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West Nile Fever, Rift Valley Fever, Japanese Encephalitis and Crimean-Congo Haemorrhagic Fever

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West Nile Fever, Rift Valley Fever, Japanese Encephalitis and Crimean-Congo Haemorrhagic Fever Rev. sci. tech. Off. int. Epiz., 2004, 23 (2), 535-555 Epidemiological processes involved in the emergence of vector-borne diseases: West Nile fever, Rift Valley fever, Japanese encephalitis and Crimean-Congo haemorrhagic fever V. Chevalier, S. de la Rocque, T. Baldet, L. Vial & F. Roger Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), Campus International de Baillarguet, 34398 Montpellier Cedex 5, France Summary Over the past few decades, the geographical distribution of arthropod-borne zoonoses has dramatically expanded. The influence of human-induced or ecological changes on the risk of disease outbreaks is undeniable. However, few hypotheses have been proposed which address the re-emergence of these diseases, the spread of these viruses to previously uninfected areas and their establishment therein. Host and vector movements play an important role in the dissemination of pathogens, and the ability of these diseases to colonise previously uninfected areas may be explained by the diversity of hosts and vectors, the presence of favourable ecological conditions, and the successful adaptations of vectors or pathogens to new ecosystems. The objective of this paper is to describe the epidemiological processes of the vector-borne diseases Rift Valley fever, West Nile fever, Japanese encephalitis and Crimean-Congo haemorrhagic fever. Keywords Crimean-Congo haemorrhagic fever – Dissemination – Diversity – Emerging disease – Epidemiological process – Japanese encephalitis – Rift Valley fever – Vector – West Nile fever. Introduction Over the past few decades, significant changes in the distribution and vector-host contact, long distance distribution and intensity of major vector-borne zoonotic transportation of arboviruses has also been described. It diseases have been recorded. While some of these diseases has recently been observed that once arboviruses reach have been described in endemic areas, little is known previously uninfected areas they may have the capacity to about the epidemiological processes involved in the settle and spread. In light of these observations, re-emergence of zoonotic arboviruses or the spread of epidemiologists have undertaken investigations to these viruses to previously uninfected areas. This lack of determine why these recent changes in distribution are knowledge combined with an absence of specific taking place now, what the influencing factors are, and for treatments and, in some cases, the lack of a vaccine (there how long such changes will continue to occur. is no vaccine for West Nile fever or Crimean-Congo haemorrhagic fever, and vaccines against Rift Valley fever The aim of this paper is to present a study of the may cause females to abort) may explain the difficulties epidemiological processes involved in the transmission of affected countries have in forecasting outbreaks and vector-borne zoonotic diseases using, as models, four controlling the diseases. current emerging arboviruses: Rift Valley fever (RVF), West Nile fever (WNF), Japanese encephalitis (JE) and Crimean- Many vector-borne zoonotic diseases have a complex Congo haemorrhagic fever (CCHF). The first part of the epidemiology. Although transmission is strongly linked to study will describe the influence of ecological and human- local ecological parameters, i.e. vector dynamics, host induced changes on the occurrence of outbreaks in 536 Rev. sci. tech. Off. int. Epiz., 23 (2) endemic areas. Mechanisms involved in long distance virus – WNV has recently reached North America and is rapidly dissemination and factors influencing the ability of a spreading across the continent. disease to survive and colonize previously uninfected areas will then be examined. The final section will review the factors and processes that determine the evolution of Japanese encephalitis arthropod-borne diseases in areas where the virus was not Japanese encephalitis virus, belonging to the genus previously present. As stated above, four current emerging Flavivirus (family Flaviviridae), is considered to be the most arboviruses will be used as examples throughout this common cause of encephalitis worldwide. The first severe paper; these diseases are briefly described below. outbreak of disease was reported in Japan in 1924, followed by a series of outbreaks occurring between 1931 and 1948 (128, 149) (Fig. 1). The virus is now endemic Rift Valley fever throughout much of Southeast Asia (93) and is responsible Rift Valley fever virus, belonging to the genus Phlebovirus for over 50,000 clinical cases annually. Symptoms range (family Bunyaviridae), can be transmitted to humans and from a mild fever to acute