Emergent Sand Fly–Borne Phleboviruses in the Balkan Region

Nazli Ayhan,Remi N Charrel

doi:10.3201/eid2412.171626

Abstract

Sand fly–borne phleboviruses are associated with febrile diseases and nervous system infections in the Mediterranean basin. Sandfly fever was first reported in the Balkan Peninsula at the end of the 19th century. Since then, accumulating data show that the Balkan Peninsula, as a transboundary region between Asia and Europe, plays a major role in the emergence of vectorborne diseases in Europe. To provide an inclusive approach, we collected published data on phleboviruses in the Balkan countries and used them to evaluate the impact of these pathogens from virologic, epidemiologic, and public health perspectives. Recent findings show a high diversity of phleboviruses belonging to 3 species or serocomplexes circulating heavily in the Balkans. Focusing on undisputable human pathogens, we found direct and indirect laboratory documentation for Toscana virus, Sandfly fever Sicilian virus, and Adria virus. These data demonstrate that the Balkans are a hotspot for phleboviruses transmitted by sand flies.

Highlights

Sand fly–borne phleboviruses are associated with febrile diseases and nervous system infections in the Mediterranean basin
We reviewed all the published data for sand fly–borne phleboviruses in the Balkan Peninsula to provide a comprehensive view of the current situation and of the public health effect on humans and vertebrate animals in the region
Historical Data on Phleboviruses in the Balkans Alois Pick made a clinical description of sandfly fever in Bosnia-Herzegovina military barracks from foreign soldiers at the end of the 19th century (Online Technical Appendix Table )

Summary

Introduction

Sand fly–borne phleboviruses are associated with febrile diseases and nervous system infections in the Mediterranean basin. Focusing on undisputable human pathogens, we found direct and indirect laboratory documentation for Toscana virus, Sandfly fever Sicilian virus, and Adria virus. These data demonstrate that the Balkans are a hotspot for phleboviruses transmitted by sand flies. Phleboviruses (genus Phlebovirus, family Phenuiviridae, order Bunyavirales) are 80–120 nm in length and display helical symmetry Their genome consists of 3 segmented negative-sense single-stranded RNA: the large segment encodes the viral RNA polymerase (RdRp), the medium segment encodes envelope glycoproteins (Gn and Gc), and the small segment encodes nucleocapsid protein (N) and nonstructural protein (NS) [1,2]. We reviewed all the published data for sand fly–borne phleboviruses in the Balkan Peninsula to provide a comprehensive view of the current situation and of the public health effect on humans and vertebrate animals in the region

Methods

Results

Conclusion