Knowledge, Attitude, and Practices Survey in Greece before the Implementation of Sterile Insect Technique against Aedes albopictus

Do we protect ourselves against West Nile Virus? A systematic review on knowledge, attitudes, and practices and their determinants

BACKGROUND

West Nile virus (WNV) is a mosquito-borne flavivirus. In humans, 80% of infections are asymptomatic, while approximately 20% experience influenza-like symptoms. Fewer than 1% develop the neuroinvasive form which can lead to encephalitis, meningitis, acute flaccid paralysis, and even death. The global spread of the virus to areas where it was not previously present has become a growing concern. Since the 2000 s, there have been numerous outbreaks affecting local and travelling populations worldwide. Given the lack of a vaccine, preventative measures are primarily focused on surveillance, vector control, and the use of personal protective behaviours (PPBs). The importance of PPBs is central to public health recommendations. However, translating these messages into coherent action by the public can prove challenging, as the uptake of such measures is inevitably influenced by socio-economic factors, awareness, knowledge, and risk perception.

METHODS

A PRISMA-based systematic research was conducted on EMBASE, PubMed/MEDLINE, and Web of Science databases. PROSPERO registration number CRD42023459714. Quality of studies included in the final stage was evaluated using the Critical Appraisal Checklist for Cross-Sectional Study (CEBMa).

RESULTS

2963 articles were screened, and 17 studies were included in the final round. Out of these, six were deemed of high quality, ten were of medium quality, and one was of low quality. In almost all studies considered, both awareness and knowledge of WNV transmission were above 90%, while concern about WNV ranged from 50% to 80%. Concern about the safety of repellents, either with or without DEET, ranged from 27% to 70%. The percentage of people actually using repellents ranged from 30% to 75%, with the lowest usage reported among individuals over 60 years old (29%) and pregnant women (33%), and the highest among students aged 9-11 (75%). Concern for West Nile Virus (WNV) was consistently linked to an increase in taking preventative measures, including the use of repellents, by two to four times across studies. The school-based intervention was effective in increasing the practice of removing standing water (AOR=4.6; 2.7-8.0) and wearing long clothing (AOR=2.4; 95%CI: 1.3-4.3), but did not have a significant impact on the use of repellents.

CONCLUSIONS

The present systematic review provides an overview of the knowledge, attitudes, and practices (KAP) of WNV and their determinants. While concern about West Nile Virus (WNV) and its effects can be a significant motivator, it is important to promote evidence-based personal protective behaviours (PPBs) to counter unwarranted fears. For example, the use of repellents among the most vulnerable age groups. Given the geographical expansion of WNV, it is necessary to target the entire population preventively, including those who are difficult to reach and areas not yet endemic. The findings of this investigation could have significant implications for public health and support well-informed and effective communication strategies and interventions.

Sterile Insect Technique (SIT) field trial targeting the suppression of Aedes albopictus in Greece

The sterile insect technique (SIT) involves releasing large numbers of sterile males to outcompete wild males in mating with females, leading to a decline in pest populations. In the current study, we conducted a suppression trial in Greece against the invasive dengue vector mosquito Aedes albopictus (Skuse) through the weekly release of sterile males for 22 weeks from June to September 2019. Our approach included the long-distance transport of sterile mosquitoes, and their release at a density of 2,547 ± 159 sterile males per hectare per week as part of an area-wide integrated pest management strategy (AW-IPM). The repeated releases of sterile males resulted in a gradual reduction in egg density, reaching 78% from mid-June to early September. This reduction remained between 70% and 78% for four weeks after the end of the releases. Additionally, in the SIT intervention area, the ovitrap index, representing the percentage of traps containing eggs, remained lower throughout the trial than in the control area. This trial represents a significant advance in the field of mosquito control, as it explores the viability and efficacy of producing and transporting sterile males from a distant facility to the release area. Our results provide valuable insights for future SIT programmes targeting Ae. Albopictus, and the methodology we employed can serve as a starting point for developing more refined and effective release protocols, including the transportation of sterile males over long distances from production units to intervention areas.

A review of knowledge, attitudes and practices regarding mosquitoes and mosquito-borne infectious diseases in nonendemic regions

