Potential Risk Areas of Aedes albopictus in South-Eastern Iran: A Vector of Dengue Fever, Zika, and Chikungunya

Knowledge, attitudes, and practices of healthcare professionals regarding dengue fever in high-risk regions of southeastern Iran

BACKGROUND

Dengue fever (DF) is one of the most prevalent arboviral infections worldwide. In Iran, the dengue-positive serological cases as well as the presence of the dengue vector Aedes aegypti have raised health concerns, highlighting the need to enhance the dengue surveillance system. This study aims to assess the knowledge, attitudes, and practices (KAP) of healthcare professionals (HCPs) regarding dengue fever in a large and high-risk region of southeastern Iran.

METHODS

A total of 492 HCPs were recruited using a multi-stage sampling method from May 2022 to July 2023. Data were collected using a self-administered questionnaire. Data analysis was done using independent t-tests, one-way analysis of variance (ANOVA), one-factor and multi-factor general linear models, and simple and multiple regression models.

RESULTS

About two-thirds (71%) of the participants did not receive any training on DF. A small percentage of participants were familiar with ovitrap (32.6%) and only 21.7% knew that destroying larval breeding sites could not eliminate the dengue vector. The knowledge of disease symptoms among HCPs was found to be lower in border areas compared to non-border areas (P = 0.018). However, the practice situation in HCPs working in border areas was better than in non-borders (P = 0.003). According to the multiple regression model, the most influential factors associated with knowledge, attitude, and practice were the type of healthcare facility and passing the DF training course. Additionally, education level, work experience, and gender were identified as other factors associated with it, respectively. Significant correlations were found between knowledge and practice (P < 0.001), indicating that higher knowledge led to better practice. Similarly, a positive attitude was significantly linked to better practice (P < 0.001).

CONCLUSION

Regular, targeted, and continuous training courses are necessary to improve the knowledge level of HCPs, particularly those with lower education levels working in low-level health centers. Utilizing comprehensive dengue KAP studies to evaluate the status and impact of health education programs and identify gaps between knowledge and practice should be a research priority.

Modelling the risk of Japanese encephalitis virus in Victoria, Australia, using an expert-systems approach

Predictive models for vector-borne diseases (VBDs) are instrumental to understanding the potential geographic spread of VBDs and therefore serve as useful tools for public health decision-making. However, predicting the emergence of VBDs at the micro-, local, and regional levels presents challenges, as the importance of risk factors can vary spatially and temporally depending on climatic factors and vector and host abundance and preferences. We propose an expert-systems-based approach that uses an analytical hierarchy process (AHP) deployed within a geographic information system (GIS), to predict areas susceptible to the risk of Japanese encephalitis virus (JEV) emergence. This modelling approach produces risk maps, identifying micro-level risk areas with the potential for disease emergence. The results revealed that climatic conditions, especially the minimum temperature and precipitation required for JEV transmission, contributed to high-risk conditions developed during January and March of 2022 in Victora. Compared to historical climate records, the risk of JEV emergence was increased in most parts of the state due to climate. Importantly, the model accurately predicted 7 out of the 8 local government areas that reported JEV-positive cases during the outbreak of 2022 in Victorian piggeries. This underscores the model's potential as a reliable tool for supporting local risk assessments in the face of evolving climate change.

Medically Significant Vector-Borne Viral Diseases in Iran

Vector-borne viral diseases (VBVDs) continue to pose a considerable public health risk to animals and humans globally. Vectors have integral roles in autochthonous circulation and dissemination of VBVDs worldwide. The interplay of agricultural activities, population expansion, urbanization, host/pathogen evolution, and climate change, all contribute to the continual flux in shaping the epidemiology of VBVDs. In recent decades, VBVDs, once endemic to particular countries, have expanded into new regions such as Iran and its neighbors, increasing the risk of outbreaks and other public health concerns. Both Iran and its neighboring countries are known to host a number of VBVDs that are endemic to these countries or newly circulating. The proximity of Iran to countries hosting regional diseases, along with increased global socioeconomic activities, e.g., international trade and travel, potentially increases the risk for introduction of new VBVDs into Iran. In this review, we examined the epidemiology of numerous VBVDs circulating in Iran, such as Chikungunya virus, Dengue virus, Sindbis virus, West Nile virus, Crimean-Congo hemorrhagic fever virus, Sandfly-borne phleboviruses, and Hantavirus, in relation to their vectors, specifically mosquitoes, ticks, sandflies, and rodents. In addition, we discussed the interplay of factors, e.g., urbanization and climate change on VBVD dissemination patterns and the consequent public health risks in Iran, highlighting the importance of a One Health approach to further surveil and to evolve mitigation strategies.

