Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;30(2):2400203.
doi: 10.2807/1560-7917.ES.2025.30.2.2400203.

Human neuroinvasive Toscana virus infections in Italy from 2016 to 2023: Increased incidence in 2022 and 2023

Emmanouil Alexandros Fotakis  1   2 , Elisa Di Maggio  3   1 , Martina Del Manso  1 , Alberto Mateo-Urdiales  1 , Daniele Petrone  1 , Massimo Fabiani  1 , Giulia Perego  4   1 , Antonino Bella  1 , Gioia Bongiorno  1 , Ilaria Bernardini  1 , Marco Di Luca  1 , Giulietta Venturi  1 , Claudia Fortuna  1 , Stefania Giannitelli  1 , Federica Ferraro  5 , Francesco Maraglino  5 , Patrizio Pezzotti  1 , Anna Teresa Palamara  1 , Flavia Riccardo  1 ; Italian Arbovirus Surveillance network  6
Collaborators, Affiliations

Human neuroinvasive Toscana virus infections in Italy from 2016 to 2023: Increased incidence in 2022 and 2023

Emmanouil Alexandros Fotakis et al. Euro Surveill. 2025 Jan.

Abstract

BackgroundToscana virus (TOSV) is transmitted to humans through bites of infected sand flies. Neuroinvasive TOSV infections are leading causes of meningitis/encephalitis in southern Europe and notifiable in Italy since 2016. In 2022-23, Italy experienced extreme climate anomalies and a concomitant increase in mosquito and tick-borne disease transmission.AimTo identify the spatiotemporal distribution and risk groups of neuroinvasive TOSV infections in Italy in 2022-23 vs 2016-21.MethodsWe retrospectively described all autochthonous, laboratory-confirmed neuroinvasive TOSV cases notified to the national surveillance system in 2016-23 using frequencies, proportions, incidences and incidence risk ratios (IRRs) with 95% CIs, stratified by year, sex, age, region/autonomous province (AP) of infection/exposure and infection/exposure municipality by urbanisation level.ResultsIn 2022-23, 276 cases were notified (average annual incidence: 2.34/1,000,000 population) vs 331 cases in 2016-21 (0.92/1,000,000), with increased incidence extending into September. In 2022-23, infections were acquired in 12/21 regions/APs, predominantly in Emilia Romagna (57.6%; 159/276) as in 2016-21, including four regions/APs with no local infections in 2016-21. Similar to 2016-21, during 2022-23 residence in rural municipalities (vs urban), male sex, working age (19-67 years) and age > 67 years (vs ≤ 18 years) were identified as risk factors with IRRs of 2.89 (95% CI: 2.01-4.17), 2.17 (95% CI: 1.66-2.84), 5.31 (95% CI: 2.81-10.0) and 5.06 (95% CI: 2.59-9.86), respectively.ConclusionItaly experienced a nearly 2.6-fold increase in neuroinvasive TOSV incidence in 2022-23 vs 2016-21. Raising public awareness on risk factors and personal protection measures may enhance prevention efforts.

Keywords: Italy; Toscana virus; neuroinvasive infections; sand flies.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Confirmed autochthonous cases of neuroinvasive Toscana virus infection by month of symptom onset and annual incidence, Italy, 2016–2023 (n = 607 cases)
Figure 2
Figure 2
Geographical distribution of confirmed autochthonous cases of neuroinvasive Toscana virus infection, Italy, 2016–2023 (n = 606 cases)
See this image and copyright information in PMC

References

    1. Ayhan N, Charrel RN. An update on Toscana virus distribution, genetics, medical and diagnostic aspects. Clin Microbiol Infect. 2020;26(8):1017-23. 10.1016/j.cmi.2019.12.015 - DOI - PubMed
    1. Ayhan N, Baklouti A, Prudhomme J, Walder G, Amaro F, Alten B, et al. Practical guidelines for studies on sandfly-borne phleboviruses: part i: important points to consider ante field work. Vector Borne Zoonotic Dis. 2017;17(1):73-80. 10.1089/vbz.2016.1957 - DOI - PubMed
    1. Ayhan N, Prudhomme J, Laroche L, Bañuls AL, Charrel RN. Broader geographical distribution of Toscana virus in the Mediterranean region suggests the existence of larger varieties of sand fly vectors. Microorganisms. 2020;8(1):114. 10.3390/microorganisms8010114 - DOI - PMC - PubMed
    1. Charrel RN, Gallian P, Navarro-Marí JM, Nicoletti L, Papa A, Sánchez-Seco MP, et al. Emergence of Toscana virus in Europe. Emerg Infect Dis. 2005;11(11):1657-63. 10.3201/eid1111.050869 - DOI - PMC - PubMed
    1. Laroche L, Jourdain F, Ayhan N, Bañuls AL, Charrel R, Prudhomme J. Incubation period for neuroinvasive Toscana virus infections. Emerg Infect Dis. 2021;27(12):3147-50. 10.3201/eid2712.203172 - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources