Ross River virus in Melbourne, how did that happen?

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Health authorities in Victoria have been warning of mosquito-borne Ross River virus for much of the summer. The state is experiencing one of its worst outbreaks of the disease but cases have mostly been across inland regions. Now it’s hit Melbourne. How has this happened?

Ross River virus is the most commonly reported mosquito-borne disease in Australia. There are usually about 5,000 cases across Australia. However, in 2015 there was a major spike in activity with around 9,000 cases reported. It is a common misconception that the disease is only found in northern regions of Australia. I’m often told “I heard the disease is moving south from QLD?” That’s not the case.

The virus is just as much a natural part of the Australian environment as the mosquitoes and the wildlife that maintain transmission cycles.

While there are generally more cases in northern Australia, nowhere is safe. Some of the largest outbreaks have occurred in southern regions of Western Australia, South Australia, Victoria and even Tasmania.

The virus is widespread but is generally associated with rural regions. A driving factor in determining the activity of Ross River virus is that more than just mosquitoes are involved in outbreaks. The virus is maintained in the environment in native wildlife, especially kangaroos and wallabies. Even when and where there are high numbers of mosquitoes, without wildlife, outbreak risk is low. This is the reason why any clusters of locally infected cases in metropolitan regions are typical in areas where there are wetlands, wildlife and mosquitoes occurring together. We’ve seen this on the urban fringe of Sydney and Perth in recent years.

The announcement of locally acquired cases in the suburbs of Frankston and Casey, in Melbourne’s south-east, has taken many by surprise. Should it have?

Victoria is no stranger to mosquitoes and outbreaks of mosquito-borne disease. There are mosquito surveillance and mosquito control programs in place in many regions and historically there have been major outbreaks of mosquito-borne disease. From freshwater flood plains of the inland to the tidally flooded estuarine wetlands of the coast, Victoria has diverse and often abundant mosquitoes. But cases in the metropolitan region are rare.

Victorian mosquitoes are not all bad but over a dozen different mosquito species can spread Ross River virus.

The region where these cases have been identified are in proximity to bushland and wetland areas. There is no doubt plenty of mosquitoes and suitable wildlife too. While this is the first time local transmission has been documented, that doesn’t mean the virus hasn’t circulated in the past, or even that cases may have occurred.

For individuals infected but only suffering mild symptoms, the illness can be easily discounted as nothing more than a mild case of the flu. Without appropriate blood tests, these cases never appear in official statistics. For this reason, many mosquito researchers believe that the number of notified cases across the country is just the tip of the iceberg with many milder infections going diagnosed.

But why in Melbourne now?

It is difficult to know for sure. The two most likely explanations are that either environmental conditions were ideal for mosquitoes and suitable populations of wildlife were present so that the virus was much more active in the local environment than previously. The second explanation is that the virus may have been introduced to the region by a traveller or movement of wildlife. In much the same way Zika virus made its way from SE Asia to South America in the last few years, mosquito-borne viruses move about in people and animals, much less so than mosquitoes themselves (but that isn’t impossible either).

Victoria (as well as inland NSW) is experiencing one of its largest outbreaks of Ross River virus on record following significant flooding of inland regions. With so much activity of the virus in the region, perhaps an infected bird or person travelling to the metropolitan region brought the virus with them. When bitten by local mosquitoes, the virus started circulated among local mosquitoes and wildlife.

Most people infected by Ross River virus are bitten by a mosquito that has previously fed on a kangaroo or wallaby.

Once it’s made its way to metropolitan regions, the virus can be spread from person to person by mosquitoes. Common backyard mosquitoes, especially Aedes notoscriptus, can transmit the virus but as these mosquitoes are not particularly abundant, don’t fly vary far and will just as likely bite animals as humans, they’re unlikely to drive major urban outbreaks of the disease. This mosquito doesn’t pack the same virus-spreading-punch as mosquitoes such as Aedes aegypti that spreads dengue, chikungunya and Zika viruses. Aedes aegypti isn’t in Victoria.

We’re unlikely to see significant spread of Ross River virus across Melbourne but that doesn’t mean Victorians should be complacent. As there is no cure for Ross River virus disease, the best approach is to avoid being infected in the first place. Preventing mosquito bites is the best approach. For my tips and tricks on avoiding mosquito bites see this recent paper in Public Health Research and Practice as well as my article for The Conversation.

Keep an eye on the website of Victoria Health for more information.

 

 

 

 

 

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West Aussies versus the local mozzies

This is a special guest post from Dr Abbey Potter, Senior Scientific Officer, Environmental Health Hazards, WA Health. I’m currently mentoring Abbey as part of The Public Health Advocacy Institute of WA (PHAIWA) Mentoring Program. Its been a great experience as we navigate through some of the strategies to raise awareness of mosquito-borne disease and advocate for better approaches to addressing the public health risks associated with mosquitoes.

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Living in WA, we’re all too familiar with the pesky mosquito. We know they bite but what we often don’t consider is that they can transmit serious and sometimes deadly diseases. In fact, a recent survey of locals indicated that knowledge of mosquito-borne disease is pretty limited, particularly among younger adults aged 18-34 years and those living in the Perth Metro. It’s pretty important we’re aware of the risks posed by these pint-sized blood suckers and how you can avoid them… and here’s why!

The Facts

On average, more than 1,000 people will be infected with a mosquito-borne disease in WA every year. Our mossies can transmit Ross River virus, Barmah Forest virus, West Nile virus (Kunjin substrain) and Murray Valley encephalitis virus. All four cause diseases that are debilitating at best, causing weeks to months of symptoms. Murray Valley encephalitis is limited to the north of the State but is so serious it can result in seizures, coma, brain damage and even death.

Forget the bush, most people bitten in their own backyard. West Aussies are all very prone to getting eaten alive while socialising outdoors but if you’re up in the north of the State, you’ve also got a much higher likelihood of being bitten while boating, camping or fishing or working outside, compared to the rest of the state.

