Virus in Clinical Specimens from Bangkok, Thailand, during 2018-2020: Co-Circulation of All Four Serotypes with Multiple Genotypes and/or Clades

Dengue is an arboviral disease highly endemic in Bangkok, Thailand. To characterize the current genetic diversity of dengue virus (DENV), we recruited patients with suspected DENV infection at the Hospital for Tropical Diseases, Bangkok, during 2018-2020. We determined complete nucleotide sequences of the DENV envelope region for 111 of 276 participant serum samples. All four DENV serotypes were detected, with the highest proportion being DENV-1. Although all DENV-1 sequences were genotype I, our DENV-1 sequences were divided into four distinct clades with different distributions in Asian countries. Two genotypes of DENV-2 were identified, Asian I and Cosmopolitan, which were further divided into two and three distinct clades, respectively. In DENV-3, in addition to the previously dominant genotype III, a cluster of 6 genotype I viruses only rarely reported in Thailand was also observed. All of the DENV-4 viruses belonged to genotype I, but they were separated into three distinct clades. These results indicated that all four serotypes of DENV with multiple genotypes and/or clades co-circulate in Bangkok. Continuous investigation of DENV is warranted to further determine the relationship between DENV within Thailand and neighboring countries in Southeast Asia and Asia.

Comparative population genetics of the invasive mosquito Aedes albopictus and the native mosquito Aedes flavopictus in the Korean peninsula

BACKGROUND

Aedes mosquitoes are important invasive species contributing to the spread of chikungunya, dengue fever, yellow fever, zika virus, and other dangerous vector-borne diseases. Aedes albopictus is native to southeast Asia, with rapid expansion due to human activity, showing a wide distribution in the Korean peninsula. Aedes flavopictus is considered to be native to East Asia, with a broad distribution in the region, including the Korean peninsula. A better understanding of the genetic diversity of these species is critical for establishing strategies for disease prevention and vector control.

METHODS

We obtained DNA from 148 specimens of Ae. albopictus and 166 specimens of Ae. flavopictus in Korea, and amplified two mitochondrial genes (COI and ND5) to compare the genetic diversity and structure of the two species.

RESULTS

We obtained a 658-bp sequence of COI and a 423-bp sequence of ND5 from both mosquito species. We found low diversity and a nonsignificant population genetic structure in Ae. albopictus, and high diversity and a nonsignificant structure in Ae. flavopictus for these two mitochondrial genes. Aedes albopictus had fewer haplotypes with respect to the number of individuals, and a slight mismatch distribution was confirmed. By contrast, Ae. flavopictus had a large number of haplotypes compared with the number of individuals, and a large unimodal-type mismatch distribution was confirmed. Although the genetic structure of both species was nonsignificant, Ae. flavopictus exhibited higher genetic diversity than Ae. albopictus.

CONCLUSIONS

Aedes albopictus appears to be an introduced species, whereas Ae. flavopictus is endemic to the Korean peninsula, and the difference in genetic diversity between the two species is related to their adaptability and introduction history. Further studies on the genetic structure and diversity of these mosquitos will provide useful data for vector control.

Molecular detection and identification of Culex flavivirus in mosquito species from Jeju, Republic of Korea

Background

Mosquito-borne flaviviruses are prime pathogens and have been a major hazard to humans and animals. They comprise several arthropod-borne viruses, including dengue virus, yellow fever virus, Japanese encephalitis virus, and West Nile virus. Culex flavivirus (CxFV) is a member of the insect-specific flavivirus (ISF) group belonging to the genus Flavivirus, which is widely distributed in a variety of mosquito populations.

Methods

Viral nucleic acid was extracted from adult mosquito pools and subjected to reverse transcriptase nested polymerase chain reaction (PCR) using target-specific primers for detecting CxFV nonstructural protein 5 (NS5). The PCR-positive samples were then sequenced, and a phylogenetic tree was constructed, including reference sequences obtained from GenBank.

