Abstract
Toscana virus (TOSV), transmitted by phlebotomine sandflies, is recognised as one of the most important causes of viral meningitis in summer in Mediterranean countries. A surveillance plan based on both human and entomological surveys was started in 2010 in the Emilia-Romagna region, Italy. Clinical samples from patients with neurological manifestations were collected during 2010 to 2012. The surveillance protocol was improved during these years, allowing the detection of 65 human infections. Most of these infections were recorded in hilly areas, where sandflies reach the highest density. Entomological sampling around the homes of the patients resulted in a low number of captured sandflies, while later sampling in a hilly area with high number of human cases (n=21) resulted in a larger number of captured sandflies. Using this approach, 25,653 sandflies were sampled, of which there were 21,157 females, which were sorted into 287 pools. TOSV RNA was detected by real-time PCR in 33 of the pools. The results highlighted the role of Phlebotomus perfiliewi as the main vector of TOSV and a potential link between vector density and virus circulation. This integrated system shows that an interdisciplinary approach improves the sensitiveness and effectiveness of health surveillance.
Highlights
Toscana virus (TOSV), first isolated from phlebotomine sandflies sampled in the eponymous Italian region in 1971 [1,2], was associated with human disease more than 15 years later [3,4]
Human cases of TOSV infection were identified through the regional West Nile virus (WNV) surveillance system that collects samples from suspected cases, i.e. hospitalised patients who presented with high fever (>38.5 °C) and neuroinvasive manifestations or polyradiculoneuritis [19,20]; patients with febrile illness only were not included in this analysis
TOSV infection was confirmed in 65 patients; of these, 61 (17 in 2010, 15 in 2011, and 29 in 2012) probably were infected inside the Emilia-Romagna region; the additional four laboratory-confirmed cases were excluded from our analysis because the patients were not resident in the Emilia-Romagna region and were probably exposed to the infection elsewhere
Summary
Toscana virus (TOSV) (family Bunyaviridae, genus Phlebovirus), first isolated from phlebotomine sandflies sampled in the eponymous Italian region in 1971 [1,2], was associated with human disease more than 15 years later [3,4]. TOSV circulates during the summer in several Mediterranean countries and was reported as one of the most important causative agents of viral meningitis since the 90s in central Italy [11,12] and since 2000 in France and Spain [9]. TOSV ecology is still largely unknown: affected sandfly species are not defined and it is unclear whether a vertebrate reservoir exists [2,6,9]
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