And don’t think you’re off the hook when you head off on holidays. A further 500 WA residents return from overseas travel with an exotic mosquito-borne disease every year. Heading to Bali? Beware of dengue, especially young adult males who return home with the illness more than others. There is limited mosquito management in many overseas countries where disease-transmitting mozzies can bite aggressively both indoors and throughout the day. This catches West Aussies off guard, as we are accustomed to mozzies biting outdoors, around dusk and dawn. When you’re in holiday mode it’s likely that you’ll be relaxing, having a couple of drinks and not thinking about applying repellent. Oddly enough, mosquitoes may actually be more attracted to people whose body temperature is higher. This happens naturally when you consume alcohol, so best pull out the repellent before you crack your first beer.

Despite our attractiveness to mosquitoes, we aren’t really aware of the most effective ways to avoid bites or how we can do our bit to reduce breeding in our own backyards. If you live by the mantra Cover Up. Repel. Clean Up you’ll have no problems!

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Western Australia has some amazingly beautiful wetlands but these saltmarshes around Mandurah can produce large populations of nuisance-biting mosquitoes!

Cover Up

If you know you are going to be outdoors when mosquitoes are active, wear loose, long-fitting clothing that is light in colour. Believe it or not, mosquitoes can bite through tight pants as tough as jeans – I’ve witnessed it!

If you’re staying in accommodation that isn’t mosquito-proof, consider bed netting.

Try to keep children indoors when mosquitoes are most active. If exposure can’t be avoided, dress them appropriately and cover their feet with socks and shoes. Pram netting can also be really useful.

Admittedly, it’s not always practical to wear long sleeves during our warm summer nights, so there are going to be times when you need to use repellent. Choose a product that actually works and apply it appropriately so it does the job. Despite our best intentions, this is where we often go wrong. There are a few basic things to cover here, so stick with it!

Ingredient: Science tells us that the best active ingredient for repelling mosquitoes is diethyltoluamide (DEET for short) or picaridin. You need to look for either one of these names on the repellent label under the ‘active constituents’ section.

Unfortunately, natural repellents and anything wearable (e.g. bands, bracelets or patches) have very limited efficacy. Experts don’t recommend you use them and I consider this very wise advice. It only takes a single mosquito bite to become infected and chances are you will receive at least one if you rely solely on a product of this nature. It just isn’t worth the risk.

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Percentage: The next thing to consider is the percentage of the active ingredient. This can range anywhere from 7% to 80% which can make choosing a repellent confusing. Just remember, the higher the percentage, the LONGER the product will remain active for. It doesn’t mean it will repel mosquitoes better.

A repellent containing 16-20% DEET will provide around 4-6 hours of protection, and is a good place to start. Repellents labelled ‘tropical strength’ usually contain greater than 20% DEET – they are useful when you spend longer periods exposed to mosquitoes or if you are heading to a region where dengue, malaria or Zika is problematic. Kids repellents usually contain picaridin or <10% DEET.

Sometimes it can be tricky to work out the percentage of the active ingredient. You can see the Bushmans example below states this clearly, but the other bottles list the ingredient in grams per litre (g/L). No need for complex maths – just divide by 10 and you have the magic number! For example, the RID label below reports the product contains 160g/L of DEET. This would convert to 16% DEET – easy!

You can see a few examples here of effective repellents:

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How to Apply: No doubt we would all prefer if repellents didn’t feel quite so gross on our skin or didn’t smell so bad. Even I have to admit that before I moved into this field, I was guilty of putting just a dab here and a dab there. Unfortunately, this is flawed logic that will only result in you being bitten!

Repellents must be applied correctly to be effective. That means reading the label and applying it evenly to all areas of exposed skin. Remember to reapply the product if you are exposed to mosquitoes for longer than the repellent protects you for. You’ll also have to reapply the repellent after sweaty activity or swimming.

For more information on repellent use in adults and children, click here.

Clean Up

Mosquitoes need water to breed, but only a very small amount. Water commonly collects in a range of things you may find in your backyard including pot plant drip trays, toys, old tyres, trailers and clogged up gutters. Mosquitoes also love breeding in pet water bowls, bird baths and pools if the water is not changed weekly or they are not well maintained. Rain water tanks can also be problematic so place some insect proof meshing over any outlets. When you’re holidaying, cover up or remove anything that may collect water.

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If you need more official info from WA Health about mosquito-borne disease or simple ways to prevent being bitten click here. And if you want to read more about how much West Aussies know (or don’t know) about mossies, check out Abbey’s excellent paper here! Joint the conversation too on Twitter by following Abbey and Cameron.

Preserve and protect? Exploring mosquito communities in urban mangroves

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This is a special guest post from Dr Suzi Claflin. Suzi found herself in Sydney, Australia, (via Cornell University, USA) in 2015 to undertake a research project investigating the role of urban landscapes in determining mosquito communities associated with urban mangroves. She was kind enough to put this post together to celebrate the publication of our research in Wetlands Ecology and Management!

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Sometimes you’ve got to make hard choices for the greater good. These situations can arise anywhere, but here – as usual – we are concerned with mosquitoes. There’s a balancing act carried out by public health officials and wetland managers trying to both preserve endangered habitat and protect human health. In this guest post, I’ll explain the science behind research I recently published in collaboration with Dr Cameron Webb, and suggest one way forward for addressing human and environmental health concerns in urban wetlands.

During my PhD, I studied how the landscape surrounding small-scale farms affects the spread of a crop virus and the community of insect pests that carry it. When I came to Australia to work with Cameron, I was surprised to find myself applying the same type of landscape ecology to mosquitoes and mangroves in urban Sydney.

The misfortune of mangroves

Mangroves are real team players. They provide a range of services to the surrounding ecosystem and to the humans lucky enough to live near them. Mangroves are extremely effective at protecting the shoreline (but this can sometimes be a problem). They prevent erosion by gripping the soil in their complex root systems and buffer the beach by serving as a wave break. By filtering sediment out of the water that flows over them, mangroves also prevent their neighbouring ecosystems, such as coral reefs and seagrass forests, from being smothered.