Results

21 pools, belonging to Culex pipiens pallens (Cx. p. pallens) were found to be positive for the CxFV RNA sequence, with a minimum infection rate of 14.5/1000 mosquitoes. The phylogenetic analysis of the NS5 protein sequences indicated that the detected sequences were closely related to strains identified in China, with 95–98% sequence similarities.

Conclusion

Our findings highlight the presence of CxFV in Cx. p. pallens mosquito species in Jeju province, Republic of Korea. This is the first study reporting the prevalence of CxFV in Culex Pipiens (Cx. pipiens) host in the Jeju province, which can create possible interaction with other flaviviruses causing human and animal diseases. Although, mosquito-borne disease causing viruses were not identified properly, more detailed surveillance and investigation of both the host and viruses are essential to understand the prevalence, evolutionary relationship and genetic characteristic with other species.

Association of Anopheles sinensis average abundance and climate factors: Use of mosquito surveillance data in Goyang, Korea

Malaria is a vector-borne disease transmitted by Anopheline mosquitoes. In Korea, Plasmodium vivax malaria is an endemic disease and the main vector is Anopheles sinensis. Plasmodium vivax malaria is common in the northwestern part of South Korea, including in the city of Goyang in regions near the demilitarized zone. This study aimed to identify the best time-series model for predicting mosquito average abundance in Goyang, Korea. Mosquito data were obtained from the Mosquito Surveillance Program of the Goyang Ilsanseogu Public Health Center for the period 2008–2012. Black light traps were set up periodically in a park, a senior community center, and a village community center, public health center, drainage pumping station, cactus research center, restaurant near forest, in which many activities occur at night. In total, 9,512 female mosquitoes were collected at 12 permanent trapping sites during the mosquito season in the study period. Weekly An. sinensis average abundance was positively correlated with minimum grass temperature (r = 0.694, p < 0.001), precipitation (r = 0.326, p = 0.001). The results showed that seasonal autoregressive integrated moving average (SARIMA) (1,0,0)(0,0,1)₂₁ with minimum grass temperature variable at time lag0 weeks and the precipitation variable at time lag1 weeks provided that best model of mosquito average abundance. The multivariate model accounted for about 54.1% of the mosquito average abundance variation. Time-series analysis of mosquito average abundance and climate factors provided basic information for predicting the occurrence of malaria mosquitoes.

Comparison of climatic factors on mosquito abundance at US Army Garrison Humphreys, Republic of Korea

Introduction

A number of studies have been conducted on the relationship between the distribution of mosquito abundance and meteorological variables. However, few studies have specifically provided specific ranges of temperatures for estimating the maximum abundance of mosquitoes as an empirical basis for climatic dynamics for estimating mosquito-borne infectious disease risks.

Methods

Adult mosquitoes were collected for three consecutive nights/week using Mosquito Magnet® Independence® model traps during 2018 and 2019 at US Army Garrison (USAG) Humphreys, Pyeongtaek, Gyeonggi Province, Republic of Korea (ROK). An estimate of daily mean temperatures (provided by the Korea Meteorological Administration) were distributed at the maximum abundance for selected species of mosquitoes using daily mosquito collection data after controlling for mosquito ecological cycles and environmental factors.

Results

Using the Monte-Carlo simulation, the overall mosquito population abundance peaked at 22.7°C (2.5^th—97.5^th: 21.7°C–23.8°C). Aedes albopictus, vector of Zika, chikungunya, dengue fever and other viruses, abundance peaked at 24.6°C (2.5^th–97.5^th, 22.3°C–25.6°C), while Japanese encephalitis virus (JEV) vectors, e.g., Culex tritaeniorhynchus and Culex pipiens, peaked at 24.3°C (2.5^th–97.5^th: 21.9°C–26.3°C) and 22.6°C (2.5^th–97.5^th: 21.9°C–25.2°C), respectively. Members of the Anopheles Hyrcanus Group, some of which are vivax malaria vectors in the ROK, abundance peaked at 22.4°C (2.5^th–97.5^th: 21.5°C–23.8°C).

Conclusion

The empirical mean temperature ranges for maximum abundance were determined for each mosquito species collected at USAG Humphreys. These data contributed to the identification of relative mosquito abundance patterns for estimating mosquito-borne disease risks and developing and implementing disease prevention practices.

