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Background The universal nature of the human–companion animal relationship and their shared ticks and tick-borne pathogens offers an opportunity for improving public and veterinary health surveillance. With this in mind, we describe the spatiotemporal trends for blacklegged tick (Ixodes scapularis) submissions from humans and companion animals in Ontario, along with pathogen prevalence. Methods We tested tick samples submitted through passive surveillance (2011–2017) from humans and companion animals for Borrelia burgdorferi, Borrelia miyamotoi, Anaplasma phagocytophilum and Babesia microti. We describe pathogen prevalence in ticks from humans and from companion animals and constructed univariable Poisson and negative binomial regression models to explore the spatiotemporal relationship between the rates of tick submissions by host type. Results During the study, there were 17,230 blacklegged tick samples submitted from humans and 4375 from companion animals. Tick submission rates from companion animals were higher than expected in several public health units (PHUs) lacking established tick populations, potentially indicating newly emerging populations. Pathogen prevalence in ticks was higher in PHUs where established blacklegged tick populations exist. Borrelia burgdorferi prevalence was higher in ticks collected from humans (maximum likelihood estimate, MLE = 17.5%; 95% confidence interval, CI 16.97–18.09%) than from companion animals (9.9%, 95% CI 9.15–10.78%). There was no difference in pathogen prevalence in ticks by host type for the remaining pathogens, which were found in less than 1% of tested ticks. The most common co-infection B. burgdorferi + B. miyamotoi occurred in 0.11% of blacklegged ticks from humans and animals combined. Borrelia burgdorferi prevalence was higher in unengorged (21.9%, 95% CI 21.12–22.65%) than engorged ticks (10.0%, 95% CI 9.45–10.56%). There were no consistent and significant spatiotemporal relationships detected via regression models between the annual rates of submission of each host type. Conclusions While B. burgdorferi has been present in blacklegged ticks in Ontario for several decades, other tick-borne pathogens are also present at low prevalence. Blacklegged tick and pathogen surveillance data can be used to monitor risk in human and companion animal populations, and efforts are under consideration to unite surveillance efforts for the different target populations. Graphical Abstract

Human granulocytic anaplasmosis (HGA), caused by the bacteria Anaplasma phagocytophilum, is transmitted to humans by blacklegged ticks (Ixodes scapularis) in eastern North America. To assess the emergence of A. phagocytophilum in Ontario, we analyzed patient serological and clinical data in combination with pathogen detection in blacklegged ticks from 2011 to 2017. Our sample population included all patients who had Anaplasma serological testing ordered by their physicians (n = 851). Eighty-three patients (10.8%) were A. phagocytophilum seropositive (IgG titers ≥ 1:64) and 686 (89.2%) were seronegative (IgG titers < 1:64). Applying published surveillance case definitions, we classified zero as confirmed, five as probable, and 78 as suspected cases. The percentage of seropositive patients remained generally stable at 13.6%. Seropositive patients were most often adult females, 40–59 years of age, and reported nonspecific signs and symptoms, such as fatigue, headache, and fever. Higher seropositivity rates (≥ 1.5 patients per 100,000 population) occurred in eastern and northwestern Ontario. The percentage of A. phagocytophilum-positive blacklegged ticks, through passive and active surveillance, was 0.4 and 1.1%, respectively, and increased over time. Serological and entomological indicators of A. phagocytophilum activity increased in areas of the province with established blacklegged tick populations. The risk of HGA is presently low in Ontario; however, further research is required to document the epidemiology of HGA in the province. To minimize the impact of HGA emergence in Ontario, increased awareness and education of the public and health-care providers is recommended, with consideration to making HGA a reportable infection in Ontario.

The American dog tick, Dermacentorvariabilis, is a tick of public and veterinary health importance in North America. Using passive tick surveillance data, we document distribution changes for the American dog tick in Ontario, Canada, from 2010 through 2018. Dermacentorvariabilis submissions from the public were geocoded and aggregated—from large to small administrative geographies—by health region, public health unit (PHU) and Forward Sortation Area (FSA). PHU hot spots with high rates of D. variabilis submissions were (1) Brant County, Haldimand-Norfolk and Niagara Regional in the Central West region and (2) Lambton and Winsor-Essex County in the South West region. The number of established D. variabilis populations with ≥ 6 submissions per year increased significantly during the study at regional (PHUs: 22 to 31) and local (FSAs: 27 to 91) scales. The range of D. variabilis increased similarly to the positive control (Ixodesscapularis) during the study and in contrast to the static range of the negative control (Ixodescookei). Submission hot spots were in warmer, low elevation areas with poorly drained soils, compared to the province’s low submission areas. Dermacentorvariabilis is spreading in Ontario and continued research into their vector ecology is required to assess medicoveterinary health risks.

