Abstract
The arrival of infected travelers from endemic regions can trigger sustained autochthonous transmission of mosquito-borne pathogens in Europe. In 2007 a Chikungunya outbreak was observed in central Italy, mostly affecting two villages characterised by a high density of Aedes albopictus. The outbreak was mitigated through intervention strategies reducing the mosquito abundance. Ten years later, in 2017, sustained Chikungunya transmission was documented in both central and southern Italy. The proposed analysis identifies suitable reactive measures for the containment and mitigation of future epidemics by combining epidemiological modeling with a health economic approach, considering different arrival times of imported infections and possible delays in the notification of cases. Obtained estimates suggest that, if the first notification will occur in the middle of the mosquito breeding season, the combination of larvicides, adulticides and breeding sites removal represents the optimal strategy. In particular, we found that interventions implemented in 2007 were cost-effective, with about 3200 prevented cases, 1450 DALYs averted and €13.5 M saved. Moreover, larvicides are proven to be more cost beneficial in early summer and warmer seasons, while adulticides should be preferred in autumn and colder seasons. Our results provide useful indications supporting urgent decision-making of public health authorities in response to emerging mosquito-borne epidemics.
Highlights
Globalisation processes and changes in climatic conditions are progressively increasing the suitability of temperate climate regions for the establishment and diffusion of mosquito species that are competent vectors for the transmission of tropical infectious diseases in human populations
Cost associated with preventive measures adopted in Emilia Romagna after the 2007 outbreak were quantified[22] and the impact of Chikungunya virus (CHIKV) either in terms of Disability Adjusted Life Years (DALYs) losses[10,23] or economic costs was evaluated for tropical regions[5,10,24]
The main goal of this work is to evaluate the cost-effectiveness of reactive vector control interventions aimed at reducing the potential burden and costs due to CHIKV disease, and to assess whether time of notification of the first index case has an impact on the identification of the optimal control strategy
Summary
Globalisation processes and changes in climatic conditions are progressively increasing the suitability of temperate climate regions for the establishment and diffusion of mosquito species that are competent vectors for the transmission of tropical infectious diseases in human populations This phenomenon combined with an increase in human mobility is raising major concerns on the potential diffusion in non-tropical countries of vector-borne diseases caused by arboviruses such as Zika, Dengue, West Nile and Chikungunya[1,2]. Only a fraction of infections shows symptoms and is notified, so that unnoticed transmission may occur It is essential, when assessing which are the most suitable containment and mitigation measures, to explicitly account for the risk of observing large outbreaks as a consequence of the importation of new cases and to consider all potential health outcomes and economic costs generated by the different intervention policies. The assessment of integrated and optimal reactive strategies in response to the notification of imported cases of vector-borne infections in temperate climate countries still represents an open key issue
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