Global Health Security 2019 – Mosquito threats and community engagement

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While we can embrace technology to track pathogens and diseases, engaging the community to be more aware of the risk and the ways to avoid them will be critical in reducing the public health burden across the globe. This was a key message repeated again and again throughout the sessions at the inaugural Global Health Security conference in Sydney.

The event around 800 delegates representing academia, local, national and international governmental and non-governmental organizations, public and animal health and security professionals, and the private sector. There were representatives from over 65 countries.

I had the opportunity to contribute in a couple of sessions, firstly the ‘Emerging Infectious Diseases in a Changing Global Environment’ workshop at the university of Sydney. This was co-presented by the Marie Bashir Institute for Infectious Diseases and Biosecurity and CREID – NHMRC Centre of Research Excellence in Emerging Infectious Disease. It was described as an “event is an opportunity for policy makers, public health and clinical researchers, veterinarians, scientists, and WHO representatives to come together and define the health security issues related to emerging infectious diseases (EIDs) and antimicrobial resistance (AMR) in the Asia-Pacific region.”

I spoke about mosquitoes in Australian cities and the challenges facing the management of issues associated with urban planning, constructed and rehabilitated wetlands, endemic mosquito-borne disease risk, and exotic mosquito threats. A little nervous having the Chief Medical Officer of Australia (Prof Brendan Murphy) in the front row, along with representatives of WHO and CDC but a wonderful opportunity to share my research and perspectives on these local issues.

The following day, I spoke in the “Challenges with Zoonotic Diseases” session alongside Elpidius Rukambile and Berihun Afera Tadele. An interesting session (chaired by Siobhan Mor) that, through the panel discussion, highlighted the importance of community engagement, as well as communications between policy makers and those “on the ground” in improving public health outcomes in the “one health” space.

I spoke about the issues surrounding exotic mosquito threats in Australia with a focus on the results of recent work on the far north coast of NSW. The work we did there highlighted the need for cooperation between all levels of government but also the critical importance of engaging the local community. Notwithstanding the effort required to go from property to property searching for introduced mosquitoes, such as Aedes aegypti or Aedes albopictus, understanding the role of the community in this response provided essential. Successful local eradication of any introduced mosquito will require assistance from the local community.

The abstract of my presentation is below:

Building capacity to address the unexpected challenges associated with the emerging threat of exotic mosquitoes in Australia

Webb C (1,2),  Doggett S (2), Piazza K (3), McNicoll D (3), Sly A (4), Neilson J (4), Dean A (5), Bethmont A (6).

1 University Of Sydney, Westmead NSW, Australia; 2 NSW Health Pathology, Westmead NSW, Australia; 3 Tweed Shire Council, Tweed Heads NSW, Australia; 4 Department of Agriculture and Water Resources, Canberra ACT, Australia; 5 University of Queensland, Brisbane QLD, Australia; 6 NSW Health, North Sydney NSW, Australia

Introduction. Ongoing evolution of trade pathways increases the risk of exotic mosquitoes, especially Aedes albopictus and pesticide resistant Ae. aegypti, establishing or expanding their range in Australia. This highlights the need for health authorities to develop strategic response plans considering different risk scenarios. Context and Aim. Key challenges to exotic mosquito response in Australian include capacity at local government level and community acceptance of measures. Several strategic initiatives were used to study these challenges in the NSW Northern Rivers region. Method. Field exercises were undertaken with representatives of 11 local and state authority stakeholders, surveying approximately 300 residential properties for potential mosquito habitats. A survey of community attitudes to mosquito threats and responses was also conducted, with over 700 responses collected. Findings. Surveys found almost 4,000 actual and potential container breeding sites, demonstrating potential for exotic mosquito establishment and subsequent need to manage local transmission risks of pathogens including dengue, chikungunya and Zika viruses. Surveys of community attitudes found significant community resistance to required mosquito control activities, indicating responses would be challenging and need strategic planning. Innovative contribution to policy and practice. Strategic response plans must address mosquito biology but also not underestimate the need for active community engagement.

Overall, it was a wonderful meeting. It was, however, unfortunate that I couldn’t spend as much time in sessions as I would have liked. There were plenty of tweets so check in on the hashtag #GHS2019. There is also the very important “The Sydney Statement on Global Health Security” to come out of the meeting, please check it out.

