Identifying the environmental conditions favouring West Nile Virus outbreaks in Europe

Genomic epidemiology of West Nile virus in Europe

West Nile virus is one of the most widespread mosquito-borne zoonotic viruses, with unique transmission dynamics in various parts of the world. Genomic surveillance has provided important insights in the global patterns of West Nile virus emergence and spread. In Europe, multiple West Nile virus lineages have been isolated, with lineage 1a and 2 being the main lineages responsible for human infections. In contrast to North America, where a single introduction of lineage 1a resulted in the virus establishing itself in a new continent, at least 13 introductions of lineages 1a and 2 have occurred into Europe, which is likely a vast underestimation of the true number of introductions. Historically, lineage 1a was the main lineage circulating in Europe, but since the emergence of lineage 2 in the early 2000s, the latter has become the predominant lineage. This shift in West Nile virus lineage prevalence has been broadly linked to the expansion of the virus into northerly temperate regions, where autochthonous cases in animals and humans have been reported in Germany and The Netherlands. Here, we discuss how genomic analysis has increased our understanding of the epidemiology of West Nile virus in Europe, and we present a global Nextstrain build consisting of publicly available West Nile virus genomes (https://nextstrain.org/community/grubaughlab/WNV-Global). Our results elucidate recent insights in West Nile virus lineage dynamics in Europe, and discuss how expanded programs can fill current genomic surveillance gaps.

Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review

BACKGROUND

West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

MAIN BODY

We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations (n = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV (n = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies (n = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

CONCLUSIONS

This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local contexts.

Lessons Learned from West Nile Virus Infection:Vaccinations in Equines and Their Implications for One Health Approaches

Humans and equines are two dead-end hosts of the mosquito-borne West Nile virus (WNV) with similar susceptibility and pathogenesis. Since the introduction of WNV vaccines into equine populations of the United States of America (USA) in late 2002, there have been only sporadic cases of WNV infection in equines. These cases are generally attributed to unvaccinated and under-vaccinated equines. In contrast, due to the lack of a human WNV vaccine, WNV cases in humans have remained steadily high. An average of 115 deaths have been reported per year in the USA since the first reported case in 1999. Therefore, the characterization of protective immune responses to WNV and the identification of immune correlates of protection in vaccinated equines will provide new fundamental information about the successful development and evaluation of WNV vaccines in humans. This review discusses the comparative epidemiology, transmission, susceptibility to infection and disease, clinical manifestation and pathogenesis, and immune responses of WNV in humans and equines. Furthermore, prophylactic and therapeutic strategies that are currently available and under development are described. In addition, the successful vaccination of equines against WNV and the potential lessons for human vaccine development are discussed.

Landscape level associations between birds, mosquitoes and microclimates: possible consequences for disease transmission?

BACKGROUND

Mosquito-borne diseases are on the rise. While climatic factors have been linked to disease occurrences, they do not explain the non-random spatial distribution in disease outbreaks. Landscape-related factors, such as vegetation structure, likely play a crucial but hitherto unquantified role.

METHODS

We explored how three critically important factors that are associated with mosquito-borne disease outbreaks: microclimate, mosquito abundance and bird communities, vary at the landscape scale. We compared the co-occurrence of these three factors in two contrasting habitat types (forest versus grassland) across five rural locations in the central part of the Netherlands between June and September 2021.

RESULTS

Our results show that forest patches provide a more sheltered microclimate, and a higher overall abundance of birds. When accounting for differences in landscape characteristics, we also observed that the number of mosquitoes was higher in isolated forest patches.

CONCLUSIONS

Our findings indicate that, at the landscape scale, variation in tree cover coincides with suitable microclimate and high Culex pipiens and bird abundance. Overall, these factors can help understand the non-random spatial distribution of mosquito-borne disease outbreaks.

Contribution of climate change to the spatial expansion of West Nile virus in Europe

West Nile virus (WNV) is an emerging mosquito-borne pathogen in Europe where it represents a new public health threat. While climate change has been cited as a potential driver of its spatial expansion on the continent, a formal evaluation of this causal relationship is lacking. Here, we investigate the extent to which WNV spatial expansion in Europe can be attributed to climate change while accounting for other direct human influences such as land-use and human population changes. To this end, we trained ecological niche models to predict the risk of local WNV circulation leading to human cases to then unravel the isolated effect of climate change by comparing factual simulations to a counterfactual based on the same environmental changes but a counterfactual climate where long-term trends have been removed. Our findings demonstrate a notable increase in the area ecologically suitable for WNV circulation during the period 1901-2019, whereas this area remains largely unchanged in a no-climate-change counterfactual. We show that the drastic increase in the human population at risk of exposure is partly due to historical changes in population density, but that climate change has also been a critical driver behind the heightened risk of WNV circulation in Europe.

Distribution of Culex pipiens life stages across urban green and grey spaces in Leiden, The Netherlands

BACKGROUND

There is an urgent need for cities to become more climate resilient; one of the key strategies is to include more green spaces in the urban environment. Currently, there is a worry that increasing green spaces might increase mosquito nuisance. As such, this study explores a comprehensive understanding of how mosquitoes utilise contrasting grey and green habitats at different life stages and which environmental factors could drive these distributions.

METHODS

We used a setup of six paired locations, park (green) vs. residential (grey) areas in a single model city (Leiden, The Netherlands), where we sampled the abundances of different mosquito life stages (eggs, larvae, adults) and the local microclimatic conditions. In this study, we focused on Culex pipiens s.l., which is the most common and abundant mosquito species in The Netherlands.

RESULTS

Our results show that while Cx. pipiens ovipositioning rates (number of egg rafts) and larval life stages were far more abundant in residential areas, adults were more abundant in parks. These results coincide with differences in the number of suitable larval habitats (higher in residential areas) and differences in microclimatic conditions (more amenable in parks).

CONCLUSIONS

These findings suggest that Cx. pipiens dispersal may be considerably more important than previously thought, where adult Cx. pipiens seek out the most suitable habitat for survival and breeding success. Our findings can inform more targeted and efficient strategies to mitigate and reduce mosquito nuisance while urban green spaces are increased, which make cities more climate resilient.

Navigating Evolving Challenges in Blood Safety

Blood safety remains a paramount public health concern, and health authorities maintain a high level of vigilance to prevent transfusion-transmitted infections (TTIs) [...].

West Nile virus spread in Europe: Phylogeographic pattern analysis and key drivers

BACKGROUND

West Nile virus (WNV) outbreaks in birds, humans, and livestock have occurred in multiple areas in Europe and have had a significant impact on animal and human health. The patterns of emergence and spread of WNV in Europe are very different from those in the US and understanding these are important for guiding preparedness activities.

METHODS

We mapped the evolution and spread history of WNV in Europe by incorporating viral genome sequences and epidemiological data into phylodynamic models. Spatially explicit phylogeographic models were developed to explore the possible contribution of different drivers to viral dispersal direction and velocity. A "skygrid-GLM" approach was used to identify how changes in environments would predict viral genetic diversity variations over time.

