Mosquitoes As Vectors of Human Disease in South Africa

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Mosquitoes As Vectors of Human Disease in South Africa Review Mosquitoes as vectors of human disease in South Africa Jupp PG, MSc, PhD, DSc (Med) Medical Entomologist, formerly of the National Institute for Virology and National Institute for Communicable Diseases, Sandringham, Johannesburg. Correspondence: 31 Ravenswood, George Street, Port Alfred, 6170. E mail: [email protected] Keywords: mosquitoes, malaria, arboviruses, chikungunya, Sindbis, West Nile, Rift Valley fever, dengue. Abstract While malaria is the most important mosquito-borne disease in South Africa, there are also several mosquito-borne viruses that also cause human disease. The most significant are chikungunya, West Nile, Sindbis and Rift Valley fever viruses. In this review these are compared with malaria, mainly in regard to their ecology and epidemiology. (SA Fam Pract 2005;47(9): 68-72) Introduction Africa, the so-called arboviruses, have (family Flaviviridae) and Rift Valley Only the female mosquito sucks blood been reviewed in some detail by fever virus to the genus Phlebovirus to obtain protein to develop her eggs. McIntosh.2 The aim of the present (family Bunyaviridae). Additionally, Spielman and D’Antonio have paper is to give an updated brief imported dengue, another Flavivirus, described the detection of the human review which includes comparison of has infected man in KwaZulu Natal. A host and subsequent blood feeding the mosquito-borne viruses with human being is always regarded as in detail.1 Briefly, this is as follows. mosquito-borne malaria. Only one an incidental host as humans are not Consider a human “victim” sitting vertebrate host-humans- are needed usually involved in the maintenance outside- a mosquito will respond to in the transmission cycle of human of the viruses in nature. Nevertheless, his scent plume, a mixture of exhaled malaria, and certain species of in certain cases humans become carbon dioxide and lactic acid, Anopheles mosquito, whereas highly viraemic and readily infect because sensors on her antennae are mosquito-borne arboviruses are true mosquitoes. tuned to these chemicals and other zoonoses. chemicals in the person’s body odour. Zoonoses are infections that are Malaria The scent plume, heavier than air, intertransmissable between animals The high risk area for malaria in South sinks to the ground and the mosquito and human beings. Hence there is Africa is a narrow strip on our eastern flies in low to intersect the plume at its mosquito transmission between wild border stretching from Musina widest part. As the mosquito gets vertebrates or domestic livestock as (previously Messina) in the north to close, the host’s movement and body well as mosquito transmission to Swaziland in the south, where it heat will guide her to any uncovered humans, sometimes including human consists mainly of the Kruger National flesh. She probes with her proboscis to human transmission. The viruses Park and adjacent private game until her fasicle nicks a venule or multiply in both vertebrates and reserves. It also includes eastern arteriole. With each insertion, a fine vectors. The viruses produce a viraemia Swaziland and northern KwaZulu salivary tube in her fasicle will deliver in vertebrates to infect the vector Natal. Rarely, limited focal transmission an anticoagulant to inhibit any mosquitoes and must infect the may occur in the North-West and bleeding. What is left behind in the salivary gland of these vectors so that Northern Cape provinces along the saliva that was pumped into the host’s vectors can secrete virus in their saliva Molopo and Orange rivers.3 skin often irritates the host and to infect further vertebrates. Twenty- The 2 vectors in South Africa are sometimes may lead to illness or even two mosquito-borne viruses have been Anopheles arabiensis and Anopheles death. isolated in southern Africa of which 10 funestus, belonging to 2 different It is well known that malaria is the are known to cause human illness. complexes of mosquito species. most important mosquito-borne Out of the 10 viruses, 4 are of signi- Within each complex, final identi- disease in South Africa. However, what ficant medical importance. Chikun- fication can only be achieved by is less well known is that there are also gunya and Sindbis viruses are both examining their chromosomes several mosquito-borne viruses that classified in the genus Alphavirus (karyotyping) or portions of their DNA also cause human disease. The (family Togaviridae) while West Nile (sequence analysis). Both species arthropod-borne viruses in South virus belongs to the genus Flavivirus lay separate floating eggs in ground 68 SA Fam Pract 2005;47(9) Review Figure 1: Anopheles arabiensis Health Departments have had to deal There is a feral transmission cycle with an increase in vector populations between these 2 mosquito species (especially after good rains), vector and both baboons and vervet resistance to insecticides and our monkeys. Viral transmission occurs whole malaria area becoming at night while the wild primates are chloroquine resistant. sleeping