Were you at the meeting? What did you think? Join the conversation on Twitter.

 

 

Mosquitoes feed on frogs, very small frogs…

I was excited to be asked back on the Science on Top podcast recently to record an episode about mosquitoes, currently declines in insect populations (are mosquitoes on the way out too?), and whether recent flooding in north QLD would result in increased mosquito populations and risk of mosquito-borne disease outbreak.

Please subscribe to the podcast, its a really fun and relaxed look at whats making headlines in the science world. The crew themselves describe the podcast as:

The Australian podcast about science, health and technology news. Join Ed Brown and his panel of co-hosts each week as we talk about the latest and coolest research and discoveries in the world of science. We’re joined by special guests from all over the science field: doctors, professors, nurses, teachers and more.

If you’re interested, you can chase up my previous guest spot with them talking “Everything Zika” back in 2016.

I still hold some aspirations of starting my own podcast. Problem is finding the time (there isn’t even enough time to catch up on my podcast “to do” list). Perhaps this is a project for the coming summer.

Would you listen to a podcast about mosquitoes and the people who study them?

You can catch up on a couple of other podcasts I’ve guested on over the past few years. Check out Flash Forward (The Ultimate Swatting) and Arthropod (Getting to Know Mosquitoes).

Oh, and mosquitoes do feed on frogs. Frog blood, not the whole thing. It would have to be a very small frog…

 

 

 

Ross River virus in Sydney, should we be worried?

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Health authorities in NSW recently released warnings to avoid mosquito bites following the detection of Ross River virus in wetlands along two major river systems in metropolitan Sydney. Whats going on and should these findings be something to be worried about?

What is Ross River virus?

Ross River virus is the most commonly reported mosquito-borne disease in Australia. The virus is spread by the bite of a mosquito and about 40 different mosquito species have been implicated in its transmission.

The disease caused by Ross River virus is not fatal but it can be severely debilitating.

Thousands of Australian’s are infected each year. We have some idea of the quantity of infections as Ross River virus disease is classified as a notifiable disease. While the official statistics indicate there are around 5,000 cases of illness across the country (there are between 500 and 1,500 cases per year in NSW), there are likely to be many more people that experience a much milder illness and so never get blood tests to confirm infection. These people won’t appear in official statistics.

What makes Ross River virus a fascinating pathogen to study is also what makes it extremely difficult to predict outbreaks. Transmission cycles require more than just mosquitoes. Mosquitoes don’t emerge from local wetlands infected with the virus, they need to bite an animal first and become infected themselves before then being able to pass on the pathogen to people.

It is generally thought that kangaroos and wallabies are the most important animals driving outbreak risk. However, we’re starting to better understand how the diversity of local wildlife may enhance, or reduce, likely transmission risk.

How was the virus found in Sydney?

The recent warnings have been triggered by the results of mosquito trapping and testing around Sydney. NSW Health coordinates an arbovirus and mosquito monitoring program across the state and this includes surveillance locations within metropolitan Sydney.

Mosquitoes are collected using traps baited with carbon dioxide. They trick the mosquitoes into thinking the trap is an animal. By catching mosquitoes, we can better understand how the pest and public health risks vary across the city and the conditions that make mosquitoes increase (or decrease) in numbers.

It mostly occurs around the metropolitan region’s northern and southern river systems and generally associated with estuarine or brackish-water wetlands. In these areas, there are often abundant mosquitoes and wildlife. Along the Parramatta River, there are often abundant mosquito populations but given the heavily urbanised landscape, there aren’t many kangaroos and wallabies.

The nuisance impacts of mosquitoes, such as Aedes vigilax, dispersing from the estuarine wetlands of the Parramatta River can create challenges for local authorities. These challenges include targeted wetland conservation and rehabilitation strategies along with ecologically sustainable mosquito control programs.

Is the detection of the virus in Sydney unusual?

The detection of Ross River virus is not that unusual. Detection of Ross River virus (as well as other mosquito-borne viruses such as Stratford virus) along the Georges River in southern Sydney is an almost annual occurrence. The local health authorities routinely issue warnings and in recent years have successfully used social media to spread their messages.

