1. Managing the risk of vector borne diseases in adaptation measures Luciana Sinisi, Italy Chair Task Force Extreme Weather Events luciana.sinisi@apat.it Water and adaptation- International workshop, Amsterdam July 1-2, 2008

2. THE RISK FACTORS increases in global temperatures, + more frequent extreme weather events, + warmer winters and evenings + Other cofactors (biodiversity loss, urbanization) = opportunity for increased distribution, expanded breeding, prolonged mosquito incubation period. Vector-borne diseases (VBD) are infections transmitted by the bite of infected, climate sensitive, arthropod species, such as mosquitoes, ticks, sandflies and blackflies:

3. OUTBREAK OF VECTOR BORNE DISEASE: experience in Italy The outbreak of chikungunya fever in north-eastern Italy is the first documented local vector-borne transmission of Chikungunya virus within the European main land. (EU CDC report, 2007) Further impact on blood trasfusion and transplants activities !!!!

4. The geographical extent

5. OUTBREAK MANAGEMENT August 9 - Initial warning by a citizen of Castiglione di Cervia August 14- 47 suspect cases had been identified through this active case search. August 20, blood samples were collected. August 24, epidemiological surveillance was extended to all general practitioners in the province, August 29, the health authorities developed criteria for active surveillance purposes: Since 18 August, vector control measures (control of breeding sites,insecticides )implementation and extension as the outbreak progressed. Source: EU CDC Mission Report Chikungunya in Italy, September 2007

6. …. PREPAREDNESS ELEMENTS.. 1: Guidelines for the control of Aedes albopictus were issued in Italy by the Ministry of Health since 1994. 2. Current vector monitoring system comprises 1 800 ovitraps in the region hitted by the outbreaks; 3. Weekly monitoring data are available on a dedicated website (www.zanzaratigreonline.it). 4.Based on current operational evidence, this regional monitoring system is among the most advanced in Italy, and probably in most parts of Europe. 5. evidence of trans-ovarian (vertical) virus transmission gained from studies done in la Réunion (2005-5)possibly increases the risk for re-appearance of infected mosquitoes

7. The ECDC risk assessment for chikungunja virus in Europe Note: Many Countries miss data

8. LESSON LEARNED/elements for discussion 1. The efficiency and preparedness of the Italian region provide a good control of the outbreak 2. Vector borne disease surveillance & control are pretty much fully delegate to public health system >>> ANY POSSIBLE SINERGY WITH OTHER SECTOR TO STREGHTEN ? e.g. early warning, ecosystem intervention …. 2. Risk of VBD are an issue of adaptation measures ? >>> e.g. health risk assessment ofopen reservoir in water management,recovery of breeding sites after floods,…..