[Ip-health] NYT: As earth warms, virus from tropics moves to Italy

[Suerie Moon]

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[ Picked text/plain from multipart/alternative ]
Dear all,
Interesting article below from the New York Times on how chikungunya, a mos=
quito-borne tropical disease related to dengue, has spread to Italy due to =
rising temperatures.  These types of trends could have interesting implicat=
ions for political will/funding for tropical disease research from Northern=
 governments, but may also complicate the IP questions if chikungunya treat=
ments/diagnostics/vaccines were suddenly to become profitable,
happy reading,
-Suerie Moon
_____________________
Research Fellow and Doctoral Candidate
Center for International Development
Kennedy School of Government, Harvard University
suerie_moon@ksgphd.harvard.edu




---------------------------------
 The New York Times
December 23, 2007
   As Earth Warms, Virus From Tropics Moves to Italy   By ELISABETH ROSENTH=
AL
           CASTIGLIONE DI CERVIA, Italy =97 Panic was spreading this August=
 through this tidy village of 2,000 as one person after another fell ill wi=
th weeks of high fever, exhaustion and excruciating bone pain, just as most=
 of Italy was enjoying Ferragosto, its most important summer holiday.
 =93At one point, I simply couldn=92t stand up to get out of the car,=94 sa=
id Antonio Ciano, 62, an elegant retiree in a pashmina scarf and trendy blu=
e glasses. =93I fell. I thought, O.K., my time is up. I=92m going to die. I=
t was really that dramatic.=94
 By midmonth, more than 100 people had come down with the same malady. Alth=
ough 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 m=
ost of all they blamed recent immigrants from tropical Africa for bringing =
the pestilence to their sleepy settlement of pastel stucco homes.
 =93Why immigrants?=94 asked Rina Ventura, who owns a shop selling shoes an=
d purses. =93I kept thinking of these terrible diseases that you see on TV,=
 like malaria. We were terrified. There was no name and no treatment.=94
 Oddly, the villagers were both right and wrong. After a month of investiga=
tion, Italian public health officials discovered that the people of Castigl=
ione di Cervia were, in fact, suffering from a tropical disease, chikunguny=
a, a relative of dengue fever normally found in the Indian Ocean region. Bu=
t the immigrants spreading the disease were not humans but insects: tiger m=
osquitoes, who can thrive in a warming Europe.
 Aided by global warming and globalization, Castiglione di Cervia has the d=
ubious distinction of playing host to the first outbreak in modern Europe o=
f a disease that had previously been seen only in the tropics.
 =93By the time we got back the name and surname of the virus, our outbreak=
 was over,=94 said Dr. Rafaella Angelini, director of the regional public h=
ealth department in Ravenna. =93When they told us it was chikungunya, it wa=
s not a problem for Ravenna any more. But I thought: this is a big problem =
for Europe.=94
 The epidemic proved that tropical viruses are now able to spread in new ar=
eas, far north of their previous range. The tiger mosquito, which first arr=
ived in Ravenna three years ago, is thriving across southern Europe and eve=
n in France and Switzerland.
 And if chikungunya can spread to Castiglione =97 =93a place not special in=
 any way,=94 Dr. Angelini said =97 there is no reason why it cannot go to o=
ther Italian villages. There is no reason why dengue, an even more debilita=
ting tropical disease, cannot as well.
 =93This is the first case of an epidemic of a tropical disease in a develo=
ped, European country,=94 said Dr. Roberto Bertollini, director of the Worl=
d Health Organization=92s Health and Environment program. =93Climate change=
 creates conditions that make it easier for this mosquito to survive and it=
 opens the door to diseases that didn=92t exist here previously. This is a =
real issue. Now, today. It is not something a crazy environmentalist is war=
ning about.=94
 Was he shocked to discover chikungunya in Italy, his native land? =93We kn=
ew this would happen sooner or later,=94 he said. =93We just didn=92t know =
where or when.=94
 It certainly caught this town off guard on Aug. 9, when public health offi=
cials in Ravenna received an angry call from Stefano Merlo, who owns the ga=
