Advances in Vector-Borne Diseases: Celebrating the First Impact Factor of TMID and in Memory of Sir Patrick Manson (1844-1922)

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Vector-Borne Diseases".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 42765

Special Issue Editors


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Guest Editor
Pathologist, Parasitology Reference Lab, Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, University of the Witwatersrand, Johannesburg 2192, South Africa
Interests: parasitic and zoonotic infections; travel and tropical medicine
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Guest Editor
1. Division of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
2. School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
Interests: neglected tropical diseases; lymphatic filariasis; dengue; malaria; occupational health; travel medicine; emerging public health threats
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201 & Department of Parasites and Insect Vectors, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
Interests: parasitology; medical entomology; epidemiology; trypanosomatids; leishmaniases; trypanosomiases

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Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicent Andres Estelles s/n, 46100 Burjassot, Valencia, Spain
Interests: epidemiology; molecular biology; ecology; pathology; diagnosis; fascioliasis; zoonosis; trematodology; helminthology; parasitology; tropical medicine

Special Issue Information

Dear Colleagues,

Based on the 2020 WHO data, vector-borne diseases account for more than 17% of all infectious diseases, causing more than 700,000 deaths annually. Major outbreaks of dengue, malaria, chikungunya, yellow fever, and Zika have afflicted populations, claimed lives, and overwhelmed health systems in many countries. In 1877, Patrick Manson, working in Amoy, China, made the seminal discovery that lymphatic filariasis was a mosquito-borne disease, paving the way for the eventual elucidation of the malaria transmission cycle, the recognition of other vector-borne diseases, and the establishment of the discipline of tropical medicine.

Tropical Medicine and Infectious Disease will receive its first Impact Factor this year. To celebrate this momentous occasion, we have decided to set up a Special Issue on ‘Advances in Vector-Borne Diseases’ in commemoration of the 100th anniversary of the death of Sir Patrick Manson, one of the founding fathers of tropical medicine. We call on the community to review the efforts of scientists in overcoming the difficulties of vector-borne diseases and to examine the latest research progress in the field. This Special Issue also celebrates the 30th anniversary of the establishment of The Australasian College of Tropical Medicine, emphasizing the role of Tropical Medicine and Infectious Disease as the official journal of the College since 2016.

Prof. Dr. John Frean
Prof. Dr. Peter A. Leggat
Dr. Brice Rotureau
Prof. Dr. Santiago Mas-Coma
Guest Editors

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Keywords

  •  Vector-borne infection
  •  Tropical medicine
  •  Arboviruses
  •  Dengue
  •  Malaria
  •  Chikungunya
  •  Yellow fever
  •  Zika
  •  Trypanosomiasis
  •  Filariasis
  •  Rickettsial infections

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Published Papers (12 papers)