Geographical Genetic Variation and Sources of Korean Aedes albopictus (Diptera: Culicidae) Populations

Aedes albopictus (Skuse, 1894) is a mosquito vector raising global health concerns owing to its transmission of dengue, Zika, and chikungunya viruses. This vector accounts for a large proportion of the Korean mosquito community; however, autochthonous clinical cases resulting from this species remain unreported in South Korea. This study aimed to examine the geographical genetic variations and sources of Ae. albopictus populations in South Korea exclusively on the basis of COI gene analysis from 292 samples collected from 37 localities in 2016-2018 and 290 reference sequences from GenBank. Thirty-eight haplotypes were identified among the 292 Ae. albopictus samples, with H1 (n = 190, 65.1%), H29 (n = 24, 8.22%), and H32 (n = 24, 8.22%) being the most common and widely distributed haplotypes in the mainland, southern coastal region, and Jeju Island, respectively. In general, high haplotype (≥0.5; 44.7%) and low nucleotide (≤0.00148 max.) diversity were observed in these populations. Based on eight regional groups, results of neutral tests and a mismatch analysis supported demographic expansions after bottlenecks. Furthermore, analysis of molecular variance, FST, and K2P distance showed that Gyeongsangnam-do, Jeju Island, and mainland groups were genetically differentiated. Haplotype network and phylogenetic analyses revealed that the sources of the main haplotypes are related to strains from other countries. The current findings need to be validated with additional sampling from heterogeneous habitats and different genetic markers. However, our results suggest that haplotype changes should be closely monitored for efficient vector surveillance and control.

Research Trends in Agenda-setting for Climate Change Adaptation Policy in the Public Health Sector in Korea

Many studies have been conducted to assess the health effects of climate change in Korea. However, there has been a lack of consideration regarding how the results of these studies can be applied to relevant policies. The current study aims to examine research trends at the agenda-setting stage and to review future ways in which health-related adaptation to climate change can be addressed within national public health policy. A systematic review of previous studies of the health effects of climate change in Korea was conducted. Many studies have evaluated the effect of ambient temperature on health. A large number of studies have examined the effects on deaths and cardio-cerebrovascular diseases, but a limitation of these studies is that it is difficult to apply their findings to climate change adaptation policy in the health sector. Many infectious disease studies were also identified, but these mainly focused on malaria. Regarding climate change-related factors other than ambient temperature, studies of the health effects of these factors (with the exception of air pollution) are limited. In Korea, it can be concluded that studies conducted as part of the agenda-setting stage are insufficient, both because studies on the health effects of climate change have not ventured beyond defining the problem and because health adaptation to climate change has not been set as an important agenda item. In the future, the sharing and development of relevant databases is necessary. In addition, the priority of agenda items should be determined as part of a government initiative.

Phylogenetic Analysis for the Origin of Typhoid Fever Outbreak on Jeju Island, Korea, in 2017

In June 2017, on Jeju Island, six patients were diagnosed with typhoid fever. All six patients were admitted to our hospital with fever, all of them had been working at the same hotel. The gyrA and gyrB genes of four out of six Salmonella typhi cases were amplified by polymerase chain reaction. The phylogenetic tree of the genes showed that the S. Typhi isolates from Jeju Island in 2017 had the same genotype and were similar to isolates from the United Kingdom. The origin of the isolates of the outbreak was the same, and the disease strain may have been imported from outside of Korea.

Climate Change, Health and Mosquito-Borne Diseases: Trends and Implications to the Pacific Region

Climate change is known to affect Pacific Island nations in a variety of ways. One of them is by increasing the vulnerability of human health induced by various climate change impacts, which pose an additional burden to the already distressed health systems in the region. This paper explores the associations between climate change and human health on the one hand, and outlines some of the health care challenges posed by a changing climate on the other. In particular, it describes the links between climate variations and the emergence of climate-sensitive infectious diseases, such as the mosquito-borne diseases dengue, chikungunya, and Zika. The paper also presents a summary of the key findings of the research initiatives Climate Change and Prevalence Study of ZIKA Virus Diseases in Fiji and the findings from the World Mosquito Program as two examples of public health action in the Pacific region.

