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Durham E-Theses Durham E-Theses Mosquito borne diseases in England:: past, present and future risks, with special reference to malaria in the Kent Marshes. Hutchinson, Robert A. How to cite: Hutchinson, Robert A. (2004) Mosquito borne diseases in England:: past, present and future risks, with special reference to malaria in the Kent Marshes., Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/3067/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 Mosqu.ito Bor.ne Diseases in England: past~ present and future risks9 with special reference to malaria i:n the Kent Marsheso A copyright of this thesis rests with the author. No quotation from it should be published! without his prior wriUellll collllsent and information derived from fit should be aclknowledged. Robert A Hutchinson Department of Biological & Biomedical Sciences University of Durham Submitted for the degree of Doctor of Philosophy March 2004 Mosquito Boirne Diseases hn .!England: past, jpiresent andl futuire Irisks, wnth special ~reference to maDall"ia in. the Kent Marshes. Malaria was once common in the marshes of southern England. In this study I investigated why a disease called benign tertian malaria became known as the killer of the marshes and looked at the present and future threat from malaria returning to these marshes. The main focus of research was carried out on the Isle of Sheppey, one of the last places in England to experience an epidemic of malaria. An historical analysis of malaria was carried out by analysing births and deaths using Parish and Hospital records. Here I make the case that the deaths associated with malaria were more likely to be caused by diarrhoeal diseases and acute respiratory infections. The present risk of malaria was assessed using several methods. Field surveys showed that populations of An. atroparvus on Sheppey were small and severely limited by the few over-wintering sites and the filamentous surface algae needed for the aquatic stages to develop. Local residents found mosquitoes a major nuisance during the summer months, but few of these were likely to be malaria vectors. Overall the risk of local malaria transmission is extremely low and far below that needed to maintain the disease. Searches of 52 aircraft arriving at Gatwick Airport from Africa revealed no malaria vectors suggesting that the risk of importing exotic mosquitoes by aircraft is remote. Finally, I developed a simple surveillance system that could be used for assessing the threat of future vector borne diseases, using West Nile virus as a model. Routine sampling with MosquitoMagnet traps, a carbon-dioxide baited trap, was extremely efficient at collecting large numbers of potential disease vectors and could be used as a tool for risk assessment programmes. These studies indicate that malaria is extremely unlikely to ever return to the United Kingdom. 2 Acknowledgements Working in the field is hard but enjoyable. Importantly it gets you to where mosquitoes actually live. Days spent romping around in the field, even in the freezing ice and snow are still inordinately superior to those sitting staring at a computer screen. For this reason alone I wish to thank the following people. Firstly, Professor Steve Lindsay, who has been an inspiration and a constant optimist over the last four years. I thank him for his time, my freedom and his friendship. When conducting any prolonged field work you will meet and greet all manner of people willing to help you. The following people are those I can remember and made life just that bit simpler in the field. Bob Gomes, Alan Johnston, Todd Read, Ken Elms and Barry on the RSPB reserve Isle of Sheppey were all instrumental in enabling me to study mosquitoes in the field. At Durham I would like to thank Professor Brian Whitton, Dr Nabie Bayoh, Michael Bone and Matt Kirby for their input into my research. A large part of my research was carried out in libraries and archives and I wish to thank the staff at Sheerness, University of Durham, The Wellcome Trust, The London School of Hygiene and Tropical Medicine and the British Library. Particular thanks go to the staff at the Centre for Kentish Studies, Maidstone for their help with the parish records data. I wish to thank Professor Chris Curtis, Shah ida Begum and Yomi Akinpelu at The London School of Hygiene and Tropical Medicine for helping with PCR and blood meal analysis work. During the course of this research I have pulled heavily on the resources of my family and friends. I would like to heartily thank Mr William Clark for all his help both in the field and with the microscopy work. My mother helped over a period of many weeks with collecting parish data from microfilms, I thank her for this and all the lunches she bought me. Lastly I thank my wife Jackie and two children, Sam and Megan for their patience and tolerance over the last four years. This work was funded by the Natural Environment Research Council grant NER/S/A/2000/03292. 