The #health and economic burden of #bloodstream #infections caused by #antimicrobial-susceptible and non-susceptible #Enterobacteriaceae and #Staphylococcus aureus in #European #hospitals, 2010 and 2011: a multicentre retrospective cohort study (@eurosurveillanc, abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Eurosurveillance, Volume 21, Issue 33, 18 August 2016  / Research article

The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study

AJ Stewardson 1 2 , A Allignol 3 4 , J Beyersmann 3 , N Graves 5 , M Schumacher 4 , R Meyer 6 , E Tacconelli 7 8 , G De Angelis 7 , C Farina 9 , F Pezzoli 9 , X Bertrand 10 , H Gbaguidi-Haore 10 , J Edgeworth 11 , O Tosas 11 , JA Martinez 12 , MP Ayala-Blanco 12 , A Pan 13 , A Zoncada 13 , CA Marwick 14 , D Nathwani 14 , H Seifert 15 16 , N Hos 15 , S Hagel 17 , M Pletz 17 , S Harbarth 1 , the TIMBER Study Group 18

Author affiliations: 1. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; 2. Department of Medicine, University of Melbourne, Melbourne, Australia; 3. Institute of Statistics, Ulm University, Ulm, Germany; 4. Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany; 5. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; 6. Information Technology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; 7. Division of Infectious Diseases, Agostino Gemelli Hospital, Rome, Italy; 8. Division of Infectious Diseases, DZIF TTU-HAARBI, University Hospital Tübingen, Tübingen, Germany; 9. Papa Giovanni XXIII Hospital, Bergamo, Italy; 10. Centre hospitalier régional et universitaire (CHRU) Besançon, Besançon, France; 11. Department of Infectious Diseases, Kings College London, London, United Kingdom; 12. Hospital Clinic de Barcelona, Barcelona, Spain; 13. Istituti Ospitalieri di Cremona, Cremona, Italy; 14. Department of Infection and Immunodeficiency, Ninewells Hospital and Medical School, Dundee, United Kingdom
15. Uniklinik Köln, Cologne, Germany; 16. German Centre for Infection Research (DZIF), Braunschweig, Germany; 17. Center for Infectious Diseases and Infection Control, University Hospital Jena, Jena, Germany; 18. The members of the group are listed at the end of the article

Correspondence: Andrew J. Stewardson (

Citation style for this article: Stewardson AJ, Allignol A, Beyersmann J, Graves N, Schumacher M, Meyer R, Tacconelli E, De Angelis G, Farina C, Pezzoli F, Bertrand X, Gbaguidi-Haore H, Edgeworth J, Tosas O, Martinez JA, Ayala-Blanco MP, Pan A, Zoncada A, Marwick CA, Nathwani D, Seifert H, Hos N, Hagel S, Pletz M, Harbarth S, the TIMBER Study Group. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Euro Surveill. 2016;21(33):pii=30319. DOI:

Received:23 September 2015; Accepted:20 April 2016



We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

Keywords: Research; Abstract; European Region; Antibiotics; Drugs Resistance; MRSA; Staphylococcus Aureus; Enterobacteriaceae.



#Zika Virus, a New #Threat for #Europe? (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical diseases, full page: (LINK). Abstract, edited.]


Zika Virus, a New Threat for Europe?

Henri Jupille, Gonçalo Seixas, Laurence Mousson, Carla A. Sousa, Anna-Bella Failloux

Published: August 9, 2016 /




Since its emergence in 2007 in Micronesia and Polynesia, the arthropod-borne flavivirus Zika virus (ZIKV) has spread in the Americas and the Caribbean, following first detection in Brazil in May 2015. The risk of ZIKV emergence in Europe increases as imported cases are repeatedly reported. Together with chikungunya virus (CHIKV) and dengue virus (DENV), ZIKV is transmitted by Aedes mosquitoes. Any countries where these mosquitoes are present could be potential sites for future ZIKV outbreak. We assessed the vector competence of European Aedes mosquitoes (Aedes aegypti and Aedes albopictus) for the currently circulating Asian genotype of ZIKV.

