[graffis-l]TROPICAL VIRUS MOVES TO ITALY

[Guest guest]

As Earth Warms Up, Tropical Virus Moves to

Italy

 

 

Posted by: " Mark Graffis "

mgraffis

mgraffis

 

 

Sun Dec 23, 2007 4:59 am (PST)

http://www.nytimes.com/2007/12/23/world/europe/23virus.html?_r=1 & ref=science & oref=slogin

December 23, 2007

As Earth Warms Up, Tropical Virus Moves to Italy By ELISABETH ROSENTHAL

CASTIGLIONE DI CERVIA, Italy ­ Panic was spreading this August

through this tidy village of 2,000 as one person after another fell ill

with weeks of high fever, exhaustion and excruciating bone pain, just as

most of Italy was enjoying Ferragosto, its most important summer holiday.

 

“At one point, I simply couldn’t stand up to get out of the car,”

said Antonio Ciano, 62, an elegant retiree in a pashmina scarf and trendy

blue glasses. “I fell. I thought, O.K., my time is up. I’m going to die.

It was really that dramatic.”

By midmonth, more than 100 people had come down with the same malady.

Although the worst symptoms dissipated after a couple of weeks, no doctor

could figure out what was wrong.

People blamed pollution in the river. They denounced the government.

But most of all they blamed recent immigrants from tropical Africa for

bringing the pestilence to their sleepy settlement of pastel stucco

homes.

“Why immigrants?” asked Rina Ventura, who owns a shop selling shoes

and purses. “I kept thinking of these terrible diseases that you see on

TV, like malaria. We were terrified. There was no name and no treatment.”

 

Oddly, the villagers were both right and wrong. After a month of

investigation, Italian public health officials discovered that the people

of Castiglione di Cervia were, in fact, suffering from a tropical

disease, chikungunya, a relative of dengue fever normally found in the

Indian Ocean region. But the immigrants spreading the disease were not

humans but insects: tiger mosquitoes, who can thrive in a warming Europe.

 

Aided by global warming and globalization, Castiglione di Cervia has

the dubious distinction of playing host to the first outbreak in modern

Europe of a disease that had previously been seen only in the tropics.

 

“By the time we got back the name and surname of the virus, our

outbreak was over,” said Dr. Rafaella Angelini, director of the regional

public health department in Ravenna. “When they told us it was

chikungunya, it was not a problem for Ravenna any more. But I thought:

this is a big problem for Europe.”

The epidemic proved that tropical viruses are now able to spread in

new areas, far north of their previous range. The tiger mosquito, which

first arrived in Ravenna three years ago, is thriving across southern

Europe and even in France and Switzerland.

And if chikungunya can spread to Castiglione ­ “a place not special

in any way,” Dr. Angelini said ­ there is no reason why it cannot go to

other Italian villages. There is no reason why dengue, an even more

debilitating tropical disease, cannot as well.

“This is the first case of an epidemic of a tropical disease in a

developed, European country,” said Dr. Roberto Bertollini, director of

the World Health Organization’s Health and Environment program. “Climate

change creates conditions that make it easier for this mosquito to

survive and it opens the door to diseases that didn’t exist here

previously. This is a real issue. Now, today. It is not something a crazy

environmentalist is warning about.”

Was he shocked to discover chikungunya in Italy, his native land? “We

knew this would happen sooner or later,” he said. “We just didn’t know

where or when.”

It certainly caught this town off guard on Aug. 9, when public health

officials in Ravenna received an angry call from Stefano Merlo, who owns

the gas station.

“Within 100 meters of my home, there were more than 30 people with

fevers over 40 degrees,” or 104 Fahrenheit, said Mr. Merlo, 47. “I wanted

to know what was going on. I knew it couldn’t be normal.”

August is not the season for high fevers, Dr. Angelini agreed, and

within days of interviewing patients she was intrigued.

“The stories were so similar and so dramatic,” she said. “But we had

no clue it was something tropical.”

Hard-working shopkeepers could not get out of bed because their hips

hurt so much. Able-bodied men could not lift spoons to their mouths.

