Arbovirus Prevention

Alex Stone, PhD

CDC
Division of Vector-Borne Diseases

Figure 1
This is an image of an arbovirus in human blood

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Table of Contents

Abstract …………………………………………………..
……………………………………………………43

Arboviruses
………………………………………………………………………
………………………..43

Mosquito Vectors…..……………………………………..
………………………………………….43

Dengue Fever…………………………………….....
………………………………………..54

West Nile Virus ………………………………….......5

Chikungunya …………………………………….......6

Zika Virus .…………………………………………..76

Vector Control Methods………..………………………….87

Biological …………………………………………...87

Chemical ……………………………………………98

Environmental …………………………………………9

Risk of Arbovirus in Times of COVID …………………...109

References ………………………………………………...110

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Table of Figures
Figure 1 …………………………………………………….1

Figure 2 …………………………………………………….3

Figure 3 …………………………………………………….4

Figure 4 …………………………………………………….5

Figure 5 …………………………………………………….6

Figure 6 …………………………………………………….7

Figure 7 …………………………………………………….7

Figure 8 …………………………………………………….8

Figure 9 ……………………………………………………10

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 Figure 2
This is an image of an arbovirus

Abstract
The purpose of this document is to remind states of mosquito prevention and
arboviruses. Currently, the focus of most state Health Departments is on combatting the
COVID-19 pandemic. However, summer is fast approaching, which is when arboviruses
pose their greatest threat to communities. Each state should be developing a mosquito
control strategy. These strategies can be divided Mosquito control strategies should be
instituted. into biological, chemical, and environmental control methods. Each of these
vector control methods can be implented state wide to reduce the risk of mosquito borne
disease transmission. This document will provide helpful information about mosquitoes,
mosquito borne arboviruses, and vector control strategies that are available to each
statecommunities.

Arboviruses

AArbovirus is the name used to refer to viruses that are

transmitted by arthropod vectors. Some common arthropod
vectors include mosquitoes, fleas, and ticks. Mosquitoes are
the most common arthropods that spread disease. Symptoms
of arboviruses can range from mild to severe, and tend to
appear 3-14 days after a bite from an infected arthropod
(Arboviral diseases fact sheet). Infections usually occur in

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warm weather, when arthropods are most active. Several examples of arbovirus
infections include Dengue fever, West Nile Virus, Chikungunya, and Zika Virus, all of
which are prevalent in the United States. It is important to take proper precautions to
prevent infections, and potential outbreaks.

Mosquito Vectors
As previously mentioned, mosquito borne diseases are transmitted by the bite of
an infected female mosquito. Female mosquitoes bite humans and other animals because
they require blood to produce eggs. The main goal of female mosquitoes is to take up
blood quickly, and to escape. Mosquitoes are able to find humans or other animals that
may serve as potential meals, by tracking carbon dioxide, which is emitted as we breathe.
A mosquitoe’s bite is specialized to ingest a small amount of blood while causing
minimal pain to the host, allowing for an escape (see figure 3). Typical bites last 2-3
minutes, allowing the mosquito to fill its stomach with blood. As the mosquitoes bite,
they secrete saliva into the host, which contains chemicals that serve as an anticoagulant,
allowing the mosquito to continuously take blood for 2-3 minutes (Jones, pg 36). It is the
saliva that allows for transmission of the virus. Male mosquitoes, however do not feed on
blood, therefore they cannot transmit mosquito-borne diseases.

Figure 3
This image shows a
mosquito biting a
human
LACV
- La
Crosse
encephalitis
DENV- Dengue
VEEV- Venezuelan
Equine Encephalitis
WNV- West Nile
Virus
SLEV- St. Louis
Encephalitis

Dengue Fever

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 Dengue viruses are spread by the bite of an infected female Aedes mosquito
(“About Dengue: what you need to know”). It is common in many parts of the world and
approximately 400 million people are infected, with about 22,000 deaths per year. Figure
4 shows a map of Dengue cases in the United States as of May, 2020. There are four
different types of Dengue viruses, making it very difficult to treat, also allowing . for a
single person to be infected up to four times in their lifetime. Symptoms appear around 4-
6 days after infection and can last up to 10 days. The infection is characterized by flu-like
symptoms including high fever, severe headaches, joint and muscle pain, and fatigue
(Ratini). There is no treatment for this disease, but painkillers and fever reducers can help
manage some of the symptoms. Some vaccines are available for people living in endemic
areas that try to limit the severity of future infections, however they are not always
reliable.