Increased risk of endemic mosquito-borne diseases in Canada due to climate change

There are currently over 80 species of mosquito endemic in Canada-although only a few of these carry pathogens that can cause disease in humans. West Nile virus, Eastern equine encephalitis virus and the California serogroup viruses (including the Jamestown Canyon and snowshoe hare viruses) are mosquito-borne viruses that have been found to cause human infections in North America, including in Canada. Over the last 20 years, the incidence of most of these endemic mosquito-borne diseases (MBD) has increased approximately 10% in Canada, due in large part to climate change. It is anticipated that both the mosquito lifecycle and virus transmission patterns will be affected by climate change, resulting in an increase in both the range and local abundance of several important mosquito species. Laboratory studies and mathematical modelling suggest that increased ambient temperatures, changes in precipitation and extreme weather events associated with climate change will likely continue to drive mosquito vector and MBD range expansion, increasing the duration of transmission seasons and leading to MBD-related epidemics. Furthermore, Canada's endemic MBDs have complex transmission cycles, involving multiple reservoir hosts (birds and mammals), multiple pathogens and multiple mosquito species-all of which may be sensitive to climate and other environmental changes, and making forecasting of potential emerging trends difficult. These expected climate-induced changes in mosquitoes and MBDs underline the need for continued (and expanded) surveillance and research to ensure timely and accurate evaluation of the risks to the public health of Canadians.

Epidemiological Characteristics of Re-emerging Vivax Malaria in the Republic of Korea (1993-2017)

Historically, Plasmodium vivax malaria has been one of the most highly endemic parasitic diseases in the Korean Peninsula. Until the 1970s, vivax malaria was rarely directly lethal and was controlled through the Korean Government Program administered by the National Malaria Eradication Service in association with the World Health Organization's Global Malaria Eradication Program. Vivax malaria has re-emerged in 1993 near the Demilitarized Zone between South and North Korea and has since become an endemic infectious disease that now poses a serious public health threat through local transmission in the Republic of Korea. This review presents major lessons learned from past and current malaria research, including epidemiological and biological characteristics of the re-emergent disease, and considers some interesting patterns of diversity. Among other features, this review highlights temporal changes in the genetic make-up of the parasitic population, patient demographic features, and spatial distribution of cases, which all provide insight into the factors contributing to local transmission. The data indicate that vivax malaria in Korea is not expanding expo- nentially. However, continued surveillance is needed to prevent future resurgence.

Potential effects of climate change on dengue transmission dynamics in Korea

Dengue fever is a major international public health concern, with more than 55% of the world population at risk of infection. Recent climate changes related to global warming have increased the potential risk of domestic outbreaks of dengue in Korea. In this study, we develop a two-strain dengue model associated with climate-dependent parameters based on Representative Concentration Pathway (RCP) scenarios provided by the Korea Meteorological Administration. We assess the potential risks of dengue outbreaks by means of the vector capacity and intensity under various RCP scenarios. A sensitivity analysis of the temperature-dependent parameters is performed to explore the effects of climate change on dengue transmission dynamics. Our results demonstrate that a higher temperature significantly enhances the potential threat of domestic dengue outbreaks in Korea. Furthermore, we investigate the effects of countermeasures on the cumulative incidence of humans and vectors. The current main control measures (comprising only travel restrictions) for infected humans in Korea are not as effective as combined control measures (travel restrictions and vector control), dramatically reducing the possibilities of dengue outbreaks.