(Months later, many still have debilitating joint pain.)

From the start, doctors suspected that the disease was spread by

insects, rather than people. While almost all homes had one person who

was ill, family members seemed not to catch the disease from one another.

 

They initially focused on sand flies, since the disease clustered on

streets by the river.

Canceling their traditional mid-August vacations (in Italy, a true

sign of panic), health officials sent off blood samples, called national

infectious-disease experts, searched the Internet and set out traps to

see what insects were in the neighborhood. The first surprise was that

the insect traps contained not sand flies but tiger mosquitoes, and huge

numbers of them.

The scientific survey confirmed what residents of Castiglione had

come to accept as a horrible nuisance, though not a deadly threat.

“In the last three or four years, you couldn’t live on these streets

because the mosquitoes were so bad,” said Rino Ricchi, a road worker who

fell ill, standing at the entrance to his neatly tended garden, where

mosquito traps have now replaced decorative fountains. “We used to

delight in having a garden or a porch to eat dinner. You couldn’t this

year, you’d get eaten alive.”

Said Dr. Angelini: “They were treating the mosquitoes like an

annoyance. They knew that mosquitoes could spread tropical diseases but

they had peace of mind because they knew this didn’t happen in Italy.”

 

Ravenna immediately set about killing the bugs in the hopes of

containing the epidemic. Workers sprayed insecticides and went into each

family’s garden, emptying flower pots, fountains and the rainwater

collection barrels to remove the mosquitoes’ breeding ground.

By early September, there were no new cases in Castiglione di Cervia.

But there were a number of mini-epidemics in the region ­ in Ravenna,

Cesena and Rimini ­ set off by tiger mosquitoes there. Each was

controlled in the same way.

By that point, the doctors had cataloged the patients’ symptoms and

tried to match them to mosquito-borne diseases.

“We realized,” Dr. Angelini said, “we were seeing a photocopy of an

outbreak on Réunion,” a French island in the Indian Ocean where more than

10,000 people have contracted chikungunya in the last two years. Blood

tests confirmed the diagnosis. By summer’s end, home-grown chikungunya

had been diagnosed in nearly 300 Italians.

Chikungunya is spread when tiger mosquitoes drink blood from an

infected person and, if conditions are right, pass the virus on when they

bite again. Tiger mosquitoes first came to southern Italy with shipments

of tires from Albania about a decade ago but their habitat has expanded

steadily northward as temperatures have risen.

But the doctors were baffled by how chikungunya made its way into

mosquitoes in northern Italy since no one in Castiglione di Cervia had

been abroad. In the past two years France, especially Paris, has had a

number of imported cases of chikungunya, in travelers returning from

Réunion. But the disease has never spread in France, because the mosquito

cannot thrive there yet.

Eventually investigators discovered a link: one of the first men to

fall ill in Castiglione di Cervia had been visited by a feverish relative

in early July. That relative, an Italian, had previously traveled to

Kerala, India. Chikungunya traveled to Italy in his blood, but climatic

conditions are now such that it can spread and find a home here.

Now it is winter in Castiglione di Cervia, near freezing as the sun

went down on a recent evening and Christmas lights glowed across the

piazza. There are no mosquitoes now.

But dozens of residents still suffer from arthritis, a known

complication of chikungunya.

Mr. Ricchi, the road worker, says he still has trouble clenching his

fists, and his left ankle has horrible pains. Three people in the town

died after getting the virus, Mr. Merlo said, although all of those

victims had other illnesses as well.

From the start, townspeople noticed that the very elderly never got

the disease. Now it makes sense: “If all you do is walk the 50 yards from

your home to the church, there’s not much chance to get bitten,” said Mr.

Ciano, the retiree.

But the biggest mystery is whether chikungunya will emerge here next

summer. In the tropics, it is a year-round disease, since the mosquitoes

breed continually. But the virus can winter over in mosquito eggs, too,

and no one knows if there are reservoirs of sleeping eggs in some pool of

water in Italy.