Despite all their good work, mangroves have an almost fatal flaw; they prefer waterfront property. Unfortunately for them, so do humans. Urban and agricultural development has eaten away at mangroves, leaving them highly endangered.

The mosquito menace

Mozzies are a public health menace, because they spread human diseases like Ross River virus (RRV). Because of this, public health officials rightly spend time considering how to supress mosquito populations in order to reduce the risk of disease transmission.

Here’s where things get tricky: mangroves are great for mosquitoes.

That leaves public health officials and wetland managers in a difficult position. On the one hand, mangroves are delicate, at-risk ecosystems that need to be preserved. On the other, mangroves and surrounding habitats potentially harbor both the animal carriers of the RRV (e.g. wallabies) and a load of mosquitoes, which means that people nearby may need to be protected.

How can we do both?

 

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Dr Suzi Claflin trapping mosquitoes in the mangroves along the Parramatta River, Sydney, Australia.

 

The potential power of prediction

This is a hard question to answer. One approach is prediction: using measurements of the environment, like rainfall and tide level, to estimate what the mosquito community will look like in a given region. The mosquito community determines what management actions, like spraying an insecticide, need to be taken, based on the threat it poses to public health.

We set out to explore how the way we use land (e.g. for residential areas or industrial areas) near urban mangroves affects the mosquito communities that live in those mangroves. The project involved dropping over retaining walls, slipping down banks, and tromping through muddy mangroves along the Parramatta River in Sydney. We set mosquito traps (billy cans of dry ice with a container on the bottom) and left them overnight to capture the mozzies when they are most active. We did this at two points in the summer, to see if there was any change over time.

We found that yes, the way we use land around a mangrove makes a difference. Mangroves with greater amounts of bushland and residential land in the surrounding area had fewer mosquitos, and fewer species of mosquitos. On the other hand, mangroves with greater amounts of industrial land surrounding them had a greater number of mosquito species, and those surrounded by greater amounts of mangrove had more mosquitos.

And, just to muddy the waters a bit more (pun intended), several of these relationships changed over time. These results show that although prediction based on the surrounding environment is a powerful technique for mangrove management, it is more complicated than we thought.

Another way forward: site-specific assessments

Our work suggests another way forward: site-specific assessments, measuring the mosquito community at a particular site in order to determine what management approaches need to be used. This is a daunting task; it requires a fair number of man-hours, and mangroves are not exactly an easy place to work. But it would be time well spent.

By assessing a site individually, managers can be confident that they are taking the best possible action for both the mangroves and the people nearby. It turns out that the best tool we have for striking a balance between environmental and public health concerns, the best tool we have for preserving and protecting, is information. In mangrove management—as in everything—knowledge is power.

Check out the abstract for our paper, Surrounding land use significantly influences adult mosquito abundance and species richness in urban mangroves, and follow the link to download from the journal, Wetlands Ecology and Management:

Mangroves harbor mosquitoes capable of transmitting human pathogens; consequently, urban mangrove management must strike a balance between conservation and minimizing public health risks. Land use may play a key role in shaping the mosquito community within urban mangroves through either species spillover or altering the abundance of mosquitoes associated with the mangrove. In this study, we explore the impact of land use within 500 m of urban mangroves on the abundance and diversity of adult mosquito populations. Carbon dioxide baited traps were used to sample host-seeking female mosquitoes around nine mangrove forest sites along the Parramatta River, Sydney, Australia. Specimens were identified to species and for each site, mosquito species abundance, species richness and diversity were calculated and were analyzed in linear mixed effects models. We found that the percentage of residential land and bushland in the surrounding area had a negative effect on mosquito abundance and species richness. Conversely, the amount of mangrove had a significant positive effect on mosquito abundance, and the amount of industrial land had a significant positive effect on species richness. These results demonstrate the need for site-specific investigations of mosquito communities associated with specific habitat types and the importance of considering surrounding land use in moderating local mosquito communities. A greater understanding of local land use and its influence on mosquito habitats could add substantially to the predictive power of disease risk models and assist local authorities develop policies for urban development and wetland rehabilitation.

Dr Suzi Claflin completed her PhD at Cornell University exploring environmental factors driving the spread of an aphid-borne potato virus on small-scale farms. She is now a postdoctoral research fellow at the Menzies Institute for Medical Research in Hobart, TAS. In her spare time she runs her own blog, Direct Transmission, focusing on disease and other public health issues (check it out here). To learn more about her doctoral research, follow this link!

Summer summary of mosquito media madness

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Summer is always a busy time for me. As well as plenty of time sloshing about in the wetlands, there is often lots of interest from mosquito-curious media. There has been some intense bursts of activity in previous summers but the 2015-2016 was particularly interesting.

I certainly covered some new ground this summer. I responded to over 160 individual media requests in the past 6 months. From flies and food safety to the emergence of Zika virus. Here is a wrap from my media adventures and some valuable lessons learned for future science and public health communication.

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The good news of new virus discoveries

Usually, the discovery of a new mosquito-borne virus brings with it new concern for public health. This time though, there was some good news.

Towards the end of 2015, a paper reporting on a collaborative research project between University of Queensland, QLD Health and University of Sydney was published in Virology. This was the first publication detailing the discovery of Parramatta River virus, an insect specific virus that exclusively infects the mosquito Aedes vigilax. This virus does not infect people and poses no health risk.

A joint media release was issued by University of Queensland and University of Sydney and there was plenty of media attention. Not surprising given the usual negative associations with mosquito-borne pathogens!

There were dozens of articles, much of the attention focused on the team at University of QLD. Dr Jody Hobson-Peters was kept busy with local media including ABC and Brisbane Times. It was a great experience sharing the research with colleagues in Queensland, particularly great seeing so much exposure for PhD student Breeanna McLean and her newly published research.