meningomyeloencephalitis, with other ruminants by several arthropods, although permanent neurological damage reported in 50% of mosquitoes of the genera Aedes and Culex are considered to recovered cases (137). Fatality rates are high (reaching up be the most common vectors of the disease. Human to 25%) in young children (13). The virus is maintained in infections may also result from contact with the tissues and a zoonotic cycle via the transmission between rice field- body fluids of infected ruminants during slaughter or the breeding mosquitoes (mainly from the genus Culex), abortus of infected animals. The disease, which is often domestic pigs and/or water birds, and humans (as clinically inapparent or mild in adult sheep or cattle, may incidental hosts). Although JE continues to spread in Asia, cause abortion in pregnant adults and death in young vaccination campaigns coupled with an improvement in animals. Infections in humans are characterised by a severe living conditions have significantly reduced the impact of influenza-like syndrome, although some patients can the disease in Japan. develop complications during the later stages of the disease, i.e. encephalitis, retinitis or fatal haemorrhagic fever (161). Restrictions on the trade of domestic animals Crimean-Congo haemorrhagic fever and animal products from infected areas can have severe Crimean-Congo haemorrhagic fever virus, belonging to the economic impacts. Rift Valley fever is endemic in many genus Nairovirus (family Bunyaviridae), is a tick-borne African countries and has recently spread to Saudi Arabia zoonosis that is a public health concern in many regions of and Yemen (3, 132). the world including Africa, the Middle East, southern and eastern Europe, and western Asia. Clinical disease in humans is initially manifested as an acute febrile illness West Nile fever followed by a fatal haemorrhagic syndrome with mortality West Nile fever virus, belonging to the genus Flavivirus rates of up to 50% (141). The virus is transmitted to (family Flaviviridae), is categorized, along with Japanese reservoir mammals and humans through the bite of hard encephalitis virus (JEV), Saint Louis encephalitis virus ticks (mainly of the genus Hyalomma). Humans may also (SLEV), and Murray Valley encephalitis virus, as part of the become infected through direct contact with blood or JEV complex (54, 136). The basic transmission cycle tissues of infected humans or livestock (139). The highly involves wild and domestic birds that act as the main hosts pathogenic nature of the virus occasionally results in and mosquitoes (mainly from the genus Culex) that act as serious nosocomial outbreaks (111). Since the first vectors. In favourable ecological conditions the basic cycle outbreak of CCHF described in Europe in 1945 (56), may be amplified by transmission of the virus to humans several subsequent outbreaks have been reported and horses, both of which act as dead-end hosts (12). Most worldwide in newly discovered foci as well as in foci where infections in humans and horses are asymptomatic or the virus has been previously recognized (165). cause non-specific mild febrile signs; however, potentially fatal cases of meningitis or encephalitis may develop, with mortality rates reported of between 26% to 43% in humans and 9% to 16% in horses. Epidemiological processes in The natural history of WNF varies considerably between endemic areas regions and continents. For example: In endemic areas, the epidemiology of the aforementioned – the virus is widespread and endemic in Africa and Asia diseases is characterised by the immunological background – in Europe, waves of outbreaks have occurred over the and density of vertebrate hosts, vector abundance, and the past two decades local environment. The temporal expression of these Rev. sci. tech. Off. int. Epiz., 23 (2) 537 1924 1994 1954 2003 diseases is based on a natural rhythm balanced by host immunity and vector population dynamics. External events, such as unusual rainfalls or human induced changes, may affect this balance and lead to outbreaks. Impacts of biological factors Rift Valley fever virus has been recorded across the continent of Africa (including Madagascar) with recent spread into Saudi Arabia. The virus is capable of inhabiting a variety of different bioclimatic conditions including wet and tropical areas, e.g. the Gambia (146), hot and arid 1984 areas, e.g. Yemen (3) or Chad (119), and irrigated regions, e.g. the Senegal River valley (66, 67, 77) and the Nile Delta (57, 130). Fig. 1 The spread of Japanese encephalitis in Asia and in Australia The presence of vectors and their population dynamics are (1924-2003) strongly linked to land cover patterns. For example, the Source: WHO website 2003 annual rainfall at Lake Nasser in Egypt is very low, http:// www.who.int/ith/chapter05-m07-japencepha/html (128, 149) resulting in minimal
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