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Abstract

Background

Toscana virus (TOSV) is transmitted to humans through bites of infected sand flies. Neuroinvasive TOSV infections are leading causes of meningitis/encephalitis in southern Europe and notifiable in Italy since 2016. In 2022–23, Italy experienced extreme climate anomalies and a concomitant increase in mosquito and tick-borne disease transmission.

Aim

To identify the spatiotemporal distribution and risk groups of neuroinvasive TOSV infections in Italy in 2022–23 vs 2016–21.

Methods

We retrospectively described all autochthonous, laboratory-confirmed neuroinvasive TOSV cases notified to the national surveillance system in 2016–23 using frequencies, proportions, incidences and incidence risk ratios (IRRs) with 95% CIs, stratified by year, sex, age, region/autonomous province (AP) of infection/exposure and infection/exposure municipality by urbanisation level.

Results

In 2022–23, 276 cases were notified (average annual incidence: 2.34/1,000,000 population) vs 331 cases in 2016–21 (0.92/1,000,000), with increased incidence extending into September. In 2022–23, infections were acquired in 12/21 regions/APs, predominantly in Emilia Romagna (57.6%; 159/276) as in 2016–21, including four regions/APs with no local infections in 2016–21. Similar to 2016–21, during 2022–23 residence in rural municipalities (vs urban), male sex, working age (19–67 years) and age > 67 years (vs ≤ 18 years) were identified as risk factors with IRRs of 2.89 (95% CI: 2.01–4.17), 2.17 (95% CI: 1.66–2.84), 5.31 (95% CI: 2.81–10.0) and 5.06 (95% CI: 2.59–9.86), respectively.

Conclusion

Italy experienced a nearly 2.6-fold increase in neuroinvasive TOSV incidence in 2022–23 vs 2016–21. Raising public awareness on risk factors and personal protection measures may enhance prevention efforts.

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2025-01-16
2025-01-18
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References