Methodology/Principal Findings

Two populations of Ae. aegypti from the island of Madeira (Funchal and Paul do Mar) and two populations of Ae. albopictus from France (Nice and Bar-sur-Loup) were challenged with an Asian genotype of ZIKV isolated from a patient in April 2014 in New Caledonia. Fully engorged mosquitoes were then maintained in insectary conditions (28°±1°C, 16h:8h light:dark cycle and 80% humidity). 16–24 mosquitoes from each population were examined at 3, 6, 9 and 14 days post-infection to estimate the infection rate, disseminated infection rate and transmission efficiency. Based on these experimental infections, we demonstrated that Ae. albopictus from France were not very susceptible to ZIKV.


In combination with the restricted distribution of European Ae. albopictus, our results on vector competence corroborate the low risk for ZIKV to expand into most parts of Europe with the possible exception of the warmest regions bordering the Mediterranean coastline.


Author Summary

In May 2015, local transmission of Zika virus (ZIKV) was reported in Brazil and since then, more than 1.5 million human cases have been reported in Latin America and the Caribbean. This arbovirus, primarily found in Africa and Asia, is mainly transmitted by Aedes mosquitoes, Aedes aegypti and Aedes albopictus. Viremic travelers returning from America to European countries where Ae. albopictus is established could become the source for local transmission of ZIKV. In order to estimate the risk of seeding ZIKV into local mosquito populations, the susceptibility of European Ae. aegypti and Ae. albopictus to ZIKV was measured using experimental infections. We demonstrated that Ae. albopictus and Ae. aegypti from Europe were not very susceptible to ZIKV. The threat for a Zika outbreak in Europe should be limited.


Citation: Jupille H, Seixas G, Mousson L, Sousa CA, Failloux A-B (2016) Zika Virus, a New Threat for Europe? PLoS Negl Trop Dis 10(8): e0004901. doi:10.1371/journal.pntd.0004901

Editor: Paulo Filemon Pimenta, Fundaçao Oswaldo Cruz, BRAZIL

Received: March 21, 2016; Accepted: July 13, 2016; Published: August 9, 2016

Copyright: © 2016 Jupille et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The work was supported by a grant FP7-HEALTH HEALTH.2011.2.3.3-2 (grant number: 282378) “Dengue research Framework for resisting epidemics in Europe” (DENFREE) and the Institut Pasteur (ACIP grant A15-2014). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Research; Abstracts; Zika Virus; Aedes Aegypti; Aedes Albopictus; European Region.


Southern #Europe’s Coming #Plagues: #VectorBorne Neglected Tropical #Diseases (PLoS Negl Trop Dis., extract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Extract.]

Open Access / Editorial

Southern Europe’s Coming Plagues: Vector-Borne Neglected Tropical Diseases

Peter J. Hotez

PLOS / Published: June 30, 2016 /

Citation: Hotez PJ (2016) Southern Europe’s Coming Plagues: Vector-Borne Neglected Tropical Diseases. PLoS Negl Trop Dis 10(6): e0004243. doi:10.1371/journal.pntd.0004243

Editor: Serap Aksoy, Yale School of Public Health, UNITED STATES

Published: June 30, 2016

Copyright: © 2016 Peter J. Hotez. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The author received no specific funding for this work.

Competing interests: The author has declared that no competing interests exist.


New social and environmental forces, including economic downturns, climate change, and human migrations from the Middle East and North Africa, are merging into a “perfect storm” to promote the widespread emergence of neglected tropical diseases (NTDs) in Southern Europe.

There is no single definition of the area or countries comprising Southern Europe, but most focus on the countries aligning the Mediterranean Sea, including Spain and Portugal (comprising the Iberian Peninsula), Italy (especially the portion on the Italian Peninsula), Southern France and Corsica, and Greece (Fig 1). The Balkan countries in southeastern Europe, including Croatia, are also sometimes included in this definition.


Keywords: Research; Arbovirus; Emerging Diseases; Infectious Diseases; European Region.


Assessing Seasonal #Risks for the #Introduction and #Mosquito-borne #Spread of #Zika Virus in #Europe (Ebio, abstract)

[Source: Ebio, full page: (LINK). Abstract, edited.]

