Integrated analysis of human-animal-vector surveillance: West Nile virus infections in Austria, 2015-2016.

The results of integrated human and veterinary surveillance for West Nile virus (WNV) infections in Austria during the transmission seasons 2015 and 2016 are shown. Altogether WNV nucleic acid was detected in 21 humans, horses, wild birds and mosquito pools. In detail: in four human clinical cases [two cases of West Nile fever (WNF) and two cases of West Nile neuroinvasive disease (WNND)]; eight blood donors [among 145,541 tested donations], of which three remained asymptomatic and five subsequently developed mild WNF; two horses with WNND, of which one recovered and one had to be euthanized; two wild birds [one goshawk and one falcon, both succumbed to WNND]; and five Culex pipiens mosquito pools. Compared to previous years the number of infections increased remarkably. All infections were recorded in the city of Vienna and neighboring regions of Lower Austria. Sixteen coding-complete WNV sequences were established which were closely related to each other and to other Austrian, Czech and Italian viruses, all belonging to the Central/Southern European cluster of WNV sublineage 2d. However, several genetically slightly different WNV strains seem to co-circulate in the same area, as demonstrated by phylogenetic analysis. Based on detailed sequence analysis, all newly discovered Austrian WNV strains had the potential to cause neurological disease, but no correlation was found between severity of disease and the analyzed genetic virulence/neuroinvasiveness markers. Results of integrated human-animal-vector surveillance presented in this paper provide a comprehensive description of WNV activity in the region and will facilitate proactive public health measures to prevent or mitigate potential outbreaks.

Spread of Aedes japonicus japonicus (Theobald, 1901) in Austria, 2011-2015, and first records of the subspecies for Hungary, 2012, and the principality of Liechtenstein, 2015.

BACKGROUND: The Asian bush mosquito, Aedes (Hulecoeteomyia) japonicus japonicus (Theobald, 1901) (Diptera: Culicidae), was first identified in Austria in August 2011 in the federal state of Styria at the border to Slovenia. METHODS: Between 2011 and 2015 the spread of Ae. j. japonicus was monitored in southern, eastern and western Austrian provinces as well as in neighbouring countries by checking natural and man-made container habitats for the aquatic stages. The search concentrated around the most recent occurrence of Ae. j. japonicus and extended up to several kilometres until the subspecies could not be found anymore. RESULTS: Between May and July 2012 the distribution area of Ae. j. japonicus was found to be extended westwards into Carinthia, and eastwards towards the federal state of Burgenland. In August 2012, the subspecies was found in Hungary, representing the first record of an invasive mosquito species in this country. In 2013 its expansion was confirmed at several sites in Austria. Additionally, between April and July 2015, the subspecies was detected in all districts of the westernmost Austrian state Vorarlberg reaching the alpine Montafon valley at the end of October 2015, at all three examined sites in southern Bavaria bordering Vorarlberg, and in the adjacent Principality of Liechtenstein, for which it also represents the first record of an invasive mosquito species. One remarkable finding of the subspecies was located close to the city of Kufstein in the lower Inn valley of the Tyrol in September 2015, which is an isolated occurrence without spatial connection to any known established population. CONCLUSIONS: Our findings demonstrate the ongoing spread of Ae. j. japonicus towards all directions within Austria and beyond. Together with the absence of supposed natural barriers, e.g. high mountain chains, at the borders of the current subspecies' distribution area in south-eastern Austria, these findings suggest a further spread to the Austrian capital Vienna and the Hungarian tourist region of Lake Balaton within the upcoming few years. The observed intrusions in western Austria represent most probably extensions of the population established and spreading in eastern Switzerland and southern Germany. The putative role of the subspecies in pathogen transmission together with its rapid spread observed argues for the implementation of comprehensive nation-wide surveillance and response preparedness.

First record of the Asian bush mosquito, Aedes japonicus japonicus, in Italy: invasion from an established Austrian population.