FINDINGS

Among the six lineages found in Europe, WNV-2a (a sub-lineage of WNV-2) has been predominant (accounting for 73% of all sequences obtained in Europe that have been shared in the public domain) and has spread to at least 14 countries. In the past two decades, WNV-2a has evolved into two major co-circulating clusters, both originating from Central Europe, but with distinct dynamic history and transmission patterns. WNV-2a spreads at a high dispersal velocity (88km/yr-215 km/yr) which is correlated to bird movements. Notably, amongst multiple drivers that could affect the spread of WNV, factors related to land use were found to strongly influence the spread of WNV. Specifically, the intensity of agricultural activities (defined by factors related to crops and livestock production, such as coverage of cropland, pasture, cultivated and managed vegetation, livestock density) were positively associated with both spread direction and velocity. In addition, WNV spread direction was associated with high coverage of wetlands and migratory bird flyways.

CONCLUSION

Our results suggest that-in addition to ecological conditions favouring bird- and mosquito- presence-agricultural land use may be a significant driver of WNV emergence and spread. Our study also identified significant gaps in data and the need to strengthen virological surveillance in countries of Central Europe from where WNV outbreaks are likely seeded. Enhanced monitoring for early detection of further dispersal could be targeted to areas with high agricultural activities and habitats of migratory birds.

Papatsiros V, Billinis C. Indication of West Nile Virus (WNV) Lineage 2 Overwintering among Wild Birds in the Regions of Peloponnese and Western Greece

West Nile virus (WNV), a zoonotic mosquito-borne virus, has recently caused human outbreaks in Europe, including Greece. Its transmission cycle in nature includes wild birds as amplifying hosts and ornithophilic mosquito vectors. The aim of this study was to assess WNV circulation among wild birds from two regions of Greece, Peloponnese and Western Greece, during 2022. To this end, a total of 511 birds belonging to 37 different species were sampled and molecularly screened. WNV RNA was detected from February to November in a total of 71 wild birds of nine species originating from both investigated regions. The first eight positive samples were sequenced on a part of NS3 and, according to the phylogenetic analysis, they belonged to evolutionary lineage 2 and presented similarity to previous outbreak-causing Greek strains (Argolis 2017, Macedonia 2010 and 2012). It was more likely to identify a PCR positive bird as the population density and the distance from water sources decreased. The present report provides evidence of WNV occurrence in both Peloponnese and Western Greece during 2022 and underlines its possible overwintering, highlighting the need for avian species surveillance to be conducted annually and throughout the year. Magpies are proposed as sentinels for WNV monitoring.

The Ongoing Epidemic of West Nile Virus in Greece: The Contribution of Biological Vectors and Reservoirs and the Importance of Climate and Socioeconomic Factors Revisited

Emerging infectious diseases have inflicted a significant health and socioeconomic burden upon the global population and governments worldwide. West Nile virus, a zoonotic, mosquito-borne flavivirus, was originally isolated in 1937 from a febrile patient in the West Nile Province of Uganda. It remained confined mainly to Africa, the Middle East, and parts of Europe and Australia until 1999, circulating in an enzootic mosquito-bird transmission cycle. Since the beginning of the 21st century, a new, neurotropic, more virulent strain was isolated from human outbreaks initially occurring in North America and later expanding to South and South-eastern Europe. Since 2010, when the first epidemic was recorded in Greece, annual incidence has fluctuated significantly. A variety of environmental, biological and socioeconomic factors have been globally addressed as potential regulators of the anticipated intensity of the annual incidence rate; circulation within the zoonotic reservoirs, recruitment and adaptation of new potent arthropod vectors, average winter and summer temperatures, precipitation during the early summer months, and socioeconomic factors, such as the emergence and progression of urbanization and the development of densely populated areas in association with insufficient health policy measures. This paper presents a review of the biological and socioenvironmental factors influencing the dynamics of the epidemics of West Nile virus (WNV) cases in Greece, one of the highest-ranked European countries in terms of annual incidence. To date, WNV remains an unpredictable opponent as is also the case with other emerging infectious diseases, forcing the National Health systems to develop response strategies, control the number of infections, and shorten the duration of the epidemics, thus minimizing the impact on human and material resources.

Evaluation of NS4A, NS4B, NS5 and 3'UTR Genetic Determinants of WNV Lineage 1 Virulence in Birds and Mammals

West Nile virus (WNV) is amplified in an enzootic cycle involving birds as amplifying hosts. Because they do not develop high levels of viremia, humans and horses are considered to be dead-end hosts. Mosquitoes, especially from the Culex genus, are vectors responsible for transmission between hosts. Consequently, understanding WNV epidemiology and infection requires comparative and integrated analyses in bird, mammalian, and insect hosts. So far, markers of WNV virulence have mainly been determined in mammalian model organisms (essentially mice), while data in avian models are still missing. WNV Israel 1998 (IS98) is a highly virulent strain that is closely genetically related to the strain introduced into North America in 1999, NY99 (genomic sequence homology > 99%). The latter probably entered the continent at New York City, generating the most impactful WNV outbreak ever documented in wild birds, horses, and humans. In contrast, the WNV Italy 2008 strain (IT08) induced only limited mortality in birds and mammals in Europe during the summer of 2008. To test whether genetic polymorphism between IS98 and IT08 could account for differences in disease spread and burden, we generated chimeric viruses between IS98 and IT08, focusing on the 3' end of the genome (NS4A, NS4B, NS5, and 3'UTR regions) where most of the non-synonymous mutations were detected. In vitro and in vivo comparative analyses of parental and chimeric viruses demonstrated a role for NS4A/NS4B/5'NS5 in the decreased virulence of IT08 in SPF chickens, possibly due to the NS4B-E249D mutation. Additionally, significant differences between the highly virulent strain IS98 and the other three viruses were observed in mice, implying the existence of additional molecular determinants of virulence in mammals, such as the amino acid changes NS5-V258A, NS5-N280K, NS5-A372V, and NS5-R422K. As previously shown, our work also suggests that genetic determinants of WNV virulence can be host-dependent.

Assessing the Influence of Climate on the Spatial Pattern of West Nile Virus Incidence in the United States

BACKGROUND

West Nile virus (WNV) is the leading cause of mosquito-borne disease in humans in the United States. Since the introduction of the disease in 1999, incidence levels have stabilized in many regions, allowing for analysis of climate conditions that shape the spatial structure of disease incidence.

OBJECTIVES

Our goal was to identify the seasonal climate variables that influence the spatial extent and magnitude of WNV incidence in humans.

METHODS

We developed a predictive model of contemporary mean annual WNV incidence using U.S. county-level case reports from 2005 to 2019 and seasonally averaged climate variables. We used a random forest model that had an out-of-sample model performance of R2=0.61.

RESULTS

Our model accurately captured the V-shaped area of higher WNV incidence that extends from states on the Canadian border south through the middle of the Great Plains. It also captured a region of moderate WNV incidence in the southern Mississippi Valley. The highest levels of WNV incidence were in regions with dry and cold winters and wet and mild summers. The random forest model classified counties with average winter precipitation levels <23.3mm/month as having incidence levels over 11 times greater than those of counties that are wetter. Among the climate predictors, winter precipitation, fall precipitation, and winter temperature were the three most important predictive variables.