in the canopies of trees or in Studies on the biting behaviour of high rocky outcrops or cliffs. The An. arabiensis in the Limpopo province vectors show a higher feeding rate in have shown that the great majority of the canopy of trees than on the ground bites occur during the night time at but nevertheless will bite humans on ground level, decreasing markedly the ground in the vicinity of the wild 72cm or higher above the ground.6 primate sleeping places. Thus human Furthermore, in another study in the infection has been entirely rural.9 Both same area, 81% of mosquitoes of this Ae. furcifer and Ae. cordellieri are tree water. An. arabiensis prefers species were shown to bite the ankles hole breeding mosquitoes. Their eggs temporary to semi-permanent ground and feet rather than other parts of the are deposited on the moist wood within pools with a moderate amount of body and the application of DEET such holes, sometimes deep within vegetation that develop after rain so (diethyltoluamide) repellent to ankles the tree. Some of the eggs hatch each that they become widespread during and feet provided 69.2% protection time rain fills or partially fills the tree the rainy season. An .funestus larvae against An .arabiensis bites.7 These hole and when the hole dries out again are found mainly in the shady margins results indicate therefore that wearing any unhatched eggs remaining can of warm perennial streams where the socks and closed shoes, emphasizing survive provided a high relative vegetation is rank and the current slow. the lower legs when applying humidity persists deep within the hole. As they are confined to perennial repellents and raising feet above In this way the vectors can survive streams, heavy rains do not favour this ground level at night could consi- several years without rain. mosquito because they flush the eggs derably reduce the risk of contracting 3 Figure 2: Aedes furcifer – vector of and larvae down stream. Up until malaria. These studies need to be chikungunya 1996 houses, particularly traditional repeated with An. funestus, although huts, were sprayed annually with it is well known that Anopheles species residual DDT when the treatment in general are most active at ground changed to the pyrethroid delta- level. methrin. This resulted in an upsurge in malaria between 1995 and 1999, Chikungunya for example a 6- fold increase in Outbreaks of this virus have occurred incidence at Ndumu in northern infrequently in the rural tropical KwaZulu Natal.4 During the DDT wooded savannah of the eastern period the only significant vector was Limpopo Province, northern KwaZulu An. arabiensis as the more endophilic Natal and the Zimbabwe lowlands. An. funestus had been well controlled. Hence its distribution is similar to that However, in 1999 An. funestus had of malaria. Human outbreaks of chikungunya reappeared in northern KwaZulu Natal The primary vectors are Aedes occurred in the eastern Northern showing resistance to pyrethroid furcifer and possibly also Aedes Province in 1956,11 1975/769 and 1977 insecticides.4 In 2003, resistance tests cordellieri. Because females of these 12,13 and in southern Zimbabwe in on An. arabiensis from northern 2 species are indistinguishable it has 1961/62 14 and 1971.15 More recently KwaZulu Natal also showed that a not always been possible to know in 2001 one case of chikungunya was degree of resistance to DDT had whether one or both have acted as diagnosed in a person who had stayed developed which has serious vectors.8 However, Ae. furcifer s. s. in the eastern Northern Province.16 implications for vector control accounted for most mosquitoes in this An epizootic in monkeys without operations in South Africa.5 Since the group during the chikungunya human cases is known to have new political dispensation in South outbreak at Mica in 1975/76 when 16 occurred in northern KwaZulu Natal Africa in April ,1994, human traffic from isolations of the virus were made from in 1964. As has been discussed neighbouring African states has greatly the Ae. furcifer group and in vector previously, in the absence of extensive increased. This has probably been competence experiments it was shown evergreen rain forest in southern Africa the cause of chloroquine resistant to be a moderately efficient vector of with an enzootic vector like Aedes strains of the parasite entering the the virus.9,10 How Ae. cordellieri , africanus, it is unlikely that a mosquito- country while concurrently mosquito which is more prevalent at some monkey forest cycle occurs for viral control and malaria prophylaxis have localities than A.e. furcifer s.s., would maintenance. Vertical transmission deteriorated in both Mozambique and compare with Ae. furcifer in such by the Ae. furcifer group, following Zimbabwe. Hence our South African experiments remains to be evaluated. virus survival in the egg stage, does SA Fam Pract 2005;47(9) 69 Review not appear to occur and this is the are poorly viraemic after infection with Ochlerotatus and the Aedes subgenus only other mechanism that would either virus, they cannot significantly Neomelaniconion are vectors.
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