1. EU Parliament Office for Science and Technology- AVIESAN Work shop Brussels, 19 June 2012 Arboviral diseases and the threats for Europe Herve Zeller Emerging and vector-borne disease programme

2.  Biological transmission  Viremic natural host  Competent vector  Sensitive host  Mechanical transmission Arthropod-borne diseases

3. Why do we bother?

4. Some examples of emergence in Europe Chikungunya fever Italy 2007 France 2010 West Nile fever Italy 2008, Greece Turkey 2010 Crimean Congo hemorrhagic fever Turkey 2002, Greece 2008 India 2009, Spain 2011 Bluetongue 2006-2007 multi-countries Schmallenberg 2011 multi-countries Dengue France 2010

5. Vector-borne diseases SituationDisease*PathogenVector 1 2 X 3 XX 4 X X 5 XXX : present; X : absent; *Acquired through local (autochthonous) transmission Braks et al. (2011) Towards an integrated approach in surveillance of vector-borne diseases in Europe. Parasites & Vectors 04:192

6. Arbovirosis in tropical/subtropical regions (Asia, Americas) Expansion in Africa, Middle-East 1st cause of hospitalisation of children in South East Asia Emerging /reemerging disease (WHO, 1993) Dengue Source: http://www.pdvi.org/about_dengue/GBD.asp Dengue Population at risk3.6 billion Endemic countries125 Infections /year 70- 500 millions Severe Cases2.1 millions Deaths/ year21,000 Source: http://www.pdvi.org/about_dengue/GBD.asp Average number of Dengue cases reported to WHO per year

7. Global Dengue Risk map 2012 Simmons CP et al. N Engl J Med 2012;366:1423-1432

8. O Schwartz, Pasteur Institute 100 nm Chikungunya Togaviridae Alphavirus «which bends up» in Makonde dialect Febrile illness with arthralgia +++ (long lasting)

9. Chikungunya outbreak 2005-2006 La Reunion 2006 2005 Population: 750 000 Emergence of a virus with a mutation that increases the rate of transmission by the local mosquito vectors  major outbreak infection of 35% population

10. Chikungunya outbreak in Italy, Aug 2007: Location of the outbreak Emilia-Romagna region

12. Mosquito vector spread distribution Are Aedes albopictus or other mosquito species from northern Italy competent to sustain new arboviral outbreaks? Medical and Veterinary Entomology (2010) 24, 83–87 Talbalhi S et al

13. Invasive mosquito species in Europe Ae. aegypti Ae. albopictus Ae. japonicus Ae. koreicus

14. West Nile fever Natural cycle between birds and mosquitoes Human infection Asymptomatic infections (>70%) Mild febrile illness Neuro-invasive illness in 1 out of 150-300 cases (mostly in elderly) with fatalities

15. Country 2010 No cases No areas 2011 No cases No areas Greece 262* 11 69 (101) 11 Hungary 17 13 3 3 Italy 3 2 14 7 Romania 52 19 10 5 Spain 2 1 Albania 2 1 FYROM 4 1 Ukraine 8 3 Russian Federation 519 8 153 6 Turkey 47 15 3 3 Israel 88 5 34 4 Tunisia 3 1 Affected countries/areas in 2011 (/2010) * Case fatality rate among patients with neuroinvasive illness: 18% (elderly) Risk of transmission through blood donations

16. Cases in horses: Spain, Italy, Greece…

17. Tick-Borne Encephalitis Annually 2,000–3,000 TBE-cases reported from the European countries. 6,000–8,000 cases reported from Russia Vaccine available Average number of cases per 100.000 inhabitants Level of endemicity Will be notifiable in 2013

18. Crimean Congo Haemorrhagic fever EID 2010, 16, No. 8 August 2010K Zakhashvili et al Hyalomma marginatum Clinical description: Crimea 1944-45 Virus isolation : 1956: human in Congo 1967: ticks in Crimea, Russia CFR 5=30% Nosocomial infections, BSL 4 virus No disease in animals

19. Crimean-Congo Hemorrhagic fever: a Re-emerging disease in Europe Nosocomial infections Kosovo 2001 Bulgaria 2008 Turkey 2008 Bulgaria 2009 ; www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18952 ; 18845; 18953 www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18952 2008 Greece Bulgaria Turkey Russia

20. Distribution of Crimean-Congo Hemorrhagic Fever virus CCHFV isolation Serology + Hyaloma vectors Hyaloma vectors Adapted from Bray, 2007 and Ergonul, 2007

21. ECDC mission Identify, assess and communicate current and emerging threats to human health from communicable diseases. Added value for Europe Provides Member States with access to expertise, topical assessments of disease risks and decision support tools with the latest scientific knowledge ECDC’s role in shaping the EU research agenda

22. Surveillance and control of vector-borne diseases ENVIRONMENT SUSCEPTIBLE HOST COMPETENT VECTOR PATHOGEN

23. Conclusions Vector-borne diseases are a growing concern in Europe Orphan diseases, lack of knowledge Surveillance not uniform in EU, not always mandatory Diagnostic tools to improve Control issues: Development of more effective tools to prevent and control outbreaks New developments for antiviral drugs and vaccines  Promote integrated approaches for a better understanding and knowledge on pathogen ecology in a changing environment to improve risk assessment and predictive models regarding potential threats, targeted preventive measures and control activities

24. Thank for your attention