Knowledge, attitude, and practice of healthcare workers regarding dengue fever in Mazandaran Province, northern Iran

Background

Dengue fever is a rapidly emerging infection worldwide with a high public health burden. Adequate training of healthcare workers is essential to warrant the timely provision of health services to improve the outcome of dengue management.

Methods

This is an analytical cross-sectional study, conducted to assess the knowledge, attitudes and practice (KAP) of healthcare workers regarding dengue from April 2021 to March 2022 in Mazandaran Province, northern Iran. Data was collected using a researcher-made structured questionnaire, prepared as Google Forms, and sent to target groups through social media and email. Data analysis was performed by SPSS 22 software using descriptive and inferential statistics (Chi-square) at a significant level of 5%.

Results

Most of the respondents had heard about dengue (83.8%); media (32.7%) and academic education (25%) were the main sources of information. Respondents had less knowledge associated with dengue symptoms (52%) than prevention and control (69%), transmission (72.2%) and clinical management (81%). Based on the 70% cut-off point, the majority of the participants had a good attitude (81%) and practice (73%). However, only 49.6% of the respondents showed good practice regarding dengue local transmission. A significant difference was observed between participants knowledge on clinical management with occupation; attitude with gender and occupation; and practice with gender (p < 0.05).

Conclusion

The results of this study revealed gaps in some dimensions of KAP in healthcare workers, therefore, a greater focus should be placed on future training programs to raise knowledge and attitude leading to sound practice and behavior for adequate management of dengue.

Dengue Fever: The Threat of Emerging Diseases Coinciding the Corona Crisis in Southeastern Iran

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Predicting the Potential Distribution of Major Malaria Vectors Based on Climate Changes in Sistan and Baluchistan Province, Southeastern Iran

Background

Given the significance of climate change and its substantial effects on mosquitoes' habitats, this study was aimed to model the spatial distribution of the main malaria vectors in the south east of Iran.

Methods

Several scientific databases between 1980 and 2019 were reviewed to find mosquito species and their spatial information in this area. The archived folders in the center for diseases control and prevention were used to exploit essential data on malaria cases and foci. Three representative concentration pathways (RCP2.6, RCP4.5 and RCP8.5) were chosen to stand for three possible climate scenarios. Finally the potential species distribution of Anopheles stephensi and An. culicifacies s.l. in the 2030s and 2050s horizons were estimated by the Maximum Entropy Model.

Results

So far, a total of 39 mosquito species belonging to the family Culicidae have been reported from the study area. In 2019, the total malaria cases have increased by 91% compared to 2015, as well as a sharp rise than 2018 (249%). In that year, 91% of cases were imported from other countries, which caused 40% increase in the new potential foci than in 2018. The Jackknife test demonstrated the annual mean temperature and precipitation of the coldest quarter with the greatest impact on the environmental suitability of the mentioned two species.

Conclusion

The effect of climate change on the appearance and recurrence of mosquito-borne diseases has been demonstrated in various studies. Collecting further data and conducting investigation on this issue will improve control management, especially for the malaria vectors.