Background Assessing the burden of rickettsial infections in Ontario, Canada, is challenging since rickettsial infections are not reportable to public health. In the absence of reportable disease data, we assessed the burden of rickettsial infections by examining patient serological data and clinical information. Methods Our retrospective, cross-sectional study included patients who had Rickettsia serological testing ordered by their physician, in Ontario, from 2013 to 2018. We tested sera from 2755 non-travel patients for antibodies against spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) using an indirect immunofluorescence assay (IFA) (positive IgG titers ≥1:64). We classified cases using a sensitive surveillance case definition: confirmed (4-fold increase in IgG titers between acute and convalescent sera with clinical evidence of infection), possible (single positive sera with clinical evidence) and previous rickettsial infection (single positive sera without clinical evidence). We classified cases seropositive for both SFGR and TGR as unspecified Rickettsia infections (URIs). Results Less than 5% of all patients had paired acute and convalescent sera tested, and of these, we found a single, laboratory-confirmed SFGR case, with a 4-fold increase in IgG titers and evidence of fever, maculopapular rash and headache. There were 45 possible (19 SFGR, 7 TGR, 19 URI) and 580 previous rickettsial infection (183 SFGR, 89 TGR, 308 URI) cases. The rate of positive tests for SFGR, TGR and URI combined (all case classifications) were 4.4 per 100,000 population. For confirmed and possible cases, the most common signs and symptoms were fever, headache, gastrointestinal complaints and maculopapular rash. The odds of having seropositive patients increased annually by 30% (odds ratio = 1.3, 95% confidence interval: 1.23–1.39). Conclusions The rates of rickettsial infections in Ontario are difficult to determine. Based on confirmed and possible cases, rates are low, but inclusion of previous rickettsial infection cases would indicate higher rates. We highlight the need for education regarding the importance of testing acute and convalescent sera and consistent completion of the laboratory requisition in confirming rickettsial disease. We suggest further research in Ontario to investigate rickettsial agents in potential vectors and clinical studies employing PCR testing of clinical samples.

Rickettsialpox, caused by Rickettsia akari, is a spotted fever group rickettsiae transmitted to humans through the bite of the house mouse mite ( Liponyssoides sanguineus). Worldwide, rickettsialpox is most commonly associated with exposure to rodents in urban environments. Here, we present the case of a 47-year-old woman from Brantford, Ontario, with fever, eschar on the right leg, expanding erythema, and right groin lymphadenopathy. Early in infection, R. akari serology was negative (IgG

To determine the Ontario-specific risk of local and travel-related Zika virus transmission in the context of a public health emergency of international concern, Public Health Ontario (PHO) completed a rapid risk assessment (RRA) on January 29, 2016, using a newly developed RRA guidance tool. The RRA concluded that risk of local mosquito-borne transmission was low, with a high risk of imported cases through travel. The RRA was updated 3 times based on predetermined triggers. An independent evaluation assessed both the application of the RRA guidance tool (process evaluation) and the usefulness of the RRA (outcome evaluation). We conducted face-to-face, semi-structured interviews with 7 individuals who participated in the creation or review of the Zika virus RRA and 4 end-users at PHO and the Ministry of Health and Long-Term Care. An inductive thematic analysis of responses was undertaken, whereby themes were directly informed by the data. The process evaluation determined that most steps outlined in the RRA guidance tool were adhered to, including forming a cross-functional writing team, clarifying the scope and describing context, completing the RRA summary report, and updating the RRA based on predefined triggers. The outcome evaluation found that end-users judged the Zika virus RRA as evidence-informed, useful, consistent, and timely. The evaluation established that the locally tailored guidance tool, adapted from national and international approaches to RRAs, facilitated a systematic, evidence-informed, and timely formal RRA process at PHO for the Zika virus RRA, which met the needs of end-users. Based on the evaluation, PHO will modify future RRAs by incorporating some flexibility into the literature review process to support timeliness of the RRA, explicitly describing the limitations of studies used to inform the RRA, and refining risk algorithms to better suit emerging infectious disease threats. It is anticipated that these refinements will improve upon the timely assessment of novel or reemerging infectious diseases.