BACKGROUND: In 2011 we identified the Asian bush mosquito, Aedes japonicus japonicus (Theobald, 1901) (Diptera: Culicidae) for the first time in northern Slovenia and in the bordering Austrian federal state of Styria. Between May and July 2012 the distribution area of Ae. j. japonicus was already found to be extended westwards into Carinthia and eastwards towards Burgenland and bordering Hungary. In August 2012 the species was first detected in a western province of Hungary. In subsequent years, follow-up field studies demonstrated an active spread westwards throughout Carinthia, reaching the border to northern Italy. FINDINGS: In July 2015 several aquatic-stage specimens of the species were discovered at three different sites in the Friuli Venezia Giulia region, north-eastern Italy. In September 2015, co-occurrence of Ae. j. japonicus and Aedes albopictus (Skuse, 1895) was observed in the same sample in that region. CONCLUSIONS: Ae. j. japonicus actively extended its geographic range from an established population in Carinthia (Austria) southwards to northern Italy by crossing Alpine ranges. Since Ae. albopictus and Aedes koreicus (Edwards, 1917) are already well established in northern Italy, it will be pivotal to monitor the consequences of a third invasive mosquito species trying to populate the same geographic region.

Overwintering of Uranotaenia Unguiculata Adult Females in Central Europe: A Possible Way of Persistence of the Putative New Lineage of West Nile Virus?

We report the overwintering of Uranotaenia unguiculata adult females in Central Europe (Czech Republic, Hungary, Austria). This finding suggests a potential mode of winter persistence of putative novel lineage of West Nile virus in the temperate regions of Europe.

West Nile virus positive blood donation and subsequent entomological investigation, Austria, 2014.

The detection of West Nile virus (WNV) nucleic acid in a blood donation from Vienna, Austria, as well as in Culex pipiens pupae and egg rafts, sampled close to the donor's residence, is reported. Complete genomic sequences of the human- and mosquito-derived viruses were established, genetically compared and phylogenetically analyzed. The viruses were not identical, but closely related to each other and to recent Czech and Italian isolates, indicating co-circulation of related WNV strains within a confined geographic area. The detection of WNV in a blood donation originating from an area with low WNV prevalence in humans (only three serologically diagnosed cases between 2008 and 2014) is surprising and emphasizes the importance of WNV nucleic acid testing of blood donations even in such areas, along with active mosquito surveillance programs.

Autochthonous Dirofilaria repens in Austria.

BACKGROUND: In Europe animal and human infections due to Dirofilaria repens are increasing. FINDINGS: In a nationwide screening for filarioid parasites in Austria, 7,632 mosquitoes were collected from June till October 2012 and divided into 437 pools according to same trapping date and sight and mosquito species. For the molecular detection, a real-time PCR approach was followed by conventional PCR. D. repens was detected in the villages Moerbisch and Rust, Burgenland in one Anopheles maculipennis group and one Anopheles algeriensis species pool, respectively. CONCLUSIONS: The geographical distribution of the two positive pools points to the invasion of D. repens from Eastern neighboring countries. The finding of D. repens in mosquito vectors suggests the occurrence of the causative agent for cutaneous dirofilariosis in Austria.

Explosive spread of a neuroinvasive lineage 2 West Nile virus in Central Europe, 2008/2009.

For the first time outside sub-Saharan Africa, a lineage 2 West Nile virus (WNV) emerged in Hungary in 2004. It caused sporadic cases of encephalitis in goshawks (Accipiter gentilis), other predatory birds, and in mammals. As a consequence, a surveillance program was initiated in Hungary and in Austria, which included virological, molecular, serological and epidemiological investigations in human beings, birds, horses, and mosquitoes. The virus strain became endemic to Hungary, however only sporadic cases of infections were observed between 2004 and 2007. Unexpectedly, explosive spread of the virus was noted in 2008, when neuroinvasive West Nile disease (WND) was diagnosed all over Hungary in dead goshawks and other birds of prey (n=25), in horses (n=12), and humans (n=22). At the same time this virus also spread to the eastern part of Austria, where it was detected in dead wild birds (n=8). In 2009, recurrent WND outbreaks were observed in Hungary and Austria, in wild birds, horses, and humans in the same areas. Virus isolates of both years exhibited closest genetic relationship to the lineage 2 WNV strain which emerged in 2004. As we know today, the explosive spread of the lineage 2 WNV in 2008 described here remained not restricted to Hungary and Austria, but this virus dispersed further to the south to various Balkan states and reached northern Greece, where it caused the devastating neuroinvasive WND outbreak in humans in 2010.