DISCUSSION

We consider which aspects of the WNV transmission cycle climate conditions may benefit the most and argued that dry and cold winters are climate conditions optimal for the mosquito species key to amplifying WNV transmission. Our statistical model may be useful in projecting shifts in WNV risk in response to climate change. https://doi.org/10.1289/EHP10986.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Spatial Analysis of Mosquito-Borne Diseases in Europe: A Scoping Review

Mosquito-borne infections are increasing in endemic areas and previously unaffected regions. In 2020, the notification rate for Dengue was 0.5 cases per 100,000 population, and for Chikungunya <0.1/100,000. In 2019, the rate for Malaria was 1.3/100,000, and for West Nile Virus, 0.1/100,000. Spatial analysis is increasingly used in surveillance and epidemiological investigation, but reviews about their use in this research topic are scarce. We identify and describe the methodological approaches used to investigate the distribution and ecological determinants of mosquito-borne infections in Europe. Relevant literature was extracted from PubMed, Scopus, and Web of Science from inception until October 2021 and analysed according to PRISMA-ScR protocol. We identified 110 studies. Most used geographical correlation analysis (n = 50), mainly applying generalised linear models, and the remaining used spatial cluster detection (n = 30) and disease mapping (n = 30), mainly conducted using frequentist approaches. The most studied infections were Dengue (n = 32), Malaria (n = 26), Chikungunya (n = 26), and West Nile Virus (n = 24), and the most studied ecological determinants were temperature (n = 39), precipitation (n = 24), water bodies (n = 14), and vegetation (n = 11). Results from this review may support public health programs for mosquito-borne disease prevention and may help guide future research, as we recommended various good practices for spatial epidemiological studies.

West Nile Virus Occurrence and Ecological Niche Modeling in Wild Bird Species and Mosquito Vectors: An Active Surveillance Program in the Peloponnese Region of Greece

West Nile Virus (WNV) is maintained in nature in a bird-mosquito cycle and human infections follow a seasonal pattern, favored by climatic conditions. Peloponnese Region, located in Southern Greece, initiated an active WNV surveillance program to protect public health during 2019–2020. The project included monitoring of avian hosts and mosquito vectors, while sampling locations were prioritized after consideration of WNV circulation in birds, mosquitos and humans during previous seasons. Biological materials were collected from 493 wild birds of 25 species and 678 mosquito pools, which were molecularly screened for WNV presence. In this case, 14 environmental variables were associated with WNV detection in wild birds and mosquitos by using two separate MaxEnt models. Viral RNA was not detected in the target species during 2019, although in 2020, it was reported on 46 wild birds of ten species and 22 mosquito pools (Culex pipiens and Aedes albopictus). Altitude and land uses were significant predictors for both models and in fact, suitable conditions for virus occurrence were identified in low altitude zones. Bird- and mosquito-based surveillance systems yielded similar results and allowed for targeted vector control applications in cases of increased virus activity. Human cases were not reported on Peloponnese in 2020.

Artificial intelligence to predict West Nile virus outbreaks with eco-climatic drivers

Background

In Europe, the frequency, intensity, and geographic range of West Nile virus (WNV)-outbreaks have increased over the past decade, with a 7.2-fold increase in 2018 compared to 2017, and a markedly expanded geographic area compared to 2010. The reasons for this increase and range expansion remain largely unknown due to the complexity of the transmission pathways and underlying disease drivers. In a first, we use advanced artificial intelligence to disentangle the contribution of eco-climatic drivers to WNV-outbreaks across Europe using decade-long (2010-2019) data at high spatial resolution.

Methods

We use a high-performance machine learning classifier, XGBoost (eXtreme gradient boosting) combined with state-of-the-art XAI (eXplainable artificial intelligence) methodology to describe the predictive ability and contribution of different drivers of the emergence and transmission of WNV-outbreaks in Europe, respectively.

Findings

Our model, trained on 2010-2017 data achieved an AUC (area under the receiver operating characteristic curve) score of 0.97 and 0.93 when tested with 2018 and 2019 data, respectively, showing a high discriminatory power to classify a WNV-endemic area. Overall, positive summer/spring temperatures anomalies, lower water availability index (NDWI), and drier winter conditions were found to be the main determinants of WNV-outbreaks across Europe. The climate trends of the preceding year in combination with eco-climatic predictors of the first half of the year provided a robust predictive ability of the entire transmission season ahead of time. For the extraordinary 2018 outbreak year, relatively higher spring temperatures and the abundance of Culex mosquitoes were the strongest predictors, in addition to past climatic trends.

Interpretation

Our AI-based framework can be deployed to trigger rapid and timely alerts for active surveillance and vector control measures in order to intercept an imminent WNV-outbreak in Europe.

Funding

The work was partially funded by the Swedish Research Council FORMAS for the project ARBOPREVENT (grant agreement 2018-05973).

Seroprevalence and Risk Factors for Equine West Nile Virus Infections in Eastern Germany, 2020

West Nile virus (WNV) infections were first detected in Germany in 2018, but information about WNV seroprevalence in horses is limited. The study’s overall goal was to gather information that would help veterinarians, horse owners, and veterinary-, and public health- authorities understand the spread of WNV in Germany and direct protective measures. For this purpose, WNV seroprevalence was determined in counties with and without previously registered WNV infections in horses, and risk factors for seropositivity were estimated. The cohort consisted of privately owned horses from nine counties in Eastern Germany. A total of 940 serum samples was tested by competitive panflavivirus ELISA (cELISA), and reactive samples were further tested by WNV IgM capture ELISA and confirmed by virus neutralization test (VNT). Information about potential risk factors was recorded by questionnaire and analyzed by logistic regression. A total of 106 serum samples showed antibodies against flaviviruses by cELISA, of which six tested positive for WNV IgM. The VNT verified a WNV infection for 54 samples (50.9%), while 35 sera neutralized tick-borne encephalitis virus (33.0%), and eight sera neutralized Usutu virus (7.5%). Hence, seroprevalence for WNV infection was 5.8% on average and was significantly higher in counties with previously registered infections (p = 0.005). The risk factor analysis showed breed type (pony), housing in counties with previously registered infections, housing type (24 h turn-out), and presence of outdoor shelter as the main significant risk factors for seropositivity. In conclusion, we estimated the extent of WNV infection in the resident horse population in Eastern Germany and showed that seroprevalence was higher in counties with previously registered equine WNV infections.

Bloodmeal regulation in mosquitoes curtails dehydration-induced mortality, altering vectorial capacity

Mosquitoes readily lose water when exposed to any humidity less than that of near saturated air unless mitigated, leading to shifts in behavior, survival, distribution, and reproduction. In this study, we conducted a series of physiological experiments on two prominent species in the Culicinae subfamily: Culex pipiens, a vector of West Nile virus, and Aedes aegypti, a vector of yellow fever and Zika to examine the effects of dehydration. We exposed C. pipiens and A. aegypti to non-dehydrating conditions (saturated air), dehydrating conditions (air at a 0.89 kPa saturation vapor pressure deficit), several recovery conditions, as well as to bloodfeeding opportunities. We show that dehydrated mosquitoes increase bloodfeeding propensity, improve retention, and decrease excretion of a post-dehydration bloodmeal. In addition, mosquitoes that take a bloodmeal prior to dehydration exposure show increased survival over non-bloodfed counterparts. Dehydration-induced alterations in survival, reproduction, and bloodfeeding propensity of C. pipiens and A. aegypti resulted in marked changes to vectorial capacity. Ultimately, these results become increasingly important as drought intensifies in association with climate change and mosquitoes become more likely to experience arid periods.

