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Marieta Braks, Ph.D.Medical Entomologist
Arbovirus outbreak preparedness and response
European and globalarbovirus surveillance systems
30 March 201711:30-12:00
Content
1. Arboviruses2. Vector borne diseases3. Risk versus burden4. Surveillance strategy5. Entomological surveillance6. Take home messages7. EXTRA
ESCMID| 29-31 March 2017
6
Arthropods Bacteria Virus Protozoa Filaria
Ticks √ √ √
Sand flies √ √
Mosquitoes √ √ √
Biting midges √ √
Body lice √
Fleas √
Mites √
Kissing bugs √Tsetse flies √
Black flies (?) √ √
Louse flies/ Keds √ √
Horse flies(mech) (√) (√)
√
Vectors
Vectors Bacteria Virus Protozoa FilariaTicks Lyme disease
RickettisosisTick borne enceph.Crimean Congo h. f.African swine fever
Babesiois
Sand flies Sandfly fever Leismaniasis
Mosquitoes a.o. WNV, RVF, CHIK, DEN, ZIK,
Malaria Filariasis
Biting midges Blue tongueSchmallenberg
Body lice Recurrent fever
Fleas Plague
Mites Epidemic typhus
Kissing bugs Chagas
Tsetse flies Sleeping Sickness
Black flies Venezuelan equineencephalitis
Avian Parasites Riverblindness
Louse flies/ Keds
Bartonellaschoenbuchensis
Avian Parasites
Horse flies(mech) (Tularemia) (Rift Valley Fever)
Loasis
18
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
20
• Pathogen data collection.• Serological data collection.• Clinical data collection.
• Syndromic data collection.
• Risk data collection.
Data collection
Surveilance information leads to action
21
vector: presence/absence/abundance/distribution
reservoir hosts: presence/absence/abundance/distribution
hospital
general practices
general pop.: Symptomatic
general pop.: (A)symptomatic infected
general population: Exposure
22
vector: presence/absence/abundance/distribution
reservoir hosts: presence/absence/abundance/distribution
hospital
general practices
general pop.: Symptomatic
general pop.: (A)symptomatic infected
general population: Exposure
Notifiable/reportable(Improved) treatment(s)
Vaccination
Vector control
Public education
Germ control
Sero-surveillance
Vector-surveillance
Germ-surveillanceThre
atD
isea
se b
urde
nIntervention Surveillance
Context 1
Context 2
Context 3
Context 4
Context 5
Disease burden
Threat
Threat
Threat
Threat
Monitoring activities
Research
Intervention
Research
PH-authority:
National orPAN European
Har
mon
izat
ion
of
indi
cato
rsH
arm
oniz
atio
n of
in
dica
tors
Prio
ritiz
atio
nPr
ioritiz
atio
n
Decision to take action
LegislationContingency plan
29
Surveillanceand intervention
30
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
31
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
32
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
Asian tiger mosquito surveillance and control
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
33
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
34
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
35
Different contexts of arboviral diseases based on the current presence (√) or absence (-)
Disease burdenDisease burden
ThreatThreat
Context Endemic
disease Pathogen Vector Contexts of arboviral diseases for the
Netherlands 1 √ √ √ Tick borne encephalitis2 ‐ √ √ n/a 3 ‐ ‐ √ West Nile Fever 4 ‐ √ ‐ Zika 5 ‐ ‐ ‐ Crimean Congo haemorrhagic fever
Internal Factors:Vector competence
External FactorsVector capacity
A good vector can 1) pick up, 2) replicate and
3) transmit a pathogen.
Internal Factors:Vector competence
Externe FactorenvectorcapaciteitExample: arthropod borneviruses (arbo virus)
A good vector can 1) pick up, 2) replicate and
3) transmit a pathogen.
Kenney & Brault 2014 Adv. Vir. Res.
1. Midgut barrier
2. Salivary glandbarrier
3. Ovarial barrier
External FactorsVector capacity
Internal Factors:Vector competence
A good vector can 1) pick up, 2) replicate and
3) transmit a pathogen.
a. Vector identity
b. Vector presence/absence
in time and space
c. Vector abundance
d. Natural infection rate
6. Take home messages
Vector borne disease surveillance
● is multidisciplinary
43
● may largely differ between diseases
● needs to be tailored to each disease
● needs to be implemented in context
– May largely differ between countries and diseases
Not everything is transmitted by everything, everywhere,
always
7. EXTRA
Dear Marieta,
Last week we received a picture of a mosquito from a person who spend her holiday in South of Italy > Shementioned she was bitten by a certain mosquito species several time.Finally she has been able to make a picture of a dead examples. She asked whether this is a tiger mosquito. (she is 19 weeks pregnant and is worried).Our physicians are not sure and adviced me to ask you.
Hartelijke groet,
Dr. MD Huppeldepup