West Nile virus in Europe: after action reviews of preparedness and response to the 2018 transmission season in Italy, Slovenia, Serbia and Greece

Abstract

Background: After Action Reviews (AAR) with a One Health perspective were performed in Slovenia, Italy, Serbia and Greece following a severe West Nile virus (WNV) transmission season in 2018. A protocol combining traditional techniques and organizational process analysis was developed and then implemented in each country.

Results: In 2018, response to the unusually intense transmission season of WNV in Slovenia, Italy, Serbia and Greece took place through routine response mechanisms. None of the four countries declared a national or subnational emergency. We found a very strong consensus on the strengths identified in responding to this event. All countries indicated the availability of One Health Plans for surveillance and response; very high laboratory diagnostic capacity in the human, veterinary and entomology sectors and strong inter-sectoral collaboration with strong commitment of engaged institutions as critical in the management of the event. Finally, countries implementing One Health surveillance for WNV (in terms of early warning and early activation of prevention measures) consistently reported a positive impact on their activities, in particular when combining mosquito and bird surveillance with surveillance of cases in humans and equids. Recurring priority areas for improvement included: increasing knowledge on vector-control measures, ensuring the sustainability of vector monitoring and surveillance, and improving capacity to manage media pressure.

Conclusions: The AARs presented here demonstrate the benefit of cross-sectoral and cross-disciplinary approaches to preparedness for West Nile virus outbreaks in Europe. In the coming years, priorities include fostering and strengthening arrangements that: enable coordinated One Health surveillance and response during WNV transmission seasons; ensure adequate laboratory capacities; strengthen risk communication; and fund longer-term research to address the knowledge gaps identified in this study.

Keywords: After action reviews; Epidemics; Infectious disease; Mosquito-borne disease; Outbreaks; Preparedness; West Nile virus.

Fig. 1

After Action Review Roadmap, adapted from WHO 2019 Guidance for After Action Reviews

Fig. 2

Standard 4-day format for the After Action Review site visits

Fig. 3

Respondents to the AAR evaluation survey by Sector (n=31/55), all countries

Fig. 4

Visual representation (BPMN) of the macro-level organizational systems for WNV preparedness, surveillance and response in 2018, (from top to bottom) Slovenia, Italy and Serbia Legend: IMI: Inštitut za mikrobiologijo in imunologijo, Medicinska fakulteta, Univerza v Ljubljani=Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana; NIJZ: Nacionalni inštitut za javno zdravje=National institute of Public Health of Slovenia; Biocide (Slovenia): Chemicals Office – use of biocidal products in the environment, Environment and Food– disinsection, virology and surveillance; OiE: World Organization for Animal Health; ECDC: European Centre for Disease Prevention and Control; ISS: Istituto Superiore di Sanità – National Centre for Health, Italy; IZS: Istituto Zooprofilattico Sperimentale – Veterinary Institute, Italy; IZSAM: Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise; ASL: Local Health Unit, Italy; MoAWMF (VD): Ministry of Agriculture, Water Management and Forestry, Veterinary Directorate; IPH-S: Institute of Public Health - Serbia "Dr. Milan Jovanovic Batut"; HCC: Clinical Centre and Hospitals; Biocide (Serbia): Institute for biocides, Serbia