Background West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the next decade. Though endemic in the most populous areas of North America, few studies have estimated the healthcare costs associated with WNV. The objective of this study was to determine direct healthcare costs attributable to WNV illness in Ontario, Canada. Methods We conducted a cost-of-illness study on incident laboratory confirmed and probable WNV infected subjects identified from the provincial laboratory database from Jan 1, 2002 through Dec 31, 2012. Infected subjects were linked to health administrative data and matched to uninfected subjects. We used phase-of-care methods to calculate costs for 3 phases of illness: acute infection, continuing care, and final care prior to death. Mean 10-day attributable costs were reported in 2014 Canadian dollars, per capita. Sensitivity analysis was conducted to test the impact of WNV neurologic syndromes on healthcare costs. Results One thousand five hundred fifty-one laboratory confirmed and probable WNV infected subjects were ascertained; 1540 (99.3%) were matched to uninfected subjects. Mean age of WNV infected subjects was 49.1 ± 18.4 years, 50.5% were female. Mean costs attributable to WNV were $1177 (95% CI: $1001, $1352) for acute infection, $180 (95% CI: $122, $238) for continuing care, $11,614 (95% CI: $5916, $17,313) for final care - acute death, and $3199 (95% CI: $1770, $4627) for final care - late death. Expected 1-year costs were $13,648, adjusted for survival. Three hundred seventeen infected subjects were diagnosed with at least one neurologic syndrome and greatest healthcare costs in acute infection were associated with encephalitis ($4710, 95% CI: $3770, $5650). Conclusions WNV is associated with increased healthcare resource utilization across all phases of care. High-quality studies are needed to understand the health system impact of vector-borne diseases and evaluate the cost effectiveness of novel WNV interventions.

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Background Aedes japonicus was first documented in Ontario, Canada, in 2001. The objective of this study was to determine the effect of Ae. japonicus establishment on the abundance of other mosquitoes in the Greater Golden Horseshoe (GGH) region of Ontario. Methods Adult mosquito data from the Ontario West Nile virus surveillance program were used. Descriptive analyses, linear trends and distribution maps of average trap count per month for six mosquito species of interest were produced. Multivariable negative binomial regression models were constructed to 1) test whether the invasion of Ae. japonicus affected the abundance of other mosquitoes by comparing the time period before Ae. japonicus was identified in an area (pre-detection), to after it was first identified (detection), and subsequently (establishment), and 2) identify the variables that explain the abundance of the various mosquito species. Results The monthly seasonal average (May–October) of Ae. japonicus per trap night increased from 2002 to 2016, peaking in September, when the average of most other mosquitoes decrease. There were increased numbers of Ae. triseriatus/hendersoni (Odds Ratio (OR): 1.40, 95% Confidence Interval (CI): 1.02–1.94) and decreased numbers of Coquillettidia perturbans (OR: 0.43, 95% CI: 0.26–0.73) in the detection period, compared to the pre-detection period. Additionally, there was a decrease in Cx. pipiens/restuans (OR: 0.87, 95% CI: 0.76–0.99) and Cq. perturbans (OR: 0.68, 95% CI: 0.49–0.94) in the establishment period, compared to the pre-detection period. None of the most parsimonious explanatory models included the period of the establishment of Ae. japonicus. Conclusions There is no evidence that the introduction of Ae. japonicus significantly reduced populations of Ae. triseriatus/hendersoni, Cx. pipiens/restuans or An. punctipennis in the GGH. While further research is needed to understand the impact of the Ae. japonicus invasion on other mosquito species, our work indicates that, on a regional scale, little impact has been noted.

Lyme disease, the most commonly reported vector-borne disease in North America, is caused by the spirochete Borrelia burgdorferi sensu stricto, which is transmitted by Ixodes scapularis in eastern Canada and Ixodes pacificus in western Canada. Recently, the northward range expansion of I. scapularis ticks, in south-eastern Canada, has resulted in a dramatic increase in the incidence of human Lyme disease. Detecting emerging areas of Lyme disease risk allows public health to target disease prevention efforts. We analysed passive tick surveillance data from Ontario and Manitoba to i) assess the relationship between the total numbers of I. scapularis submissions in passive surveillance from humans, and the number of human Lyme disease cases, and ii) develop province-specific acarological indicators of risk that can be used to generate surveillance-based risk maps. We also assessed associations between numbers of nymphal I. scapularis tick submissions only and Lyme disease case incidence. Using General Estimating Equation regression, the relationship between I. scapularis submissions (total numbers and numbers of nymphs only) in each census sub-division (CSD) and the number of reported Lyme disease cases was positively correlated and highly significant in the two provinces (P ≤ 0.001). The numbers of I. scapularis submissions over five years discriminated CSDs with ≥ 3 Lyme disease cases from those with < 3 cases with high accuracy when using total numbers of tick submission (Receiver Operating Characteristics area under the curve [AUC] = 0.89) and moderate accuracy (AUC = 0.78) when using nymphal tick submissions only. In Ontario the optimal cut-off point was a total 12 tick submissions from a CSD over five years (Sensitivity = 0.82, Specificity = 0.84), while in Manitoba the cut-off point was five ticks (Sensitivity = 0.71, Specificity = 0.79) suggesting regional variability of the risk of acquiring Lyme disease from an I. scapularis bite. The performances of the acarological indicators developed in this study for Ontario and Manitoba support the ability of passive tick surveillance to provide an early signal of the existence Lyme disease risk areas in regions where ticks and the pathogens they transmit are expanding their range.

