Arbovirus Prevention

Alex Stone, PhD

CDC
Division of Vector-Borne Diseases

Figure 1
This is an image of an arbovirus in human blood
Table of Source: workcare.com Contents

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Abstract ……………………………………………………4

Arboviruses ………………………………………………..4

Mosquito Vectors ………………………………………….4

Dengue Fever ………………………………………..5

West Nile Virus ………………………………….......5

Chikungunya …………………………………….......6

Zika Virus .…………………………………………..7

Vector Control Methods………..………………………….8

Biological …………………………………………...8

Chemical ……………………………………………9

Environmental ………………………………………9

Risk of Arbovirus in Times of COVID …………………...10

References ………………………………………………...11

Table of Figures
Figure 1 …………………………………………………….1

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Figure 2 …………………………………………………….3

Figure 3 …………………………………………………….4

Figure 4 …………………………………………………….5

Figure 5 …………………………………………………….6

Figure 6 …………………………………………………….7

Figure 7 …………………………………………………….7

Figure 8 …………………………………………………….8

Figure 9 ……………………………………………………10

Figure 2
This is an image of an arbovirus

Abstract
The purpose of this document is to remind states of mosquito prevention and arboviruses.
Currently, the focus of most state Health Departments is on combatting the COVID-19
pandemic. However, summer is fast approaching, which is when arboviruses pose their

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greatest threat to communities. Each state should be developing a mosquito control
strategy. These strategies can be divided into biological, chemical, and environmental
control methods. Each of these vector control methods can be implented state wide to
reduce the risk of mosquito borne disease transmission.This document will provide
helpful information about mosquitoes, mosquito borne arboviruses, and vector control
strategies that are available to each state.

Arboviruses
Arbovirus is the name used to refer to viruses that are transmitted by arthropod vectors.
Some common arthropod vectors include mosquitoes, fleas, and ticks. Mosquitoes are the
most common arthropods that spread disease. Symptoms of arboviruses can range from
mild to severe, and tend to appear 3-14 days after a bite from an infected arthropod
(Arboviral diseases fact sheet). Infections usually occur in warm weather, when
arthropods are most active. Several examples of arbovirus infections include Dengue
fever, West Nile Virus, Chikungunya, and Zika Virus, all of which are prevalent in the
United States. It is important to take proper precautions to prevent infections, and
potential outbreaks.

Mosquito Vectors
As previously mentioned, mosquito borne diseases are transmitted by the bite of an
infected female mosquito. Female mosquitoes bite humans and other animals because
they require blood to produce eggs. The main goal of female mosquitoes is to take up
blood quickly, and to escape. Mosquitoes are able to find humans or other animals that
may serve as potential meals, by tracking carbon dioxide, which is emitted as we breathe.
A mosquito’s bite is specialized to ingest a small amount of blood while causing minimal
pain to the host, allowing for an escape (see figure 3). Typical bites last 2-3 minutes,
allowing the mosquito to fill its stomach with blood. As the mosquitoes bite, they secrete
saliva into the host, which contains chemicals that serve as an anticoagulant, allowing the
mosquito to continuously take blood for 2-3 minutes (Jones, pg 36). It is the saliva that
allows for transmission of the virus. Male mosquitoes, however do not feed on blood,
therefore they cannot transmit mosquito-borne diseases.

Figure 3
This image shows a
mosquito biting a
human

Dengue Fever
Dengue viruses are spread by the
bite of an infected female Aedes mosquito (“About Dengue: what you need to know”). It

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is common in many parts of the world and approximately 400 million people are infected,
with about 22,000 deaths per year. Figure 4 shows a map of Dengue cases in the United
States as of May, 2020. There are four different types of Dengue viruses, making it very
difficult to treat, also allowing for a single person to be infected up to four times in their
lifetime. Symptoms appear around 4-6 days after infection and can last up to 10 days.
The infection is characterized by flu-like symptoms including high fever, severe
headaches, joint and muscle pain, and fatigue (Ratini). There is no treatment for this
disease, but painkillers and fever reducers can help manage some of the symptoms. Some
vaccines are available for people living in endemic areas that try to limit the severity of
future infections, however they are not always reliable.

Figure 4
This map shows the number of Dengue cases in each state in 2020.
Source: CDC, 2020

West Nile Virus

The West Nile Virus is spread by the bite of an infected female Culex mosquito.
Interestingly, West Nile Virus is transmitted to humans by mosquitoes that have fed on
an infected bird (Vector Disease Control International). This is different from other
mosquito borne diseases, as birds are required to complete its life cycle. Therefore, there
is no person to mosquito transmission like the other diseases. It is the leading cause of
mosquito borne disease in the United States with about 2,000 people infected per year
(“Symptoms, diagnosis & treatment”). Figure 5 shows the number of West Nile Virus
cases in the United States in 2018. Most people tend to have little to no symptoms,
however some infections can result in severe illness affecting the central nervous system.
Some symptoms include headache, high fever, and neck stiffness. This can ultimately
lead to encephalitis or meningitis. There are currently no vaccines for West Nile Virus
and there are few treatments for this disease.