Assessing Seasonal Risks for the Introduction and Mosquito-borne Spread of Zika Virus in Europe

Joacim Rocklöv, Mikkel Brandon Quam1, Bertrand Sudre1, Matthew German1, Moritz U.G. Kraemer, Oliver Brady, Isaac I. Bogoch, Jing Liu-Helmersson, Annelies Wilder-Smith, Jan C. Semenza, Mark Ong, Kaja Kaasik Aaslav, Kamran Khan

1These authors contributed equally to this work.

Open Access / Article has an altmetric score of 54 / DOI:

Publication History: Accepted: June 6, 2016Received in revised form: May 26, 2016Received: April 20, 2016

User License: Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)



  • Based on a temperature dependent model validated to epidemiological data, the risk of mosquito-borne transmission of Zika virus is estimated to peak between June and August in parts of Southern Europe.
  • Our analysis assumed similar competence of European and Latin American Aedes vectors, including Ae. albopictus, to transmit Zika virus
  • The flow of air travellers arriving into several European cities from regions of the Americas where they might be exposed to Zika virus, coincides with peak predicted capacity of European Aedes vectors to transmit Zika virus.
  • These findings could help the European public, healthcare providers, and public health officials identify locations and times where the risk for Zika virus importation and subsequent local transmission is heightened.


The imminent arrival of summer in the northern hemisphere brings an elevated risk of Zika virus epidemics outside of the Americas. In Europe, established populations of Aedes aegypti and Aedes albopictus mosquitoes might be capable of transmitting Zika virus locally, if travellers introduce the virus from other areas of the world. Here we calibrate a model of vectorial capacity for Zika virus transmission in Europe, which we overlay with arriving air travellers into Europe from Zika affected areas in the Americas. We highlight specific geographic areas and timing of risk for Zika virus introduction and potential autochthonous transmission to inform European disease surveillance and control activities.


The explosive Zika virus epidemic in the Americas is amplifying spread of this emerging pathogen into previously unaffected regions of the world, including Europe ( Gulland, 2016 ), where local populations are immunologically naïve. As summertime approaches in the northern hemisphere, Aedes mosquitoes in Europe may find suitable climatic conditions to acquire and subsequently transmit Zika virus from viremic travellers to local populations. While Aedes albopictus has proven to be a vector for the transmission of dengue and chikungunya viruses in Europe ( Delisle et al., 2015; ECDC, n.d. ) there is growing experimental and ecological evidence to suggest that it may also be competent for Zika virus(Chouin-Carneiro et al., 2016; Grard et al., 2014; Li et al., 2012; Wong et al., 2013). Here we analyze and overlay the monthly flows of airline travellers arriving into European cities from Zika affected areas across the Americas, the predicted monthly estimates of the basic reproduction number of Zika virus in areas where Aedes mosquito populations reside in Europe (Aedes aegypti in Madeira, Portugal and Ae. albopictus in continental Europe), and human populations living within areas where mosquito-borne transmission of Zika virus may be possible. We highlight specific geographic areas and timing of risk for Zika virus introduction and possible spread within Europe to inform the efficient use of human disease surveillance, vector surveillance and control, and public education resources.

Keywords: ZIKV, Zika, Air travel, Globalization, mosquito, Climate, Aedes

© 2016 Published by Elsevier Inc.

Keywords: Research; Abstracts; Zika Virus; European Region.


#Dengue and other #Aedes-borne #viruses: a #threat to #Europe? (@eurosurveillanc, edited)

[Source: Eurosurveillance, full page: (LINK). Edited.]

Eurosurveillance, Volume 21, Issue 21, 26 May 2016 / Editorial

Dengue and other Aedes-borne viruses: a threat to Europe?

G Rezza 1

Author affiliations: 1. Department of Infectious, Parasitic, and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy

Correspondence: Giovanni Rezza (

Citation style for this article: Rezza G. Dengue and other Aedes-borne viruses: a threat to Europe?. Euro Surveill. 2016;21(21):pii=30238. DOI:

Received:24 May 2016; Accepted:26 May 2016


At the beginning of the 20th century, dengue outbreaks were rather common in the Mediterranean basin. The last major epidemic on the European continent occurred in 1927/28 and predominantly affected Athens and neighbouring areas of Greece. After a first mild wave, which nearly ended with the arrival of cold weather in the winter season, a small number of cases continued to occur through the winter and spring, increasing dramatically in August 1928 [1-3]. It is conceivable that both the virus and its primary vector, the Aedes aegypti mosquito, survived the winter in the city, inside heated houses. Serological surveys detected neutralising antibodies to different dengue virus (DENV) serotypes in samples of individuals living in Athens in that period [4,5]. Some time after this severe outbreak, with 1,000 to 1,500 deaths, both dengue and its primary vector ‘abandoned’ the European continent.

