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

EU Parliament Office for Science and Technology- AVIESAN Work shop

Brussels, 19 June 2012

Arboviral diseases and the threats for Europe

Herve ZellerEmerging and vector-borne disease programme

Biological transmission

Viremic natural host

Competent vector

Sensitive host

Mechanical transmission

Arthropod-borne diseases

Blood and

tissue donation

Public concer

nLimited

knowledge

Disease:

Increase

Why do we bother?

Outbreaks: media attention

Sensitive issue

Control issues

Some examples of emergence in Europe

Chikungunya feverItaly 2007 France 2010

West Nile feverItaly 2008, Greece Turkey 2010

Crimean Congo hemorrhagic feverTurkey 2002, Greece 2008India 2009, Spain 2011

Bluetongue2006-2007 multi-

countries

Schmallenberg2011 multi-countries

Dengue France 2010

Vector-borne diseases

Situation Disease* Pathogen Vector

1 2 X 3 X X 4 X X

5 X X X: 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

• 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

908 15497122174

295554

479848

925896

1279668

1451083

2204516

0

500000

1000000

1500000

2000000

2500000

55-59 60-69 70-79 80-89 90-99 00-07 2008 2009 2010

Period or year

Nu

mb

er

of

ca

se

s

Dengue Population at risk 3.6 billion

Endemic countries 125

Infections /year 70- 500 millions

Severe Cases 2.1 millions

Deaths/ year 21,000

Source: http://www.pdvi.org/about_dengue/GBD.asp

Average number of Dengue cases reported to WHO per year

Global Dengue Risk map 2012

Simmons CP et al. N Engl J Med 2012;366:1423-1432

O Schwartz, Pasteur Institute 100 nm

Chikungunya

TogaviridaeAlphavirus

«which bends up»

in Makonde dialect

Febrile illness witharthralgia +++(long lasting)

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

Þmajor outbreak infection of 35% population

Chikungunya outbreak in Italy, Aug 2007: Location of the outbreak

Emilia-Romagna region

1995 2000

2005 2011

Mosquito vector spread distribution

Are Aedes albopictus or other mosquito speciesfrom northern Italy competent to sustain newarboviral outbreaks? Medical and Veterinary Entomology (2010) 24, 83–87 Talbalhi S et al

Invasive mosquito species in EuropeAe. aegyptiAe. albopictusAe. japonicusAe. koreicus

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

Country 2010No cases No areas

2011No 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 tr

ansmiss

ion through blood donatio

ns

Cases in horses:

Spain, Italy, Greece…

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

Crimean Congo Haemorrhagic fever

EID 2010, 16, No. 8 • August 2010 K 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 virusNo disease in animals

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

2008

• Greece • Bulgaria• Turkey• Russia

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

250

500

750

1000

1250

1500

17

133

249 266

438

717

1315

1318

868

6 13 13 27 33 6361

Number of cases of CCHF reported in Turkey 2001-2010

Fatal cases

Year

Nu

mb

er

of

case

s

Distribution of Crimean-Congo Hemorrhagic Fever virus

CCHFV isolation

Serology + Hyaloma vectors

Hyaloma vectors

Adapted from Bray, 2007 and Ergonul, 2007

ECDC mission

• Identify, assess and communicate current and emerging threats to human health from communicable diseases.

Addedvalue forEurope

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

Surveillance and control of vector-borne diseases

ENVIRONMENT

SUSCEPTIBLEHOST COMPETEN

TVECTOR

PATHOGEN

SURVEILLANCE

PREVENTION

CONTROL

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

Thank for your attention