Dengue infection in patients with febrile illness and its relationship to climate factors: A case study in the city of Jeddah, Saudi Arabia, for the period 2010-2014

Dengue is an important global arboviral disease with expanding geographical range. It is a major public health concern in Western Saudi Arabia since its first detection in the city of Jeddah in 1994. In this retrospective study, we examined dengue incidence among febrile patients suspected for acute dengue infection at King Abdulaziz University Hospital, Jeddah from 2010 to 2014 and we tried to determine the effect of climate factors on dengue incidence in the city. Acute dengue incidence rates among clinically suspected patients showed annual variation with a range from 29.3% to 57%. Male gender and 11-30 years age range were found to be risk factors for dengue infection in Jeddah. While dengue infections can be detected throughout the year, most cases occurred between March and July with peaks in May and June. Seasonality of dengue was found to be significantly associated with the decrease in relative humidity and increase in temperature within the range of ∼25 °C to ∼33 °C but not extremely hot temperatures. Moreover, we found that rainfall during winter (November to February) has a significant lag effect on dengue infection among febrile patients in the city. Jeddah is the second largest city in Saudi Arabia and a major hub for pilgrims because of its close proximity to the holy sites in the Kingdom. The observed high rates of acute dengue infections clearly show the endemicity of dengue in Jeddah. The observed higher incidence rates at young age are expected to cause an increase in severe dengue cases in the future especially that multiple dengue serotypes are co-circulating in the city. Furthermore, the significant association between the different climate factors and dengue and their impact on the disease seasonality should help in the effort to implement effective control and management measures to reduce dengue burden in the Kingdom.

Effects of climate change on the spread of zika virus: a public health threat

Zika is a vector-borne viral disease transmitted to humans primarily by Aedes aegypti mosquitoes. The increased climate instability has contributed to the emergence of infections carried by mosquitoes like dengue, chikungunya and zika. While infection with the zika virus is not new, the recent epidemic of microcephaly in Brazil and other countries in South America resulting from the infection of pregnant women with the zika virus raise a number of serious public health concerns. These include the question of how climate change affects the range of zika vectors, what can we do to shorten the length of mosquito season, how and why the symptoms of zika infection have changed and what can be done to reduce the burden of human disease from this infection? Another important question that needs to be answered is what are the factors that caused the zika virus to leave the non-human primates and/or other mammals and invade the human population?

Epidemiology and Clinical Characteristics of Zika Virus Infections Imported into Korea from March to October 2016

Zika is a re-emerging, mosquito-borne viral infection, which has been recently shown to cause microcephaly and Guillain-Barré syndrome. Since 2015 the number of infected patients has increased significantly in South America. The purpose of this study was to identify the epidemiologic and clinical characteristics of patients with Zika virus (ZIKV) infections in Korea. Patients who had visited areas of risk and tested positive in the ZIKV reverse transcriptase polymerase chain reaction (RT-PCR) in blood, urine, or saliva specimens were included. The first Korean case of ZIKV infection was reported in March 2016, and 14 cases had been reported by October 2016. The median age of the patients was 34 years (19-64 years). Ten patients had been exposed in Southeast Asia and 4 in Latin America. Rash was the most common symptom (92.9%; 13/14), followed by myalgia (50.0%; 7/14), and arthralgia (28.6%, 4/14). There were no neurologic abnormalities and none of the patients was pregnant. Results of biochemical tests were normal. Positivity rates of RT-PCR for ZIKV in serum, urine, and saliva were 53.8%, 100.0%, and 83.3%, respectively in the first week of symptoms. In conclusion, 14 patients with ZIKV infections were reported in Korea by October 2016 and all of them had mild clinical symptoms.

Breaking the chain of zoonoses through biosecurity in livestock

Increases in global travel, trade and urbanisation are leading to greater incidence of zoonotic disease, and livestock are often a key link in the spread of disease to humans. As such, livestock vaccination strategies, as a part of broader biosecurity solutions, are critical to both animal and human health. Importantly, approaches that restrict infectious agents in livestock, not only protects their economic value but should reduce the potential for spill over infections in humans. Biosecurity solutions to livestock health can take a number of different forms and are generally heavily weighted towards prevention of infection rather than treatment. Therefore, vaccination can provide an effective component of a strategic approach, particularly as production economics dictate the use of cost effective solutions. Furthermore, in an evolving global environment there is a need for vaccines that accommodate for lower socioeconomic and rapidly emerging zoonotics.