I was surprised at how little attention there was in the news from Sydney media. The lesson here though was more about bad timing than uninteresting research. A couple of weeks after the initial media release, I forwarded around a few emails and sent out a couple of tweets and next thing you know, we made the front page of the local newspaper, the Parramatta Advertiser (see above). It was some great local coverage, not only about the virus discovery but it also provided an opportunity to raise awareness of mosquitoes and mosquito-borne disease on the eve of summer!

Lesson learned: A good reminder that if your research isn’t picked up immediately, give it another shot a few weeks later. Timing may make all the difference but perseverance does too!

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To stop sickness, swat or spray

Just in time for Christmas lunch and summer holiday picnics, I published an article on flies and food safety at The Conversation. I really expected this article to slip under the radar of most people. Coming out on Christmas eve doesn’t seem likely many would be clicking about on the internet but within a few days over 600,000 people had clicked on the piece!

Many of those clicks were thanks to the article being shared by IFLS but there was also plenty of interest from local media and I was busy with interview requests from ABC Local Radio across the country. Who doesn’t love hearing about how flies poop and vomit on your food? I was even interviewed by Grey Nomad Magazine!

Lesson learned: Applying a little science to seasonal urban myths and common uncertainties can prove popular and may be a good opportunity to promote a little science!

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Rain, rain everywhere with mozzies soon to come

With all the talk of El Nino and predictions of a hot and dry summer for the east coast of Australia, the summer was actually reasonably mild and extremely wet. Sydney was particularly battered by a series of storms and intense rainfall early in 2016.

More water generally means more mosquitoes. In response to the rain, many media outlets were interested in chatting about the prospects of a bumper mosquito problem. As well as talking about the prospects of an increase in mosquito-borne disease risk, it was a great opportunity to talk about personal protection measures.

There were some radio, print and tv spots that provided opportunities to talk about how to choose and use the right repellents.

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In 2015 I published a paper in the Medical Journal of Australia explaining that health authorities need to provide more guidance on how the community can get mosquito repellents working more effectively.

Typical health warnings and media release from health authorities (usually limited to grabs on news bulletins) but when there is an opportunity to do longer form radio interviews, there is a chance to put an emphasis on aspect of public health messages. The hook to get these longer spots is giving more than just warnings, by mixing up some interesting things about mosquitoes, you can catch a little extra attention and sneak in the public health messages between the fun and fascinating facts about mosquitoes!

One news outlet was really insistent in grabbing a hold of me for some comments ahead of the evening bulletin. They even sent a crew to meet me in the city while I was taking the kids along to the Sydney Festival!

Lesson learned: When doing tv for the evening news, it is ok to wear a t-shirt, shorts and runners just so long as you have a rain jacket handy to make you like like you could have just stepped straight out of the wetlands!

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From African forests to South American cities

While many of us were keeping our eyes on the developing outbreak of mosquito-borne Zika virus in South America towards the end of 2015, it wasn’t until February 2016 that the situation really grabbed the attention of the world’s media.

In late January, I published a piece at The Conversation titled “Does Zika virus pose a threat to Australia?” It prompted a little interest but it was the media conference coordinated by University of Sydney Media and Communications together with Australian Science Media Centre (AusSMC) that coincided with the announcement of the World Health Organization that the Zika virus outbreak was a Public Health Emergency of International Concern.

Together with colleagues from the University of Sydney’s Marie Bashir Institute of Infectious Disease and Biosecurity, I spoke at a media conference broadcast nationally on ABC News 24. There was a huge amount of media stories stemming from this media conference with over 500 individual articles identified across radio, tv, print and online. During the days and weeks following, I felt like I was spending more time at the ABC studios in Ultimo than I was in our lab! There were days when I spent hours on the phone doing radio interviews.

There were a couple of great longer form interviews that I really appreciated the opportunity to contribute to such as ABC Radio National’s Health Report and Rear Vision. There were also a couple of podcasts too, check out Science on Top and Flash Forward.

This flood of media requests also exposed me to a few more new experiences. There were live tv appearances on Sunrise, ABC News 24 and Sky News but probably one of the most interesting was my spot on Channel Ten’s The Project. It was interesting for a number of reasons.

Firstly, I was warned early on that one of the guests on the panel was comedian Jimmy Carr, a somewhat controversial figure notorious for jokes a little too close to bad taste. I’m not typically one to play the “wacky scientist” during interviews but what I was most cautious of was not being seen to be treating a very serious disease outbreak too lightly. I was determined to play the straight guy. In the end the interview turned ok but there were a couple of awkward moments that, luckily, ended up being edited out.

Secondly, simply doing the interview was unusual. It was a pre-recorded interview with me in a tiny room at the Channel Ten studio in Sydney and the panel in the Melbourne studio. I was sitting in front of a green-screen, staring down the camera with an earpiece blasting away in my ear. I have done live crosses before but they’re all been one-on-one interviews. This time it was with the panel and I found it incredibly difficult to get the feel for each of the panelists when they were asking questions. Missing that eye-to-eye contact was a disconcerting experience. Luckily, all turned out well in the end.

Lesson learned: Lots (I mean LOTS) learned while dealing with the interest in Zika virus! Probably another post in itself…but I would say that managing this volume of media wasn’t easy and it did eat up a lot of time (even though communicating public health messages is central to my “day job”) but this was important work.

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A morning with Dr Karl!

When it comes to science communicators in Australia, there are few with a higher profile than Dr Karl Kruszelnicki. We’d spoken on a number of occasions about mosquitoes but I’d never actually met him in person before. “Dr Karl” invited me to hang out for a morning recording interviews for ABC News 24, ABC Local Radio and also guest on his national “Science Talk” segment on Triple J’s Mornings Show with Zan Rowe.

The experience of a behind-the-scenes perspective on Karl’s hectic schedule and how he manages the frenetic pace of work at the ABC was an eye opener. Doing the hour long segment on Triple J was great, enlightening to get questions from a slice of the Australian community I don’t usually cross paths with when doing the usual community engagement. I good reminder of just how much anxiety there can be within the community when news of international disease outbreaks occur. Not surprising given the thousands of Australians travelling to South America each month….with more to come later this year when the Rio Olympic Games kick off!