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Research

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14 pages, 2311 KiB  
Article
Distribution and Risk of Cutaneous Leishmaniasis in Khyber Pakhtunkhwa, Pakistan
by Wasia Ullah, Tsai-Ying Yen, Sadaf Niaz, Nasreen Nasreen, Yu-Feng Tsai, Roger Ivan Rodriguez-Vivas, Adil Khan and Kun-Hsien Tsai
Trop. Med. Infect. Dis. 2023, 8(2), 128; https://doi.org/10.3390/tropicalmed8020128 - 20 Feb 2023
Cited by 6 | Viewed by 4183
Abstract
Cutaneous leishmaniasis (CL) is a zoonotic infection caused by obligate intracellular protozoa of the genus Leishmania. This study aimed to investigate CL in Khyber Pakhtunkhwa, Pakistan and to estimate the risk of epidemics. Clinico-epidemiological data of 3188 CL patients were collected from [...] Read more.
Cutaneous leishmaniasis (CL) is a zoonotic infection caused by obligate intracellular protozoa of the genus Leishmania. This study aimed to investigate CL in Khyber Pakhtunkhwa, Pakistan and to estimate the risk of epidemics. Clinico-epidemiological data of 3188 CL patients were collected from health facilities in 2021. Risk factors were analyzed using the chi-square test. ArcGIS V.10.7.1 was applied for spatial analysis. The association between CL occurrence and climatic variables was examined by Bayesian geostatistical analysis. The clinical data revealed males or individuals younger than 20 years old were more affected. Most patients presented with a single lesion, and the face was the most attacked body part. CL was prevalent in the southern region in winter. A proportional symbol map, a choropleth map, and a digital elevation model map were built to show the distribution of CL. Focal transmission was predicted by inverse distance weighting interpolation. Cluster and outlier analysis identified clusters in Bannu, Dir Lower, and Mardan, and hotspot analysis suggested Bannu as a high-risk foci. Bayesian geostatistical analysis indicated that increasing precipitation and temperature as well as low altitudes were associated with CL infection. The study has provided important information for public health sectors to develop intervention strategies for future CL epidemics. Full article
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13 pages, 328 KiB  
Article
Epidemiological Survey on Tick-Borne Pathogens with Zoonotic Potential in Dog Populations of Southern Ethiopia
by Hana Tadesse, Marika Grillini, Giulia Simonato, Alessandra Mondin, Giorgia Dotto, Antonio Frangipane di Regalbono, Bersissa Kumsa, Rudi Cassini and Maria Luisa Menandro
Trop. Med. Infect. Dis. 2023, 8(2), 102; https://doi.org/10.3390/tropicalmed8020102 - 3 Feb 2023
Cited by 6 | Viewed by 2764
Abstract
Dogs are known to host several tick-borne pathogens with zoonotic potential; however, scant information is available on the epidemiology of these pathogens in low-income tropical countries and in particular in sub-Saharan Africa. With the aim of investigating a wide range of tick-borne pathogens [...] Read more.
Dogs are known to host several tick-borne pathogens with zoonotic potential; however, scant information is available on the epidemiology of these pathogens in low-income tropical countries and in particular in sub-Saharan Africa. With the aim of investigating a wide range of tick-borne pathogens (i.e., Rickettsia spp., Anaplasma spp., Erhlichia spp., Borrelia spp., Hepatozoon spp. and Babesia spp.), 273 blood samples were collected from dogs in selected districts of Ethiopia and analyzed by real-time and/or end-point PCR. The results of the study showed that Hepatozoon canis was the most prevalent pathogen (53.8%), followed by Anaplasma phagocythophilum (7.0%), Babesia canis rossi (3.3%), Ehrlichia canis (2.6%) and Anaplasma platys (2.2%). Furthermore, five samples tested positive for Borrelia spp., identified as Borrelia afzelii (n = 3) and Borrelia burgdorferi (n = 2), and two samples for Rickettsia spp., identified as Rickettsia conorii (n = 1) and Rickettsia monacensis (n = 1). The finding of Anaplasma phagocythophilum and different species of the genera Borrelia and Rickettsia with zoonotic potential was unexpected and alarming, and calls for further investigation on the roles of dogs and on the tick, species acting as vector in this specific context. Other pathogens (Hepatozoon canis, Babaesia canis rossi, Anaplasma platys, Ehrlichia canis) are already known to have an important impact on the dogs’ health but have minor zoonotic potential as they were rarely or never reported in humans. Dogs from rural areas were found to be at higher risk for different pathogens, probably due to the presence of other wild canids in the same environment. The findings of the present study contribute to a better knowledge of the epidemiology of tick-borne pathogens, which is relevant to human and animal health. Full article