Both consumptive and non-consumptive effects of predators impact mosquito populations and have implications for disease transmission

Predator-prey interactions influence prey traits through both consumptive and non-consumptive effects, and variation in these traits can shape vector-borne disease dynamics. Meta-analysis methods were employed to generate predation effect sizes by different categories of predators and mosquito prey. This analysis showed that multiple families of aquatic predators are effective in consumptively reducing mosquito survival, and that the survival of Aedes, Anopheles, and Culex mosquitoes is negatively impacted by consumptive effects of predators. Mosquito larval size was found to play a more important role in explaining the heterogeneity of consumptive effects from predators than mosquito genus. Mosquito survival and body size were reduced by non-consumptive effects of predators, but development time was not significantly impacted. In addition, Culex vectors demonstrated predator avoidance behavior during oviposition. The results of this meta-analysis suggest that predators limit disease transmission by reducing both vector survival and vector size, and that associations between drought and human West Nile virus cases could be driven by the vector behavior of predator avoidance during oviposition. These findings are likely to be useful to infectious disease modelers who rely on vector traits as predictors of transmission.

Reviewing Health Security Capacities in Nigeria Using the Updated WHO Joint External Evaluation and WHO Benchmarks Tool: Experience from a Country-Led Self-Assessment Exercise

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.

Spatial patterns of West Nile virus distribution in the Volgograd region of Russia, a territory with long-existing foci

Southern Russia remains affected by West Nile virus (WNV). In the current study, we identified the spatial determinants of WNV distribution in an area with endemic virus transmission, with special reference to the urban settings, by mapping probable points of human infection acquisition and points of virus detection in mosquitoes, ticks, birds, and mammals during 1999-2016. The suitability of thermal conditions for extrinsic virus replication was assessed based on the approach of degree-day summation and their changes were estimated by linear trend analysis. A generalized linear model was used to analyze the year-to-year variation of human cases versus thermal conditions. Environmental suitability was determined by ecological niche modelling using MaxEnt software. Human population density was used as an offset to correct for possible bias. Spatial analysis of virus detection in the environment showed significant contributions from surface temperature, altitude, and distance from water bodies. When indicators of location and mobility of the human population were included, the relative impact of factors changed, with roads becoming most important. When the points of probable human case infection were added, the percentage of leading factors changed only slightly. The urban environment significantly increased the epidemic potential of the territory and created quite favorable conditions for virus circulation. The private building sector with low-storey houses and garden plots located in the suburbs provided a connection between urban and rural transmission cycles.

Climate change and infectious disease in Europe: Impact, projection and adaptation

Europeans are not only exposed to direct effects from climate change, but also vulnerable to indirect effects from infectious disease, many of which are climate sensitive, which is of concern because of their epidemic potential. Climatic conditions have facilitated vector-borne disease outbreaks like chikungunya, dengue, and West Nile fever and have contributed to a geographic range expansion of tick vectors that transmit Lyme disease and tick-borne encephalitis. Extreme precipitation events have caused waterborne outbreaks and longer summer seasons have contributed to increases in foodborne diseases. Under the Green Deal, The European Union aims to support climate change health policy, in order to be better prepared for the next health security threat, particularly in the aftermath of the traumatic COVID-19 experience. To bolster this policy process we discuss climate change-related hazards, exposures and vulnerabilities to infectious disease and describe observed impacts, projected risks, with policy entry points for adaptation to reduce these risks or avoid them altogether.

Diversity of West Nile and Usutu virus strains in mosquitoes at an international airport in Austria

Increased globalization and international transportation have resulted in the inadvertent introduction of exotic mosquitoes and new mosquito‐borne diseases. International airports are among the possible points of entry for mosquitoes and their pathogens. We established a mosquito and mosquito‐borne diseases monitoring programme at the largest international airport in Austria and report the results for the first two years, 2018 and 2019. This included weekly monitoring and sampling of adult mosquitoes, and screening them for the presence of viral nucleic acids by standard molecular diagnostic techniques. Additionally, we surveyed the avian community at the airport, as birds are potentially amplifying hosts. In 2018, West Nile virus (WNV) was detected in 14 pools and Usutu virus (USUV) was detected in another 14 pools of mosquitoes (minimum infection rate [MIR] of 6.8 for each virus). Of these 28 pools, 26 consisted of female Culex pipiens/torrentium, and two contained male Culex sp. mosquitoes. Cx. pipiens/torrentium mosquitoes were the most frequently captured mosquito species at the airport. The detected WNV strains belonged to five sub‐clusters within the sub‐lineage 2d‐1, and all detected USUV strains were grouped to at least seven sub‐clusters among the cluster Europe 2; all strains were previously shown to be endemic in Austria. In 2019, all mosquito pools were negative for any viral nucleic acids tested. Our study suggests that airports may serve as foci of arbovirus activity, particularly during epidemic years, and should be considered when designing mosquito control and arbovirus monitoring programmes.

Ecological Effects on the Dynamics of West Nile Virus and Avian Plasmodium: The Importance of Mosquito Communities and Landscape

Humans and wildlife are at risk from certain vector-borne diseases such as malaria, dengue, and West Nile and yellow fevers. Factors linked to global change, including habitat alteration, land-use intensification, the spread of alien species, and climate change, are operating on a global scale and affect both the incidence and distribution of many vector-borne diseases. Hence, understanding the drivers that regulate the transmission of pathogens in the wild is of great importance for ecological, evolutionary, health, and economic reasons. In this literature review, we discuss the ecological factors potentially affecting the transmission of two mosquito-borne pathogens circulating naturally between birds and mosquitoes, namely, West Nile virus (WNV) and the avian malaria parasites of the genus Plasmodium. Traditionally, the study of pathogen transmission has focused only on vectors or hosts and the interactions between them, while the role of landscape has largely been ignored. However, from an ecological point of view, it is essential not only to study the interaction between each of these organisms but also to understand the environmental scenarios in which these processes take place. We describe here some of the similarities and differences in the transmission of these two pathogens and how research into both systems may facilitate a greater understanding of the dynamics of vector-borne pathogens in the wild.

Movement can mediate temporal mismatches between resource availability and biological events in host-pathogen interactions

Global change is shifting the timing of biological events, leading to temporal mismatches between biological events and resource availability. These temporal mismatches can threaten species' populations. Importantly, temporal mismatches not only exert strong pressures on the population dynamics of the focal species, but can also lead to substantial changes in pairwise species interactions such as host-pathogen systems. We adapted an established individual-based model of host-pathogen dynamics. The model describes a viral agent in a social host, while accounting for the host's explicit movement decisions. We aimed to investigate how temporal mismatches between seasonal resource availability and host life-history events affect host-pathogen coexistence, that is, disease persistence. Seasonal resource fluctuations only increased coexistence probability when in synchrony with the hosts' biological events. However, a temporal mismatch reduced host-pathogen coexistence, but only marginally. In tandem with an increasing temporal mismatch, our model showed a shift in the spatial distribution of infected hosts. It shifted from an even distribution under synchronous conditions toward the formation of disease hotspots, when host life history and resource availability mismatched completely. The spatial restriction of infected hosts to small hotspots in the landscape initially suggested a lower coexistence probability due to the critical loss of susceptible host individuals within those hotspots. However, the surrounding landscape facilitated demographic rescue through habitat-dependent movement. Our work demonstrates that the negative effects of temporal mismatches between host resource availability and host life history on host-pathogen coexistence can be reduced through the formation of temporary disease hotspots and host movement decisions, with implications for disease management under disturbances and global change.