Sindbis virus infection of mosquito species in the wetlands of northwestern Iran and modeling the probable ecological niches of SINV vectors in the country

Sindbis virus (SINV) and Chikungunya virus (CHIKV) are among the most widely spread mosquito-borne viruses worldwide. Due to the key role of mosquitoes in the transmission cycle of vector-borne diseases, models such as Maximum Entropy (MaxEnt) have been used in recent years to predict the environmental suitability and ecological niches of mosquito vectors. Infection of three mosquito species (Anopheles maculipennis s.l., Culex tritaeniorhynchus, and Culiseta longiareolata) with CHIKV has recently been reported in Iran. However, given the importance of vector-borne diseases in the country, there is a need for extensive studies on the infection of mosquitoes with CHIKV and SINV in different areas of the country. Accordingly, the current research was conducted to investigate the infection of mosquitoes with the two aforementioned viruses in the northwestern part of Iran and also to model the ecological niches of the vectors of these mosquito-borne viruses in the country. In the current study, 4639 mosquito specimens, consisting of 2515 adults and 2124 larvae, were collected from the wetlands of West Azerbaijan Province and identified. Ten species belonging to four genera were identified in this study. The specimens were allocated to 149 pools for the determination of infection with CHIKV and SINV. The amplification pattern of five pools comprising two mosquito species (Culex pipiens complex and Cx. Theileri) corresponded to the reference strain of SINV, and the isolates were sequenced to confirm the presence of SINV genome. No cases of CHIKV infection were found among the 149 examined mosquito pools. Data on the distribution of Cx. Pipiens complex and Cx. Theileri were mapped using ArcMap 10.5. Prediction maps of the presence probability for these species revealed that they are most likely to be found in and spread to the north, northwest, south, and southeastern areas of the country and in areas with abundant water resources. For the first time in Iran, our study investigated the presence probability of SINV vectors using ecological niche modeling. Ecological niche profiling showed that the most suitable habitats for Cx. pipiens are mainly concentrated in the north and northwestern parts of the country, whereas Cx. theileri is mostly located in the northwest and western regions. However, there were some other areas of low suitability for these two species in the country. Further studies in a broader geographical area with more species of mosquitos and the determination of infection with other mosquito-borne viruses can provide a clear understanding of the potential spread of mosquito-borne diseases in various regions of Iran.

Employing Different Traps for Collection of Mosquitoes and Detection of Dengue, Chikungunya and Zika Vector, Aedes albopictus, in Borderline of Iran and Pakistan

Background:

Southeastern Iran has been established as an area with the potential to harbor Asian tiger mosquito populations. In 2013, a few numbers of Aedes albopictus were detected in three sampling sites of this region. This field study was aimed to evaluate the efficacy of various traps on monitoring mosquitoes and status of this dengue vector, in five urban and 15 suburban/rural areas.

Methods:

For this purpose, four adult mosquito traps (BG-sentinel 2, bednet, Malaise, and resting box trap) were used and their efficacy compared. In addition, large numbers of CDC ovitraps were employed, within 12 months.

Results:

A total of 4878 adult samples including 22 species covering five genera were collected and identified from traps. It was not revealed any collection of Ae. albopictus. Statistical analysis showed no significant difference in meteorological variables between the two periods, the previous report and the current study. There were significant differences in the total number of mosquitoes collected by various traps in the region across different months.

Conclusion:

The resulting data collected here on the efficiency of the various trap types can be useful for monitoring the densities of mosquito populations, which is an important component of a vector surveillance system. While the presence of Ae. albopictus was determined in this potential risk area, there is no evidence for its establishment and further monitoring needs to be carried out.

Vertical Distribution, Biodiversity, and Some Selective Aspects of the Physicochemical Characteristics of the Larval Habitats of Mosquitoes (Diptera: Culicidae) in Chaharmahal and Bakhtiari Province, Iran