The lone star tick, Amblyomma americanum, is spreading northward from its historical stronghold in the southeastern United States. As a vector and biting pest, public and veterinary health officials must remain vigilant of the lone star tick's expanding range. We use ticks submitted to Public Health Ontario Laboratory (1999-2016) to describe the spatial and temporal dynamics of A. americanum in Ontario, Canada, as well as submitter demographics. We identified 847 A. americanum submissions during the surveillance period, with 773 (91.3%) non-travel-related and 74 (8.7%) travel-related submissions. Annual A. americanum submissions increased over the surveillance period. Approximately 91% of non-travel-related submissions were adult ticks and 9% were nymphs. The highest submission rates were from individuals living in the Eastern and South West regions of the province. Adult specimens were primarily submitted from May through July and nymphs from March through September. Higher numbers of submissions were from young children (

Lyme disease (LD) is the most common vector-borne disease in Ontario, Canada. We describe the epidemiology and clinical manifestations of LD in Ontario and examine trends in the incidence of non-disseminated and disseminated LD. LD surveillance data from the integrated Public Health Information System (iPHIS) from 2005–2014 were mapped to symptoms according to syndrome groups (erythema migrans (EM), flu-like, cardiac, neurologic or arthritic) and disease stages (early localized, early disseminated or late disseminated). During the study period, 1,230 cases due to Borrelia burgdoferi were reported in Ontario with annual incidence rates ranging from 0.32 (2006) to 2.16 (2013) cases per 100,000 population. Seventy percent of cases had EM and the proportion of cases with EM increased over time. Other clinical manifestations included flu-like (75%), arthritic (42%), neurologic (41%) and cardiac (6%) symptoms. Early localized disease (n = 415) manifested with EM (87%) and flu-like (57%) symptoms; early disseminated disease (n = 216) manifested with neurologic (94%), cardiac (10%) and EM (63%) symptoms; and late disseminated disease (n = 475) manifested with EM (62%), neurologic (55%), cardiac (9%), and arthritic symptoms (i.e., arthralgia (93%) and arthritis (7%)). Early localized and early disseminated cases (88% each) occurred primarily from May through September, compared to late disseminated cases (81%). The proportion of cases reported to public health within 30 days of illness onset increased during the study period, while the proportion of cases reported within 1–3 months and >3 months decreased. Geographical variations characterized by higher incidence of early localized disease and earlier public health notification (within 30 days of illness onset) occurred in regions with established or recently established LD risk areas, while later public health notification (>3 months after illness onset) was reported more frequently in regions with recently established or no identified risk areas. This is the first study to describe the clinical manifestations of LD in Ontario, Canada. The observed geographical variations in the epidemiology of LD in Ontario reinforce the need for regionally focused public health strategies aimed at increasing awareness, promoting earlier recognition and reporting, and encouraging greater uptake of preventive measures.

The objective of this study was to determine healthcare costs attributable to laboratory-confirmed Lyme disease (LD) from the healthcare payer perspective in Ontario, Canada. A cost-of-illness study was conducted for incident LD subjects from 1 January 2006 through 31 December 2013 ascertained from provincial laboratory and reportable disease databases, linked to health administrative data. All LD subjects included were laboratory-confirmed, according to provincial case definitions. Incident LD subjects were propensity-score matched to uninfected subjects on age, sex, comorbidities and urban/rural status. We used phase-of-care methods to calculate attributable costs for two phases of illness: initial care (≤30 days following "index date") and continuing care (>30 days after index date to the end of the follow-up period). A total of 663 incident, confirmed LD subjects were identified from 2006 through 2013. Mean age was 44.2 ± 20.1 years; 339 (51.1%) were female; and 31 (4.7%) were hospitalized ≤30 days after index date. Six hundred fifty-eight (99.2%) LD subjects were matched to uninfected subjects; mean follow-up time was 3.3 years. Mean attributable costs per case during the initial care phase and continuing care were $277 (95% CI: $197, $357) and -$5 (-$27, $17), respectively. Attributable costs per LD subject aged 5-14 years were $440 ($132, $747), greater than the costs observed for other age strata. Expected 1-year attributable costs were $832, given continuing care costs were negligible. Limitations to our study include estimating costs using a cohort of only laboratory-confirmed LD cases, introducing selection bias for diagnosed and treated patients who may have a lower risk of developing sequelae. In conclusion, the initial care phase of LD is associated with increased healthcare costs, but without significant costs attributable to LD infection after 30 days. Estimates of costs attributable to LD are important for healthcare resource prioritization and the evaluation of novel interventions.