Spring temperature shapes West Nile virus transmission in Europe

West Nile Virus (WNV) is now endemic in many European countries, causing hundreds of human cases every year, with a high spatial and temporal heterogeneity. Previous studies have suggested that spring temperature might play a key role at shaping WNV transmission. Specifically, warmer temperatures in April-May might amplify WNV circulation, thus increasing the risk for human transmission later in the year. To test this hypothesis, we collated publicly available data on the number of human infections recorded in Europe between 2011 and 2019. We then applied generalized linear models to quantify the relationship between human cases and spring temperature, considering both average conditions (over years 2003-2010) and deviations from the average for subsequent years (2011-2019). We found a significant positive association both spatial (average conditions) and temporal (deviations). The former indicates that WNV circulation is higher in usually warmer regions while the latter implies a predictive value of spring conditions over the coming season. We also found a positive association with WNV detection during the previous year, which can be interpreted as an indication of the reliability of the surveillance system but also of WNV overwintering capacity. Weather anomalies at the beginning of the mosquito breeding season might act as an early warning signal for public health authorities, enabling them to strengthen in advance ongoing surveillance and prevention strategies.

Environmental drivers, climate change and emergent diseases transmitted by mosquitoes and their vectors in southern Europe: A systematic review

Mosquito borne diseases are a group of infections that affect humans. Emerging or reemerging diseases are those that (re)occur in regions, groups or hosts that were previously free from these diseases: dengue virus; chikungunya virus; Zika virus; West Nile fever and malaria. In Europe, these infections are mostly imported; however, due to the presence of competent mosquitoes and the number of trips both to and from endemic areas, these pathogens are potentially emergent or re-emergent. Present and future climatic conditions, as well as meteorological, environmental and demographic aspects are risk factors for the distribution of different vectors and/or diseases. This review aimed to identify and analyze the existing literature on the transmission of mosquito borne diseases and those factors potentially affecting their transmission risk of them in six southern European countries with similar environmental conditions: Croatia, France, Greece, Italy, Portugal and Spain. In addition, we would identify those factors potentially affecting the (re)introduction or spread of mosquito vectors. This task has been undertaken with a focus on the environmental and climatic factors, including the effects of climate change. We undertook a systematic review of the vectors, diseases and their associations with climactic and environmental factors in European countries of the Mediterranean region. We followed the PRISMA guidelines and used explicit and systematic methods to identify, select and critically evaluate the studies which were relevant to the topic. We identified 1302 articles in the first search of the databases. Of those, 160 were selected for full-text review. The final data set included 61 articles published between 2000 and 2017.39.3% of the papers were related with dengue, chikungunya and Zika virus or their vectors. Temperature, precipitation and population density were key factors among others. 32.8% studied West Nile virus and its vectors, being temperature, precipitation and NDVI the most frequently used variables. Malaria have been studied in 23% of the articles, with temperature, precipitation and presence of water indexes as the most used variables. The number of publications focused on mosquito borne diseases is increasing in recent years, reflecting the increased interest in that diseases in southern European countries. Climatic and environmental variables are key factors on mosquitoes' distribution and to show the risk of emergence and/or spread of emergent diseases and to study the spatial changes in that distributions.

Human West Nile Meningo-Encephalitis in a Highly Endemic Country: A Complex Epidemiological Analysis on Biotic and Abiotic Risk Factors

West Nile virus (WNV) is one of the most prevalent mosquito-borne viruses. Although the infection in humans is mostly asymptomatic, 15–20% of cases show flu-like symptoms with fever. In 1% of infections, humans develop severe nervous symptoms and even die, a condition known as West Nile neuroinvasive disease (WNND). The aim of our study was to analyze the influence of abiotic and biotic factors with the human WNND cases during the period 2015–2019. A database containing all the localities in Romania was developed. Abiotic and biotic predictors were included for each locality: geographic variables, climatic data, and biotic factors. Spatial distribution of the WNND infections was analyzed using directional distribution (DD). The Spearman’s rank correlation coefficient was employed to assess the strength of association between the WNND infections and predictors. A model was generated using the random forest ensemble learning method. A total number of 535 human WNND cases were confirmed in 308 localities. The DD showed a south-eastern geographical distribution. Weak correlation was observed between the number of human WNND cases for each year and the predictors. The highest predicted probability was around urbanized patches in the south and southeast. Increased surveillance and control measures of vectors in risk areas should be implemented and educational campaigns should be made available for the general public in order to raise awareness of the disease and inform the population about prophylactic measures.

Predicting WNV Circulation in Italy Using Earth Observation Data and Extreme Gradient Boosting Model

West Nile Disease (WND) is one of the most spread zoonosis in Italy and Europe caused by a vector-borne virus. Its transmission cycle is well understood, with birds acting as the primary hosts and mosquito vectors transmitting the virus to other birds, while humans and horses are occasional dead-end hosts. Identifying suitable environmental conditions across large areas containing multiple species of potential hosts and vectors can be difficult. The recent and massive availability of Earth Observation data and the continuous development of innovative Machine Learning methods can contribute to automatically identify patterns in big datasets and to make highly accurate identification of areas at risk. In this paper, we investigated the West Nile Virus (WNV) circulation in relation to Land Surface Temperature, Normalized Difference Vegetation Index and Surface Soil Moisture collected during the 160 days before the infection took place, with the aim of evaluating the predictive capacity of lagged remotely sensed variables in the identification of areas at risk for WNV circulation. WNV detection in mosquitoes, birds and horses in 2017, 2018 and 2019, has been collected from the National Information System for Animal Disease Notification. An Extreme Gradient Boosting model was trained with data from 2017 and 2018 and tested for the 2019 epidemic, predicting the spatio-temporal WNV circulation two weeks in advance with an overall accuracy of 0.84. This work lays the basis for a future early warning system that could alert public authorities when climatic and environmental conditions become favourable to the onset and spread of WNV.

Transmission of West Nile and five other temperate mosquito-borne viruses peaks at temperatures between 23°C and 26°C

The temperature-dependence of many important mosquito-borne diseases has never been quantified. These relationships are critical for understanding current distributions and predicting future shifts from climate change. We used trait-based models to characterize temperature-dependent transmission of 10 vector-pathogen pairs of mosquitoes (Culex pipiens, Cx. quinquefascsiatus, Cx. tarsalis, and others) and viruses (West Nile, Eastern and Western Equine Encephalitis, St. Louis Encephalitis, Sindbis, and Rift Valley Fever viruses), most with substantial transmission in temperate regions. Transmission is optimized at intermediate temperatures (23-26°C) and often has wider thermal breadths (due to cooler lower thermal limits) compared to pathogens with predominately tropical distributions (in previous studies). The incidence of human West Nile virus cases across US counties responded unimodally to average summer temperature and peaked at 24°C, matching model-predicted optima (24-25°C). Climate warming will likely shift transmission of these diseases, increasing it in cooler locations while decreasing it in warmer locations.