  1. Ayhan N, Charrel RN. An update on Toscana virus distribution, genetics, medical and diagnostic aspects. Clin Microbiol Infect. 2020;26(8):1017-23.  https://doi.org/10.1016/j.cmi.2019.12.015  PMID: 31904562 
  2. Ayhan N, Baklouti A, Prudhomme J, Walder G, Amaro F, Alten B, et al. Practical guidelines for studies on sandfly-borne phleboviruses: part i: important points to consider ante field work. Vector Borne Zoonotic Dis. 2017;17(1):73-80.  https://doi.org/10.1089/vbz.2016.1957  PMID: 28055576 
  3. Ayhan N, Prudhomme J, Laroche L, Bañuls AL, Charrel RN. Broader geographical distribution of Toscana virus in the Mediterranean region suggests the existence of larger varieties of sand fly vectors. Microorganisms. 2020;8(1):114.  https://doi.org/10.3390/microorganisms8010114  PMID: 31947561 
  4. Charrel RN, Gallian P, Navarro-Marí JM, Nicoletti L, Papa A, Sánchez-Seco MP, et al. Emergence of Toscana virus in Europe. Emerg Infect Dis. 2005;11(11):1657-63.  https://doi.org/10.3201/eid1111.050869  PMID: 16318715 
  5. Laroche L, Jourdain F, Ayhan N, Bañuls AL, Charrel R, Prudhomme J. Incubation period for neuroinvasive Toscana virus infections. Emerg Infect Dis. 2021;27(12):3147-50.  https://doi.org/10.3201/eid2712.203172  PMID: 34808074 
  6. Depaquit J, Grandadam M, Fouque F, Andry PE, Peyrefitte C. Arthropod-borne viruses transmitted by Phlebotomine sandflies in Europe: a review. Euro Surveill. 2010;15(10):19507.  https://doi.org/10.2807/ese.15.10.19507-en  PMID: 20403307 
  7. Terrosi C, Olivieri R, Bianco C, Cellesi C, Cusi MG. Age-dependent seroprevalence of Toscana virus in central Italy and correlation with the clinical profile. Clin Vaccine Immunol. 2009;16(8):1251-2.  https://doi.org/10.1128/CVI.00376-08  PMID: 19553552 
  8. Calamusa G, Valenti RM, Vitale F, Mammina C, Romano N, Goedert JJ, et al. Seroprevalence of and risk factors for Toscana and Sicilian virus infection in a sample population of Sicily (Italy). J Infect. 2012;64(2):212-7.  https://doi.org/10.1016/j.jinf.2011.11.012  PMID: 22120113 
  9. Defilippo F, Carrera M, Lelli D, Canziani S, Moreno A, Sozzi E, et al. Distribution of phlebotomine sand flies (Diptera: Psychodidae) in the Lombardy Region, Northern Italy. Insects. 2022;13(5):463.  https://doi.org/10.3390/insects13050463  PMID: 35621798 
  10. Calzolari M, Romeo G, Munari M, Bonilauri P, Taddei R, Sampieri M, et al. Sand Flies and Pathogens in the Lowlands of Emilia-Romagna (Northern Italy). Viruses. 2022;14(10):2209.  https://doi.org/10.3390/v14102209  PMID: 36298764 
  11. Charrel RN, Bichaud L, de Lamballerie X. Emergence of Toscana virus in the mediterranean area. World J Virol. 2012;1(5):135-41.  https://doi.org/10.5501/wjv.v1.i5.135  PMID: 24175218 
  12. European Centre for Disease Prevention and Control (ECDC). Toscana virus infection. Stockholm: ECDC. [Accessed: 10 Dec 2024]. Available from: https://www.ecdc.europa.eu/en/toscana-virus-infection
  13. Reusken C, Baronti C, Mögling R, Papa A, Leitmeyer K, Charrel RN. Toscana, West Nile, Usutu and tick-borne encephalitis viruses: external quality assessment for molecular detection of emerging neurotropic viruses in Europe, 2017. Euro Surveill. 2019;24(50):1900051.  https://doi.org/10.2807/1560-7917.ES.2019.24.50.1900051  PMID: 31847946 
  14. Paz S. Climate change impacts on vector-borne diseases in Europe: Risks, predictions and actions. Lancet Reg Health Eur. 2020;1:100017.  https://doi.org/10.1016/j.lanepe.2020.100017  PMID: 35104838 
  15. Italian Institute for Environmental, Protection and Research. The Italian climate in 2022: a preliminary assessment. 2022. Available from: https://scia.isprambiente.it
  16. Copernicus. Surface air temperature maps. Paris: European Space Agency (ESA). [Accessed: 14 Feb 2024]. Available from: https://climate.copernicus.eu/surface-air-temperature-maps
  17. Istituto Superiore di Sanità. Arbovirosi in Italia 2024. [Arboviruses in Italy 2024]. Rome: Istituto Superiore di Sanità (ISS). [Accessed: 12 Feb 2024]. Available from: https://www.epicentro.iss.it/arbovirosi/dashboard
  18. Italian Ministry of Health. Piano Nazionale di prevenzione, sorveglianza e risposta alle Arbovirosi (PNA) 2020-2025. [National Plan for prevention, surveillance and response to Arboviruses 2020-2025]. Rome: Italian Ministry of Health; 2019. Italian. Available from: https://www.salute.gov.it/imgs/C_17_pubblicazioni_2947_allegato.pdf
  19. Italian National Institute of Statistics. Population and Households. [Accessed: 2 Feb 2024]. Available from: https://www.istat.it/en/population-and-households?data-and-indicators
  20. Eurostat. Local administrative units. Luxembourg: Eurostat. [Accessed: 5 Nov 2023]. Available from: https://ec.europa.eu/eurostat/web/nuts/local-administrative-units
  21. Mellace F, Del Manso M, Oradini-Alacreu A, Ceccarelli E, Mateo-Urdiales A, Petrone D, et al. Meningiti, meningo-encefaliti ed encefaliti da virus Toscana in Italia, 2016-2021: punta dell’iceberg di una arbovirosi endemica poco conosciuta. [Meningitis, meningoencephalitis and encephalitis from Toscana virus in Italy, 2016-2021: the tip of the iceberg of a little-known endemic arbovirus]. Boll Epidemiol Naz.2022;3(2):10-9. Italian.
  22. Todeschini R, Musti MA, Pandolfi P, Troncatti M, Baldini M, Resi D, et al. Re-emergence of human leishmaniasis in northern Italy, 2004 to 2022: a retrospective analysis. Euro Surveill. 2024;29(4):2300190.  https://doi.org/10.2807/1560-7917.ES.2024.29.4.2300190  PMID: 38275016 
  23. Azzalini D, Belloli GL, Gualanduzzi C, Mattei G, Matteo G, Mattivi A, et al. Toscana virus in Emilia-Romagna. Bologna: Settore Prevenzione collettiva e Sanità pubblica - Regione Emilia-Romagna; 2022. Italian. Available from: https://www.epicentro.iss.it/territorio/emilia-romagna/pdf/Epidemiologia-Toscana-Virus-2022.pdf