Background and aims: Mosquitoes (Diptera: Culicidae) are still a focus of research because of their role in the transmission of diseases and annoying biting behavior. Source reduction is an effective measure to control mosquito populations, which is based on good knowledge of larval habitats. This study was conducted to obtain that basic knowledge in Chaharmahal and Bakhtiari province. Methods: This study was carried out in 2011 and 2012. Geographical coordinates, altitude, pH, temperature, and the dissolved oxygen level of larval habitats were recorded by relevant devices, followed by documenting physical attributes by direct observation. In addition, the indices of biodiversity were calculated to analyze the vertical biodiversity of species. Finally, the affinity index was calculated to elucidate species co-occurrence. Results: Eighteen species were recovered from 92 larval habitats. Low- (≤ 1400 m), mid- (1401–2000 m), and high- (≥ 2001 m) altitudes lodged 7, 17, and 14 species, respectively. Further, the indices of the species richness and biodiversity for these altitudinal categories were 0.93, 1.94, and 1.58, as well as 1.54, 2.13, and 1.96, respectively. Larval habitats were mostly natural, temporary, with standing but clear water, muddy substrate, sunlit, and with vegetation. Other physicochemical characteristics and affinity of species were described and discussed as well. Conclusion: To the best of our knowledge, this is the first report of vertical distribution and biodiversity of mosquito larvae in Iran. The relative uniformity of physicochemical characteristics of larval habitats was attributed to prevailing water resources in the studied area and sampling design. The oviposition site selection of gravid mosquitoes is still an unresolved problem which needs further investigations.

Semi-Supervised Text Classification Framework: An Overview of Dengue Landscape Factors and Satellite Earth Observation

In recent years there has been an increasing use of satellite Earth observation (EO) data in dengue research, in particular the identification of landscape factors affecting dengue transmission. Summarizing landscape factors and satellite EO data sources, and making the information public are helpful for guiding future research and improving health decision-making. In this case, a review of the literature would appear to be an appropriate tool. However, this is not an easy-to-use tool. The review process mainly includes defining the topic, searching, screening at both title/abstract and full-text levels and data extraction that needs consistent knowledge from experts and is time-consuming and labor intensive. In this context, this study integrates the review process, text scoring, active learning (AL) mechanism, and bidirectional long short-term memory (BiLSTM) networks, and proposes a semi-supervised text classification framework that enables the efficient and accurate selection of the relevant articles. Specifically, text scoring and BiLSTM-based active learning were used to replace the title/abstract screening and full-text screening, respectively, which greatly reduces the human workload. In this study, 101 relevant articles were selected from 4 bibliographic databases, and a catalogue of essential dengue landscape factors was identified and divided into four categories: land use (LU), land cover (LC), topography and continuous land surface features. Moreover, various satellite EO sensors and products used for identifying landscape factors were tabulated. Finally, possible future directions of applying satellite EO data in dengue research in terms of landscape patterns, satellite sensors and deep learning were proposed. The proposed semi-supervised text classification framework was successfully applied in research evidence synthesis that could be easily applied to other topics, particularly in an interdisciplinary context.

Detection of arboviruses in mosquitoes: Evidence of circulation of chikungunya virus in Iran

Mosquitoes are vectors of viruses affecting animal and human health. In Iran, the prevalence of mosquito-borne viruses remains poorly investigated. Once infected, mosquito females remain infected for all their life making virus detections possible at early steps before infections are reported in vertebrate hosts. In this study, we used a recently developed high-throughput chip based on the BioMark Dynamic arrays system capable of detecting 37 arboviruses in a single experiment. A total of 1,212 mosquitoes collected in Mazandaran, North-Khorasan, and Fars provinces of Iran were analyzed. Eighteen species were identified, belonging to five genera; the most prevalent species were Anopheles maculipennis s.l. (42.41%), Culex pipiens (19.39%), An. superpictus (11.72%), and Cx. tritaeniorhynchus (10.64%). We detected chikungunya virus (CHIKV) of the Asian genotype in six mosquito pools collected in North Khorasan and Mazandaran provinces. To our knowledge, this is the first report of mosquitoes infected with CHIKV in Iran. Our high-throughput screening method can be proposed as a novel epidemiological surveillance tool to identify circulating arboviruses and to support preparedness to an epidemic in animals and humans.