With climate change at hand, Dr. Bertollini said, chikungunya will

surely be back somewhere in Europe again. At 08:39 AM 12/23/07, you wrote:

As Earth Warms Up, Tropical Virus

Moves to Italy

Posted by: " Mark Graffis " mgraffis

mgraffis

Sun Dec 23, 2007 4:59 am (PST)

http://www.nytimes.com/2007/12/23/world/europe/23virus.html?_r=1 & ref=science & oref=slogin

December 23, 2007

As Earth Warms Up, Tropical Virus Moves to Italy

By ELISABETH ROSENTHAL

CASTIGLIONE DI CERVIA, Italy — Panic was spreading this August through

this tidy village of 2,000 as one person after another fell ill with

weeks of high fever, exhaustion and excruciating bone pain, just as most

of Italy was enjoying Ferragosto, its most important summer holiday.

 

“At one point, I simply couldn’t stand up to get out of the car,” said

Antonio Ciano, 62, an elegant retiree in a pashmina scarf and trendy blue

glasses. “I fell. I thought, O.K., my time is up. I’m going to die. It

was really that dramatic.”

By midmonth, more than 100 people had come down with the same malady.

Although the worst symptoms dissipated after a couple of weeks, no doctor

could figure out what was wrong.

People blamed pollution in the river. They denounced the government. But

most of all they blamed recent immigrants from tropical Africa for

bringing the pestilence to their sleepy settlement of pastel stucco

homes.

“Why immigrants?” asked Rina Ventura, who owns a shop selling shoes and

purses. “I kept thinking of these terrible diseases that you see on TV,

like malaria. We were terrified. There was no name and no treatment.”

 

Oddly, the villagers were both right and wrong. After a month of

investigation, Italian public health officials discovered that the people

of Castiglione di Cervia were, in fact, suffering from a tropical

disease, chikungunya, a relative of dengue fever normally found in the

Indian Ocean region. But the immigrants spreading the disease were not

humans but insects: tiger mosquitoes, who can thrive in a warming Europe.

 

Aided by global warming and globalization, Castiglione di Cervia has the

dubious distinction of playing host to the first outbreak in modern

Europe of a disease that had previously been seen only in the tropics.

 

“By the time we got back the name and surname of the virus, our outbreak

was over,” said Dr. Rafaella Angelini, director of the regional public

health department in Ravenna. “When they told us it was chikungunya, it

was not a problem for Ravenna any more. But I thought: this is a big

problem for Europe.”

The epidemic proved that tropical viruses are now able to spread in new

areas, far north of their previous range. The tiger mosquito, which first

arrived in Ravenna three years ago, is thriving across southern Europe

and even in France and Switzerland.

And if chikungunya can spread to Castiglione — “a place not special in

any way,” Dr. Angelini said — there is no reason why it cannot go to

other Italian villages. There is no reason why dengue, an even more

debilitating tropical disease, cannot as well.

“This is the first case of an epidemic of a tropical disease in a

developed, European country,” said Dr. Roberto Bertollini, director of

the World Health Organization’s Health and Environment program. “Climate

change creates conditions that make it easier for this mosquito to

survive and it opens the door to diseases that didn’t exist here

previously. This is a real issue. Now, today. It is not something a crazy

environmentalist is warning about.”

Was he shocked to discover chikungunya in Italy, his native land? “We

knew this would happen sooner or later,” he said. “We just didn’t know

where or when.”

It certainly caught this town off guard on Aug. 9, when public health

officials in Ravenna received an angry call from Stefano Merlo, who owns

the gas station.

“Within 100 meters of my home, there were more than 30 people with fevers

over 40 degrees,” or 104 Fahrenheit, said Mr. Merlo, 47. “I wanted to

know what was going on. I knew it couldn’t be normal.”

August is not the season for high fevers, Dr. Angelini agreed, and within

days of interviewing patients she was intrigued.

“The stories were so similar and so dramatic,” she said. “But we had no

clue it was something tropical.”

Hard-working shopkeepers could not get out of bed because their hips hurt

so much. Able-bodied men could not lift spoons to their mouths. (Months

later, many still have debilitating joint pain.)

