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.


#Spread of the Invasive #Mosquitoes #Aedes aegypti and Aedes albopictus in the #BlackSea Region Increases Risk of #Chikungunya, #Dengue, and #Zika #Outbreaks in #Europe (PLoS Negl Trop Dis., extract)

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


Spread of the Invasive Mosquitoes Aedes aegypti and Aedes albopictus in the Black Sea Region Increases Risk of Chikungunya, Dengue, and Zika Outbreaks in Europe

Muhammet M. Akiner, Berna Demirci, Giorgi Babuadze, Vincent Robert, Francis Schaffner

Published: April 26, 2016 /

Citation: Akiner MM, Demirci B, Babuadze G, Robert V, Schaffner F (2016) Spread of the Invasive Mosquitoes Aedes aegypti and Aedes albopictus in the Black Sea Region Increases Risk of Chikungunya, Dengue, and Zika Outbreaks in Europe. PLoS Negl Trop Dis 10(4): e0004664. doi:10.1371/journal.pntd.0004664

Editor: Roberto Barrera, Centers for Disease Control and Prevention, Puerto Rico, UNITED STATES

Published: April 26, 2016

Copyright: © 2016 Akiner 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.

Funding: This work was carried out under the VectorNet framework contract OC/EFSA/AHAW/2013/02-FWC1 funded by the European Food Safety Authority (EFSA) and the European Centre for Disease prevention and Control (ECDC). The funders contributed to the study design, but had no role in data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Francis Schaffner is employed by the private company Avia-GIS, performing consultancy about vector surveillance and control, and producing software to support vector surveillance and mapping.


The yellow fever and dengue mosquito Aedes aegypti previously flourished around the Mediterranean and Black Sea for decades until the 1950s, and was responsible of large outbreaks of both yellow fever and dengue [1]. The first well-described large dengue outbreak in Greece in 1927–28 caused more than 1 million cases (90% of the population in Athens) with 1000–1500 fatalities. The disappearance of Ae. aegypti from the European continent in Mediterranean, Black Sea, and Macaronesian biogeographical regions [2] is not well understood and its return in these regions raises concerns about a possible resurgence of the pathogens that can be transmitted by this vector species. Besides, the tiger mosquito Aedes albopictus is extending its distribution range worldwide, and it has already invaded large parts of the Mediterranean [1].


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


#Aflatoxin B1 #contamination in #maize in #Europe increases due to #climatechange (Sci Rep., abstract)

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

Article / Open

Aflatoxin B1 contamination in maize in Europe increases due to climate change

P. Battilani, P. Toscano, H. J. Van der Fels-Klerx, A. Moretti, M. Camardo Leggieri, C. Brera,  A. Rortais, T. Goumperis & T. Robinson

Scientific Reports 6, Article number: 24328 (2016) / doi:10.1038/srep24328

Received: 09 December 2015 – Accepted: 24 March 2016 – Published online: 12 April 2016



Climate change has been reported as a driver for emerging food and feed safety issues worldwide and its expected impact on the presence of mycotoxins in food and feed is of great concern. Aflatoxins have the highest acute and chronic toxicity of all mycotoxins; hence, the maximal concentration in agricultural food and feed products and their commodities is regulated worldwide. The possible change in patterns of aflatoxin occurrence in crops due to climate change is a matter of concern that may require anticipatory actions. The aim of this study was to predict aflatoxin contamination in maize and wheat crops, within the next 100 years, under a +2 °C and +5 °C climate change scenario, applying a modelling approach. Europe was virtually covered by a net, 50 × 50 km grids, identifying 2254 meshes with a central point each. Climate data were generated for each point, linked to predictive models and predictions were run consequently. Aflatoxin B1 is predicted to become a food safety issue in maize in Europe, especially in the +2 °C scenario, the most probable scenario of climate change expected for the next years. These results represent a supporting tool to reinforce aflatoxin management and to prevent human and animal exposure.

Keywords: Research; Abstracts; European Region; Climate Change; Food Safety; Aflatoxins.


#Predominance of #influenza #H1N1pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in #Europe (@eurosurveillanc, abstract)

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

Eurosurveillance, Volume 21, Issue 13, 31 March 2016 / Rapid communication

Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe

E Broberg 1 , A Melidou 2 , K Prosenc 3 , K Bragstad 4 , O Hungnes 4 , on behalf of the WHO European Region and the European Influenza Surveillance Network members of the reporting countries 5

Author affiliations: 1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; 2. National Influenza Centre for northern Greece, Microbiology Department, School of Medicine, Aristotle University of Thessaloniki, Greece; 3. Laboratory for Public Health Virology, National Laboratory for Health, Environment and Food, Slovenia; 4. Norwegian Institute of Public health, Department of Virology, Oslo, Norway; 5. The members of the network who provided data are listed at the end of the article

Correspondence: Eeva Broberg (

Citation style for this article: Broberg E, Melidou A, Prosenc K, Bragstad K, Hungnes O, on behalf of the WHO European Region and the European Influenza Surveillance Network members of the reporting countries. Predominance of influenza A(H1N1)pdm09 virus genetic subclade 6B.1 and influenza B/Victoria lineage viruses at the start of the 2015/16 influenza season in Europe. Euro Surveill. 2016;21(13):pii=30184. DOI:

Received:09 March 2016; Accepted:31 March 2016



Influenza A(H1N1)pdm09 viruses predominated in the European influenza 2015/16 season. Most analysed viruses clustered in a new genetic subclade 6B.1, antigenically similar to the northern hemisphere vaccine component A/California/7/2009. The predominant influenza B lineage was Victoria compared with Yamagata in the previous season. It remains to be evaluated at the end of the season if these changes affected the effectiveness of the vaccine for the 2015/16 season.