Background Clinical syndromes associated with West Nile virus (WNV) infection range from fever to neuroinvasive disease. Understanding WNV epidemiology and disease history is important for guiding patient care and healthcare decision-making. The objective of this review was to characterize the existing body of peer-reviewed and surveillance literature on WNV syndromes and summarize epidemiologic and clinical parameters. Methods We followed scoping review methodology described by the Joanna Briggs Institute. Terms related to WNV epidemiology, hospitalization, and surveillance were searched in four bibliographic databases (MEDLINE, EMBASE, Scopus, and CINAHL) for literature published from January 1999 to December 2015. Results In total, 2334 non-duplicated titles and abstracts were screened; 92 primary studies were included in the review. Publications included one randomized controlled trial and 91 observational studies. Sample sizes ranged from under 25 patients (n = 19) to over 400 patients (n = 28). Eight studies were from Canada, seven from Israel, and the remaining (n = 77) from the United States. N = 17 studies were classified as outbreak case investigations following epidemics; n = 37 with results of regional/national surveillance and monitoring programs. Mean patient ages were > 40 years old; three studies (3%) focused on the pediatric population. Patients with encephalitis fared worse than patients with meningitis and fever, considering hospitalization, length of stay, discharge, recovery, and case-fatality. Several studies examined risk factors; however, age was the only risk factor for neuroinvasive disease/death consistently identified. Overall, patients with acute flaccid paralysis or encephalitis fared worse than patients with meningitis and West Nile fever in terms of hospitalization and mortality. Among the included studies, proportion hospitalized, length of stay, proportion discharged home and case-fatality ranged considerably. Conclusion Our review highlights the heterogeneity among reporting clinical WNV syndromes and epidemiologic parameters of WNV-related illness. Presently, there is potential for further synthesis of the risk factors of WNV-illness and mortality; undertaking further analysis through a systematic review and meta-analysis may benefit our understanding of risk factors for emerging mosquito-borne diseases. Future research on the burden of WNV can build on existing evidence summarized in this review, not only to support our understanding of endemic WNV, but also to strengthen research on emerging arboviruses with similar clinical manifestations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2637-9) contains supplementary material, which is available to authorized users.

OBJECTIVES: The purpose of this study is to describe the impact of the 2016 Zika virus (ZIKV) outbreak on the health-seeking and information-seeking behaviours of Ontarians. METHODS: A timeline that included events and announcements from health agencies was constructed to describe the unfolding of the ZIKV outbreak between January 1 and September 30, 2016. In order to gain an understanding of the information and health-seeking behaviours of Ontarians, data from the following sources were collected and analyzed descriptively over time in 1-week intervals: trends in web searches, calls to a provincial telemedicine advice line, test submissions to the provincial laboratory and Zika-related media coverage. RESULTS: The World Health Organization’s declaration that the ZIKV outbreak was a public health emergency of international concern (PHEIC) prompted a surge in media coverage peaking at 165 articles in a 1-week period. Concurrently, the frequency of Zika-related web searches was at its highest over the time period of the study, weekly telemedicine calls requesting Zika-related information were at their highest (177 calls/week) and requests for laboratory testing increased (162 patients submitting specimens/week). CONCLUSIONS: Understanding the public response to novel and re-emerging infectious disease outbreaks as they unfold has the potential to facilitate timely public messaging for disease prevention, enable resource planning and inform effective public health action.

Background The blacklegged tick Ixodes scapularis transmits Borrelia burgdorferi (sensu stricto) in eastern North America; however, the agent of Lyme disease is not the sole pathogen harbored by the blacklegged tick. The blacklegged tick is expanding its range into areas of southern Canada such as Ontario, an area where exposure to blacklegged tick bites and tick-borne pathogens is increasing. We performed a systematic review to evaluate the public health risks posed by expanding blacklegged tick populations and their associated pathogens. Methods We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting our systematic review. We searched Ovid MEDLINE, Embase, BIOSIS, Scopus and Environment Complete databases for studies published from 2000 through 2015, using subject headings and keywords that included “Ixodes scapularis”, “Rickettsia”, “Borrelia”, “Anaplasma”, “Babesia” and “pathogen.” Two reviewers screened titles and abstracts against eligibility criteria (i.e. studies that included field-collected blacklegged ticks and studies that did not focus solely on B. burgdorferi) and performed quality assessments on eligible studies. Results Seventy-eight studies were included in the final review, 72 were from the US and eight were from Canada (two studies included blacklegged ticks from both countries). Sixty-four (82 %) studies met ≥ 75 % of the quality assessment criteria. Blacklegged ticks harbored 91 distinct taxa, 16 of these are tick-transmitted human pathogens, including species of Anaplasma, Babesia, Bartonella, Borrelia, Ehrlichia, Rickettsia, Theileria and Flavivirus. Organism richness was highest in the Northeast (Connecticut, New York) and Upper Midwest US (Wisconsin); however, organism richness was dependent on sampling effort. The primary tick-borne pathogens of public health concern in Ontario, due to the geographic proximity or historical detection in Ontario, are Anaplasma phagocytophilum, Babesia microti, B. burgdorferi, Borrelia miyamotoi, deer tick virus and Ehrlichia muris-like sp. Aside from B. burgdorferi and to a much lesser concern A. phagocytophilum, these pathogens are not immediate concerns to public health in Ontario; rather they represent future threats as the distribution of vectors and pathogens continue to proliferate. Conclusions Our review is the first systematic assessment of the literature on the human pathogens associated with the blacklegged tick. As Lyme disease awareness continues to increase, it is an opportune time to document the full spectrum of human pathogens transmittable by blacklegged ticks. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1529-y) contains supplementary material, which is available to authorized users.