You can listen to the segment here and you can also follow Dr Karl on Twitter.

Lesson learned: From a public health perspective, this is a great reminder that the concerns and anxieties around infectious disease can change depending on the sector of the community you’re dealing with. The core messages may remain the same but you’ll always need to consider your audience when fine tuning your public health messages.

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So, was all this worth it?

It was stressful. It was fun. It eroded much of my time that may have been spent in other ways but I see this as “doing my job” perhaps a little more than pure research scientists do. But how does all this convert into tangible metrics. How do you measure the reach and economics of all these media activities?

I’m fortunate to be supported by the University of Sydney media and communications team that helps out by providing some data on the metrics of my media activities each summer. What was all this time and effort worth?

Between November 2015 and Match 2016, I was quoted in over 160 media items. This adds up to a cumulative audience of around 8.9 million people, that is quite some reach! How much was it worth? Based on current advertising rates, about $1.6 million.

I’ve written before about how we can better value science and public health communication. Collecting these types of metrics can be useful for a range of purposes. Recently, I’ve been including media engagement as an “in kind” contribution to grant applications with valuation calculated on average media coverage that may be expected.

The lesson here is to take the time to record your media activities, not just so you have a list to demonstrate quantity but also so you can assess audience and value to your media activities. Work with your media and communications departments to see what extra information you can collect.

Got any other tips? Share them via Twitter!

 

 

 

 

 

Can social media help translate research to practice and promote informed public health messages?

I’m a Senior Investigator with the Centre for Infectious Diseases and Microbiology – Public Health. One of our primary focuses is translating research into improved public health outcomes. With NSW Population Health and Health Services Research Support Program assisting our work, we’re exploring new ways to achieve this objective. My experience of using social media was selected to be showcased among other case studies in 2015. 


Nuisance-biting mosquitoes and mosquito-borne disease are concerns for local authorities in Australia. 2015 saw the largest outbreak of mosquito-borne Ross River virus disease for more than 20 years with over 9,500 cases nationwide. In NSW, there were 1,633 cases compared to the annual average since 1993 of 742 cases per year. Notwithstanding the current outbreak, other endemic, as well as exotic, mosquito-borne pathogens represent future threats to public health.

As there is no large-scale mosquito control program in NSW, reducing the contact between mosquitoes and people is primarily achieved through the promotion of personal protection measures. NSW Health promotes the use of topical insect repellents in combination with behavioural change to avoid natural mosquito habitats and the creation of mosquito habitats around the home. This information is typically provided in the form of posters, brochures, online factsheets, and seasonal or outbreak-triggered public health messages issued by Local Health Districts or the NSW Ministry of Health.

With the emergence of new communications technologies, particularly the rise in popularity of social media, there are new opportunities for public health communications.

The aim of the current research was to determine the reach of public health messages through social media by tracking engagement, audience and relative value as assessed by media monitoring organisations and metrics provided by hosting services of social media platforms.

Assessing activities and processes

Dr Cameron Webb (CIDM-PH) has focused much attention on filling the gaps between current public health messages and findings from recent research into topical mosquito repellents.[1] For example, while public health messages provide accurate information on the insect repellents that provide the best protection, there is a paucity of information provided on how best these products should be used by individuals and those they care for.

Dr Webb’s engagement with mass media, online media (e.g. The Conversation), a personal blog (e.g. Mosquito Research and Management) and social media (e.g. Twitter) has resulted in substantial exposure of focused and informed public health messages. From mid-2014 through to the end of 2015, Dr Webb participated in over 80 mass media articles and interviews in print, online, radio and television media with public health information reaching an estimated audience of over 10 million people.[2] The focus of his messaging around mosquito-borne disease was to highlight the best way for the community to choose and use mosquito repellents; stressing the importance of active ingredients and application methods. This fills a gap in the current provision of public health information while also augmenting public health alerts and messages associated with the 2015 outbreak of Ross River virus disease.

Social media has become a “go to” source of information for much of the community. Information shared on Facebook, Twitter, Instagram, and YouTube has the potential to shape the habitats and behaviour of the community. Dr Webb is active on Twitter (currently followed by over 4,500 people); he uses the platform to engage with the social media accounts of journalists and broadcasters to establish a voice of authority in the field of mosquito-borne disease prevention and extend the reach and exposure of public health messages broadcast through mass media. Using Twitter to share links to informed articles following interviews reached hundreds of thousands of people by being shared by the social media accounts of journalists, media outlets, government organisations and community groups. During the 2014-2015 summer, tweets by Dr Webb reached an estimate 1.28 million people.[3]

Dr Webb regularly writes open access articles on his website, attracting around 250 daily visitors with over 117,000 article views.[4] In addition to his personal website, Dr Webb regularly contributes articles to The Conversation (a website for academics to share expert opinion and write about their latest research). His articles have attracted over 120,000 readers. However, one article “why mosquitoes seem to bite some people more” (published 26 January 2015) has alone been read by over 1.3 million people.[5] This “non-scholarly” writing not only establishes CIDM-PH scientists as authorities in public health matters but can also assist in directing the public to official health guidance provided on official websites and other sources.

Dr Webb’s activities provide a framework for how health authorities may engage with social media to extend public health messages. Organisations or individuals can connect health authority information with the community through media outlets. He has been invited to share his experiences in this field at local and international conferences and workshops including those coordinated by the Public Health Association of Australia, Australian Entomological Society and Entomological Society of America. In addition, Dr Webb has been invited to provide lectures on the benefits of social media for public health advocacy to undergraduate and post-graduate students at the University of Sydney.

While traditional messaging provided by health authorities will remain a staple in public health campaigns, social media provides a connection between traditional and emerging media and communication organisations. This increased connectivity between public health advocates, the media and community has the potential to greatly improve the awareness of mosquito-borne disease and increase the rate of uptake and application of strategic personal protection measures.