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 Figure 5
This map shows the number of West Nile Virus cases in each state in 2018.
Source: CDC, 2018

Chikungunya
Chikungunya is a virus spread by the bite of an infected female Aedes mosquito.
Mosquitoes become infected when they bite a person that has already been infected by
the virus. It is found in many countries around the world with about 100 cases per year in
the United States (“Chikungunya”). Figure 6 shows a map of reported cases of
Chikungunya in 2020. Most cases in the U.S. are imported cases from Africa and Asia,
where the disease is commonly found. Chikungunya commonly causes fever, severe joint
pain, nausea, and fatigue. There is no cure for the disease, and there are limited
treatments that focus on relieving the joint pain.

Figure 6
This map shows a map of states with confirmed cases of Chikungunya in 2020
Source: CDC, 2020

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Zika Virus
Zika virus is spread by the bite of an infected female Aedes mosquito. It is commonly
found in Africa, the Americas and some islands in the Pacific. Few cases are reported
each year in the U.S., with most being imported from abroad. Figure 7 shows the
approximate number of Zika Viruses cases in each state in 2019. Symptoms of the Zika
virus are generally mild and include fever, rash, and joint pains, and tend to last about 2-7
days. The most serious consequences of the illness, however, occur if infection occurs
during pregnancy. If a pregnant woman contracts the Zika virus, this can result in
complications for the baby, including microcephaly, and other malformations (“Zika
Virus”). Microcephaly can lead to infant death. There is currently no vaccine or treatment
for this disease.

Figure 7
This map shows the approximate number of cases in each state in 2019
Source: CDC, 2019

Vector Control Methods

As discussed above, mosquitoes can transmit several diseases, so it is important to take
precautions to prevent any potential outbreaks. Mosquitos are ubiquitous and plentiful,
therefore eradication is not possible, but there are several mechanisms to reduce the risk
they pose to humans. These control methods can be divided into biological, chemical, and
environmental control methods. Each of these methods attempts to reduce the size of
vector populations or more simply put, the number of mosquitos.

Biological Control Methods

In the past, the primary biological control method for mosquitoes was the introduction of
a predator to reduce the population of mosquitoes. The introduction of predatory species
has played an important role in population reduction. These predators are typically fish or
other microorganisms that feed on mosquito larvae, preventing reproduction. One
example is the Gambusia affinis, also called the mosquito fish, which is a fresh water fish

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that feeds on mosquito larvae (Huang et al). A picture of a mosquito fish can be seen in
figure 9. This fish is also noted to be tolerant to insecticides, making them an ideal
predator for the control of the mosquito population.

Another rapidly growing biological control method is the use of bacteria to reduce the
transmission of arboviruses and parasites. Several studies have been done using the gram-
negative bacteria Wolbachia, which is naturally found in many insect species. Early
results have shown that, “Infection of Wolbachia in mosquitoes can … reduce or block
the transmission of arboviruses and parasites” (Huang et al). Additionally, introducing
Wolbachia into mosquito populations has shown that it significantly reduces the lifespan
of infected female mosquitoes. By shortening the lifespan of the female mosquito, the
period of transmission is also shortened.

Figure 8
This is an image of the mosquito fish, Gambusia affinis
Source: Seriouslyfish.com

Chemical Control Methods

Chemical control methods include the use of insecticides. Insecticides are used to kill
mosquitoes. These consist of larvicides and adulticides designed to kill mosquito larvae
and adults respectively. Larvicides are pesticides that are introduced into the water to kill
mosquito larvae before they become adults. Small amounts of pesticides are put into the
water so that other animals and humans are not affected. One common larvicide used in
the United States is a mixture of clay with the bacteria Bacillus sphaericus. It is put in the
water with the mosquito larvae; larvae then eat the bacteria. The bacteria ultimately
destroys the guts of the larvae resulting in its death (“What You Should Know About
Mosquito Control Pesticides”). Adulticides are pesticides that are used to kill adult
mosquitoes. These pesticides usually work by inhibiting the mosquito’s brain from
functioning properly. A common adulticide that is used in the United States are
Pyrethoids. These are man made chemicals that block the movement of information from
the mosquito’s brain to its heart so that its heart cannot beat, resulting in death.