Figure 4
This map shows the number of Dengue cases in each state in 2020.
Source: CDC, 2020

West Nile Virus

The West Nile Virus is spread by the bite of an infected female Culex mosquito.
Interestingly, West Nile Virus is transmitted to humans by mosquitoes that have fed on
an infected bird (Vector Disease Control International). This is different from other
mosquito borne diseases, as birds are required to complete its life cycle. Therefore, there
is no person to mosquito transmission like the other diseases. It is the leading cause of
mosquito borne disease in the United States with about 2,000 people infected per year

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(“Symptoms, diagnosis & treatment”). Figure 5 shows the number of West Nile Virus
cases in the United States in 2018. Most people tend to have little to no symptoms,
however some infections can result in severe illness affecting the central nervous system.
Some symptoms include headache, high fever, and neck stiffness. This can ultimately
lead to encephalitis or meningitis. There are currently no vaccines for West Nile Virus
and there are few treatments for this disease.

Figure 5
This map shows the number of West Nile Virus cases in each state in 2018.
Source: CDC, 2018

Chikungunya

Chikungunya is a virus spread by the bite of an infected female Aedes mosquito.

Mosquitoes become infected when they bite a person that has already been infected by
the virus. It is found in many countries around the world with about 100 cases per year in
the United States (“Chikungunya”). Figure 6 shows a map of reported cases of
Chikungunya in 2020. Most cases in the U.S. are imported cases from Africa and Asia,
where the disease is commonly found. Chikungunya commonly causes fever, severe joint
pain, nausea, and fatigue. There is no cure for the disease, and there are limited
treatments that focus on relieving the joint pain.

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 Figure 6
This map shows a map of states with confirmed cases of Chikungunya in 2020
Source: CDC, 2020

Zika Virus
Zika virus is spread by the bite of an infected female Aedes mosquito. It is
commonly found in Africa, the Americas and some islands in the Pacific. Few cases are
reported each year in the U.S., with most being imported from abroad. Figure 7 shows the
approximate number of Zika Viruses cases in each state in 2019. Symptoms of the Zika
virus are generally mild and include fever, rash, and joint pains, and tend to last about 2-7
days. The most serious consequences of the illness, however, occur if infection occurs
during pregnancy. If a pregnant woman contracts the Zika virus, this can result in
complications for the baby, including microcephaly, and other malformations (“Zika
Virus”). Microcephaly can lead to infant death. There is currently no vaccine or treatment
for this disease.

Figure 7
This map shows the approximate number of cases in each state in 2019
Source: CDC, 2019

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Vector Control Methods
As discussed above, mosquitoes can transmit several diseases, so it is important to
take precautions to prevent any potential outbreaks. Mosquitos are ubiquitous and
plentiful, therefore eradication is not possible, but there are several mechanisms to reduce
the risk they pose to humans. These control methods can be divided into biological,
chemical, and environmental control methods. Each of these methods attempts to reduce
the size of vector populations or more simply put, the number of mosquitos.

Biological Control Methods

In the past, the primary biological control method for mosquitoes was the
introduction of a predator to reduce the population of mosquitoes. The introduction of
predatory species has played an important role in population reduction. These predators
are typically fish or other microorganisms that feed on mosquito larvae, preventing
reproduction. One example is the Gambusia affinis, also called the mosquito fish, which
is a fresh water fish that feeds on mosquito larvae (Huang et al). A picture of a mosquito
fish can be seen in figure 9. This fish is also noted to be tolerant to insecticides, making
them an ideal predator for the control of the mosquito population.

Another rapidly growing biological control method is the use of bacteria to reduce
the transmission of arboviruses and parasites. Several studies have been done using the
gram-negative bacteria Wolbachia, which is naturally found in many insect species. Early
results have shown that, “Infection of Wolbachia in mosquitoes can … reduce or block
the transmission of arboviruses and parasites” (Huang et al). Additionally, introducing
Wolbachia into mosquito populations has shown that it significantly reduces the lifespan
of infected female mosquitoes. By shortening the lifespan of the female mosquito, the
period of transmission is also shortened.

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 Gambusia affinis Wolbachia vector control

Figure 8
This is an image of the mosquito fish, Gambusia affinis
Source: Seriouslyfish.com

Chemical Control Methods

Chemical control methods include the use of insecticides. Insecticides are used to
kill mosquitoes. These consist of larvicides and adulticides designed to kill mosquito
larvae and adults respectively. Larvicides are pesticides that are introduced into the water
to kill mosquito larvae before they become adults. Small amounts of pesticides are put
into the water so that other animals and humans are not affected. One common larvicide
used in the United States is a mixture of clay with the bacteria Bacillus sphaericus. It is
put in the water with the mosquito larvae; larvae then eat the bacteria. The bacteria
ultimately destroys the guts of the larvae resulting in its death (“What You Should Know
About Mosquito Control Pesticides”). Adulticides are pesticides that are used to kill adult
mosquitoes. These pesticides usually work by inhibiting the mosquito’s brain from
functioning properly. A common adulticide that is used in the United States are
Pyrethoids. These are man made chemicals that block the movement of information from
the mosquito’s brain to its heart so that its heart cannot beat, resulting in death.