Animal models for dengue vaccine development and testing

Dengue fever is a tropical endemic disease; however, because of climate change, it may become a problem in South Korea in the near future. Research on vaccines for dengue fever and outbreak preparedness are currently insufficient. In addition, because there are no appropriate animal models, controversial results from vaccine efficacy assessments and clinical trials have been reported. Therefore, to study the mechanism of dengue fever and test the immunogenicity of vaccines, an appropriate animal model is urgently needed. In addition to mouse models, more suitable models using animals that can be humanized will need to be constructed. In this report, we look at the current status of model animal construction and discuss which models require further development.

Climate Change Influences Potential Distribution of Infected Aedes aegypti Co-Occurrence with Dengue Epidemics Risk Areas in Tanzania

Background

Dengue is the second most important vector-borne disease of humans globally after malaria. Incidence of dengue infections has dramatically increased recently, potentially due to changing climate. Climate projections models predict increases in average annual temperature, precipitation and extreme events in the future. The objective of this study was to assess the effect of changing climate on distribution of dengue vectors in relation to epidemic risk areas in Tanzania.

Methods/Findings

We used ecological niche models that incorporated presence-only infected Aedes aegypti data co-occurrence with dengue virus to estimate potential distribution of epidemic risk areas. Model input data on infected Ae. aegypti was collected during the May to June 2014 epidemic in Dar es Salaam. Bioclimatic predictors for current and future projections were also used as model inputs. Model predictions indicated that habitat suitability for infected Ae. aegypti co-occurrence with dengue virus in current scenarios is highly localized in the coastal areas, including Dar es Salaam, Pwani, Morogoro, Tanga and Zanzibar. Models indicate that areas of Kigoma, Ruvuma, Lindi, and those around Lake Victoria are also at risk. Projecting to 2020, we show that risk emerges in Mara, Arusha, Kagera and Manyara regions, but disappears in parts of Morogoro, Ruvuma and near Lake Nyasa. In 2050 climate scenario, the predicted habitat suitability of infected Ae. aegypti co-occurrence with dengue shifted towards the central and north-eastern parts with intensification in areas around all major lakes. Generally, model findings indicated that the coastal regions would remain at high risk for dengue epidemic through 2050.

Conclusion/Significance

Models incorporating climate change scenarios to predict emerging risk areas for dengue epidemics in Tanzania show that the anticipated risk is immense and results help guiding public health policy decisions on surveillance and control of dengue epidemics. A collaborative approach is recommended to develop and adapt control and prevention strategies.

The spread of Zika and the potential for global arbovirus syndemics

It is estimated that over a million people die each year from infectious diseases of zoonotic origin and hundreds of millions suffer from these pervasive threats to human well-being. In light of the emergent global concern over the Zika virus, evidence that it has not one but two competent mosquito vector species in the Aedes family, and that both can be co-infected with other pathogens including dengue and chikungunya, this paper examines research suggesting the prospect of significant twenty-first-century outbreaks of arbovirus syndemics. Uniting the concepts 'synergy' with 'epidemic', a syndemics approach recognises that diseases in a population occur neither independent of social and ecological conditions, nor in isolation from other diseases. Assessment of the potential for arbovirus syndemics entails a review of the human role in the global spread of Aedes mosquitoes, the socio-environmental conditions of Aedes diffusion, the increasing likelihood of co-transmission of arbovirus diseases, evidence of co-infection and concern about the adverse health effects of arbovirus syndemic interaction, and the need for an appropriate environment-sensitive framework for effective public health responses. Called Planetary Health, this emergent framework confronts conceptual, knowledge, and governance challenges created by the dramatic shifts in environments, climates, people, vectors, and pathogens in the world.