Spatial risk analysis for the introduction and circulation of six arboviruses in the Netherlands

Background

Arboviruses are a growing public health concern in Europe, with both endemic and exotic arboviruses expected to spread further into novel areas in the next decades. Predicting where future outbreaks will occur is a major challenge, particularly for regions where these arboviruses are not endemic. Spatial modelling of ecological risk factors for arbovirus circulation can help identify areas of potential emergence. Moreover, combining hazard maps of different arboviruses may facilitate a cost-efficient, targeted multiplex-surveillance strategy in areas where virus transmission is most likely. Here, we developed predictive hazard maps for the introduction and/or establishment of six arboviruses that were previously prioritized for the Netherlands: West Nile virus, Japanese encephalitis virus, Rift Valley fever virus, tick-borne encephalitis virus, louping-ill virus and Crimean-Congo haemorrhagic fever virus.

Methods

Our spatial model included ecological risk factors that were identified as relevant for these arboviruses by an earlier systematic review, including abiotic conditions, vector abundance, and host availability. We used geographic information system (GIS)-based tools and geostatistical analyses to model spatially continuous datasets on these risk factors to identify regions in the Netherlands with suitable ecological conditions for arbovirus introduction and establishment.

Results

The resulting hazard maps show that there is spatial clustering of areas with either a relatively low or relatively high environmental suitability for arbovirus circulation. Moreover, there was some overlap in high-hazard areas for virus introduction and/or establishment, particularly in the southern part of the country.

Conclusions

The similarities in environmental suitability for some of the arboviruses provide opportunities for targeted sampling of vectors and/or sentinel hosts in these potential hotspots of emergence, thereby increasing the efficient use of limited resources for surveillance.

West Nile Virus: An Update on Pathobiology, Epidemiology, Diagnostics, Control and "One Health" Implications

West Nile virus (WNV) is an important zoonotic flavivirus responsible for mild fever to severe, lethal neuroinvasive disease in humans, horses, birds, and other wildlife species. Since its discovery, WNV has caused multiple human and animal disease outbreaks in all continents, except Antarctica. Infections are associated with economic losses, mainly due to the cost of treatment of infected patients, control programmes, and loss of animals and animal products. The pathogenesis of WNV has been extensively investigated in natural hosts as well as in several animal models, including rodents, lagomorphs, birds, and reptiles. However, most of the proposed pathogenesis hypotheses remain contentious, and much remains to be elucidated. At the same time, the unavailability of specific antiviral treatment or effective and safe vaccines contribute to the perpetuation of the disease and regular occurrence of outbreaks in both endemic and non-endemic areas. Moreover, globalisation and climate change are also important drivers of the emergence and re-emergence of the virus and disease. Here, we give an update of the pathobiology, epidemiology, diagnostics, control, and “One Health” implications of WNV infection and disease.

Inter-annual variability of the effects of intrinsic and extrinsic drivers affecting West Nile virus vector Culex pipiens population dynamics in northeastern Italy

Background

Vector-borne infectious diseases (VBDs) represent a major public health concern worldwide. Among VBDs, West Nile virus (WNV) showed an increasingly wider spread in temperate regions of Europe, including Italy. During the last decade, WNV outbreaks have been recurrently reported in mosquitoes, horses, wild birds, and humans, showing great variability in the temporal and spatial distribution pattern. Due to the complexity of the environment–host–vector–pathogen interaction and the incomplete understanding of the epidemiological pattern of the disease, WNV occurrences can be difficult to predict. The analyses of ecological drivers responsible for the earlier WNV reactivation and transmission are pivotal; in particular, variations in the vector population dynamics may represent a key point of the recent success of WNV and, more in general, of the VBDs.

Methods

We investigated the variations of Culex pipiens population abundance using environmental, climatic and trapping data obtained over nine years (2010 to 2018) through the WNV entomological surveillance programme implemented in northeastern Italy. An information theoretic approach (IT-AIC_c) and model-averaging algorithms were implemented to examine the relationship between the seasonal mosquito population growth rates and both intrinsic (e.g. intraspecific competition) and extrinsic (e.g. environmental and climatic variables) predictors, to identify the most significant combinations of variables outlining the Cx. pipiens population dynamics.

Results

Population abundance (proxy for intraspecific competition) and length of daylight were the predominant factors regulating the mosquito population dynamics; however, other drivers encompassing environmental and climatic variables also had a significant impact, although sometimes counterintuitive and not univocal. The analyses of the single-year datasets, and the comparison with the results obtained from the overall model (all data available from 2010 to 2018), highlighted remarkable differences in coefficients magnitude, sign and significance. These outcomes indicate that different combinations of factors might have distinctive, and sometimes divergent, effects on mosquito population dynamics.

Conclusions

A more realistic acquaintance of the intrinsic and extrinsic mechanisms of mosquito population fluctuations in relation to continuous changes in environmental and climatic conditions is paramount to properly reinforce VBDs risk-based surveillance activities, to plan targeted density control measures and to implement effective early detection programmes.

Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

Relative Distribution, Diversity, and Bloodmeal Sources of Mosquitoes and Known Vectors of Rift Valley Fever Phlebovirus in Three Differing Ecosystems in Bura, Tana River County, Kenya

Environmental modifications disturb the equilibrium of mosquito populations, altering the risk of mosquito-borne diseases. Mosquito distribution, diversity, and bloodmeal sources were examined to compare Rift Valley fever (RVF) risk among irrigated, riverine, and pastoral ecosystems in Bura, Tana River County, Kenya, between September 2014 and June 2015. Thirty-eight households and 21 irrigation fields were selected for the study. Mosquitoes were trapped with carbon dioxide-impregnated CDC traps, one trap per household and three traps per irrigated field, and morphologically identified using taxonomic keys. Host DNA was extracted from engorged females and cytochrome b genes amplified by PCR to identify sources of bloodmeals. A total of 21,015 mosquitoes were collected; 5742 within households in the 3 ecosystems and 15,273 within irrigated fields. Mosquitoes collected within irrigated fields belonged to 8 genera and 37 species, while those from households within the irrigation scheme belonged to 6 genera and 29 species. Collections from riverine and pastoral households belonged to five and four genera, respectively. The most abundant genera in the irrigated fields were Aedes (21%) and Mansonia (22%), while Anopheles (43%) was the most abundant within households. Most mosquitoes in riverine and pastoral households belonged to Anopheles (76%) and Aedes (65%) genera, respectively. Seasonal variation driven by rainfall was evidenced by spikes in mosquito numbers within irrigated and riverine ecosystems. Host species identification revealed that goats and humans were the main sources of bloodmeal. There was an overall increase in mosquito abundance and diversity as a result of the presence of the irrigated ecosystem in this county, and an increased availability of highly RVF-susceptible hosts as a result of the establishment and concentration of residential areas, promoting potential vector-host contacts. These results highlight the impact of anthropogenic changes on mosquito ecology, potentially heightening the risk of transmission and maintenance of RVF in this region.

Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model

Motivated by the One Health paradigm, we found the expected changes in temperature and UV radiation (UVR) to be a common trigger for enhancing the risk that viruses, vectors, and diseases pose to human and animal health. We compared data from the mosquito field collections and medical studies with regional climate model projections to examine the impact of climate change on the spreading of one malaria vector, the circulation of West Nile virus (WNV), and the incidence of melanoma. We analysed data obtained from ten selected years of standardised mosquito vector sampling with 219 unique location-year combinations, and 10 years of melanoma incidence. Trends in the observed data were compared to the climatic variables obtained by the coupled regional Eta Belgrade University and Princeton Ocean Model for the period 1961-2015 using the A1B scenario, and the expected changes up to 2030 were presented. Spreading and relative abundance of Anopheles hyrcanus was positively correlated with the trend of the mean annual temperature. We anticipated a nearly twofold increase in the number of invaded sites up to 2030. The frequency of WNV detections in Culex pipiens was significantly correlated to overwintering temperature averages and seasonal relative humidity at the sampling sites. Regression model projects a twofold increase in the incidence of WNV positive Cx. pipiens for a rise of 0.5°C in overwintering TOctober-April temperatures. The projected increase of 56% in the number of days with Tmax ≥ 30°C (Hot Days-HD) and UVR doses (up to 1.2%) corresponds to an increasing trend in melanoma incidence. Simulations of the Pannonian countries climate anticipate warmer and drier conditions with possible dominance of temperature and number of HD over other ecological factors. These signal the importance of monitoring the changes to the preparedness of mitigating the risk of vector-borne diseases and melanoma.

The knowns and unknowns of West Nile virus in Europe: what did we learn from the 2018 outbreak?

Introduction: West Nile virus (WNV) is a mosquito-borne human and animal pathogen with nearly worldwide distribution. In Europe, the virus is endemic with seasonal regional outbreaks that have increased in frequency over the last 10 years. A massive outbreak occurred across southern and central Europe in 2018 with the number of confirmed human cases increasing up to 7.2-fold from the previous year, and expanding to include previously virus-free regions.Areas covered: This review focuses on potential causes that may explain the 2018 European WNV outbreak. We discuss the role genetic, ecological, and environmental aspects may have played in the increased activity during the 2018 transmission season, summarizing the latest epidemiological and virological publications.Expert opinion: Optimal environmental conditions, specifically increased temperature, were most likely responsible for the observed outbreak. Other factors cannot be ruled out due to limited available information, including factors that may influence host/vector abundance and contact. Europe will likely experience even larger-scale outbreaks in the coming years. Increased surveillance efforts should be implemented with a focus on early-warning detection methods, and large-scale host and vector surveys should continue to fill gaps in knowledge.

A quantitative comparison of West Nile virus incidence from 2013 to 2018 in Emilia-Romagna, Italy

Background

West Nile virus (WNV) transmission was much greater in 2018 than in previous seasons in Europe. Focusing on Emilia-Romagna region (northern Italy), we analyzed detailed entomological and epidemiological data collected in 2013–2018 to quantitatively assess environmental drivers of transmission and explore hypotheses to better understand why the 2018 epidemiological season was substantially different than the previous seasons. In particular, in 2018 WNV was detected at least two weeks before the observed circulation in 2013–2017 and in a larger number of mosquito pools. Transmission resulted in 100 neuroinvasive human cases in the region, more than the total number of cases recorded between 2013 and 2017.

Methodology

We used temperature-driven mathematical models calibrated through a Bayesian approach to simulate mosquito population dynamics and WNV infection rates in the avian population. We then estimated the human transmission risk as the probability, for a person living in the study area, of being bitten by an infectious mosquito in a given week. Finally, we translated such risk into reported WNV human infections.

Principal findings

The estimated prevalence of WNV in the mosquito and avian populations were significantly higher in 2018 with respect to 2013–2017 seasons, especially in the eastern part of the region. Furthermore, peak avian prevalence was estimated to have occurred earlier, corresponding to a steeper decline towards the end of summer. The high mosquito prevalence resulted in a much greater predicted risk for human transmission in 2018, which was estimated to be up to eight times higher than previous seasons. We hypothesized, on the basis of our modelling results, that such greater WNV circulation might be partially explained by exceptionally high spring temperatures, which have likely helped to amplify WNV transmission at the beginning of the 2018 season.

West Nile virus (WNV) is one of the most recent emerging mosquito-borne diseases in Europe and North America. While most human infections are asymptomatic, about 1% of them can result in severe neurological diseases which might be fatal. WNV transmission was unusually greater in 2018 than in previous years in many European countries, resulting in a large number of human infections. Focusing on Emilia-Romagna region (Italy), we developed an epidemiological model informed by entomological data; through that we found that exceptionally high spring temperatures might have contributed at amplifying WNV transmission at the beginning of the season, causing greater WNV prevalence in mosquito and avian populations during the summer, which resulted in a higher estimated risk for human transmission. Thus, weather anomalies at the beginning of the mosquito breeding season, which are likely to become more common under the projected scenarios of climate change, might act as an early warning signal for public health authorities, enabling them to design efficient surveillance and prevention strategies.

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

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

The Role of Temperature in Transmission of Zoonotic Arboviruses

We reviewed the literature on the role of temperature in transmission of zoonotic arboviruses. Vector competence is affected by both direct and indirect effects of temperature, and generally increases with increasing temperature, but results may vary by vector species, population, and viral strain. Temperature additionally has a significant influence on life history traits of vectors at both immature and adult life stages, and for important behaviors such as blood-feeding and mating. Similar to vector competence, temperature effects on life history traits can vary by species and population. Vector, host, and viral distributions are all affected by temperature, and are generally expected to change with increased temperatures predicted under climate change. Arboviruses are generally expected to shift poleward and to higher elevations under climate change, yet significant variability on fine geographic scales is likely. Temperature effects are generally unimodal, with increases in abundance up to an optimum, and then decreases at high temperatures. Improved vector distribution information could facilitate future distribution modeling. A wide variety of approaches have been used to model viral distributions, although most research has focused on the West Nile virus. Direct temperature effects are frequently observed, as are indirect effects, such as through droughts, where temperature interacts with rainfall. Thermal biology approaches hold much promise for syntheses across viruses, vectors, and hosts, yet future studies must consider the specificity of interactions and the dynamic nature of evolving biological systems.

Biological Adaptations Associated with Dehydration in Mosquitoes

Diseases that are transmitted by mosquitoes are a tremendous health and socioeconomic burden with hundreds of millions of people being impacted by mosquito-borne illnesses annually. Many factors have been implicated and extensively studied in disease transmission dynamics, but knowledge regarding how dehydration impacts mosquito physiology, behavior, and resulting mosquito-borne disease transmission remain underdeveloped. The lapse in understanding on how mosquitoes respond to dehydration stress likely obscures our ability to effectively study mosquito physiology, behavior, and vectorial capabilities. The goal of this review is to develop a profile of factors underlying mosquito biology that are altered by dehydration and the implications that are related to disease transmission.