Zoos present a unique assemblage of arthropods, captive vertebrates, free-roaming wildlife, humans, and plants, each with its own biota of symbiotic organisms. Arthropods of medicoveterinary importance are well represented in zoos, and an ample literature documents their influence in these animal-rich environments. Mosquitoes are of greatest significance because of the animal and human pathogens they transmit, followed by ectoparasites, many of which are exotic and present health risks to captive and native animals. Biting flies, cockroaches, filth flies, and triatomid bugs represent additional concerns. Integrated management programs for arthropods in zoos are commonplace. Zoos can play a role in biosurveillance, serving as an advanced guard for detecting exotic arthropods and vector-borne diseases. We provide the first review of arthropods of medicoveterinary importance in zoos. A case is made for the value of collaborations between entomologists and zoo personnel as a means of enhancing research and public education while safeguarding the health of captive animals and the public.

Following observations by a service engineer (mid-2007), 12 of the hundreds of installed packaged plant (PP) sewage systems were producing relatively large numbers of Culex quinquefasciatus (Say) and a variety of filth flies in George Town, Grand Cayman. Due to the vector potential of C . quinquefasciatus in the Caribbean, we explored the efficacy of industry-standard insecticides against C . quinquefasciatus . Since PP systems contain an organic biofilm on the water surface, we devised a modified technique for collecting immatures and for the application of insecticides. We treated functioning and non-functioning PP systems with Bacillus sphaericus (VectoLex ® WDG), Bacillus thuringiensis var. israelensis (Bti; VectoBac ® CG), temephos (Abate ® 4-E), monomolecular film or ethyoxylated alcohol surfactant (Agnique ® MMF) and (S)-methoprene (Altosid ® Pro-G). B. thuringiensis var. israelensis gave control for 35 and 48 days for functioning and non-functioning systems, respectively, with less control from B . sphaericus (high label rate) ( c. 25 and 35 days) and temephos (suggested label rate) ( c. 27 and 33 days). B. sphaericus (low label rate), monomolecular film and (S)-methoprene gave limited control of immatures (i.e. no mortality detected after 24 h). Treatment options for PP systems are discussed with regard to economics, operational feasibility, and within the context of integrated mosquito management. Functioning systems were recolonized at a faster rate than those that were not functioning, but the level of infestation in the non-functioning systems was considerably greater.

The range of Ixodes scapularis is expanding in Ontario, increasing the risk of Lyme disease. As an effective public health response requires accurate information on disease distribution and areas of risk, this study aims to establish the geographic distribution of I. scapularis and its associated pathogen, B. burgdorferi, in northwestern Ontario. We assessed five years of active and passive tick surveillance data in northwestern Ontario. Between 2013 and 2017, 251 I. scapularis were submitted through passive surveillance. The submission rate increased over time, and the proportion infected with B. burgdorferi was 13.5%. Active tick surveillance from 2014 to 2016 found few I. scapularis specimens. In 2017, 102 I. scapularis were found in 10 locations around the city of Kenora, 60% were infected with B. burgdorferi, eight tested positive for A. phagocytophilum, and one for POWV. I. scapularis ticks were found in 14 locations within the Northwestern Health Unit area, with seven locations containing B. burgdorferi-positive ticks. We found abundant I. scapularis populations in the southern portion of northwestern Ontario and northward expansion is expected. It is recommended that I. scapularis populations continue to be monitored and mitigation strategies should be established for rural northern communities.

The Asian tiger mosquito Aedes albopictus (Skuse) is rapidly increasing its global range and importance in transmission of chikungunya and dengue viruses. We tested pellet formulations of a monomolecular film (Agnique) and (S)-methoprene (Altosid) under laboratory and field conditions. In the laboratory, Agnique provided 80% control for 20 days, whereas Altosid, in combination with Agnique, provided 80% control for > 60 days. During field trials, the 1:1 pel- let ratio of combined products provided > 95% control for at least 32 days and 50% control for at least 50 days. Altosid remained effective after a 107-day laboratory-induced drought, suggesting that the product serves as a means of control during drought conditions and against spring broods in temperate regions. Agnique and Altosid, when used in tandem for cryptic, difficult-to-treat locations, can provide long-term control of Ae . albopictus larvae and pupae. The possible additive or synergistic effects of the combined products deserve further investigation.