References

  1. Webb C.E. (2015). Are we doing enough to promote the effective use of mosquito repellents? Medical Journal of Australia, 202(3): 128-129.
  2. Estimated audience reported by Kobi Print, Media and Public Relations, University of Sydney, 23 April 2015, based on data provided by media monitoring organisation isentia.
  3. Estimated from total “tweet impressions” for the period October 2014 through April 2015 provided by Twitter Analytics (https://analytics.twitter.com/user/Mozziebites/home accessed 30 April 2015)
  4. Data provided by WordPress statistics (accessed 18 December 2015)
  5. Data provided by The Conversation metrics (accessed 18 December 2015)

This article was originally published by NSW Health showcasing some of the work within the NSW Population Health and Health Services Research Support Program. You can see the original article here.

Could a mosquito bite make you a Jedi?

yoda

On the eve of the release of Star Wars The Force Awakens, I’ve been revisiting bits and pieces of the previous six Star Wars movies. You know what stands out? I’ve been thinking about the possibility that wielding “The Force” may just be a symptom of parasitic infection!

Growing up with the original trilogy of Star Wars films, my perspective on “The Force” was entirely defined by Obi-Wan Kenobi’s explanation to Luke in A New Hope, “The Force is what gives a Jedi his power. It’s an energy field created by all living things. It surrounds us and penetrates us. It binds the galaxy together.”

I always thought of it as more a spiritual, rather than a scientific, thing. If I thought about it really hard, I could snatch that tv remote into my hand from across the room. Apparently it doesn’t quite work that way. I’d need to be infected with a parasitic pathogen. Midi-chlorians.

Midi-chlorians were explained to a young Anakin Skywalker by Jedi Master Qui-Gon Jinn in The Phantom Menace as “Midi-chlorians are a microcopic lifeform that reside within all living cells and communicates with the Force. We are symbionts with the midi-chlorians. Life forms living together for mutual advantage. Without the midi-chlorians, life could not exist, and we would have no knowledge of the Force. They continually speak to you, telling you the will of the Force.”

So, these intracellular microbes speak to us? Do they control the host? Are Jedi just doing the dirty work of midi-chlorians? I know midi-chlorians have sparked a sea of frustration among some Star Wars fans but lets just assume for a moment that the only reason Force users can do what they do is because they’re infected with special strains of these parasites.

Luke_lightsaber_wampacave

How many times have you imagined you could snatch the remote from coffee table through nothing more than concentrated thought alone?

Can pathogens and parasites control their hosts?

We know that in a galaxy not so far away and not so long ago, parasites have been described that alter the behaviour of their hosts. See here  and here and here. From mind-controlling fungi to parasites that break down your fear of predators there are plenty of examples of how parasites change the behaviour of hosts to their own benefits.

There are insect symbiotes and mostly they’re beneficial. But when it comes to mosquitoes, microbes including viruses, bacteria, fungi and protozoa can influence their role in disease outbreaks.

Viruses, such as dengue, may even influence the behaviour of mosquitoes to increase the chances of their transmission to new hosts. Infection with a virus may also change the way mosquitoes respond to insect repellents. But when some mosquitoes are infected with an intracellular bacteria, a bacteria that’s not naturally found in this mosquito, their ability to transmit dengue viruses is blocked. It can also disrupt their blood feeding and reduce their lifespan.

Now, if mosquitoes are capable of transmitting blood-borne pathogens, could they also transmit midi-chlorians? If a mosquito bites you after its taken a blood meal from Yoda, Obi-Wan Kenobi or Luke Skywalker, could you start using the force? Is the ability to use the force a symptom of vector-borne disease?

Aedes aegypti

Itchy yet? Dozens of mosquitoes drinking in a mosquito researcher’s blood! (Image: Alex Wild)

Are there Medical Entomologists in the Star Wars universe?

I don’t know how many medical entomologists will be featured in The Force Awakens. According to Wookiepedia there are mosquitoes (or at least mosquito-like insects called Msqitoes) in the Star Wars universe but how would you go about working out if theses or any other blood feeding arthropods could transmit midi-chlorians between Jedi and us normal non-Jedi folk?

When investigating outbreaks of suspected mosquito-borne disease, there is a number of things to consider. Are there clusters of cases that may suggest localised exposure to mosquitoes? If there is widespread disease with little or no link to environments associated with mosquitoes, it is usually enough to suggest the pathway of pathogen transmission doesn’t include mosquitoes. But where there is evidence to suggest mosquitoes are playing a role, where to next?

Collecting and testing field collected specimens can provide some evidence. There are mosquito-borne pathogen surveillance programs in many parts of the world. They rely on collecting and testing adult mosquitoes but can also involve taking blood from wild or domestic birds to determine the circulation of mosquito-borne pathogens in the environment. However, just because a mosquito tests positive to a pathogen, it doesn’t mean it is spreading it to people.

There are thousands of mosquito species worldwide but relatively few effectively transmit mosquito-borne pathogens. For example, in Australia around 40 mosquitoes have been implicated in the transmission of Ross River virus but only one mosquito can transmit dengue viruses. Unless there is a specific relationship between the pathogen and the mosquito, the pathogen wont be transmitted.

Complex path of pathogens from host blood to mozzie spit

Mosquitoes aren’t like dirty syringes. They don’t transfer infected droplets of blood between people. Mosquitoes must become infected with the pathogen before it can then pass it on. Taking a virus as an example, the virus must be ingested by the mosquito together with a blood meal from an animal and then the virus must pass into and out of the cells lining the insect’s gut before spreading throughout the body of the mosquito. Once the salivary glands are infected (a process that takes about a week), the virus is passed on through the spit of the mosquito when it next bites (when feeding on an animal, a mosquito will inject some saliva to get the blood flowing).

Not all mosquitoes can transmit all mosquito-borne pathogens. Mosquitoes cannot transmit non-mosquito-borne pathogens. That’s why mosquitoes don’t spread Ebola virus.

