DONDENA Centre for Research on Social Dynamics, Bocconi University, Milano, Italy.
Center for Information Technology, Bruno Kessler Foundation, Trento, Italy.
Sci Rep. 2018 Jun 13;8(1):9034. doi: 10.1038/s41598-018-27443-9.
The arrival of infected travelers from endemic regions can trigger sustained autochthonous transmission of mosquito-borne pathogens in Europe. In 2007 a Chikungunya outbreak was observed in central Italy, mostly affecting two villages characterised by a high density of Aedes albopictus. The outbreak was mitigated through intervention strategies reducing the mosquito abundance. Ten years later, in 2017, sustained Chikungunya transmission was documented in both central and southern Italy. The proposed analysis identifies suitable reactive measures for the containment and mitigation of future epidemics by combining epidemiological modeling with a health economic approach, considering different arrival times of imported infections and possible delays in the notification of cases. Obtained estimates suggest that, if the first notification will occur in the middle of the mosquito breeding season, the combination of larvicides, adulticides and breeding sites removal represents the optimal strategy. In particular, we found that interventions implemented in 2007 were cost-effective, with about 3200 prevented cases, 1450 DALYs averted and €13.5 M saved. Moreover, larvicides are proven to be more cost beneficial in early summer and warmer seasons, while adulticides should be preferred in autumn and colder seasons. Our results provide useful indications supporting urgent decision-making of public health authorities in response to emerging mosquito-borne epidemics.
来自流行地区的感染旅行者的到来可能会引发欧洲蚊媒病原体的持续本地传播。2007 年，意大利中部发生了基孔肯雅热疫情，主要影响两个以白纹伊蚊密度高为特征的村庄。通过减少蚊子数量的干预策略缓解了疫情。十年后，即 2017 年，意大利中部和南部都有持续的基孔肯雅热传播。该分析通过将流行病学模型与健康经济学方法相结合，考虑到输入感染的不同到达时间和病例报告的可能延迟，提出了适当的反应措施，以控制和减轻未来的疫情。所得估计表明，如果第一次报告发生在蚊子繁殖季节的中期，那么使用幼虫剂、成虫剂和清除滋生地的组合将是最佳策略。特别是，我们发现 2007 年实施的干预措施具有成本效益，可预防约 3200 例病例，避免 1450 个 DALY，并节省 1350 万欧元。此外，幼虫剂在初夏和温暖季节更具成本效益，而成虫剂应在秋季和寒冷季节优先使用。我们的研究结果提供了有用的信息，支持公共卫生当局在应对新出现的蚊媒传染病时做出紧急决策。