Present and future projections of habitat suitability of the Asian tiger mosquito, a vector of viral pathogens, from global climate simulation

Climate change can influence the transmission of vector-borne diseases (VBDs) through altering the habitat suitability of insect vectors. Here we present global climate model simulations and evaluate the associated uncertainties in view of the main meteorological factors that may affect the distribution of the Asian tiger mosquito (Aedes albopictus), which can transmit pathogens that cause chikungunya, dengue fever, yellow fever and various encephalitides. Using a general circulation model at 50 km horizontal resolution to simulate mosquito survival variables including temperature, precipitation and relative humidity, we present both global and regional projections of the habitat suitability up to the middle of the twenty-first century. The model resolution of 50 km allows evaluation against previous projections for Europe and provides a basis for comparative analyses with other regions. Model uncertainties and performance are addressed in light of the recent CMIP5 ensemble climate model simulations for the RCP8.5 concentration pathway and using meteorological re-analysis data (ERA-Interim/ECMWF) for the recent past. Uncertainty ranges associated with the thresholds of meteorological variables that may affect the distribution of Ae. albopictus are diagnosed using fuzzy-logic methodology, notably to assess the influence of selected meteorological criteria and combinations of criteria that influence mosquito habitat suitability. From the climate projections for 2050, and adopting a habitat suitability index larger than 70%, we estimate that approximately 2.4 billion individuals in a land area of nearly 20 million km² will potentially be exposed to Ae. albopictus. The synthesis of fuzzy-logic based on mosquito biology and climate change analysis provides new insights into the regional and global spreading of VBDs to support disease control and policy making.

Modelling Anopheles gambiae s.s. Population Dynamics with Temperature- and Age-Dependent Survival

Climate change and global warming are emerging as important threats to human health, particularly through the potential increase in vector- and water-borne diseases. Environmental variables are known to affect substantially the population dynamics and abundance of the poikilothermic vectors of disease, but the exact extent of this sensitivity is not well established. Focusing on malaria and its main vector in Africa, Anopheles gambiae sensu stricto, we present a set of novel mathematical models of climate-driven mosquito population dynamics motivated by experimental data suggesting that in An. gambiae, mortality is temperature and age dependent. We compared the performance of these models to that of a "standard" model ignoring age dependence. We used a longitudinal dataset of vector abundance over 36 months in sub-Saharan Africa for comparison between models that incorporate age dependence and one that does not, and observe that age-dependent models consistently fitted the data better than the reference model. This highlights that including age dependence in the vector component of mosquito-borne disease models may be important to predict more reliably disease transmission dynamics. Further data and studies are needed to enable improved fitting, leading to more accurate and informative model predictions for the An. gambiae malaria vector as well as for other disease vectors.

Japanese Cedar (Cryptomeria japonica) Pollinosis in Jeju, Korea: Is It Increasing?

Jeju is an island in South Korea located in a temperate climate zone. The Japanese cedar tree (JC) has become the dominant tree species while used widely to provide a windbreak for the tangerine orchard industry. An increase in pollen counts precedes atopic sensitization to pollen and pollinosis, but JC pollinosis in Jeju has never been studied. We investigated JC pollen counts, sensitization to JC pollen, and JC pollinosis. Participants were recruited among schoolchildren residing in Jeju City, the northern region (NR) and Seogwipo City, the southern region (SR) of the island. The JC pollen counts were monitored. Sensitization rates to common aeroallergens were evaluated by skin prick tests. Symptoms of pollinosis were surveyed. Among 1,225 schoolchildren (49.6% boys, median age 13 years), 566 (46.2%) were atopic. The rate of sensitization to Dermatophagoides pteronyssinus (35.8%) was highest, followed by D. farinae (26.2%), and JC pollen (17.6%). In the SR, 156 children (23.8%) were sensitized to JC pollen; this rate was significantly higher than that in the NR (59 children, 10.4%, P<0.001). A significant increment in the sensitization rate for JC pollen with increasing school level was observed only in the SR. JC pollen season in the SR started earlier and lasted longer than that in the NR. JC pollen season in Jeju was defined as extending from late January to mid-April. The prevalence of JC pollinosis was estimated to be 8.5%. The prevalence differed significantly between the NR and SR (5.3% vs 11.3%, P<0.001), mainly due to the difference in sensitization rates. JC pollen is the major outdoor allergen for early spring pollinosis in Jeju. JC pollen season is from late January to mid-April. Warmer weather during the flowering season scatters more JC pollen in the atmosphere, resulting in a higher sensitization rate in atopic individuals and, consequently, making JC pollinosis more prevalent.