Mosquito-borne infectious diseases (MBIDs) present significant public health risks within tropical and subtropical regions. However, the rapid spread of MBIDs from these areas to temperate regions increase the risk of their emergence in nonendemic regions, i.e., regions where diseases are still sporadic and not sustained in the population. Raising awareness about preventive measures and protective behaviors is of primary importance to face the risks of vector-borne diseases. In this context, the number of studies on knowledge, attitude, and practice (KAP) about mosquitoes and MBIDs has grown rapidly in response to the need to identify knowledge and practices in nonendemic countries to fight mosquito proliferation. Building upon the recent developments in this field, we conducted the first-ever literature review to examine KAP studies conducted in nonendemic regions. Our aim was to identify the community's knowledge and attitudes that shape practices concerning the prevention of MBIDs. We used specific keywords regarding the scope of this review and then selected studies that were performed in nonendemic regions for MBIDs, including regions located in European countries, the USA or Asia. We identified 32 KAP studies, the oldest from 2003. The findings in the reviewed studies show that survey participants generally possessed a rather good understanding of mosquito breeding sites. However, there were notable variations in knowledge and perception of MBIDs, primarily linked to the geographic location of the survey and the prevalence of infectious outbreaks related to mosquito transmission. These findings highlight the significant influence of knowledge and awareness in fostering effective mosquito control practices. Moreover, socioeconomic status, particularly educational attainment, and respondents' gender emerged as key determinants in explaining the variability of appropriate practices. The survey results thus show the crucial role of knowledge, emphasizing the need for widespread awareness and information campaigns, encompassing both appropriate practices and efficient mosquito control methods. Understanding the interaction between these factors could provide good guidelines for implementing awareness plans and ultimately motivate the population to actively fight against mosquito proliferation and MBIDs development.

Winter survival of adults of two geographically distant populations of Aedes albopictus in a microclimatic environment of Athens, Greece

Overwintering capacity is a major step towards establishment of invasive mosquitoes from the tropics in temperate zone areas and one of the main elements determining next seasons' population size that regulates disease transmission of competent invasive vector species. The Asian tiger mosquito, Aedes albopictus (Skuse) (Diptera: Culiciidae) is an aggressive invasive species that has greatly expanded its geographical boundaries over the last few decades. The species' ability to induce photoperiodic-based egg diapause allows its overwintering in temperate regions, which favors its establishment in higher latitudes. In warmer temperate areas winter survival can be accomplished in the adult stage as well especially in human-made shelters. Aedes albopictus is already showing signs of adaptation to colder climates which may result in disease transmission in new areas. Although the Asian tiger mosquito has invaded Greece since 2003-4, little is known regarding its overwintering capacity in the country, especially as far as adults are regarded. We studied the survival of Ae. albopictus adults during winter in a protected shelter in Athens, the capital city of Greece. The study involved two geographically isolated populations originating from Chania (Crete, most southern part of Greece), and Palaio Faliro (Athens, Central Greece). We exposed different cohorts of F3 adults of the above two populations that emerged from field collected eggs to "winter condition" from November 2018 to beginning of January 2019. in a protected microclimatic environment. Adult mortality was recorded systematically until the death of the last individual in the cohort. Results demonstrated evidence of winter survival of adults for both populations. Longevity of both females and males of the Palaio Faliro population was longer than that of the Chania population for almost all installation dates. Survival curves, regardless of the date of installation, were steeper for females of the Chania population compared to those from Palaio Faliro. In conclusion, overwinter survival of both populations in the adult stage highlights the need for future studies, considering local and microclimatic condition that vary significantly between regions. Winter climatic conditions play vital role in adult survival of this highly important public health species concerning distribution limits and knowledge on winter survival of Ae. albopictus transmitted viruses.

Knowledge, Attitudes and Perception of Mosquito Control in Different Citizenship Regimes within and Surrounding the Malakasa Open Accommodation Refugee Camp in Athens, Greece

The study aims to evaluate the Knowledge, Attitude and Perception (KAP) of different societal groups concerning the implementation of targeted community-based mosquito surveillance and control interventions in different citizenship regimes. Targeted surveys were carried out within Malakasa camp for migrants and refugees, neighboring residential areas and urban areas in the wider Athens metropolitan area to investigate different knowledge levels and the role that both local and migrant communities can play in the implementation of community-based interventions based on their attitudes and perceptions. A scoring system was used to rate the collected responses. Results indicate different levels of KAP among the various groups of respondents and different priorities that should be considered in the design and execution of community interventions. Findings indicate a lower level of Knowledge Attitudes and Perceptions for the migrants, while the rate of correct answers for Perception significantly improved for migrants following a small-scale information session. The study highlights disparities in the levels of knowledge for certain public health issues and the feasibility of certain approaches for alleviating health-related challenges such as mosquito-borne diseases. Findings suggest that essential preparedness is needed by public authorities to respond to public health challenges related to migration and the spread of vector-borne diseases.