Recent rapid changes in the spatio-temporal distribution of West Nile Neuro-invasive Disease in Italy

In Italy, the first human case of West Nile Virus (WNV) infection was reported in 2008 and, since then, the number of cases has been steadily increasing. In this study, we describe the temporal and spatial pattern of WNV infection risk among humans in Italy, focusing on the human cases of West Nile Neuro-invasive Disease (WNND) observed between 2008 and 2017. Incidence rates are estimated for each year and province under study. The incidence temporal trend is estimated using Poisson regression, and a spatio-temporal cluster detection analysis is performed to detect high-risk areas. In total, 231 WNND cases were notified in Italy between 2008 and 2017. The annual incidence rates increased during the study period (annual percentage change: 11.7%; 95%CI: -0.9%; 26.1%). A geographical spread of the disease was observed during the study period throughout Northern Italy, with an increasing number of affected provinces. Provinces close to the Po River (the main river in the north of Italy) and the Oristano province (in the Sardinia Island) experienced the highest incidence rates during the study period. Our study shows a gradual, but rapid spread of WNND across Northern Italy from east to west and suggests the hypothesis that provinces close to Po River might present ecological and climatic conditions favourable to the virus circulation.

A Lack of “Environmental Earth Data” at the Microhabitat Scale Impacts Efforts to Control Invasive Arthropods That Vector Pathogens

We currently live in an era of major global change that has led to the introduction and range expansion of numerous invasive species worldwide. In addition to the ecological and economic consequences associated with most invasive species, invasive arthropods that vector pathogens (IAVPs) to humans and animals pose substantial health risks. Species distribution models that are informed using environmental Earth data are frequently employed to predict the distribution of invasive species, and to advise targeted mitigation strategies. However, there are currently substantial mismatches in the temporal and spatial resolution of these data and the environmental contexts which affect IAVPs. Consequently, targeted actions to control invasive species or to prepare the population for possible disease outbreaks may lack efficacy. Here, we identify and discuss how the currently available environmental Earth data are lacking with respect to their applications in species distribution modeling, particularly when predicting the potential distribution of IAVPs at meaningful space-time scales. For example, we examine the issues related to interpolation of weather station data and the lack of microclimatic data relevant to the environment experienced by IAVPs. In addition, we suggest how these data gaps can be filled, including through the possible development of a dedicated open access database, where data from both remotely- and proximally-sensed sources can be stored, shared, and accessed.

Twenty Years of Progress Toward West Nile Virus Vaccine Development

Although West Nile virus (WNV) has been a prominent mosquito-transmitted infection in North America for twenty years, no human vaccine has been licensed. With a cumulative number of 24,714 neurological disease cases and 2314 deaths in the U.S. since 1999, plus a large outbreak in Europe in 2018 involving over 2000 human cases in 15 countries, a vaccine is essential to prevent continued morbidity, mortality, and economic burden. Currently, four veterinary vaccines are licensed, and six vaccines have progressed into clinical trials in humans. All four veterinary vaccines require multiple primary doses and annual boosters, but for a human vaccine to be protective and cost effective in the most vulnerable older age population, it is ideal that the vaccine be strongly immunogenic with only a single dose and without subsequent annual boosters. Of six human vaccine candidates, the two live, attenuated vaccines were the only ones that elicited strong immunity after a single dose. As none of these candidates have yet progressed beyond phase II clinical trials, development of new candidate vaccines and improvement of vaccination strategies remains an important area of research.

Satellite Earth Observation Data in Epidemiological Modeling of Malaria, Dengue and West Nile Virus: A Scoping Review

Earth Observation (EO) data can be leveraged to estimate environmental variables that influence the transmission cycle of the pathogens that lead to mosquito-borne diseases (MBDs). The aim of this scoping review is to examine the state-of-the-art and identify knowledge gaps on the latest methods that used satellite EO data in their epidemiological models focusing on malaria, dengue and West Nile Virus (WNV). In total, 43 scientific papers met the inclusion criteria and were considered in this review. Researchers have examined a wide variety of methodologies ranging from statistical to machine learning algorithms. A number of studies used models and EO data that seemed promising and claimed to be easily replicated in different geographic contexts, enabling the realization of systems on regional and national scales. The need has emerged to leverage furthermore new powerful modeling approaches, like artificial intelligence and ensemble modeling and explore new and enhanced EO sensors towards the analysis of big satellite data, in order to develop accurate epidemiological models and contribute to the reduction of the burden of MBDs.

Vector-borne diseases and climate change: a European perspective

Climate change has already impacted the transmission of a wide range of vector-borne diseases in Europe, and it will continue to do so in the coming decades. Climate change has been implicated in the observed shift of ticks to elevated altitudes and latitudes, notably including the Ixodes ricinus tick species that is a vector for Lyme borreliosis and tick-borne encephalitis. Climate change is also thought to have been a factor in the expansion of other important disease vectors in Europe: Aedes albopictus (the Asian tiger mosquito), which transmits diseases such as Zika, dengue and chikungunya, and Phlebotomus sandfly species, which transmits diseases including Leishmaniasis. In addition, highly elevated temperatures in the summer of 2010 have been associated with an epidemic of West Nile Fever in Southeast Europe and subsequent outbreaks have been linked to summer temperature anomalies. Future climate-sensitive health impacts are challenging to project quantitatively, in part due to the intricate interplay between non-climatic and climatic drivers, weather-sensitive pathogens and climate-change adaptation. Moreover, globalisation and international air travel contribute to pathogen and vector dispersion internationally. Nevertheless, monitoring forecasts of meteorological conditions can help detect epidemic precursors of vector-borne disease outbreaks and serve as early warning systems for risk reduction.

Defining ecological regions in Italy based on a multivariate clustering approach: A first step towards a targeted vector borne disease surveillance

Ecoregionalization is the process by which a territory is classified in similar areas according to specific environmental and climatic factors. The climate and the environment strongly influence the presence and distribution of vectors responsible for significant human and animal diseases worldwide. In this paper, we developed a map of the eco-climatic regions of Italy adopting a data-driven spatial clustering approach using recent and detailed spatial data on climatic and environmental factors. We selected seven variables, relevant for a broad set of human and animal vector-borne diseases (VBDs): standard deviation of altitude, mean daytime land surface temperature, mean amplitude and peak timing of the annual cycle of land surface temperature, mean and amplitude of the annual cycle of greenness value, and daily mean amount of rainfall. Principal Component Analysis followed by multivariate geographic clustering using the k-medoids technique were used to group the pixels with similar characteristics into different ecoregions, and at different spatial resolutions (250 m, 1 km and 2 km). We showed that the spatial structure of ecoregions is generally maintained at different spatial resolutions and we compared the resulting ecoregion maps with two datasets related to Bluetongue vectors and West Nile Disease (WND) outbreaks in Italy. The known characteristics of Culicoides imicola habitat were well captured by 2/22 specific ecoregions (at 250 m resolution). Culicoides obsoletus/scoticus occupy all sampled ecoregions, according to its known widespread distribution across the peninsula. WND outbreak locations strongly cluster in 4/22 ecoregions, dominated by human influenced landscape, with intense cultivations and complex irrigation network. This approach could be a supportive tool in case of VBDs, defining pixel-based areas that are conducive environment for VBD spread, indicating where surveillance and prevention measures could be prioritized in Italy. Also, ecoregions suitable to specific VBDs vectors could inform entomological surveillance strategies.