The outbreak of seven autochthonous dengue cases reported by Succo et al. in this issue of Eurosurveillance [6] was triggered by one infected traveller returning from French Polynesia in the summer of 2015, and occurred in an area where another vector, Ae. albopictus, the Asian Tiger mosquito, was established in 2005.

This is not the first event of local transmission of DENV reported in Europe in recent years. Since 2010, at least 23 dengue cases were detected. In September 2010, two autochthonous cases of dengue fever were identified in Nice, southern France. The index case had friends from the West French Indies staying with him, while the second case was an individual living nearby [7]. In the summer of the same year, another transmission event occurred in Croatia [8,9]. The index case was a German man returning in mid-August from a two-week holiday spent at the Peljesac peninsula and the isle of Korĉula, ca 100 km north-west of Dubrovnik. A second autochthonous case, and other 15 individuals with serological evidence of recent infection, were identified in October 2010. How the virus was introduced in Croatia remains unclear. In 2013 and 2014, five autochthonous case of dengue were identified in southern France, one in Bouches-du-Rhône (2013) [10], and four in Aubage and Toulon-Hìres (2014) [11]. Ae. albopictus was the vector in all the transmission events listed here.

Dengue is not the only Aedes-borne viral disease threatening the health of European citizens. Nearly 10 years ago, in the summer of 2007, more than 250 cases of chikungunya occurred in the north-east of Italy [12]. The primary case was a viraemic individual arriving from the Indian State of Kerala. The chikungunya virus (CHIKV) implicated in the sustained outbreak carried the A226V mutation, which increases virus fitness and is usually detected in areas where the Tiger mosquito is the predominant vector [13]. In September 2010, autochthonous transmission of the CHIKV was also identified in south-east France, where chikungunya was diagnosed in two children living in the same area as another child who developed a febrile illness after returning from Rajasthan, India [14].

At present, there is concern about the possible emergence of Zika virus, which has been recently declared a ‘Public Health Emergency of International Concern’ by the World Health Organization [15]. Whether the increased risk of mosquito-borne transmission during the summer season in Europe will materialise in form of Aedes-borne autochthonous cases of Zika virus infections is unknown.

With the exception of a large dengue outbreak with over  2,100 cases that occurred from October 2012 to March 2013 in the subtropical archipelago of Madeira, located in the Atlantic Ocean at around 1,000 km from mainland Portugal, where Ae. aegypti is largely predominant [16], the vector involved in local transmission of DENV and CHIKV in Europe has always been Ae. albopictus.

The importance of Ae. albopictus is constantly growing as a consequence of rapid changes in its overall distribution and virus adaptation to the vector [17]. Since the time of World War II, the Tiger mosquito was involved in several dengue and chikungunya outbreaks that occurred in Japan, Hawaii, southern China, Indian Ocean Islands, and the Indian sub-continent [18].

In temperate areas, the global spread of Ae. albopictus is a prerequisite for transmission. Furthermore, several factors may increase the risk of importation of dengue and similar mosquito-borne infections into previously disease-free areas, well beyond the tropical and subtropical belt, where the vector is present: (i) the massive increase of mosquito-borne infections such as dengue, in certain areas of the world, driven by rapid population growth and uncontrolled urbanisation [19]; (ii) the spread of dengue, chikungunya, and Zika viruses in many touristic destinations in south-east Asia, Indian Ocean Islands, Pacific Islands, and in particular Central and South America; (iii) increased human mobility, which is an important driver of long-distance virus transportation.

The article by Succo et al. is an additional example that dengue transmission can occur in Europe However, to what extent tropical vector-borne infections may cause large outbreaks or even become endemic in Europe cannot be easily predicted. In a likely scenario, autochthonous cases may appear once the virus is introduced and amplified by local mosquitoes in a permissive environment. However, implementation of vector control measures following early detection of cases, combined with the decline of mosquito activity at the beginning of the winter season, may cut down the basic reproductive number (R0) and to stop transmission.