Ross River virus has also previously been detected along the Parramatta River.

While there have been confirmed local clusters of locally acquired Ross River virus in the suburbs along the Georges River, there have been no confirmed cases of Ross River virus disease in the suburbs along the Parramatta River.

There are a few reasons why more disease isn’t reported. Health authorities are active in promoting personal protection measures, sharing recommendations on insect repellent use and providing regular reminders of the health risks associated with local mosquitoes. It isn’t unreasonable to think these actions raise awareness and encourage behaviour change that reduces mosquito bites and subsequent disease.

Along the Georges River, there is clearly a higher risk of infection given the more significant wildlife populations, especially the wallabies common throughout Georges River National Park. By comparison, along the Parramatta River there are fewer bushland areas and virtually no wallabies (except for the occasional one hopping across the Sydney Harbour Bridge). Even in the wetland areas around Sydney Olympic Park, there is abundant bird life, meaning mosquitoes are probably more likely to be biting the animals than people. A study looking at the blood feeding preferences of mosquitoes in the local area found that animals were more likely to be bitten, mosquitoes actually only fed on humans about 10% of the time.

It is important that if you’re spending a lot of time outdoors in these areas, especially close to wetlands and bush land areas at dawn and dusk when mosquitoes are most active, take measure to reduce the risk of being bitten. Cover up with long sleeved shirts and long pants and apply an insect repellent. Choose a repellent that contains either DEET (diethlytoluamide), picaridin, or oil of lemon eucalyptus. Apply it to all exposed skin to ensure there is a thin even coat – a dab “here and there” doesn’t provide adequate protection. More tips here.

Also, keep in mind that just because cooler weather has arrived, the health risks associated with mosquitoes remain. That means keeping in mind that mosquitoes will be out and about just as football and netball seasons start so take along some mosquito repellent to training nights.

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Join the conversation on Twitter!

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Can citizen science help stop mosquito-borne disease outbreaks?

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Mosquito surveillance has been a critical component of how health authorities manage the risk of mosquito-borne disease. Data on the abundance and diversity of mosquitoes, together with activity of mosquito-borne pathogens, can guide decisions on when and how to apply mosquito control agents or issue public health warnings.

Almost every state and territory in Australia conducts seasonal mosquito surveillance. The exceptions are Tasmania and ACT, although both have had some limited investigations over the years. Even among those doing routine surveillance, the program structure varies but most include the collection of mosquitoes. This is how we can determine if it really is “the worst mosquito season ever”!

The programs are currently are working well in providing early warnings of outbreaks of mosquito-borne disease. These programs often include mosquito trapping undertaken by local governments and, occasionally, members of the public. For may years there has been a strong interest in citizen scientists undertaking mosquito sampling, particularly by some schools. The projects that I’ve been involved with have rarely got off the ground for various reasons. School holidays at the peak of mosquito season doesn’t help. Beyond that, the consumable costs of the traps we use, especially the dry-ice (carbon dioxide) used to bait the traps, can be a barrier to involvement. Dry-ice use in schools, and the associated health and safety issues, has been a cause for concern too. Finally, the fact that mosquitoes may be attracted to traps operated in school or community grounds and that these mosquitoes may be carrying disease-causing pathogens can often raise concerns.

As a result, there really haven’t been any major citizen science based mosquito surveillance programs until recently. Things are changing.

One reason local authorities are starting to turn their minds to a citizen science based approach is that the threat of exotic mosquitoes will require a shift in focus from the swamps to the suburbs. The mosquitoes that drive outbreaks of dengue, particularly Aedes aegypti and Aedes albopictus live in water-holding containers in backyards and populations are not as easily measured by traditional surveillance approaches. This is why there has been a much stronger engagement with the public in Far North QLD (a region where Aedes aegypti is present and causes occasional outbreaks of dengue) where health authorities are regularly visiting backyards looking for and controlling backyard mosquitoes

There are many reasons why citizen science is starting to come into play when it comes to mosquito surveillance more broadly. Technology is getting better (as highlighted by many smartphone apps) but also, some of the laboratory techniques are getting cheaper. This is a really critical issue.