Dagobah_Wookipedia

For a mosquito researcher, surely Dagobah is top of the list of fantasy field trip destinations! There has to be plenty of mozzies on this swamp covered planet! (Image: Star Wars)

How would you test the ability of mosquitoes to transmit midi-chlorians?

Firstly you need some blood feeding mosquitoes. If there was anywhere in the Star Wars universe where mosquitoes could be found, surely it is Dagobah. The whole planet is essentially covered in wetlands. Once you’ve got the mosquitoes, now all you need is some midi-chlorian-filled blood.

Expose caged mosquitoes to a mix of blood and midi-chlorians (or ask a Jedi to kindly volunteer their arm). For those mosquitoes that feed, they can be put aside and kept alive for as long as possible. Every few days, mosquitoes are removed and tested for infection. Legs and wings can be removed from the mosquito and tested separately from the body. If they’re positive, it indicates the virus has spread through the body of the mosquito.

Next, the proboscis of the mosquito can be inserted into a micro-capillary tube filled with growth media. Once inserted into the liquid, the mosquito will instinctively feed and expectorate saliva. The saliva and growth media mix can then be tested for the presence of virus. If this mix is positive, it indicates the mosquito is transmitting the pathogen.

vcexperiments

Known as “vector competence” experiments, studies investigating the ability of different mosquito species to transmit different pathogens help build up a profile of each mosquito and its potential role in the spread of local and exotic mosquito-borne pathogens.

Studies of this nature have been conducted for many, many mosquito species worldwide and many, many different pathogens. Here is a recent example of a study conducted to determine how the transmission of a strain of West Nile virus by mosquitoes influenced an outbreak of mosquito-borne disease in horses.

Things can start to get a little more complicated when you take into account the interaction between the host (e.g. an animal) and the pathogen, the level of viremia that may develop and the propensity of the mosquito to bite people. For example, some mosquito species may be very susceptible to infection and effective at transmitting a pathogen but if those mosquitoes prefer to only feed on birds, the risk to people are generally much lower.

The take home message from all these studies is that the interactions between pathogens, mosquitoes and the animals and people carrying the pathogens are complex. When assessing the risk of mosquito-borne disease outbreak, designing more effective mosquito-borne pathogen surveillance programs or developing strategic public health responses, it is critical to understand the ability of local mosquitoes to transmit pathogens.

In theory, a mosquito taking a blood meal from a Jedi whose blood contains a high concentration of midi-chlorians could potentially pass on some Force-inducing infections to other people. Makes you wonder why Yoda was hanging out in a swamp planet?

Disclaimer: There is little doubt the issue of midi-chlorians has been discussed, dissected and the implications for the ability to wield the force determined within Star Wars Expanded Universe/Legends literature. I know I’ve taken a little artistic license here but if you’re a Star Wars aficionado, please take this article for what it is, a fun way to communicate the science behind mosquito and mosquito-borne disease research.

Why not join the conversation on Twitter?

I’ll leave you with this great CDC video on immunization.

UPDATE! [9 January 2016] So, it seems that not only do mosquitoes potentially help make Jedi in the Star Wars universe but, as the The Force Awakens demonstrates, mosquito-inspired aliens are out and about in the bars and cantinas of the galaxy! Just in the remote chance you haven’t seen the movie, I won’t describe when and where these creatures pop up but they’re known as the “Dengue Sisters” and represent a sentient species of small insectoids known as Culisetto. They look pretty awesome (see photo below from “Star Wars: The Force Awakens Visual Dictionary” by Pablo Hidalgo)

denguesisters

Dengue Sisters from Star Wars: The Force Awakens Visual Dictionary (Thanks Cybergosh for the tip off)!

Perhaps I need to petition Hasbro to create a “Dengue Sister” action figure!

 

 

Why is mosquito-borne disease risk greater in autumn?

Repel_illustration_DSMosquito-borne disease risk in Australia is greatest during summer right? Wrong. Imagine you’re heading off to football training for the first time this season. Training kicks off in mid-March ahead of an April start to the season. Training is once a week, typically at dusk. Playing fields are located close to wetlands. There mozzies aren’t as bad as they were back in January so why put on insect repellent? The reality is you are more likely to catch Ross River virus during autumn. Recent health warnings confirm it. Why?

The most common mosquito-borne disease in Australia is caused by Ross River virus. Infection can cause symptoms that can be highly variable in their severity but may include  rash, fever, fatigue as well as arthritic pain. Disease caused by infection with this mosquito-borne virus is reported in over 4,000 people each year from across the country.

Can we predict outbreaks of Ross River virus?

Predicting outbreaks of Ross River virus can be difficult. There are differing drivers of outbreaks between both regions and season. While outbreaks typically occur when mosquito populations are high, abundant mosquito populations don’t guarantee an outbreak of disease. Similarly, outbreaks can still occur when mosquito populations are low. The reasons for this are complex.

Perhaps most importantly, mosquitoes don’t emerge from the wetlands infected with Ross River virus, they must bite an infected animal first. The animals most likely to pass the virus onto mosquitoes are kangaroos and wallabies (waterbirds are most likely to be involved in the transmission cycles of other Australian mosquito-borne viruses such as Murray Valley encephalitis virus). This means that, despite the relative abundance of mosquitoes, without the presence of kangaroos and wallabies, the risks of Ross River virus transmission are low. This is why Ross River virus is generally considered a rural disease. However, there have been small outbreaks in metropolitan Sydney where kangaroos and wallabies are present. Outbreaks will almost always required the presence of macropods.

mosquitoes_undermicroscopeWhat has been happening in 2014?

There has been plenty of activity of Ross River virus in coastal NSW this year, particularly around the Georges River region of Sydney. This is one of my key study sites and provides a good opportunity to study Ross River virus in a region where mosquitoes, wildlife, wetlands and people are all present. The detection of Ross River virus, along with Barmah Forest virus and Stratford virus, in mosquitoes in the suburbs of Lugarno, Alfords Point, Illawong and Bankstown in early 2014 has prompted warnings from local health authorities. Similarly, Ross River virus has been isolated from mosquitoes in the Newcastle/Port Stephens region, also prompting the release of health warnings. So too around Port Macquarie. There were plenty of mosquitoes about in summer but why are the risks comparatively much higher in autumn?

georgesriversharks

Sharks may patrol the waters of Georges River but mosquitoes rule the wetlands. When it comes to mosquito-borne disease risk, it is the swamp wallabies that really raise the risks.

