Mosquito-borne Infections

Henroy P. Scarlett, Dr.PH, MPH, BHSc. (Hons.), REHS/RS

Lecturer
Department of Community Health & Psychiatry
UWI, Mona
henroy.scarlett@uwimona.edu.jm

February 5, 2019
 Overview
• Worldwide, there are over 3,000 species of mosquitoes
• 66 species exist in Jamaica, belonging to 13 genera, which are
distributed among 3 sub-families.
• Important species are:
- Anopheles albimanus – vector of malaria
- Aedes aegypti – vector of yellow fever, dengue, Zika virus and
chikungunya
- Aedes taeniorhynchus – serious biting pest
- Culex quinquefasciatus – an aggressive evening/night biting pest
- Culex negripalpus – vector of St. Louis encephalitis
 Overview
• Mosquito is the most dangerous animal on earth
• Adult female mosquitoes require a blood meal in order to produce
viable eggs.
• While feeding, the females inject saliva-containing anticoagulants that
prevent the blood from clotting (Flying syringe)
• Because mosquitoes take numerous blood meals, they can acquire
disease organisms from an infected host and later transmit those
organisms to previously uninfected hosts.
 Mosquito-borne Diseases
• Up to 500 million cases occur every year, 90% of them in Africa
• There are up to 2.7 million deaths annually
• In 2015 malaria alone caused 438 000 deaths
• Dengue is the world's most important mosquito-borne virus disease,
with 2.500 billion people worldwide at risk of infection and 20 million
cases a year in more than 100 countries.
http://blog.healthgenie.in/mosquito-borne-diseases-symptoms-prevention-and-treatment/
 Mosquito-borne diseases
• Aedes
• Chikungunya
• Dengue fever
• Lymphatic filariasis
• Rift Valley fever
• Yellow fever
• Zika
• Anopheles
• Malaria
• Lymphatic filariasis
• Culex
• Japanese encephalitis Female Aedes aegypti feeding
• Lymphatic filariasis
• West Nile fever
 Egg Stage
.

Anopheles Aedes Culex

http://entomology.unl.edu/urbanent/mosquito.htm
 Larval Stage
.

Anopheles Aedes Culex

http://entomology.unl.edu/urbanent/mosquito.htm
 Key facts on Malaria
• Malaria is a life-threatening disease caused by parasites that are
transmitted to people through the bites of infected female Anopheles
mosquitoes.
• It is preventable and curable.
• In 2017, there were an estimated 219 million cases of malaria in 90
countries.
• Malaria deaths reached 435 000 in 2017.
• The WHO African Region carries a disproportionately high share of the
global malaria burden.
• In 2017, the region was home to 92% of malaria cases and 93% of malaria
deaths.
Female Anopheles albimanus mosquito feeding on human host
 Key facts on Malaria
• Malaria is caused by Plasmodium parasites
• There are 5 parasite species that cause malaria in humans, and 2 of
these species – P. falciparum and P. vivax – pose the greatest threat
• All of the important vector species bite between dusk and dawn
• Symptoms usually appear 10–15 days after the infective mosquito
bite. The first symptoms include: fever, headache, and chills
• In malaria endemic areas, people may develop partial immunity,
allowing asymptomatic infections to occur
• Vector control is the main way to prevent and reduce malaria
transmission.
 Infectious agents
• Protozoan parasites with sexual and asexual phases:
- Plasmodium falciparum (most deadly)
- Plasmodium vivax
- Plasmodium ovale
- Plasmodium malariae
- Plasmodium knowlesi
 Key facts on Yellow Fever
• Yellow fever is an acute viral haemorrhagic disease transmitted by infected
mosquitoes. The "yellow" in the name refers to the jaundice that affects
some patients.
• Incubation period of 3-6 days
• Transmitted by mosquitoes, belonging to the Aedes
and Haemogogus species
• Symptoms of yellow fever include fever, headache, jaundice, muscle pain,
nausea, vomiting and fatigue.
• A small proportion of patients who contract the virus develop severe
symptoms and approximately half of those die within 7 to 10 days.
• The virus is endemic in tropical areas of Africa and Central and South
America.
 Key facts on Yellow Fever
• There are 3 types of transmission cycles:
Sylvatic or Jungle yellow fever
Intermediate yellow fever
Urban yellow fever
• Large epidemics of yellow fever occur when infected people introduce the
virus into heavily populated areas with high mosquito density and where
most people have little or no immunity, due to lack of vaccination
• Yellow fever is prevented by an extremely effective vaccine, which is safe
and affordable. A single dose of yellow fever vaccine is sufficient to confer
sustained immunity and life-long protection against yellow fever disease
• Vaccination is the most important means of preventing yellow fever.
• Certificate of vaccination is required from visitors to Jamaica from endemic
countries
 Yellow fever in Latin America (PAHO, 2019)
• Between January 2017 and December 2018, six countries and
territories in the Region of the Americas reported confirmed cases of
yellow fever:
Bolivia
Brazil (2016-2019; 2,166 cases with 751 deaths)
Colombia
Ecuador
French Guiana
Peru.
 Key Facts on Chikungunya
• Chikungunya is a viral disease that is spread by mosquitoes. It causes fever
and severe joint pain. Other symptoms include muscle pain, headache,
nausea, fatigue and rash.
• The disease is transmitted by the same mosquitoes involved in the dengue
transmission (Aedes aegypti and Aedes albopictus).
• There is no cure for the disease. Treatment is focused on relieving the
symptoms.
• The proximity of mosquito breeding sites to human habitation is a
significant risk factor for chikungunya.
• On December 2013, PAHO/WHO received confirmation of the first cases of
autochthonous transmission of chikungunya in the Americas (Caribbean).
 Number of Reported Cases of Chikungunya Fever in the
Americas, by Country or Territory 2013-2014 (Updated 23 Oct
2015)
Region Suspected Confirmed No. of Deaths
Cases Cases
The Americas 1, 118,578 25,627 194
(Total)
Caribbean 17, 899 4, 454 5
Jamaica 1,420 89 0
 Key facts on Zika Virus
• Zika virus disease is caused by a virus transmitted primarily by Aedes
mosquitoes, which bite during the day.
• Symptoms are generally mild and include fever, rash, conjunctivitis,
muscle and joint pain, malaise or headache.
• Symptoms typically last for 2–7 days.
• Most people with Zika virus infection do not develop symptoms.
Countries and territories in the Americas with confirmed autochthonous (vector-borne) Zika virus
cases, 2015-2017. (PAHO, 2019)
Distribution of suspected and confirmed Zika cases by EW and sub-region. Region of
the Americas, 2015 – 2017 (PAHO, 2019)
 Complications
• Zika virus infection during pregnancy can cause infants to be born
with microcephaly and other congenital malformations, known as
congenital Zika syndrome.
• Infection with Zika virus is also associated with other complications of
pregnancy including preterm birth and miscarriage.
• An increased risk of neurologic complications is associated with Zika
virus infection in adults and children, including Guillain-Barré
syndrome, neuropathy and myelitis.
https://www.paho.org/hq/index.php?option=com_content&view=article&id=11599:regional-zika-
epidemiological-update-americas&Itemid=41691&lang=en
 Key Facts - Dengue
• Dengue is a mosquito-borne viral infection.
• The infection causes flu-like illness, and occasionally develops into a potentially
lethal complication called severe dengue.
• The global incidence of dengue has grown dramatically in recent decades. About
half of the world's population is now at risk.
• Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban
and semi-urban areas.
• Severe dengue is a leading cause of serious illness and death among children in
some Asian and Latin American countries.
• There is no specific treatment for dengue/ severe dengue, but early detection
and access to proper medical care lowers fatality rates below 1%.
• Dengue prevention and control depends on effective vector control measures.
 Global burden of dengue