3 Table Of contents Title page 1 Abstract 2 Acknowledgements 3 Table of contents 4 List of table/figure legends 5-9 Declarations 10 Forward 11-15 Chapter 1: History of malaria in the English marshes 16-37 Chapter 2: Present and future risk of malaria in the UK 38-49 Chapter 3: Causes of excessive mortality in coastal marshland communities in early modem southern England 50-79 Chapter 4: Resting behaviour of adult Anopheles atroparvus on the Isle ofSheppey, Kent 80-100 Chapter 5: Identifying the aquatic habitats of Anopheles atroparvus on the Isle of Sheppey 101-125 Chapter 6: The risk of African malaria vectors arriving in the UK by aircraft 126-136 Chapter 7: Perceived nuisance of mosquitoes on the Isle of Sheppey, Kent, UK 137-149 Chapter 8: Mosquito surveillance for vector-borne diseases in southern and central England 150-174 Chapter 9: Conclusions 175-181 4 Table and Figure Legends Foreword Figure 1 Top right outline ofthe UK with area in green showing Page 15 location oflsle of Sheppey. Areas in pink on large map show fields sites used on the Isle of Sheppey. Chapter 1 Table 1.1 Clinical Symptoms of malaria Page 18 Figure 1.1 Proportion of ague deaths compared to all cause mortality Page 21 taken from the bills of health London. Table 1.2 Human Blood Index (HBI) of Anopheles atroparvus. Page 24 Table 1.3 Minimum temperature for parasite development. Page 26 Chapter 2 Figure 2.1 Annual cases of malaria reported to the PHLS Malaria Page 43 Reference Laboratory, UK. Where open circle represent all cases of malaria and closed circles are those due to P. falciparum. Chapter3 Figure 3.1 Father Thames introducing his offspring to the fair city of Page 51 London (1858). Figure 3.2 Map of North Kent showing parish boundaries and three Page 55 regions used for baptism burial data. Table 3.1 Comparisons ofwealth between different geographical Page 58 locations by monies and properties left in wills in Lincolnshire. Table 3.2 Decadal census data for all parishes in the three regions used Page 59 in this analysis showing population figures. Figure 3.3 Regression analysis for the parish of Eastwell, Kent 1801 - Page 60 1921 comparing two methods of indices of mortality. Error bars show 95% C.l. Figure 3.4 Comparison of Baptism Burial ratios for 2 marsh Page 61 communities parishes (Sheppey & Thanet) and I inland community (North Downs) using a 7 year moving average 1680-1925. Figure 3.5 Monthly mean crude death rates for children aged 0-9yrs in Page 61 two marsh regions (Sheppey & Thanet) and one inland region (North Downs) 1813-1925. 5 Table 3.3 Results ofTukey's Test showing differences between mean Page 62 baptism/burial ratios for 3 regions over 5 time periods. Regions in columns compared to regions in rows. Figure 3.6 Mean number of deaths for four regions. Graph A shows Page 63 absence of peak in August-September whilst B & C show peaks during this period. Graph D shows Durham parishes an area in which vivax was never considered a problem but still showing a September peak. Figure 3.7 Seasonality of cases of respiratory and gastro-intestinal Page 64 diseases in children under 9 years old at Kent General Hospital for a period when malaria was extremely uncommon. 1881-1924. Table 3.4 Results of paired t-tests for the mean number of deaths in Page 65 June- July compared with August- September over a 225 year period for three regions in Kent. Table 3.5 Results of paired t-tests for mean number of deaths in March Page 65 compared with April for three regions in Kent. Figure 3.8 Seasonality of all salmonella infections in the UK 1997- Page 66 2000. Table 3.6 Main cause of death for different age groups recorded at Page 67 Kent General Hospital 1881 - 1924.
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