Why are there more Ross River virus cases in autumn?

Remember when I posted the question back in January 2014… “could the Autumn of 2014 see a surge in cases of disease?” When national notification data for Ross River virus infections are reviewed, there is a distinct peak in cases around March. With regard to overall seasonal averages, there are more cases in the three months of autumn than those of summer. In part, the official statistics may reflect a delay between initial infection of an individual and the collection of official statistics but there are also other factors at play.

MonthlyRRV

Average monthly notifications of Ross River virus across Australia between 1992-2013 (National Notifiable Diseases Surveillance System)

What may be some of the driving factors in the autumn peak of disease notifications?

  1. It takes time for the pathogens to circulate amongst animals and mosquitoes. We don’t exactly know what kick starts outbreaks of Ross River virus. Is the virus present at very low levels all the time, only to explode when conditions are right or is it introduced by an animal or travelling human? Either way, it may take time for the pathogens to spread amongst local wildlife and, subsequently, sufficient numbers of mosquitoes becoming infected to drive increases in human disease notifications.
  2. Diversity of mosquito populations. While the abundance of estuarine mosquitoes (such as Aedes vigilax), and those associated with ephemeral habitats, will tend to go up and down over the summer and autumn, freshwater mosquitoes like Culex annulirostris will tend to build in their abundance from mid-summer through until autumn. These mosquitoes have been identified as key to outbreaks of Ross River virus. Perhaps it is the overall diversity, rather than abundance of a particular mosquito species that is important?
  3. Mosquitoes are living longer. As mentioned earlier, mosquitoes must bite an infected animal to become infective themselves. The longer a mosquito lives, the more likely it is to acquire an infected bloodmeal from a wallaby or kangaroo and then more likely to pass it on to one or more people. Like all insects, the mortality of mosquitoes is influenced by climate. Mosquitoes live longer during the cooler and, generally, more humid conditions in autumn than the hot and dry summer.
  4. We’re getting complacent. It may have been a long hot summer full of mosquitoes. Back in January you may have been chased out of the local wetlands due to the number of mosquitoes. As the intensity of nuisance-biting declines, most people are probably increasingly likely to skip the application of insect repellents or be vigilant about mosquito bites. Similarly, we’re probably less likely to apply a sunscreen in cooler months. I’ve worked with local health authorities to coordinate public health messages ahead of the Easter long weekend. I’ve often thought that this is a time when many head off on a camping weekend and may not be thinking about mozzies. Fortunately, in 2014, the Easter holiday falls towards the end of April, greatly reducing the risks when compared to early April holidays.
  5. More people are being tested in autumn. There is probably not an even spread of awareness of mosquito-borne disease amongst health professionals. Recently, my GP told me I’m the only person he’s ever requested a Barmah Forest virus test for (just routine testing for me). I live in a very low risk region but I’m only a 20min drive from a region currently experiencing Ross River virus and Barmah Forest virus activity amongst mosquito populations. When there are outbreaks, or when there is media coverage of Ross River virus activity, GPs and the community will be more aware of potential disease and perhaps may be more willing to request tests. This awareness is likely to build over the summer and into autumn so that, perhaps, more people are being tested in autumn than summer.

How does this influence public health messages?

While working for the Living with Mosquitoes group in the Hunter region, we discussed many different ways to increase awareness of mosquito-borne disease within the region. As well as developing a range of different approaches to raising awareness amongst the community, it was suggested that perhaps a local sports person could become a spokesperson for a television campaign. What sports person would you choose? A cricketer obviously right? Perhaps it should be a footballer given their considerably higher profile at this time of the year?

Should a NRL player, rather than summer sports star, be the face of a mosquito-borne disease awareness? (Photo: Sharks)

For me, I’m always trying to think of groups in the community that may be at higher risks or activities that may hold greater potential for exposure to mosquito bites. Bushwalking, camping and fishing are obvious cases in point. This was one of the reasons why we developed “mosquito risk tide charts” for a couple of years back, highlighting periods of the summer when mosquitoes were most likely to be in high abundance (as well as providing some general advice on mosquito repellents and other personal protection strategies).

The autumn peak in Ross River virus risk is always a consideration ahead of Easter holidays. This year, we’re fortunate in that the long weekend falls in mid-late April so the risks may be less had Easter fallen at the end of March or early April. Nonetheless, it is always important to spread the word as Australian’s head off for a weekend of camping. Make sure you’ve packed the repellent!

Lastly, I’ve been thinking back to the start of the football season. I’ve seen plenty of people out training hard throughout March in the lead up to the stat of the season. You may be less likely to be bitten by mozzies while actually running about but how about down down and the coaches, support staff and parents standing about. I must stress that there is no evidence from the human notification data that football training is resulting in increased numbers of cases but I wonder if this is a group of people to whom public health messages could be directed. They are typically a well connected group of people with good lines of communications, perhaps a reminder at the start of the football season about mosquito repellent use would be handy?

UPDATE [11 April 2014] NSW and Victorian Health authorities have issued new health warnings to avoid mosquito bites during the school holidays and Easter long weekend following the detection of the potentially fatal Murray Valley encephalitis virus in sentinel chicken flocks in the Riverina region. Other mosquito-borne viruses including Ross River and Barmah Forest viruses continue to be detected in mosquito populations collected along the coast. Current understandings of the more serious Murray Valley encephalitis virus and Kunjin virus are not thought to be active in coastal regions of NSW and SE QLD.

Why not join the conversation on Twitter by following me at @mozziebites?

The illustration at the top of this piece comes from the 1943 booklet “This is Ann – She’s dying to meet you” by the US War Department. Recognise the work of a very famous illustrator?