To better assess the risk of sustained transmission and persistence of Aedes-borne infections in Europe, the characteristics of the vector and the influence of climatic factors should be considered. Ae. albopictus adapts better than Ae. aegypti to temperate climate and may be implicated in outbreaks in areas where Ae. aegypti is not established. However, Ae. albopictus usually feeds on a single individual while Ae. aegypti tends to feed on more individuals during one gonotrophic cycle and only on humans. Thus, outbreaks caused by Ae. albopictus, may be more limited in size that those cause by Ae. aegypti, even if vector density is similar [17,18]. Moreover, vertical transmission of DENV and CHIKV from mosquitoes to their offspring is not very efficient. The low efficiency of transovarial transmission combined with the decline of mosquito activity during the cold season may explain the self-limiting nature of outbreaks occurring in temperate climate areas. Finally, even though DENV and Zika fitness for Ae. albopictus is not negligible, it is lower than for Ae. aegypti [20,21]; thus the sustainability of DENV, ZIKV and, to a lesser extent, CHIKV variant transmission, in areas where Ae. albopictus is the predominant vector, is not likely to be high.

Some of the consideration reported above may appear reassuring. However, the likelihood of future occurrence of dengue and other Aedes-borne viruses in Europe will be impacted by (i) repeated introduction of the infection, (ii) climate change, which may favour overwintering of virus and mosquitoes, (iii) possible increased fitness of viruses for the Tiger mosquito, as happened for CHIKV, and (iv) the return of Ae. aegypti, which is now established Caucasian cost of the Black Sea, where it competes with Ae. albopictus and Ae. koreicus [22]. To this regard, further expansion of Ae. aegypti towards the Mediterranean shores may not be fully excluded.

The article by Succo et al., published in this issue of Eurosurveillance, confirms the potential risk represented by dengue and other Aedes-borne scourges to Mediterranean Europe, underlining the importance of risk assessment, enhanced surveillance aimed at early detection of transmission chains, and mosquito control programs. Though the risk of large scale outbreaks and endemicity may appear rather low for most European countries, the effect of environmental, ecological, entomological, demographic, and behavioural changes on the epidemic potential of exotic Aedes-borne infections should not be underestimated.

Conflict of interest

None declared.