Larval black flies were collected monthly from streams in southern Alabama and assayed for the presence of gut fungi (trichomycetes). Eight trichomycete species were found, each showing seasonality and specific host usage. Trichomycete taxa collected were Genistellospora homothallica, Harpella melusinae, Harpella sp. 1, Pennella hovassi, Pennella simulii, Pennella sp. 1, Simuliomyces microsporus, and Smittium brasiliense, from the hosts Simulium decorum, Simulium jonsei, Simulium tribulatum, and Simulium ubiquitum. Seven trichomycete species were collected in the spring, summer (4), fall (2), and winter (4). S. ubiquitum hosted all 8 species of trichomycetes, S. jonsei (3), S. decorum (3) and S. tribulatum (2). Our results indicate that trichomycetes occupy a restricted subset of potential hosts and vary in prevalence according to season, independent of host prevalence.

Rapid detection of West Nile virus (WNV) in mosquito pools is essential for predicting epizootics and epidemics. We compare the efficiency and sensitivity of the Rapid Analyte Measurement Platform (RAMP) to reverse transcriptase polymerase chain reaction (RT-PCR) from 2005 to 2008 from field mosquito populations in Mercer County, NJ. Overall, 316 pools tested negative and 115 pools tested positive for WNV. Eighty-nine pools tested positive using RAMP and all were confirmed by RT-PCR; 26 pools were WNV-negative using RAMP but positive using RT-PCR. False-positives from RAMP were not detected in our four-year study, indicating that RAMP is a reliable tool when used to augment existing RT-PCR-based WNV surveillance programs. Local mosquito control programs using RAMP will benefit from its ease of use, quick results, and lack of false positives but should understand the sensitivity of this test when compared to RT-PCR. Used with standard methods, RAMP will enhance existing mosquito control and WNV surveillance by providing rapid results and improved mosquito management decisions.

From a discarded heavy-equipment tire (ca. 57 liter) at an industrial construction site, we collected 655 (86.0%) Orthopodomyia signifera, 23 (3.0%) Toxorhynchites rutilus septentrionalis, 17 (2.2%) Aedes japonicus japonicus, and 67 (8.8%) Culex pipiens pipiens. Although larvae of Aedes albopictus and Aedes triseriatus were not collected from this container, both species were prevalent as host-seeking adults and readily collected as larvae from other containers at this site. Laboratory trials to test the survival of prey (Ae. albopictus, Cx. p. pipiens, or Or. signifera) in the presence of Tx. rut. septentrionalis showed that survival of prey larvae differed among species. Multiple comparisons revealed that Ae. albopictus had the lowest and Or. signifera the highest survival in the presence of Tx. rut. septentrionalis. Survival of Or. signifera and Cx. p. pipiens was not significantly different from one another, but both were different from Ae. albopictus. Further testing is warranted to test other factors responsible for differences in the interspecific relationship between Or. signifera and other species in tree hole communities.

The Asian tiger mosquito Aedes albopictus (Skuse) was first detected in New Jersey in 1995 during mosquito surveillance operations in Monmouth County. We tracked statewide changes in populations of the Asian tiger mosquito and its association with West Nile virus from 2003 to 2007. Ae. albopictus population abundance has increased in New Jersey since 2003, primarily along the urban corridor between New York City and Philadelphia, and they are now expanding their range further into suburban and rural areas of the state. Ae. albopictus has invaded all counties of New Jersey except for two northwest rural counties (Sussex and Warren). West Nile virus was detected in Ae. albopictus throughout several foci in New Jersey during the study, underscoring the public health significance of this mosquito.

Standard surveillance traps in North America for adult Aedes albopictus (Skuse) (Diptera: Culicidae), an invasive mosquito with public health implications, are currently ineffective. We compared the efficacy of the BG-Sentinel trap (BGS) with and without lures (BG-lure, octenol, and CO2), the Centers for Disease Control and Prevention light trap (CDC) with and without lures, and the gravid trap (GT) for Ae. albopictus collection in two urban sites in New Jersey. The BGS with or without lures collected more Ae. albopictus compared with other trap configurations and was more specific for Ae. albopictus. In Camden County, the BGS with lures collected three times more Ae. albopictus than the CDC (with CO2 only) and five times more than the GT. In Mercer County, BGS with lures collected the most mosquitoes, with 3 times more Ae. albopictus than the CDC with all lures and 50 times more than the GT. The BGS collected more male Ae. albopictus than other traps in both counties, providing further population monitoring. The GT and BGS provided a relative measure of the enzootic activity of West Nile virus in Culex spp. and the potential epidemic activity of WNV in Ae. albopictus. The BGS provides effective chemical and visual cues for host-seeking Ae. albopictus and should be used as a part of existing surveillance programs and new initiatives targeting this mosquito.