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The effects of insecticides usually last a few days. Insecticides are not recommended for
constant or repeated use. This is due to the potential increase in insecticide resistance in
mosquitoes. Over time, mosquitoes can develop resistance to pesticides, increasing the
threat of arboviruses and other mosquito borne disease transmission in humans.
Therefore, it is important to monitor the use of insecticides, as you could be putting
yourself at an even greater risk of disease.

The use of mosquito or insect repellant can be used to protect the individual from getting
bit by a mosquito. These repellants work by blocking a mosquito’s sense of smell,
thereby preventing it from finding a target. This is among one of the best methods to
protect individuals from mosquito borne illness. Therefore, when going outdoors in
warm, tropical weather it is a good idea to use mosquito repellant to lower the chances of
being bit.

Environmental Control Methods

Several environmental methods can be used to reduce risk of infection and transmission
as well. The first method involves mosquito proofing your home. This can range from
setting up mosquito netting to using a mosquito trap to kill mosquitoes. Mosquito netting
is a type of curtain that be draped over beds to provide protection from mosquitoes. This
is particularly useful when camping or if there is open-air exposure in the home. Homes
should have screens installed in all windows, and air conditioning should be used when
available. Mosquito traps are another good method to prevent bites. These traps mimic
people by emitting small amounts of carbon dioxide. This attracts mosquitoes to the area,
trapping them in a container, where they ultimately die of dehydration (“How do
Mosquito Traps Work?”). Another way to prevent infection is to get rid of any standing
water around the home and communities.

Risk of Arborvirus in Times of COVID

Currently, countries such as Brazil are experiencing a medical crisis with an outbreak of
both Dengue and COVID 19. This is taxing the medical system and confusing physicians
since there can be overlap of symptoms. Currently, the U.S. is still trying to manage the
COVID pandemic. At the same time, summer is approaching when the incidence of
arbovirus-related infections naturally increase. Because of the COVID pandemic, more
individuals are spending time outdoors. If states and communities are not proactive in
practicing mosquito control, we could become the next Brazil.

It is important that states and communities start practicing vector control immediately.
The safest long-term strategies are the biologic. It is important that communities start
immediately introducing mosquito fish into some of the fresh water canals and lakes. The
introduction of Wolbachia into the mosquito population is more complicated and should
be done as a pilot program, in smaller cities and expanded upon more gradually.
Chemical control strategies with adulticides and larvacides, because of their toxic effect
on the environment, should be used sparingly only in situations where the mosquito

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population has grown exponentially and immediate action is required. Public service
campaigns should be encouraged reminding individuals of the risk of mosquito born
illnesses and the personal steps they can take to reduce vector population, as well as
personal protective strategies.

Figure 9
This is an image of the coronavirus
Source: CNN

References

“About Dengue: What You Need to Know.” Centers for Disease Control and Prevention,
Centers for Disease Control and Prevention, 3 May 2019,
www.cdc.gov/dengue/about/index.html.

“Chikungunya.” World Health Organization, World Health Organization,

www.who.int/news-room/fact-sheets/detail/chikungunya.

“Department of Health.” Arboviral (Arthropod-Borne Viral) Diseases Fact Sheet,

www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm.

“How Do Mosquito Traps Work?: Types, Brands & Products Reviews.”

MosquitoReviews, 18 Dec. 2019, mosquitoreviews.com/mosquito-traps.

Huang, Yan-Jang, et al. “Biological Control Strategies for Mosquito Vectors of

Arboviruses.” Insects, vol. 8, no. 1, 2017, p. 21., doi:10.3390/insects8010021.

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Jones, Richard. Mosquito. Reaktion Books, 2012.

Ratini, Melinda. “Dengue Fever: Symptoms, Causes, and Treatments.” WebMD,

WebMD, 28 June 2019, www.webmd.com/a-to-z-guides/dengue-fever-reference#1.

“Symptoms, Diagnosis, & Treatment.” Centers for Disease Control and Prevention,
Centers for Disease Control and Prevention, 10 Dec. 2018,
www.cdc.gov/westnile/symptoms/index.html.

Vector Disease Control International. “West Nile Virus: Education, Public Health,
Mosquito Management.” West Nile Virus: Education, Public Health, Mosquito
Management, www.vdci.net/vector-borne-diseases/west-nile-virus-education-and-
mosquito-management-to-protect-public-health.

What You Should Know About Mosquito Control Pesticides. California Department of
Health Services,
westnile.ca.gov/website/mosq_control/Mosquito_Control_Pesticides.pdf.

“Zika Virus.” World Health Organization, World Health Organization,

www.who.int/news-room/fact-sheets/detail/zika-virus.

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