  1. Cardamatis JP. La dengue in Greece.Bull Soc Pathol Exot. 1929;22:272-92.
  2. Papaevangelou G, Halstead SB. Infections with two dengue viruses in Greece in the 20th century. Did dengue hemorrhagic fever occur in the 1928 epidemic?J Trop Med Hyg. 1977;80(3):46-51.PMID: 327086
  3. Schaffner F, Mathis A. Dengue and dengue vectors in the WHO European region: past, present, and scenarios for the future.Lancet Infect Dis. 2014;14(12):1271-80.DOI: 10.1016/S1473-3099(14)70834-5 PMID: 25172160
  4. Theiler M, Casals J, Moutousses C. Etiology of t e 1927-28 epidemic of dengue in Greece.Proc Soc Exp Biol Med. 1960;103(1):244-6.DOI: 10.3181/00379727-103-25474 PMID: 13837683
  5. Halstead SB, Papaevangelou G. Transmission of dengue 1 and 2 viruses in Greece in 1928.Am J Trop Med Hyg. 1980;29:635-7.
  6. Succo T, Leparc-Goffart I, Ferré J, Roiz DBroche BMaquart M et al. Autochthonous dengue outbreak in Nîmes, South of France, July to September 2015.Euro Surveill. 2016;21(21):30240. DOI: 10.2807/1560-7917.ES.2016.21.21.30240
  7. La Ruche G, Souarès Y, Armengaud A, Peloux-Petiot F, Delaunay P, Desprès P, et al. First two autochthonous dengue virus infections in metropolitan France, September 2010. Euro Surveill. 2010;15(39):19676.PMID: 20929659
  8. Schmidt-Chanasit J, Haditsch M, Schöneberg I, Günther S, Stark K, Frank C. Dengue virus infection in a traveller returning from Croatia to Germany.Euro Surveill. 2010;15(40):19677.PMID: 20946759
  9. Gjenero-Margan I, Aleraj B, Krajcar D, Lesnikar V, Klobučar A, Pem-Novosel I, et al. Autochthonous dengue fever in Croatia, August-September 2010. Euro Surveill. 2011;16(9):19805.PMID: 21392489
  10. Marchand E, Prat C, Jeannin C, Lafont E, Bergmann T, Flusin O, et al. Autochthonous case of dengue in France, October 2013. Euro Surveill. 2013;18(50):20661.DOI: 10.2807/1560-7917.ES2013.18.50.20661 PMID: 24342514
  11. Giron S, Rizzi J, Leparc-Goffart I, Septfons A, Tine R, Cadiou B , et al. New occurrence of autochthonous cases of dengue fever in Southern France, August-September 2014. Bull Epidemiol Hebd (Paris). 2015;13-14:217-23.
  12. Rezza G, Nicoletti L, Angelini R, Romi R, Finarelli AC, Panning M, et al. , CHIKV study group. Infection with chikungunya virus in Italy: an outbreak in a temperate region.Lancet. 2007;370(9602):1840-6.DOI: 10.1016/S0140-6736(07)61779-6 PMID: 18061059
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  15. World Health Organization (WHO). WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. Geneva: WHO; 1 February 2016. Available from:
  16. Alves MJ, Fernandes PL, Amaro F, Osório H, Luz T, Parreira P, et al. Clinical presentation and laboratory findings for the first autochthonous cases of dengue fever in Madeira island, Portugal, October 2012. Euro Surveill. 2013;18(6):20398.PMID: 23410256
  17. Rezza G. Aedes albopictus and the reemergence of dengue. BMC2012; 12:72.
  18. Rezza G. Dengue and chikungunya: long-distance spread and outbreaks in naïve areas.Pathog Glob Health. 2014;108(8):349-55.DOI: 10.1179/2047773214Y.0000000163 PMID: 25491436
  19. Gubler DJ. Dengue, urbanization and globalization: the unholy trinity of the 21(st) Century.Trop Med Health. 2011;39(4) Suppl;3-11.DOI: 10.2149/tmh.2011-S05 PMID: 22500131
  20. Moutailler S, Barré H, Vazeille M, Failloux AB. Recently introduced Aedes albopictus in Corsica is competent to Chikungunya virus and in a lesser extent to dengue virus.Trop Med Int Health. 2009;14(9):1105-9.DOI: 10.2807/1560-7917.ES.2016.21.15.30199 PMID: 19725926
  21. Di Luca M, Severini F, Toma L, Boccolini D, Romi R, Remoli ME, et al. Experimental studies of susceptibility of Italian Aedes albopictus to Zika virus. Euro Surveill. 2016;21(18):30223.DOI: 10.2807/1560-7917.ES.2016.21.18.30223 PMID: 27171034
  22. Ganushkina LA, Patraman IV, Rezza G, Migliorini L, Litvinov SK, Sergiev VP. Detection of Aedes aegypti, Aedes albopictus, and Aedes koreicus in the Area of Sochi, Russia.Vector Borne Zoonotic Dis. 2016;16(1):58-60.DOI: 10.1089/vbz.2014.1761 PMID: 26741323

Keywords: Research; Zika Virus; Dengue Fever; Chikungunya Fever; Aedes Albopictus; European Region.


Estimated #Zika virus #importations to #Europe by #travellers from #Brazil (Glob Health Action, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Glob Health Action. 2016 May 17;9:31669. doi: 10.3402/gha.v9.31669. eCollection 2016.

Estimated Zika virus importations to Europe by travellers from Brazil.

Massad E1,2, Tan SH3, Khan K4, Wilder-Smith A5,6,7.

Author information: 1Department of Medicine, University of Sao Paolo, Sao Paolo, Brazil. 2London School of Hygiene and Tropical Medicine, London, UK. 3School of Computer Engineering, Nanyang Technological University, Singapore. 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada. 5Institute of Public Health, University of Heidelberg, Germany. 6Department Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden. 7Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;




Given the interconnectivity of Brazil with the rest of the world, Zika virus (ZIKV) infections have the potential to spread rapidly around the world via viremic travellers. The extent of spread depends on the travel volume and the endemicity in the exporting country. In the absence of reliable surveillance data, we did mathematical modelling to estimate the number of importations of ZIKV from Brazil into Europe.