11 pages, 1339 KiB  
Article
Entomological Surveillance Activities in Regions in Greece: Data on Mosquito Species Abundance and West Nile Virus Detection in Culex pipiens Pools (2019–2020)
by Annita Vakali, Stavroula Beleri, Nikolaos Tegos, Anastasia Fytrou, Anastasia Mpimpa, Theodoros N. Sergentanis, Danai Pervanidou and Eleni Patsoula
Trop. Med. Infect. Dis. 2023, 8(1), 1; https://doi.org/10.3390/tropicalmed8010001 - 20 Dec 2022
Cited by 4 | Viewed by 2910
Abstract
Human cases of West Nile virus (WNV) infections have been recorded in Greece since 2010, with seasonal outbreaks (summer-autumn) on an almost annual basis, caused mainly by the WNV lineage 2 strain (Nea Santa-Greece-2010). National Public Health Organization (NPHO) in Greece is annually [...] Read more.
Human cases of West Nile virus (WNV) infections have been recorded in Greece since 2010, with seasonal outbreaks (summer-autumn) on an almost annual basis, caused mainly by the WNV lineage 2 strain (Nea Santa-Greece-2010). National Public Health Organization (NPHO) in Greece is annually implementing enhanced surveillance of human WNV infection, in order to promptly identify human cases of WNV infection and monitor distribution in terms of time and place. Entomological surveillance activities were carried out on a national basis in 2019 and 2020, under NPHO coordination and the collaboration of several private subcontractors, along with the Unit of Medical Entomology, Laboratory for Surveillance of Infectious Diseases (LSID). The aim was to monitor mosquito species composition, abundance, and WNV circulation in mosquito pools of Culex pipiens s.l. species. Adult mosquito traps were placed in selected sites; collected samples were morphologically characterized and pooled by date of collection, location, and species types. Female Culex pipiens s.l. pools were tested for WNV and WNV infection rates (MIR and MLE) were estimated. Highest mean number of female Culex pipiens s.l. species was recorded in Central Macedonia both for 2019 and 2020. Six hundred and fifty-nine mosquito pools (147 in 2019 and 512 in 2020) of female Culex pipiens s.l. were examined for WNV presence. The highest MLE was detected in Western Macedonia in 2019 and in Thessaly in 2020. Here, we present data on the mosquito species composition in the studied areas and WNV detection in mosquitoes from areas in Greece where the specific national mosquito surveillance program was implemented, for two years, 2019 and 2020. Full article
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24 pages, 1880 KiB  
Article
West Nile Virus Infection: A Cross-Sectional Study on Italian Medical Professionals during Summer Season 2022
by Matteo Riccò, Alessandro Zaniboni, Elia Satta, Silvia Ranzieri, Milena Pia Cerviere, Federico Marchesi and Simona Peruzzi
Trop. Med. Infect. Dis. 2022, 7(12), 404; https://doi.org/10.3390/tropicalmed7120404 - 28 Nov 2022
Cited by 5 | Viewed by 2340
Abstract
West Nile virus (WNV) has progressively endemized in large areas of continental Europe, and particularly in Northern Italy, in the Po River Valley. During summer season 2022, Italy experienced an unprecedented surge in incidence cases of WNV infections, including its main complications (West [...] Read more.
West Nile virus (WNV) has progressively endemized in large areas of continental Europe, and particularly in Northern Italy, in the Po River Valley. During summer season 2022, Italy experienced an unprecedented surge in incidence cases of WNV infections, including its main complications (West Nile fever (WNF) and West Nile neuroinvasive disease (WNND)). As knowledge, attitudes, and practices (KAP) of medical professionals may be instrumental in guaranteeing a prompt diagnosis and an accurate management of incident cases, we performed a cross-sectional study specifically on a sample of Italian medical professionals (1 August 2022–10 September 2022; around 8800 potential recipients). From a total of 332 questionnaires (response rate of 3.8%), 254 participating medical professionals were eventually included in the analyses. Knowledge status of participants was unsatisfying, as most of them exhibited knowledge gaps on the actual epidemiology of WNV, with similar uncertainties on the clinical features of WNF and WNND. Moreover, most of participants substantially overlooked WNV as a human pathogen when compared to SARS-CoV-2, TB, and even HIV. Interestingly, only 65.4% of respondents were either favorable or