A breakthrough in rapid testing of mosquitoes led to the development of an award winning initiative in Brisbane by Metro South Health and Queensland Health Forensic & Scientific Services. The Zika Mozzie Seeker project combines this new laboratory technique with DIY mosquito traps by the general public to help track exotic mosquitoes. In short, residents create their own mosquito trap out of a bucket or recycled plastic container, it is filled with water and placed in a yard with a small piece of paper hung inside. Mosquitoes then drop by to lay eggs on the paper. After a couple of weeks, the traps are collected and egg filled paper strips sent to the lab and tested to track the DNA of local and exotic mosquitoes. The project has been an amazing success with around 2,000 participants being involved in recent years (that adds up to about 150,000 mosquito eggs collected and tested). Luckily, no exotic mosquitoes have been detected.

But when it comes to citizen science based projects, perhaps it isn’t the mosquitoes collected (the backyard mosquito battles are fun to track though) but the awareness raised that is important. Awareness not only of the risks posed by mosquitoes, but what you can do about them through the safe and effective use of mosquito repellents and other personal protection measures. Engaging the public through citizen science may be the way to go. It doesn’t always work in reaching new audiences, as was discovered in a mosquito surveillance project in South Australia, but that doesn’t mean it won’t!

Perhaps the rise in new smartphone apps will help. There are a few out there, like the Globe Observer and Mosquito Alert. These, and other smartphone apps, deserve their own post (stay tuned). However, the significant initiative of recent years has been the Global Mosquito Alert project. Launched in May 2017, here is an extract from their media release:

The new initiative, launched under the name ‘Global Mosquito Alert’, brings together thousands of scientists and volunteers from around the world to track and control mosquito borne viruses, including Zika, yellow fever, chikungunya, dengue, malaria and the West Nile virus. It is the first global platform dedicated to citizen science techniques to tackle the monitoring of mosquito populations. The programme is expected to move forward as a collaboration involving the European, Australian and American Citizen Science Associations as well as the developing citizen science community in Southeast Asia.

With such momentum, it is an exciting time to consider the potential of citizen science in Australian mosquito surveillance programs. This is what i will be exploring in my presentation at the Australian Citizen Science Conference in Adelaide this week.

I’ll be presenting the paper on Wednesday 7 February 2018 in the “Empower with Data” session. The full abstract of our presentation is below:

The public as a partner in enhancing mosquito surveillance networks to protect public health

Craig Williams (1), Brian L. Montgomery (2), Phil Rocha (2), and Cameron Webb (3)

(1) University of South Australia, School of Pharmacy and Medical Sciences; (2) Metro South Public Health Unit, Queensland Health; (3) Medical Entomology, Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney

Mosquito-borne diseases are pervasive public health concerns on a global scale. Strategic management of risk requires well-designed surveillance programs, typically coordinated by local health authorities, for both endemic and exotic mosquitoes as well as the pathogens that they may transmit. There is great potential to utilise citizen science to expand the reach of current surveillance programs, particularly those centred on urban areas. There is increasing focus internationally on the role of citizen science in mosquito surveillance as evidenced by the establishment of the ‘Global Mosquito Alert’ project driven by multiple international stakeholders and citizen science associations. In Australia, new initiatives to engage the public in mosquito surveillance are emerging in multiple centres; utilizing a range of emerging field and laboratory technologies that remove previously existing barriers to community involvement. In South Australia, citizen science entomology programs have been trialed, and mosquito trapping and identification technology to expand existing trapping networks has been assessed. In suburban South-East Queensland, Zika Mozzie Seeker is linking citizen scientists into a network by using new laboratory techniques to rapidly screen for Ae. aegypti DNA in large numbers of eggs collected from DIY ovitraps,. In NSW, citizen science is being used to promote biodiversity and delineate pest and non-pest activity of mosquitoes associated with urban wetlands and surrounding suburbs. Citizen science holds great potential for public engagement activities as well as serving to enhance existing surveillance operations.

 

Join the conversation on Twitter by following Dr Cameron Webb, A/Prof Craig Williams and keep an eye on the meeting via the hashtag

Ross River virus in Melbourne, how did that happen?

aedesnotoscriptus

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.