• One recent estimate indicates 390 million dengue infections per year
• One study estimates that 3.9 billion people, in 128 countries, are at risk of
infection with dengue viruses
• Before 1970, only 9 countries had experienced severe dengue epidemics.
• The disease is now endemic in more than 100 countries
• The America, South-East Asia and Western Pacific regions are the most
seriously affected.
• In 2015, 2.35 million cases of dengue were reported in the Americas alone,
of which 10 200 cases were diagnosed as severe dengue causing 1181
deaths.
 Transmission

• The Aedes aegypti mosquito is the primary vector of dengue.

• The virus is transmitted to humans through the bites of infected female
mosquitoes.
• After virus incubation for 4–10 days, an infected mosquito is capable of
transmitting the virus for the rest of its life.
• Infected symptomatic or asymptomatic humans are the main carriers and
multipliers of the virus, serving as a source of the virus for uninfected
mosquitoes.
• Patients who are already infected with the dengue virus can transmit the
infection (for 4–5 days; maximum 12) via Aedes mosquitoes after their first
symptoms appear
 Transmission

• The Aedes aegypti mosquito lives in urban habitats and breeds mostly
in man-made containers.
• Unlike other mosquitoes Ae. aegypti is a day-time feeder; its peak
biting periods are early in the morning and in the evening before
dusk.
• Female Ae. aegypti bites multiple people during each feeding period.
• Aedes albopictus, a secondary dengue vector in Asia, has spread to
North America and more than 25 countries in the European Region,
largely due to the international trade in used tyres (a breeding
habitat) and other goods
 Characteristics

• Dengue fever is a severe, flu-like illness that affects infants, young

children and adults, but seldom causes death.
• Dengue should be suspected when a high fever (40°C/104°F) is
accompanied by 2 of the following symptoms: severe headache, pain
behind the eyes, muscle and joint pains, nausea, vomiting, swollen
glands or rash.
• Symptoms usually last for 2–7 days, after an incubation period of 4–
10 days after the bite from an infected mosquito.
 Severe Dengue
• Severe dengue is a potentially deadly complication due to plasma
leaking, fluid accumulation, respiratory distress, severe bleeding, or
organ impairment.
• Warning signs occur 3–7 days after the first symptoms in conjunction
with a decrease in temperature (below 38°C/100°F) and include:
severe abdominal pain, persistent vomiting, rapid breathing, bleeding
gums, fatigue, restlessness and blood in vomit.
• The next 24–48 hours of the critical stage can be lethal; proper
medical care is needed to avoid complications and risk of death.
 Treatment

• There is no specific treatment for dengue fever.

• For severe dengue, medical care by physicians and nurses
experienced with the effects and progression of the disease can save
lives – decreasing mortality rates from more than 20% to less than
1%.
• Maintenance of the patient's body fluid volume is critical to severe
dengue care
 Prevention and control

At present, the main method to control or prevent the transmission of dengue

virus is to combat vector mosquitoes through:
• preventing mosquitoes from accessing egg-laying habitats by environmental management and
modification;
• disposing of solid waste properly and removing artificial man-made habitats;
• covering, emptying and cleaning of domestic water storage containers on a weekly basis;
• applying appropriate insecticides to water storage outdoor containers;
• using of personal household protection such as window screens, long-sleeved clothes, insecticide
treated materials, coils and vaporizers;
• improving community participation and mobilization for sustained vector control;
• applying insecticides as space spraying during outbreaks as one of the emergency vector-control
measures;
• active monitoring and surveillance of vectors should be carried out to determine effectiveness of
control interventions.