Adapting to the health impacts of climate change in a sustainable manner

The climate is changing and this poses significant threats to human health. Climate change is one of the greatest challenges facing Pacific Island countries and territories due to their unique geophysical features, and their social, economic and cultural characteristics. The Pacific region also faces challenges with widely dispersed populations, limited resources and fragmented health systems. Over the past few years, there has been a substantial increase in international aid for health activities aimed at adapting to the threats of climate change. This funding needs to be used strategically to ensure an effective approach to reducing the health risk from climate change. Respecting the principles of development effectiveness will result in more effective and sustainable adaptation, in particular, 1) processes should be owned and driven by local communities, 2) investments should be aligned with existing national priorities and policies, and 3) existing systems must not be ignored, but rather expanded upon and reinforced.

Mosquito surveillance revealed lagged effects of mosquito abundance on mosquito-borne disease transmission: a retrospective study in Zhejiang, China

Mosquito-borne diseases (MBDs) are still threats to public health in Zhejiang. In this study, the associations between the time-lagged mosquito capture data and MBDs incidence over five years were used to examine the potential effects of mosquito abundance on patterns of MBDs epidemiology in Zhejiang during 2008–2012. Light traps were used to collect adult mosquitoes at 11 cities. Correlation tests with and without time lag were performed to investigate the correlations between MBDs incidence rates and mosquito abundance by month. Selected MBDs consisted of Japanese encephalitis (JE), dengue fever (DF) and malaria. A Poisson regression analysis was performed by using a generalized estimating equations (GEE) approach, and the most parsimonious model was selected based on the quasi-likelihood based information criterion (QICu). We identified five mosquito species and the constituent ratio of Culex pipiens pallens, Culex tritaeniorhynchus, Aedes albopictus, Anopheles sinensis and Armigeres subalbatus was 66.73%, 21.47%, 6.72%, 2.83% and 2.25%, respectively. The correlation analysis without and with time lag showed that Culex mosquito abundance at a lag of 0 or 1 month was positively correlated with JE incidence during 2008–2012, Ae. albopictus abundance at a lag of 1 month was positively correlated with DF incidence in 2009, and An. sinensis abundance at a lag of 0–2 months was positively correlated with malaria incidence during 2008–2010. The Poisson regression analysis showed each 0.1 rise of monthly mosquito abundance corresponded to a positive increase of MBD cases for the period of 2008–2012. The rise of mosquito abundance with a lag of 0–2 months increased the risk of human MBDs infection in Zhejiang. Our study provides evidence that mosquito monitoring could be a useful early warning tool for the occurrence and transmission of MBDs.

Ticks collected from migratory birds, including a new record of Haemaphysalis formosensis, on Jeju Island, Korea

Migratory birds may disperse parasites across ecological barriers, and recent climate change may alter the pattern of ectoparasite dispersal via changed patterns of bird migration. In order to document the parasitization of migratory birds by Ixodidae ticks on Jeju Island in Korea, we examined 934 migratory birds comprising 75 species for ticks from 2010 to 2012. In total, 313 ticks were collected from 74 migratory birds across 17 avian species and identified based on morphological keys. These ticks represented six species: Haemaphysalis flava, H. formosensis, H. longicornis, H. concinna, Ixodes turdus and I. nipponensis. Of particular note was the presence of H. formosensis, a species not previously reported to have been found in Korea, and H. concinna, which had not been previously reported on Jeju Island. The dominant tick species found were H. flava (226 ticks, 72.2 %) and I. turdus (54 ticks, 17.3 %), and ground-dwelling thrushes such as Pale thrushes (Turdus pallidus; 39 birds, 52.7 %) were the most important hosts. Although H. longicornis is the most abundant and prevalent terrestrial tick on Jeju Island, the species accounted for only 3.8 % of the total ticks collected in this study, suggesting that ticks on migratory birds may differ from the local tick fauna and that exotic ticks may be introduced via migratory birds. Therefore, long-term programs for tick and tick-borne disease surveillance are recommended to understand the role of migratory animals in the introduction of exotic species and associated pathogens and in life cycles of ticks at different stages in this region.