Spatial and Temporal Dynamics of Aedes albopictus Populations in Rural and Agricultural Areas in Chania, Greece, After Its Invasion

Aedes albopictus, also known as the Asian tiger mosquito, is an aggressive invasive mosquito species that transmits parasites that cause several major human diseases such as dengue, Chikungunya, and Zika. Its recent establishment in many European countries and the reported autochthonous cases of Aedes-transmitted arboviral diseases highlight the importance of effective surveillance programs to plan and implement efficient mosquito-control interventions. Aedes albopictus invaded the Greek island of Crete in 2014 and rapidly spread throughout; however, there are no comprehensive population-related data yet available. Our study focused on spatial and temporal dynamics of Ae. albopictus populations in rural and agricultural areas in Chania (western part of the Crete Island). An oviposition surveillance network, consisting of 51 ovitraps, was established in 2017 and systematically inspected for 2 years. Thirty ovitraps were established in rural areas and 21 in the surrounding agricultural areas. Eggs were collected weekly and transferred to the laboratory for counting and assessment of hatching rates. The spatial and temporal egg distribution was assessed by using geographical information systems and spatial statistical analysis tools. Kernel density and hot spot analysis were employed to identify clusters of high populations of eggs. Oviposition activity (eggs in traps) was recorded during April–May and December (of both years), while the maximum egg-laying rates were observed during September–October. The proportion of traps with eggs was similar between rural and agricultural areas, while the higher number of eggs was recorded in rural compared to agricultural areas during 2017. Egg hatch rates were high (>90%) until the end of September. The proportion of diapausing non-hatched eggs rapidly increased at the end of November. All hatched larvae were identified as Ae. Albopictus, indicating a negative effect of the invasion on the population of the local species Ae. cretinus. This was a systematic attempt to monitor the seasonal and spatial patterns of the Asian tiger mosquito in the island of Crete, the southernmost area of Europe, and a study in Europe that assessed temporal and spatial dynamics of Ae. albopictus soon after its invasion and establishment in an area.

Community Knowledge and Attitudes about the Transmission of Dengue Haemorrhagic Fever and Its Relationship to Prevention Behaviour in Palembang, South Sumatra, Indonesia

BACKGROUND: PSN 3 M Plus is a long-running program in Indonesia for the prevention and control of dengue hemorrhagic fever (DHF). AIM: This study aimed to determine the knowledge, behavior, attitudes, and beliefs of the community toward PSN 3 M Plus in preventing and controlling the spread of DHF. METHODS: A cluster random sampling method was used to recruit 200 respondents in endemic areas and 100 respondents in sporadic locations of Indonesia from August 2020 to February 2021. The respondents were interviewed directly by interviewers and the relationships between demographics and characteristics with the practice of PSN 3M Plus prevention behavior on the incidence of DHF were analyzed. RESULTS: Most respondents had good knowledge regarding the cause of DHF. Although respondents recognized and understood the dangers of and how to control DHF, most did not follow PSN 3 M Plus and believed that fogging was the most effective control measure. There was a significant relationship between the characteristics of the respondents in terms of education, occupation, and attitude on vector control practice. CONCLUSION: Although community environmental modifications can be a cost-effective approach to reduce the incidence of DHF, there is a need to raise public awareness regarding preventive vector control measures as good knowledge does not guarantee good compliance with PSN 3M Plus recommendations.

Curcumin Derivatives as Potential Mosquito Larvicidal Agents against Two Mosquito Vectors, Culex pipiens and Aedes albopictus

Vector-borne diseases have appeared or re-emerged in many Southern Europe countries making the transmission of infectious diseases by mosquitoes (vectors) one of the greatest worldwide health threats. Larvicides have been used extensively for the control of Aedes (Stegomyia) albopictus (Skuse, 1895) (Diptera: Culicidae) and Culex pipiens Linnaeus, 1758 (Diptera: Culicidae) mosquitoes in urban and semi-urban environments, causing the increasing resistance of mosquitoes to commercial insecticides. In this study, 27 curcuminoids and monocarbonyl curcumin derivatives were synthesised and evaluated as potential larvicidal agents against Cx. pipiens and Ae. albopictus. Most of the compounds were more effective against larvae of both mosquito species. Four of the tested compounds, curcumin, demethoxycurcumin, curcumin-BF2 complex and a monocarbonyl tetramethoxy curcumin derivative exhibited high activity against both species. In Cx. pipiens the recorded LC50 values were 6.0, 9.4, 5.0 and 32.5 ppm, respectively, whereas in Ae. albopictus they exhibited LC50 values of 9.2, 36.0, 5.5 and 23.6 ppm, respectively. No conclusive structure activity relationship was evident from the results and the variety of descriptors values generated in silico provided some insight to this end.

Sterile Insect Technique (SIT) and Its Applications

Although most insect species have a beneficial role in the ecosystems, some of them represent major plant pests and disease vectors for livestock and humans. During the last six-seven decades, the sterile insect technique (SIT) has been used as part of area-wide integrated pest management strategies to suppress, contain, locally eradicate or prevent the (re)invasion of insect pest populations and disease vectors worldwide. This Special Issue on "Sterile insect technique (SIT) and its applications", which consists of 27 manuscripts (7 reviews and 20 original research articles), provides an update on the research and development efforts in this area. The manuscripts report on all the different components of the SIT package including mass-rearing, development of genetic sexing strains, irradiation, quality control as well as field trials.