Detection of Plasmodium sp.-infested Anopheles hyrcanus (Pallas 1771) (Diptera: Culicidae) in Austria, 2012.

On July 15, 2012, adult Anopheles hyrcanus (Pallas 1771) mosquitoes were caught next to a farm barn near Rust, Burgenland, close to Lake Neusiedl National Park in eastern Austria. Six weeks later, adults of this invasive species were also found in a sheep shelter outside the village of Oggau and another 2 weeks later, in a horse barn in Mörbisch. The morphological typing was confirmed genetically by amplification and sequencing of a 1,404-bp-long fragment within the 5.8S ribosomal RNA gene, the internal transcribed spacer 2, and the 28S ribosomal RNA gene. Out of two A. hyrcanus pools analyzed, one was found positive for Plasmodium sp. A 460-bp-long sequence within the mitochondrial cytochrome b region revealed 100 % identity to a sequence of a Plasmodium parasite identified in a New Zealand bellbird (Anthornis melanura). The Austrian finding sites are close to the Hungarian border. In Hungary, the occurrence of A. hyrcanus was already reported in 1963. A. hyrcanus is considered the most important potential vector of malaria in southern France today. In Austria, sporadic autochthonous malaria cases could emerge, caused by immigration from malaria-endemic countries and heavy tourism. However, the broad population coverage of the Austrian health care system makes the reestablishment of endemic areas for malaria unlikely.

Progression of heart failure in right univentricular pacing compared to biventricular pacing.

BACKGROUND: Cardiac resynchronization therapy (CRT) improves hemodynamics and symptoms of heart failure by reducing ventricular dyssynchronity. Conversely, recent studies have demonstrated that right univentricular pacing in patients with an ejection fraction below 40% aggravates heart failure. In this retrospective study, we compared progression of disease in patients with mild to moderate heart failure that were treated with a right univentricular pacing device and patients with congestive heart failure that were treated with a biventricular system. METHODS: 107 patients were included. 59 received a right ventricular pacing device and 48 a biventricular system. Patients were assessed after 1 and 6 months by NYHA class, echocardiographic parameters (EF, LVEDD) and hospitalization for heart failure. RESULTS: Hospitalization for heart failure after implantation of the devices was more frequent in patients that received a conventional pacemaker with a single lead in the right ventricle than in patients that were treated with a CRT system (12% vs. 6%, p<0.05), although heart failure was more advanced in the CRT group at baseline. Ejection fraction in the right ventricular pacing group further decreased from 43%+/-4 at baseline to 38%+/-4 after 6 months (p<0.05). Left ventricular enddiastolic diameter (LVEDD) was 51+/-7 mm and 58+/-6 mm (p<0.05) at 6 months. In the CRT group, EF was 23%+/-4 at baseline and 31%+/-7 after 6 months (p<0.05.). LVEDD improved from 56+/-4 mm before implantation to 52+/-7 mm and 6 months (p<0.05). CONCLUSION: Progression of heart failure symptoms in the right univentricular pacing group was more pronounced compared to the CRT group, despite the fact that patients assigned to the CRT group had more severe symptoms of heart failure at baseline. Biventricular pacing relieved symptoms of heart failure, whereas right univentricular pacing with subsequent conduction delay of the left ventricle further deteriorated pre-existing heart failure. Therefore, patients with an indication for pacemaker therapy because of bradycardia and co-existing mild to moderate heart failure might benefit from early implantation of a CRT system.

An atypical member of the brevinin-1 family of antimicrobial peptides isolated from the skin of the European frog Rana dalmatina.

A single peptide with antimicrobial activity was extracted from the skin of the European agile frog (R. dalmatina). The primary structure of this 17 amino-acid-residue peptide (ILPLLLGKVVCAITKKC) does not immediately suggest membership of any of the previously described families of antimicrobial peptides from ranid frogs. However, if it is assumed that the peptide has undergone several residue deletions during the course of speciation, it shows sequence similarity with peptides belonging to the widely distributed brevinin-1 family, particularly those isolated from the related species Rana temporaria. The minimum inhibitory concentration of the peptide, termed brevinin-1 Da, against the Gram-positive bacterium Staphylococcus aureus was 7 microM and against the Gram-negative bacterium Escherichia coli was 30 microM.