From the start, doctors suspected that the disease was spread by

insects, rather than people. While almost all homes had one person who

was ill, family members seemed not to catch the disease from one another.

 

They initially focused on sand flies, since the disease clustered on

streets by the river.

Canceling their traditional mid-August vacations (in Italy, a true sign

of panic), health officials sent off blood samples, called national

infectious-disease experts, searched the Internet and set out traps to

see what insects were in the neighborhood. The first surprise was that

the insect traps contained not sand flies but tiger mosquitoes, and huge

numbers of them.

The scientific survey confirmed what residents of Castiglione had come to

accept as a horrible nuisance, though not a deadly threat.

“In the last three or four years, you couldn’t live on these streets

because the mosquitoes were so bad,” said Rino Ricchi, a road worker who

fell ill, standing at the entrance to his neatly tended garden, where

mosquito traps have now replaced decorative fountains. “We used to

delight in having a garden or a porch to eat dinner. You couldn’t this

year, you’d get eaten alive.”

Said Dr. Angelini: “They were treating the mosquitoes like an annoyance.

They knew that mosquitoes could spread tropical diseases but they had

peace of mind because they knew this didn’t happen in Italy.”

Ravenna immediately set about killing the bugs in the hopes of containing

the epidemic. Workers sprayed insecticides and went into each family’s

garden, emptying flower pots, fountains and the rainwater collection

barrels to remove the mosquitoes’ breeding ground.

By early September, there were no new cases in Castiglione di Cervia. But

there were a number of mini-epidemics in the region — in Ravenna, Cesena

and Rimini — set off by tiger mosquitoes there. Each was controlled in

the same way.

By that point, the doctors had cataloged the patients’ symptoms and tried

to match them to mosquito-borne diseases.

“We realized,” Dr. Angelini said, “we were seeing a photocopy of an

outbreak on Réunion,” a French island in the Indian Ocean where more than

10,000 people have contracted chikungunya in the last two years. Blood

tests confirmed the diagnosis. By summer’s end, home-grown chikungunya

had been diagnosed in nearly 300 Italians.

Chikungunya is spread when tiger mosquitoes drink blood from an infected

person and, if conditions are right, pass the virus on when they bite

again. Tiger mosquitoes first came to southern Italy with shipments of

tires from Albania about a decade ago but their habitat has expanded

steadily northward as temperatures have risen.

But the doctors were baffled by how chikungunya made its way into

mosquitoes in northern Italy since no one in Castiglione di Cervia had

been abroad. In the past two years France, especially Paris, has had a

number of imported cases of chikungunya, in travelers returning from

Réunion. But the disease has never spread in France, because the mosquito

cannot thrive there yet.

Eventually investigators discovered a link: one of the first men to fall

ill in Castiglione di Cervia had been visited by a feverish relative in

early July. That relative, an Italian, had previously traveled to Kerala,

India. Chikungunya traveled to Italy in his blood, but climatic

conditions are now such that it can spread and find a home here.

 

Now it is winter in Castiglione di Cervia, near freezing as the sun went

down on a recent evening and Christmas lights glowed across the piazza.

There are no mosquitoes now.

But dozens of residents still suffer from arthritis, a known complication

of chikungunya.

Mr. Ricchi, the road worker, says he still has trouble clenching his

fists, and his left ankle has horrible pains. Three people in the town

died after getting the virus, Mr. Merlo said, although all of those

victims had other illnesses as well.

From the start, townspeople noticed that the very elderly never got the

disease. Now it makes sense: “If all you do is walk the 50 yards from

your home to the church, there’s not much chance to get bitten,” said Mr.

Ciano, the retiree.

But the biggest mystery is whether chikungunya will emerge here next

summer. In the tropics, it is a year-round disease, since the mosquitoes

breed continually. But the virus can winter over in mosquito eggs, too,

and no one knows if there are reservoirs of sleeping eggs in some pool of

water in Italy.

With climate change at hand, Dr. Bertollini said, chikungunya will surely

be back somewhere in Europe again.

 

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