Seroepidemiology of dengue and chikungunya fever in patients with rash and fever in Iran, 2017

After the mass campaign of Measles and Rubella vaccination in 2003 in Iran, the cases of measles and rubella infection decreased but still, the cases of rash and fever were reported. It is worth noting that some other viral infections show signs similar to measles and rubella such as some arboviruses. Considering the epidemic outbreak of arbovirus infections in countries neighbouring Iran, we performed this study to estimate the possibility of chikungunya and dengue fever among measles and rubella IgM negative patients presenting with rash and fever from December 2016 to November 2017 in the National Measles Laboratory at Tehran University of Medical Sciences. Serum samples were selected at random from patients from eight provinces. The presence of DENV IgM and CHIKV IgM was examined by enzyme-linked immunosorbent assay. Of the 1306 sera tested, 210 were CHIKV seropositive and 82 were dengue seropositive. Statistical analysis demonstrated a significant increase in the CHIKV IgM antibody seropositivity rate in Kerman (OR = 2.07, 95% CI: 1.10–3.92; P = 0.024) and Fars (OR = 1.77, 95% CI: 1.06–2.93; P = 0.027). The DENV and CHIKV seropositivity rate in summer is higher than in other seasons (P < 0.01). Our seropositive samples suggest possible CHIKV and DENV infection in Iran. It is likely that these viruses are circulating in Iran and there is a need to study vector carriage of these two viruses.

Risk map development for soil-transmitted helminth infections in Argentina

BACKGROUND

Soil-transmitted helminths (STHs) comprise a group of helminth parasites that are included in the list of Neglected Tropical Diseases and require a passage through the soil to become infective. Several studies have detected that infection with STHs are associated with certain socioeconomic, environmental and soil characteristics. In Argentina, the presence of these parasites has been detected through a few point studies conducted in localities from 11 of the 23 provinces that comprise the country.

METHODS/PRINCIPAL FINDINGS

The most important characteristics previously associated with the presence of STHs were identified and ranked through the use of an expert survey and the Analytical Hierarchy Process (AHP) in order to construct a risk map of STHs specific for Argentina. Prevalence data from previous studies was used to validate the generated risk map. The map shows that half of Argentina, from the Central provinces to the North, contains localities with the characteristics necessary for the development of these parasites.

CONCLUSIONS/SIGNIFICANCE

The predicted map should serve as a useful tool for guiding the identification of survey areas for the generation of baseline data, detecting hotspots of infection, planning and prioritizing areas for control interventions, and eventually performing post-implementation surveillance activities.

Imported cases of Chikungunya virus in Iran

BACKGROUND

Chikungunya virus (CHIKV) is a widespread mosquito-borne virus representing a serious challenge to public health. The largest outbreak in the Middle-East was recorded in 2016-2017 in Pakistan. Sistan and Baluchistan Province of Iran shares a wide border with Pakistan; accordingly, introduction of CHIKV from Pakistan to Iran seems to be probable. The current study is aimed at investigating CHIKV infection in Sistan and Baluchistan Province.

METHODS

Between April 2017 and June 2018, a total of 159 serum samples of CHIK suspected cases from 10 cities of Sistan and Baluchistan Province were tested by molecular and serological assays. Samples obtained up to 4 days after onset of illness were tested by real time PCR (n = 8). Samples collected 5-10 days after disease onset were subjected to ELISA, as well as real time PCR tests (n = 72). Samples obtained after the 10th day of disease onset were tested by only ELISA (n = 79). Phylogenetic analysis of real time PCR positive samples was carried out by sequencing of a 1014-bp region of Envelope 1 gene (E1 gene). Chi-square and independent t tests were used to evaluate the association between variables and CHIKV infection.

RESULTS

In total, 40 (25.1%) out of 159 samples tested positive either by real time PCR or ELISA tests.Out of 151 samples serologically analyzed, 19 (12.6%) and 28 (18.6%) cases were positive for anti-CHIKV IgM and anti-CHIKV IgG antibodies, respectively. Of 80 samples tested by real time PCR, CHIKV RNA was detected in 11 (13.7%) sera, all of them had recent travel history to Pakistan. Additionally, phylogenetic analysis of 5 samples indicated their similarity with recent isolates of Pakistan outbreak 2016-2017 belonging to Indian Ocean sub-lineage of ECSA genotype. A significant correlation between abroad travel history and CHIKV infection was observed (P < 0.001). The most common clinical symptoms included fever, arthralgia/arthritis, myalgia, headache, and chill.