Keywords: Research; Abstracts; Seasonal Influenza; European Region; H1N1pdm09.


#Survival of #patients with #MDR #TB in Eastern #Europe: what makes a difference? (Thorax, abstract)

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

Thorax / doi:10.1136/thoraxjnl-2015-207638 / Tuberculosis / Original article

Survival of patients with multidrug-resistant TB in Eastern Europe: what makes a difference?

Yanina Balabanova1,2,3, Olga Ignatyeva4, Lena Fiebig3, Vija Riekstina5, Manfred Danilovits6, Kadri Jaama6, Edita Davidaviciene7, Birute Radiulyte7, Christina Marcela Popa8, Vladyslav Nikolayevskyy1,2, Francis Drobniewski1,2

Author Affiliations: 1Blizard Institute, Queen Mary, University of London, London, UK; 2Department of Infectious Diseases, Imperial College London, London, UK; 3Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; 4N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Samara, Russia; 5Department of Mycobacteriology, State Agency “Infectology Center of Latvia”, Clinic for Tuberculosis and Lung Diseases, “Upeslejas” Stopinunovads, Riga, Latvia; 6United Laboratory, Department of Mycobacteriology, Tartu University Hospital, Tartu, Estonia; 7National Tuberculosis and Infectious Diseases University Hospital, Vilnius, Lithuania; 8Marius Nasta Institute of Pneumology, Bucharest, Romania

Correspondence to: Yanina Balabanova, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin 13353, Germany;

Received 29 July 2015 – Revised 26 February 2016 – Accepted 28 February 2016 – Published Online First 24 March 2016




The quality of care for patients with TB in Eastern Europe has improved significantly; nevertheless drug resistance rates remain high. We analysed survival in a cohort of patients with multidrug-resistant and extensively drug-resistant (MDR-/XDR-) TB from Latvia, Lithuania, Estonia and Bucharest city.


Consecutive adult new and retreatment patients with culture-confirmed pulmonary MDR-TB registered for treatment in 2009 (and in 2007 in Latvia) were enrolled; prospective survival information was collected.


A total of 737 patients were included into the cohort. Of all MDR-TB cases, 46% were newly diagnosed; 56% of all MDR-TB cases had no additional resistance to fluoroquinolones or injectable agents, 33% had pre-XDR-TB and 11% XDR-TB. Median survival was 5.9 years in patients with MDR-TB and XDR-TB; 1.9 years in patients coinfected with HIV. Older age, male gender, alcohol abuse, retirement, co-morbidities, extrapulmonary involvement and HIV coinfection independently worsened survival. Inclusion of fluoroquinolones and injectable agents improves survival in patients with MDR-TB. Pre-XDR and XDR status did not significantly shorten survival as long as fluoroquinolones and injectable agents were part of the regimen. Moxifloxacin seems to improve survival in ofloxacin-susceptible patients when compared with older generation fluoroquinolones.


The burden of additional resistances in patients with MDR-TB is high likely due to primary transmission of resistant strains. Social and programmatic factors including management of alcohol dependency, expansion of HIV testing and antiretroviral treatment need to be addressed in order to achieve cure and to interrupt transmission. The role of last generation fluoroquinolones and injectable agents in treatment of patients with pre-XDR and XDR-TB needs to be further investigated.

Keywords: Research; Abstracts; Tuberculosis; Antibiotics; Drugs Resistance; European Region.


#Clinical #Management of #Ebola Virus Disease in the #US and #Europe (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Original Article

Clinical Management of Ebola Virus Disease in the United States and Europe [      ]

Timothy M. Uyeki, M.D., M.P.H., M.P.P., Aneesh K. Mehta, M.D., Richard T. Davey, Jr., M.D., Allison M. Liddell, M.D., Timo Wolf, M.D., Pauline Vetter, M.D., D.T.M.&H., Stefan Schmiedel, M.D., Thomas Grünewald, M.D., Ph.D., Michael Jacobs, M.B., B.S., Ph.D., D.T.M.&H., Jose R. Arribas, M.D., Laura Evans, M.D., Angela L. Hewlett, M.D., Arne B. Brantsaeter, M.D., Ph.D., M.P.H., Giuseppe Ippolito, M.D., Christophe Rapp, M.D., Ph.D., Andy I.M. Hoepelman, M.D., Ph.D., and Julie Gutman, M.D. for the Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe

N Engl J Med 2016; 374:636-646 / February 18, 2016 / DOI: 10.1056/NEJMoa1504874




Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.


We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.


A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.


Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

Keywords: Research; Abstracts; Ebola; USA; European Region.