Forgotten tropical diseases, over half of which are also present in Italy

Forgotten tropical diseases, over half of which are also present in Italy

In 2023, in Italy there were 82 indigenous cases of dengue, the “bone-breaking fever”, which occurred directly in our country, and 280 cases imported by travelers returning from places where the disease is endemic; 7 cases of chikungunya; 600 cases of Chagas disease have been diagnosed since 1998, and hundreds have tested positive for strongyloidosis, a form of parasitosis, especially widespread among the over-65s. These are the data that concern only some of the 12 pathologies, which are transmitted on Italian territory, of the 21 that make up the mosaic of neglected tropical infectious diseases (NTDs).

A heterogeneous group of pathologies, many of which are infectious, caused by viruses, bacteria, fungi and toxins which also include, among others, scabies, echinococcosis and leishmaniasis, united by being more widespread in poor areas, especially tropical ones, with scarce resources and forgotten by the political agenda, by scientific research and invisible to public opinion.

1.7 billion people are involved in the world

“Globally, there are almost 1.7 billion people who require health interventions for these diseases, with more than half a million deaths a year. Approximately 4000-5000 people are affected in our country where, in particular dengue, according to surveillance data from the Istituto Superiore di Sanità, recorded the European record for indigenous cases in 2023 – he explains Federico Gobbidirector of the department of infectious and tropical diseases of the Sacro Cuore Don Calabria hospital in Negrar (Verona) and associate professor of infectious diseases at the University of Brescia -. These seem like insignificant figures, but in reality the phenomenon is underestimated and continually growing, not only at a global level and in the rest of Europe, but also here. Italy is a special observation, thanks to climate change which has led to the spread of the tiger mosquito throughout the national territory. Of concern is the endemic risk of dengue and also chikungunya increasing with the arrival of spring.”

Dengue, bone-breaking fever and chikungunya

“It is important to focus attention on these 2 pathologies, as the vector mosquito is present in Italy, which can acquire these viruses from infected travelers and transmit these diseases which cause fever, headache, skin manifestations, and above all very severe osteoarticular pain “, says Gobbi.

This is confirmed by an analysis of the literature conducted by Swiss researchers and recently published in New Microbes and New Infections which highlighted how Aedes albopictus (more commonly known as tiger mosquito), one of the main vectors of dengue and chikungunya fever, is present in Europe which is now established in the southern regions of the continent. “These mosquitoes arrived in Italy for the first time in 1990 from the United States, arriving in Genoa and Padua and then spreading throughout the country. Where a vector is present, there is the risk of transmission of all the pathologies connected to the vector itself : it is sufficient for a traveler to arrive with the disease to trigger indigenous epidemics of that “imported” pathology.

In 2020 in Veneto, in the province of Vicenza, the first indigenous dengue epidemic in Italy occurred with 11 cases and in 2023 three different independent clusters were recorded: one in Lombardy in the province of Lodi and two in Lazio, in Rome and Circeo, reaching 82 indigenous cases in 2023 – he adds Gobbi -. Since dengue appears asymptomatic or very mild in 50-90% of individuals, many cases go unnoticed and we can therefore hypothesize that the incidence is much higher than what emerges from surveillance statistics.”

Climate change, tourism and globalization

“We must prepare for increasingly important indigenous dengue and chikungunya epidemics. In the coming years, a globalization of infectious diseases will become increasingly frequent: goods travel, people travel and carriers travel. In an increasingly interconnected world, pathologies will also be interconnected” , Gobbi underlines.

To accentuate the phenomenon and the infections, climate change which, by causing a rise in temperatures, creates the ideal conditions for the proliferation of tiger mosquitoes. “Aedes albopictus thrives at temperatures between 15°C and 35°C, but – he adds Gobbi – can also tolerate generally warm winters like the one we are experiencing, which are therefore unable to decimate the larvae and this will lead to an increase in mosquitoes with the arrival of spring.”

A global commitment

It is therefore important to implement active surveillance of imported cases, to prevent widespread epidemics from developing from a few limited episodes. “It is urgent to implement greater measures against this public health problem – underlines the expert -. The lack of attention towards “forgotten” infectious diseases increases the risk that non-endemic countries will also be affected, as is happening precisely in Italy”.

In 2021, the World Health Organization launched a road map for neglected tropical diseases for the decade 2021-2030 in which global objectives are defined to prevent, control, eliminate and eradicate these diseases. “To date – concludes Gobbi – we are still far from fully achieving these results and according to the 2023 report on the progress of the road map, only 47 countries have eliminated at least one NTDs. There is therefore still a lot of work to do to reduce infections and circulation of diseases and to reduce the danger globally”.

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