highly favorable towards a hypothetical WNV vaccine. Overall, acknowledging a higher risk perception on WNV was associated with individual factors such as reporting a seniority ≥ 10 years (adjusted odds ratio [aOR] 2.39, 95% Confidence interval [95%CI] 1.34 to 4.28), reporting a better knowledge score (aOR 2.92, 95%CI 1.60 to 5.30), having previously managed cases of WNV infections (aOR 3.65, 95%CI 1.14 to 14.20), being favorable towards a hypothetic vaccine (aOR 2.16, 95%CI 1.15 to 4.04), and perceiving WNV infections as potentially affecting daily activities (aOR 2.57, 95%CI 1.22 to 5.42). In summary, substantial knowledge gaps and the erratic risk perception collectively enlighten the importance and the urgency for appropriate information campaigns among medical professionals, and particularly among frontline personnel. Full article
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15 pages, 3728 KiB  
Article
Evaluating Molecular Xenomonitoring as a Tool for Lymphatic Filariasis Surveillance in Samoa, 2018–2019
by Brady McPherson, Helen J. Mayfield, Angus McLure, Katherine Gass, Take Naseri, Robert Thomsen, Steven A. Williams, Nils Pilotte, Therese Kearns, Patricia M. Graves and Colleen L. Lau
Trop. Med. Infect. Dis. 2022, 7(8), 203; https://doi.org/10.3390/tropicalmed7080203 - 22 Aug 2022
Cited by 9 | Viewed by 3467
Abstract
Molecular xenomonitoring (MX), the detection of filarial DNA in mosquitoes using molecular methods (PCR), is a potentially useful surveillance strategy for lymphatic filariasis (LF) elimination programs. Delay in filarial antigen (Ag) clearance post-treatment is a limitation of using human surveys to provide an [...] Read more.
Molecular xenomonitoring (MX), the detection of filarial DNA in mosquitoes using molecular methods (PCR), is a potentially useful surveillance strategy for lymphatic filariasis (LF) elimination programs. Delay in filarial antigen (Ag) clearance post-treatment is a limitation of using human surveys to provide an early indicator of the impact of mass drug administration (MDA), and MX may be more useful in this setting. We compared prevalence of infected mosquitoes pre- and post-MDA (2018 and 2019) in 35 primary sampling units (PSUs) in Samoa, and investigated associations between the presence of PCR-positive mosquitoes and Ag-positive humans. We observed a statistically significant decline in estimated mosquito infection prevalence post-MDA at the national level (from 0.9% to 0.3%, OR 0.4) but no change in human Ag prevalence during this time. Ag prevalence in 2019 was higher in randomly selected PSUs where PCR-positive pools were detected (1.4% in ages 5–9; 4.8% in ages ≥10), compared to those where PCR-positive pools were not detected (0.2% in ages 5–9; 3.2% in ages ≥10). Our study provides promising evidence for MX as a complement to human surveys in post-MDA surveillance. Full article
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16 pages, 2804 KiB  
Article
Systematic Surveillance of Rickettsial Diseases in 27 Hospitals from 26 Provinces throughout Vietnam
by Nguyen Vu Trung, Le Thi Hoi, Tran Mai Hoa, Dang Thi Huong, Ma Thi Huyen, Vuong Quang Tien, Dao Thi Tuyet Mai, Nguyen Thi Thu Ha, Nguyen Van Kinh, Christina M. Farris and Allen L. Richards
Trop. Med. Infect. Dis. 2022, 7(6), 88; https://doi.org/10.3390/tropicalmed7060088 - 31 May 2022
Cited by 8 | Viewed by 2985
Abstract
In Vietnam, the public health burden of rickettsial infections continues to be underestimated due to knowledge gaps in the epidemiology of these diseases. We conducted a systematic study among 27 hospitals from 26 provinces in eight ecological regions throughout Vietnam to investigate the [...] Read more.
In Vietnam, the public health burden of rickettsial infections continues to be underestimated due to knowledge gaps in the epidemiology of these diseases. We conducted a systematic study among 27 hospitals from 26 provinces in eight ecological regions throughout Vietnam to investigate the prevalence, distribution, and clinical characteristics of rickettsial diseases. We recruited 1834 patients in the study from April 2018 to October 2019. The findings showed that rickettsial diseases were common among undifferentiated febrile patients, with 564 (30.8%) patients positive by qPCR for scrub typhus, murine typhus or spotted fever. Scrub typhus (484, 85.8%) was the most common rickettsial disease, followed by murine typhus (67, 11.9%) and spotted fever (10, 1.8%). Rickettsial diseases were widely distributed in all regions of Vietnam and presented with nonspecific clinical manifestations. Full article
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Review