CONCLUSIONS

These results present substantial evidence of CHIKV introduction to Iran from Pakistan and emphasize the need for the enhancement of surveillance system and preventive measures.

A detailed review of the mosquitoes (Diptera: Culicidae) of Iran and their medical and veterinary importance

Mosquitoes (Diptera: Culicidae) are the most significant arthropods of medical importance because of the burden of diseases, such as malaria, encephalitis and filariasis, which are caused by pathogens and parasites they transmit to humans. In 2007, the most recently published checklist of Iranian mosquitoes included 64 species representing seven genera. Public databases were searched to the end of August 2018 for publications concerning the diseases in Iran caused by mosquito-borne pathogens. Pertinent information was extracted and analyzed, and the checklist of Iranian mosquitoes was updated. Six arboviral diseases, two bacterial diseases, four helminthic diseases and two protozoal diseases occur in Iran. The agents of these diseases are biologically or mechanically known or assumed to be transmitted by mosquitoes. The updated checklist of Iranian mosquitoes includes 69 species representing seven or 11 genera depending on the generic classification of aedines. There is no published information about the role of mosquitoes in the transmission of the causal agents of avian malaria, avian pox, bovine ephemeral fever, dengue fever, Rift Valley fever, Sindbis fever, Deraiophoronema evansi infection, lymphatic filariasis, anthrax and tularemia in Iran. There is just one imported case of lymphatic filariasis, which is not endemic in the country. It seems arthropods do not play an important role in the epidemiology of anthrax and ixodid ticks are the main vectors of the tularemia bacterium. In view of the recent finding of only a few adults and larvae of Aedes albopictus in southeastern Iran and the absence of Ae. aegypti, it is not possible to infer the indigenous transmission of the dengue fever virus in Iran. Considering the importance of mosquito-borne diseases in the country, it is necessary to improve vector and vector-borne disease surveillance in order to apply the best integrated vector management interventions as a part of the One Health concept.

Widespread circulation of West Nile virus, but not Zika virus in southern Iran

West Nile virus (WNV) and Zika virus (ZIKV) are mosquito-borne viral infections. Over the past few decades, WNV has been associated with several outbreaks involving high numbers of neuroinvasive diseases among humans. The recent re-emergence of ZIKV has been associated with congenital malformation and also with Guillain-Barre syndrome in adults. The geographic range of arthropod-borne viruses has been rapidly increasing in recent years. The objectives of this study were to determine the presence of IgG specific antibodies and the genome of WNV and ZIKV in human samples, as well as WNV and ZIKV genomes in wild-caught mosquitoes in urban and rural areas of the Hormozgan province, in southern Iran. A total of 494 serum samples were tested for the presence of WNV and ZIKV IgG antibodies using ELISA assays. One hundred and two (20.6%) samples were reactive for WNV IgG antibodies. All serum samples were negative for ZIKV IgG antibodies. Using the multivariable logistic analysis, age (45+ vs. 1-25; OR = 3.4, 95% C.I.: 1.8-6.3), occupation (mostly outdoor vs. mostly indoor; OR = 2.4, 95% C.I.: 1.1-5.2), and skin type(type I/II vs. type III/IV and type V/VI; OR = 4.3, 95% C.I.: 1.7-10.8 and OR = 2.7, 95% C.I.: 1.3-5.5 respectively, skin types based on Fitzpatrick scale) showed significant association with WNV seroreactivity. We collected 2,015 mosquitoes in 136 pools belonging to 5 genera and 14 species. Three pools of Culex pipiens complex were positive for WNV RNA using real-time reverse transcription polymerase chain reaction (rtRT-PCR). ZIKV RNA was not detected in any of the pools. All WNV ELISA reactive serum samples were negative for WNV RNA. In conclusion, we provided evidence of the establishment of WNV in southern Iran and no proof of ZIKV in serum samples or in mosquito vectors. The establishment of an organized arbovirus surveillance system and active case finding strategies seems to be necessary.