  24. Alten B, Maia C, Afonso MO, Campino L, Jiménez M, González E, et al. Seasonal dynamics of phlebotomine sand fly species proven vectors of mediterranean leishmaniasis caused by Leishmania infantum. PLoS Negl Trop Dis. 2016;10(2):e0004458.  https://doi.org/10.1371/journal.pntd.0004458  PMID: 26900688 
  25. Moirano G, Ellena M, Mercogliano P, Richiardi L, Maule M. Spatio-temporal pattern and meteo-climatic determinants of visceral leishmaniasis in Italy. Trop Med Infect Dis. 2022;7(11):337.  https://doi.org/10.3390/tropicalmed7110337  PMID: 36355879 
  26. Simsek FM, Alten B, Caglar SS, Ozbel Y, Aytekin AM, Kaynas S, et al. Distribution and altitudinal structuring of phlebotomine sand flies (Diptera: Psychodidae) in southern Anatolia, Turkey: their relation to human cutaneous leishmaniasis. J Vector Ecol. 2007;32(2):269-79.  https://doi.org/10.3376/1081-1710(2007)32[269:DAASOP]2.0.CO;2  PMID: 18260517 
  27. Gualano MR, Corradi A, Voglino G, Bert F, Siliquini R. Beyond COVID-19: a cross-sectional study in Italy exploring the covid collateral impacts on healthcare services. Health Policy. 2021;125(7):869-76.  https://doi.org/10.1016/j.healthpol.2021.03.005  PMID: 33840478 
  28. Calzolari M, Romeo G, Callegari E, Bonilauri P, Chiapponi C, Carra E, et al. Co-circulation of phleboviruses and leishmania parasites in sand flies from a single site in Italy monitored between 2017 and 2020. Viruses. 2021;13(8):1660.  https://doi.org/10.3390/v13081660  PMID: 34452524 
  29. Francisci D, Papili R, Camanni G, Morosi S, Ferracchiato N, Valente M, et al. Evidence of Toscana virus circulation in Umbria: first report. Eur J Epidemiol. 2003;18(5):457-9.  https://doi.org/10.1023/A:1024295710118  PMID: 12889693 
  30. Venturi G, Madeddu G, Rezza G, Ciccozzi M, Pettinato ML, Cilliano M, et al. Detection of Toscana virus central nervous system infections in Sardinia Island, Italy. J Clin Virol. 2007;40(1):90-1.  https://doi.org/10.1016/j.jcv.2007.06.005  PMID: 17662649 
  31. Feliciangeli MD. Natural breeding places of phlebotomine sandflies. Med Vet Entomol. 2004;18(1):71-80.  https://doi.org/10.1111/j.0269-283X.2004.0487.x  PMID: 15009450 
  32. Gámbaro F, Pérez AB, Prot M, Agüera E, Baidaliuk A, Sánchez-Seco MP, et al. Untargeted metagenomic sequencing identifies Toscana virus in patients with idiopathic meningitis, southern Spain, 2015 to 2019. Euro Surveill. 2023;28(45):2200913.  https://doi.org/10.2807/1560-7917.ES.2023.28.45.2200913  PMID: 37943504 
  33. Fournet F, Simard F, Fontenille D. Green cities and vector-borne diseases: emerging concerns and opportunities. Euro Surveill. 2024;29(10):2300548.  https://doi.org/10.2807/1560-7917.ES.2024.29.10.2300548  PMID: 38456216 
  34. Christova I, Panayotova E, Trifonova I, Taseva E, Gladnishka T, Ivanova V. Serologic evidence of widespread Toscana virus infection in Bulgaria. J Infect Public Health. 2020;13(2):164-6.  https://doi.org/10.1016/j.jiph.2019.07.008  PMID: 31401037 
Human neuroinvasive Toscana virus infections in Italy from 2016 to 2023: Increased incidence in 2022 and 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Emmanouil+Alexandros+Fotakis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fotakis Emmanouil Alexandros</a>, <a href="/search?value1=Elisa+Di+Maggio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Di Maggio Elisa</a>, <a href="/search?value1=Martina+Del+Manso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Del Manso Martina</a>, <a href="/search?value1=Alberto+Mateo-Urdiales&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mateo-Urdiales Alberto</a>, <a href="/search?value1=Daniele+Petrone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Petrone Daniele</a>, <a href="/search?value1=Massimo+Fabiani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fabiani Massimo</a>, <a href="/search?value1=Giulia+Perego&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Perego Giulia</a>, <a href="/search?value1=Antonino+Bella&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bella Antonino</a>, <a href="/search?value1=Gioia+Bongiorno&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bongiorno Gioia</a>, <a href="/search?value1=Ilaria+Bernardini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bernardini Ilaria</a>, <a href="/search?value1=Marco+Di+Luca&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Di Luca Marco</a>, <a href="/search?value1=Giulietta+Venturi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Venturi Giulietta</a>, <a href="/search?value1=Claudia+Fortuna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fortuna Claudia</a>, <a href="/search?value1=Stefania+Giannitelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Giannitelli Stefania</a>, <a href="/search?value1=Federica+Ferraro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ferraro Federica</a>, <a href="/search?value1=Francesco+Maraglino&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maraglino Francesco</a>, <a href="/search?value1=Patrizio+Pezzotti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pezzotti Patrizio</a>, <a href="/search?value1=Anna+Teresa+Palamara&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Palamara Anna Teresa</a>, <a href="/search?value1=Flavia+Riccardo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Riccardo Flavia</a>, <a href="/search?value1=Italian+Arbovirus+Surveillance+network&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Italian Arbovirus Surveillance network</a></span>. Human neuroinvasive Toscana virus infections in Italy from 2016 to 2023: Increased incidence in 2022 and 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(2):pii=2400203. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.2.2400203" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.2.2400203</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 29 Mar 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 29 Jul 2024 </span> </p>
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