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A Review of Viral Zoonoses Throughout Europe
ticks or by serological surveys.
75,76
The most recent outbreaks described in Ae. albopictus. This species, with Asian roots, spread to the American and
Europe were a family cluster of eight cases in Albania in 2001
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and 69 African continents in the last two decades and it is now firmly established in
suspected cases, with six deaths, in Kosovo in 2001.
78
Since 2003, North and South America, Africa, Australia and Europe. It was first detected
outbreaks have occurred in Turkey with increasing numbers of cases and a in Europe in 1979 in Albania and probably introduced into that country from
wider distribution.
79
The most efficient and common vectors for CCHF China around 1975.
96
It is likely that the initial infestation took place at a
appear to be members of the Hyalomma genus. Domestic animals such as rubber factory adjacent to the port of Durres (Durazzo). From there the eggs
cattle, sheep and goats remain viremic for about one week after infection of the mosquito were shipped in vehicle tyres to other parts of the country.
without any clinical symptoms. Humans acquire the virus from direct This was the first recorded infestation of Ae. albopictus outside Asia.
contact with blood or other infected tissues of livestock, by tick removal Climate and other ecological changes such as reduced biodiversity and
from livestock or by a tick bite. CCHF is a severe disease in humans, with a habitat fragmentation might also lead to a shift in the prevalence of vector
mortality of approximately 5–30% of hospitalised patients.
80
There is a and reservoir populations of species already present in Europe. It may lead
serious risk of nosocomial spread of the infection when patients are to the increase and spread of existing vector-borne diseases (viral and
admitted to hospital.
81
Patients with suspected or confirmed CCHF should bacterial) in Europe, and there are a number of infections whose
be isolated and barrier-nursing techniques should be applied. Other tick- importation may result in epidemic transmission in Europe due to the
transmitted viruses of lesser importance present in Europe include the presence of potential vectors.
Bhanja virus (Bunyavirus complex), which is present in southern Europe and
the Balkans, along with Africa and Asia.
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The first report of human illness Rift Valley fever must be considered a serious threat. Blue tongue virus has
due to infection with Bhanja virus occurred in Dalmatia, Croatia in 1977, already rampaged through western Europe in 2005 and 2006. The spread
where an antibody rate of 31% was found on the island of Brac and where of Israel spotted fever to Portugal and the appearance of Boutonneuse fever
the virus was isolated from Haemaphysalis punctata.
83
Thogoto virus and in Switzerland demonstrate that if a suitable local vector is present, local
Dhori virus are members of the family Orthomyxoviridae. Thogoto virus is transmission of introduced diseases can occur. Cases of African tick-bite
widely distributed in Africa and in Europe it has been found in Italy (Sicily) fever have been reported in France, but all were among travellers returning
and Portugal.
84
Dhori virus has been isolated from Hyalomma marginatum from endemic areas in southern Africa.
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The Intergovernmental Panel on
in Portugal and antibodies were also found in humans in Portugal.
85,86
They Climate Change (IPCC) stated in its fourth assessment report that by 2100
are known to cause neurological disorders, although it does not appear to average global temperatures will increase by 1.0–3.5°C. Significant
be of public health importance in Europe. Tribec virus, an Orbivirus, was ecological changes are to be expected. Such increases in temperatures in
first isolated from I. ricinus in Slovakia
87
and has been reported in Belarus, Europe might allow the establishment of tropical and semi-tropical vector
Estonia, France, the Czech Republic, Hungary, Italy, Norway, Romania, the species, permitting the transmission of diseases in areas where low
Russian Federation and Ukraine. Although some 20 patients with CNS temperatures have hitherto prevented their ‘over-wintering’.
infection in Czechoslovakia had antibodies to the tribec virus,
88
its overall
public health importance is limited. The spectrum of viral zoonoses in Europe encompasses the ‘common’ viral
diseases such as TBEV and hantavirus infections to rare or very rare viral
Tettnang virus, for which the taxonomy remains unclear, was isolated from diseases such as Inkoo, Batai, Thogoto and Bhanja virus. The risk of the
I. ricinus ticks, rodents and mosquitoes in the former Czechoslovakia.
89,90
(re-) emergence of new and exotic viruses owing to climate change and
Tettnang virus was also isolated from the cerebrospinal fluid (CSF) of an 18- globalisation renders the situation even more complex. The answer to these
month-old child with pharyngitis, accompanied by an encephalitic problems evidently lies in enhanced surveillance on a European scale and
reaction.