s station.
 =93Within 100 meters of my home, there were more than 30 people with fever=
s over 40 degrees,=94 or 104 Fahrenheit, said Mr. Merlo, 47. =93I wanted to=
 know what was going on. I knew it couldn=92t be normal.=94
 August is not the season for high fevers, Dr. Angelini agreed, and within =
days of interviewing patients she was intrigued.
 =93The stories were so similar and so dramatic,=94 she said. =93But we had=
 no clue it was something tropical.=94
 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 lat=
er, 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, fami=
ly members seemed not to catch the disease from one another.
  They initially focused on sand flies, since the disease clustered on stre=
ets by the river.
 Canceling their traditional mid-August vacations (in Italy, a true sign of=
 panic), health officials sent off blood samples, called national infectiou=
s-disease experts, searched the Internet and set out traps to see what inse=
cts 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.
  =93In the last three or four years, you couldn=92t live on these streets =
because the mosquitoes were so bad,=94 said Rino Ricchi, a road worker who =
fell ill, standing at the entrance to his neatly tended garden, where mosqu=
ito traps have now replaced decorative fountains. =93We used to delight in =
having a garden or a porch to eat dinner. You couldn=92t this year, you=92d=
 get eaten alive.=94
 Said Dr. Angelini: =93They were treating the mosquitoes like an annoyance.=
 They knew that mosquitoes could spread tropical diseases but they had peac=
e of mind because they knew this didn=92t happen in Italy.=94
 Ravenna immediately set about killing the bugs in the hopes of containing =
the epidemic. Workers sprayed insecticides and went into each family=92s ga=
rden, emptying flower pots, fountains and the rainwater collection barrels =
to remove the mosquitoes=92 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 =97 in Ravenna, Cesena=
 and Rimini =97 set off by tiger mosquitoes there. Each was controlled in t=
he same way.
 By that point, the doctors had cataloged the patients=92 symptoms and trie=
d to match them to mosquito-borne diseases.
  =93We realized,=94 Dr. Angelini said, =93we were seeing a photocopy of an=
 outbreak on R=E9union,=94 a French island in the Indian Ocean where more t=
han 10,000 people have contracted chikungunya in the last two years. Blood =
tests confirmed the diagnosis. By summer=92s end, home-grown chikungunya ha=
d been diagnosed in nearly 300 Italians.
 Chikungunya is spread when tiger mosquitoes drink blood from an infected p=
erson 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 northwa=
rd as temperatures have risen.
 But the doctors were baffled by how chikungunya made its way into mosquito=
es 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 import=
ed cases of chikungunya, in travelers returning from R=E9union. But the dis=
ease has never spread in France, because the mosquito cannot thrive there y=
et.
 Eventually investigators discovered a link: one of the first men to fall i=
ll in Castiglione di Cervia had been visited by a feverish relative in earl=
y July. That relative, an Italian, had previously traveled to Kerala, India=
. Chikungunya traveled to Italy in his blood, but climatic conditions are n=
ow such that it can spread and find a home here.
 Now it is winter in Castiglione di Cervia, near freezing as the sun went d=
own on a recent evening and Christmas lights glowed across the piazza. Ther=
e 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 fist=
s, and his left ankle has horrible pains. Three people in the town died aft=
er getting the virus, Mr. Merlo said, although all of those victims had oth=
er illnesses as well.
 From the start, townspeople noticed that the very elderly never got the di=
sease. Now it makes sense: =93If all you do is walk the 50 yards from your =
home to the church, there=92s not much chance to get bitten,=94 said Mr. Ci=
ano, the retiree.
 But the biggest mystery is whether chikungunya will emerge here next summe=
r. In the tropics, it is a year-round disease, since the mosquitoes breed c=
ontinually. 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 It=
aly.
 With climate change at hand, Dr. Bertollini said, chikungunya will surely =
be back somewhere in Europe again.