The effects of insecticides usually last a few days. Insecticides are not recommended for
constant or repeated use. This is due to the potential increase in insecticide resistance in
mosquitoes. Over time, mosquitoes can develop resistance to pesticides, increasing the
threat of arboviruses and other mosquito borne disease transmission in humans.
Therefore, it is important to monitor the use of insecticides, as you could be putting
yourself at an even greater risk of disease.

The use of mosquito or

insect repellant can
be used to protect the
individual from getting
bit by a mosquito.
These repellants
work by blocking a
mosquito’s sense of

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smell, thereby preventing it from finding a target. This is among one of the best methods
to protect individuals from mosquito borne illness. Therefore, when going outdoors in
warm, tropical weather it is a good idea to use mosquito repellant to lower the chances of
being bit.

Mosquito repellant

Environmental Control Methods

Several environmental methods can be used to reduce risk of infection and

transmission as well. The first method involves mosquito proofing your home. This can
range from setting up mosquito netting to using a mosquito trap to kill mosquitoes.
Mosquito netting is a type of curtain that be draped over beds to provide protection from
mosquitoes. This is particularly useful when camping or if there is open-air exposure in
the home. Homes should have screens installed in all windows, and air conditioning
should be used when available. Mosquito traps are another good method to prevent bites.
These traps mimic people by emitting small amounts of carbon dioxide. This attracts
mosquitoes to the area, trapping them in a container, where they ultimately die of
dehydration (“How do Mosquito Traps Work?”). Another way to prevent infection is to
get rid of any standing water around the home and communities.

Risk of Arborvirus in Times of COVID

Currently, countries such as Brazil,Brazil are experiencing a medical crisis with an
outbreak of both Dengue and COVID 19. This is taxing the medical system and

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confusing physicians since there can be overlap of symptoms. Currently, the U.S. is still
trying to manage the COVID pandemic. At the same time, summer is approaching when
the incidence of arbovirus-related infections naturally increase. Because of the COVID
pandemic, more individuals are spending time outdoors. If states and communities are not
proactive in practicing mosquito control, we could become the next Brazil.

It is important that states and communities start practicing practice vector control
immediately. The safest long-term strategies are the biologic. It is important that
communities start immediately introducing mosquito fish into some of the fresh water
canals and lakes. The introduction of Wolbachia into the mosquito population is more
complicated and should be done as a pilot program, in smaller cities and expanded upon
more gradually. Chemical control strategies with adulticides and larvacides, because of
their toxic effect on the environment, should be used sparingly only in situations where
the mosquito population has grown exponentially and immediate action is required. using
the strategies mentioned above. Public service campaigns should be encouraged
reminding individuals of the risk of mosquito born illnesses and the personal steps they
can take to reduce vector population, as well as personal protective strategies.

Figure 9
This is an image of the coronavirus
Coronavirus Source: CNN

References

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“About Dengue: What You Need to Know.” Centers for Disease Control and Prevention,
Centers for Disease Control and Prevention, 3 May 2019,
www.cdc.gov/dengue/about/index.html.

“Chikungunya.” World Health Organization, World Health Organization,

www.who.int/news-room/fact-sheets/detail/chikungunya.

“Department of Health.” Arboviral (Arthropod-Borne Viral) Diseases Fact Sheet,

www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm.

“How Do Mosquito Traps Work?: Types, Brands & Products Reviews.”

MosquitoReviews, 18 Dec. 2019, mosquitoreviews.com/mosquito-traps.

Huang, Yan-Jang, et al. “Biological Control Strategies for Mosquito Vectors of

Arboviruses.” Insects, vol. 8, no. 1, 2017, p. 21., doi:10.3390/insects8010021.

Jones, Richard. Mosquito. Reaktion Books, 2012.

Ratini, Melinda. “Dengue Fever: Symptoms, Causes, and Treatments.” WebMD,

WebMD, 28 June 2019, www.webmd.com/a-to-z-guides/dengue-fever-reference#1.

“Symptoms, Diagnosis, & Treatment.” Centers for Disease Control and Prevention,
Centers for Disease Control and Prevention, 10 Dec. 2018,
www.cdc.gov/westnile/symptoms/index.html.

Vector Disease Control International. “West Nile Virus: Education, Public Health,
Mosquito Management.” West Nile Virus: Education, Public Health, Mosquito
Management, www.vdci.net/vector-borne-diseases/west-nile-virus-education-and-
mosquito-management-to-protect-public-health.

What You Should Know About Mosquito Control Pesticides. California Department of
Health Services,
westnile.ca.gov/website/mosq_control/Mosquito_Control_Pesticides.pdf.

“Zika Virus.” World Health Organization, World Health Organization,

www.who.int/news-room/fact-sheets/detail/zika-virus.

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