We applied a previously developed mathematical model on importations of dengue to estimate the number of ZIKV importations into Europe, based on the travel volume, the probability of being infected at the time of travel, the population size of Brazil, and the estimated incidence of ZIKV infections.


Our model estimated between 508 and 1,778 imported infections into Europe in 2016, of which we would expect between 116 and 355 symptomatic Zika infections; with the highest number of importations being into France, Portugal and Italy.


Our model identified high-risk countries in Europe. Such data can assist policymakers and public health professionals in estimating the extent of importations in order to prepare for the scale up of laboratory diagnostic assays and estimate the occurrence of Guillain-Barré Syndrome, potential sexual transmission, and infants with congenital ZIKV syndrome.

KEYWORDS: Brazil; Europe; Zika virus; importations; travel

PMID: 27193266 [PubMed – in process]

Keywords: Research; Abstracts; Zika Virus; European Region.


#Zoonotic and #Vector-Borne #Infections Among #Urban #Homeless and Marginalized People in the #USA and #Europe, 1990–2014 (Vector Borne Zoo Dis., abstract)

[Source: Vector Borne and Zoonotic Diseases, full page: (LINK). Abstract, edited.]

Vector-Borne and Zoonotic Diseases 

Zoonotic and Vector-Borne Infections Among Urban Homeless and Marginalized People in the United States and Europe, 1990–2014

To cite this article: Leibler Jessica H., Zakhour Christine M., Gadhoke Preety, and Gaeta Jessie M.. Vector-Borne and Zoonotic Diseases. May 2016, ahead of print. doi:10.1089/vbz.2015.1863.

Online Ahead of Print: May 9, 2016

Author information: 1Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts. 2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. 3College of Pharmacy and Health Sciences, St. Johns University, Queens, New York. 4Boston Health Care for the Homeless Program, Boston, Massachusetts. 5Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.

Address correspondence to: Jessica H. Leibler, Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, T430W, Boston, MA 02118, E-mail:




In high-income countries, homeless individuals in urban areas often live in crowded conditions with limited sanitation and personal hygiene. The environment of homelessness in high-income countries may result in intensified exposure to ectoparasites and urban wildlife, which can transmit infections. To date, there have been no systematic evaluations of the published literature to assess vector-borne and zoonotic disease risk to these populations.


The primary objectives of this study were to identify diversity, prevalence, and risk factors for vector-borne and zoonotic infections among people experiencing homelessness and extreme poverty in urban areas of high-income countries.


We conducted a systematic review and narrative synthesis of published epidemiologic studies of zoonotic and vector-borne infections among urban homeless and very poor people in the United States and Europe from 1990 to 2014.


Thirty-one observational studies and 14 case studies were identified (n = 45). Seroprevalence to the human louse-borne pathogen Bartonella quintana (seroprevalence range: 0–37.5%) was identified most frequently, with clinical disease specifically observed among HIV-positive individuals. Seropositivity to Bartonella henselae (range: 0–10.3%) and Rickettsia akari (range: 0–16.2%) was noted in multiple studies. Serological evidence of exposure to Rickettsia typhi, Rickettsia prowazekii, Bartonella elizabethae, West Nile virus, Borellia recurrentis, lymphocytic choriomeningitis virus, Wohlfartiimonas chitiniclastica, Seoul hantavirus (SEOV), and Leptospira species was also identified in published studies, with SEOV associated with chronic renal disease later in life. HIV infection, injection drug use, and heavy drinking were noted across multiple studies as risk factors for infection with vector-borne and zoonotic pathogens.


B. quintana was the most frequently reported vector-borne infection identified in our article. Delousing efforts and active surveillance among HIV-positive individuals, who are at elevated risk of complication from B. quintana infection, are advised to reduce morbidity. Given documented exposure to rodent-borne zoonoses among urban homeless and marginalized people, reducing human contact with rodents remains an important public health priority.

Keywords: Research; Abstracts; Zoonoses; USA; Europe.