91
The few reports of illness appear to limit its public health more research into these viruses, with the development of more and better
importance. Each virus (Orbivirus) is closely related to the Colorado tick fever diagnostic tools. Concerted action on a European level is already taking
virus. It has been isolated from I. ricinus in Baden-Wurttemberg, Germany
92
place. The European Centre of Disease Prevention and Control (ECDC)
and from I. ricinus and I. ventalloi ticks in France.
93
Chastel et al. observed (cdc.europa.eu/) was established in 2005 with the mission of strengthening
that the virus is able to infect humans and induce severe neurological Europe’s defences against infectious diseases by identifying, assessing and
disorders.
94
Each virus has also been found in The Netherlands and the communicating current and emerging threats and to develop disease
Czech Republic. The virus is widespread in hare populations and probably in surveillance and early warning systems. In order to achieve this goal, the
rodents as well.
95
Furthermore, there are a number of other viruses that ECDC collaborates closely with national public health institutions in the EU.
have recently been isolated in various parts of Europe whose importance as Under the ECDC umbrella, several specialised networks are active. In the
causative agents of disease is unknown or uncertain; their discussion is field of viral diseases, the European Network for Diagnostics of Imported
beyond the scope of this review. As many areas of the European continent Viral Diseases (ENIVD) (enivd.de/), established in 1995, is currently
remain unstudied, further research will undoubtedly find other viruses. incorporated in the ECDC Programme on Emerging and Vector-borne
Increased travel and the transport of goods, particularly by containers, have Diseases (EVD). The ENIVD member laboratories have been implicated in the
resulted in the introduction and establishment of vector species not diagnostics of imported severe acute respiratory syndrome (SARS) and viral
previously present in Europe. A striking example is the mosquito haemorrhagic fever (VHF) cases into the EU.
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1. Vapalahti O, Mustonen J, Lundkvist A, et al., Hantavirus infections 4. Golovljova I, Vasilenko V, Mittzenkov V, et al., Characterization of region of Hungary, Virus Res, 2007;128(1–2):149–52.
in Europe, Lancet Infect Dis, 2003; 3(10):653–61. haemorrhagic fever with renal syndrome caused by hantaviruses, 7. Papa A, Bojovic B, Antoniadis A, Hantaviruses in Serbia and
2. Heyman P, Vaheri A, Enivd M, Situation of hantavirus infections Estonia, Emerg Infect Dis, 2007;13(11):1773–6 . Montenegro, Emerg Infect Dis, 2006;12(6):1015–18.
and haemorrhagic fever with renal syndrome in European 5. Cerar D, Avsic-Zupanc T, Jereb M, Strle F, Case report:severe 8. Sandmann S, Meisel H, Razanskiene A, et al., Detection of human
countries as of December 2006, Euro Surveill, 2008;13(28). neurological manifestation of Dobrava hantavirus infection, J Med hantavirus infections in Lithuania, Infection, 2005;33(2):66–72.
3. Klempa B, Tkachenko EA, Dzagurova TK, et al., Haemorrhagic Virol, 2007;79(12):1841–3. 9. Lundkvist A, Lindegren G, Brus SK, et al., Hantavirus infections in
fever with renal syndrome caused by 2 lineages of Dobrava 6. Jakab F, Horvath G, Ferenczi E, et al., Detection of Dobrava Latvia, Eur J Clin Microbiol Infect Dis, 2002;21(8):626–9.
hantavirus, Russia, Emerg Infect Dis, 2008;14(4):617–25. hantaviruses in Apodemus agrarius mice in the Transdanubian 10. Markotic A, Nichol ST, Kuzman I, et al., Characteristics of Puumala
EUROPEAN INFECTIOUS DISEASE 73
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