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23 pages, 1831 KiB  
Review
Ecological Niche Modelling Approaches: Challenges and Applications in Vector-Borne Diseases
by Pablo Fernando Cuervo, Patricio Artigas, Jacob Lorenzo-Morales, María Dolores Bargues and Santiago Mas-Coma
Trop. Med. Infect. Dis. 2023, 8(4), 187; https://doi.org/10.3390/tropicalmed8040187 - 25 Mar 2023
Cited by 7 | Viewed by 3741
Abstract
Vector-borne diseases (VBDs) pose a major threat to human and animal health, with more than 80% of the global population being at risk of acquiring at least one major VBD. Being profoundly affected by the ongoing climate change and anthropogenic disturbances, modelling approaches [...] Read more.
Vector-borne diseases (VBDs) pose a major threat to human and animal health, with more than 80% of the global population being at risk of acquiring at least one major VBD. Being profoundly affected by the ongoing climate change and anthropogenic disturbances, modelling approaches become an essential tool to assess and compare multiple scenarios (past, present and future), and further the geographic risk of transmission of VBDs. Ecological niche modelling (ENM) is rapidly becoming the gold-standard method for this task. The purpose of this overview is to provide an insight of the use of ENM to assess the geographic risk of transmission of VBDs. We have summarised some fundamental concepts and common approaches to ENM of VBDS, and then focused with a critical view on a number of crucial issues which are often disregarded when modelling the niches of VBDs. Furthermore, we have briefly presented what we consider the most relevant uses of ENM when dealing with VBDs. Niche modelling of VBDs is far from being simple, and there is still a long way to improve. Therefore, this overview is expected to be a useful benchmark for niche modelling of VBDs in future research. Full article
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16 pages, 1207 KiB  
Review
Vector-Borne Tularemia: A Re-Emerging Cause of Cervical Lymphadenopathy
by Kaja Troha, Nina Božanić Urbančič, Miša Korva, Tatjana Avšič-Županc, Saba Battelino and Domen Vozel
Trop. Med. Infect. Dis. 2022, 7(8), 189; https://doi.org/10.3390/tropicalmed7080189 - 16 Aug 2022
Cited by 6 | Viewed by 5032
Abstract
Tularemia is a zoonosis caused by the highly invasive bacterium Francisella tularensis. It is transmitted to humans by direct contact with infected animals or by vectors, such as ticks, mosquitos, and flies. Even though it is well-known as a tick-borne disease, it [...] Read more.
Tularemia is a zoonosis caused by the highly invasive bacterium Francisella tularensis. It is transmitted to humans by direct contact with infected animals or by vectors, such as ticks, mosquitos, and flies. Even though it is well-known as a tick-borne disease, it is usually not immediately recognised after a tick bite. In Slovenia, tularemia is rare, with 1–3 cases reported annually; however, the incidence seems to be increasing. Ulceroglandular tularemia is one of its most common forms, with cervical colliquative lymphadenopathy as a frequent manifestation. The diagnosis of tularemia largely relies on epidemiological information, clinical examination, imaging, and molecular studies. Physicians should consider this disease a differential diagnosis for a neck mass, especially after a tick bite, as its management significantly differs from that of other causes. Tularemia-associated lymphadenitis is treated with antibiotics and surgical drainage of the colliquated lymph nodes. Additionally, tularemia should be noted for its potential use in bioterrorism on behalf of the causative agents’ low infectious dose, possible aerosol formation, no effective vaccine at disposal, and the ability to produce severe disease. This article reviews the recent literature on tularemia and presents a case of an adult male with tick-borne cervical ulceroglandular tularemia. Full article
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Other

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2 pages, 133 KiB  
Obituary
Remembering Professor Peter A. Leggat, AM, ADC (1961–2023)
by Colleen Lau and John Frean
Trop. Med. Infect. Dis. 2024, 9(2), 28; https://doi.org/10.3390/tropicalmed9020028 - 24 Jan 2024
Viewed by 1517
Abstract
Professor Peter Leggat, the Immediate Past President of the Australasian College of Tropical Medicine (ACTM), passed away peacefully in Brisbane on 20 September 2023 [...] Full article
6 pages, 695 KiB  
Opinion
Malaria Vector Surveillance and Control in an Elimination Setting in South Africa
by Basil D. Brooke
Trop. Med. Infect. Dis. 2022, 7(11), 391; https://doi.org/10.3390/tropicalmed7110391 - 21 Nov 2022
Cited by 5 | Viewed by 2385
Abstract
South Africa’s malaria elimination plans are aligned to the World Health Organization’s aim for a malaria-free world and include specific objectives within a specified time frame. These are proving difficult to achieve owing to the sporadic nature of locally acquired malaria in some [...] Read more.
South Africa’s malaria elimination plans are aligned to the World Health Organization’s aim for a malaria-free world and include specific objectives within a specified time frame. These are proving difficult to achieve owing to the sporadic nature of locally acquired malaria in some affected districts, while other districts that were endemic for the disease are either malaria-free or very close to that goal. The WHO also specifies that continued measures to prevent the re-establishment of transmission are required in areas where elimination has been achieved. These measures include routine malaria vector surveillance in endemic districts that are free of malaria to assess receptivity and risk of reintroduction, which may prove difficult to justify in the face of competing public health priorities and limited resources. These issues are discussed here within the framework of vector surveillance and control and include recommendations on how they can be addressed going forward. Full article
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8 pages, 1283 KiB  
Case Report
Fever and Ulcerative Skin Lesions in a Patient Referred for Altered Mental Status: Clinical and Microbiological Diagnosis of Ulceroglandular Tularemia
by Loukas Kakoullis, Justin Pitman, Lydia Flier and Robert Colgrove
Trop. Med. Infect. Dis. 2022, 7(9), 220; https://doi.org/10.3390/tropicalmed7090220 - 2 Sep 2022
Viewed by 4528
Abstract
Background: Tularemia is a devastating disease that affects multiple organ systems and can have several different presentations. In its most frequent form—that of ulceroglandular tularemia—a detailed history and physical examination can enable a physician to make the diagnosis clinically, leading to the prompt [...] Read more.
Background: Tularemia is a devastating disease that affects multiple organ systems and can have several different presentations. In its most frequent form—that of ulceroglandular tularemia—a detailed history and physical examination can enable a physician to make the diagnosis clinically, leading to the prompt initiation of the appropriate antibiotic treatment. Detailed Case Description: A 63-year-old man was brought by ambulance to the emergency department for an evaluation of an altered mental status noted by his psychiatrist at a telehealth appointment. A physical examination revealed a fever and two ulcerative lesions with a central eschar on his left leg (of which the patient was unaware) with ipsilateral tender inguinal lymphadenopathy. When asked, the patient recalled visiting Martha’s Vineyard and having removed ticks from his legs. Gentamicin was administered on the clinical suspicion of ulceroglandular tularemia. Blood and skin lesion cultures grew Gram-negative rods, which were confirmed to be Francisella tularensis on hospital day eight, and the patient fully recovered. Conclusion: This case highlights the importance of clinician perception of altered mental status as a key alarm sign, the necessity of a thorough physical exam independent of the chief compliant in the emergency department, and the essential role of pattern recognition by front-line providers for the appropriate management of uncommon but serious infections such as tularemia. Full article
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6 pages, 575 KiB  
Perspective
The Emergence of Japanese Encephalitis in Australia and the Implications for a Vaccination Strategy
by Luis Furuya-Kanamori, Narayan Gyawali, Deborah J. Mills, Leon E. Hugo, Gregor J. Devine and Colleen L. Lau
Trop. Med. Infect. Dis. 2022, 7(6), 85; https://doi.org/10.3390/tropicalmed7060085 - 29 May 2022
Cited by 20 | Viewed by 5189
Abstract
Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. Until 2022, only six locally transmitted human JE cases had been reported in Australia; five in northern Queensland and one in the Northern Territory. Thus, JE was mainly considered to be [...] Read more.
Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. Until 2022, only six locally transmitted human JE cases had been reported in Australia; five in northern Queensland and one in the Northern Territory. Thus, JE was mainly considered to be a disease of travellers. On 4 March 2022, JE was declared a ‘Communicable Disease Incident of National Significance’ when a locally acquired human case was confirmed in southern Queensland. By 11 May 2022, 41 human JE cases had been notified in four states in Australia, in areas where JE has never been detected before. From this perspective, we discuss the potential reasons for the recent emergence of the JE virus in Australia in areas where JE has never been previously reported as well as the implications of and options for mass immunisation programs if the outbreak escalates in a JE virus-immunologically naïve population. Full article
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