In mammals, adipose tissue stores energy in the form of fat. The ability to regulate fat storage is essential for the growth, development and reproduction of most animals, thus any abnormalities caused by excess fat accumulation can result in pathological conditions which are linked to several interrelated diseases, such as cardiovascular diseases, diabetes, and obesity. In recent years significant effort has been applied to understand basic mechanism of fat accumulation in mammalian system. Work in mouse has shown that the family of Krüppel-like factors (KLFs), a conserved and important class of transcription factors, regulates adipocyte differentiation in mammals. However, how fat storage is coordinated in response to positive and negative feedback signals is still poorly understood. To address mechanisms underlying fat storage we have studied two Caenorhabditis elegans KLFs and demonstrate that both worm klfs are key regulators of fat metabolism in C. elegans. These results provide the first in vivo evidence supporting essential regulatory roles for KLFs in fat metabolism in C. elegans and shed light on the human counterpart in disease-gene association. This finding allows us to pursue a more comprehensive approach to understand fat biology and provides an opportunity to learn about the cascade of events that regulate KLF activation, repression and interaction with other factors in exerting its biological function at an organismal level. In this review, we provide an overview of the most current information on the key regulatory components in fat biology, synthesize the diverse literature, pose new questions, and propose a new model organism for understanding fat biology using KLFs as the central theme.

Pachycondyla chinensis (Emery) (Formicidae: Ponerinae), a species introduced into North America > 70 yr ago, is found throughout Southeast Asia. Stinging of zookeepers by P. chinensis at the Greenville Zoo (Greenville, SC) initiated an investigation of this exotic species and a survey of sting victims. Eighty percent of sting victims experienced local reactions, including swelling 5 cm in diameter around the sting site, recurring pain, skin redness, severe urticaria, and symptoms lasting 3-14 d. P. chinensis represents an emerging public health threat throughout its present range in the southeastern United States (i.e., Georgia, North Carolina, South Carolina, and Virginia). Because of reported adverse reactions to stings of P. chinensis, further studies on its ecology and medical and veterinary importance need to be undertaken.

Aim We tested the hypothesis that endemism of black flies in the Caucasus of Armenia is reflected in their gut symbiotes, i.e. trichomycete fungi and ichthyosporean protists. Location The study area, Armenia, is a biodiversity hotspot, with high levels of plant and animal endemism. Located in the southern Caucasus, Armenia is a rugged, mountainous, landlocked country of 29,800 km2, with fast-flowing rivers and little forested land. About half of the 51 species of black flies in Armenia are endemic to the Caucasus. Methods The larvae of 22 species of black flies, including seven endemic to the Caucasus, were collected from 35 sites throughout Armenia, from 1998 to 2004, and assayed microscopically for gut-inhabiting trichomycete fungi and ichthyosporean protists. Results Nearly 68% of larval black flies in Armenia contained at least one species of gut symbiote, with a mean of 0.9 ± 0.04 species per host larva. Eight species of trichomycete fungi and two species of ichthyosporeans were found in larval guts. Seven of these species were recorded for the first time in Asian black flies. Species accumulation curves showed no additional species of gut symbiotes after 17 host species and 22 sites had been examined. All gut symbiotes were widely distributed, indicating an absence of endemic trichomycetes in the black flies of Armenia. Main conclusions Although the Caucasus Region is noted for its high levels of endemism for plants and animals, including black flies, the gut symbiotes of black flies are all widespread species. The absence of endemic gut symbiotes in larval black flies might be explained by their lack of host specificity; an absence of host specificity would not constrain the geographical distribution of the symbiotes.

Road-killed animals are overlooked as the source of ectoparasites for monitoring vectors of zoonotic pathogens. We demonstrate that by exclusively sampling road-killed animals, a wide spectrum of vertebrate hosts and ectoparasites can be collected. Fifty-one species of ectoparasites were recovered from 35 species of road-killed vertebrates in northwestern South Carolina. Approximately, 11% of the total known terrestrial vertebrate species in the region were examined, which included more than 25% of the known mammal species. Our sampling techniques produced new state and regional records for chewing lice, ticks, and parasitic mites. Most ectoparasites were alive when they were collected, which would allow them to be screened for zoonotic pathogens.

Smittium, the most speciose genus of the "gut fungi" (Zygomycota: Trichomycetes), is found attached to the hindgut cuticle of larval aquatic Diptera. Smittium spp. colonize several host families (e.g., Smittium culisetae in Chironomidae, Culicidae and Simuliidae), but some species appear to be specific to a single host family (e.g., Smittium morbosum Sweeney in Culicidae). The specificity of Smittium spp. within a host family has been difficult to resolve. This research presents evidence that certain Smittium spp. differentially colonize particular species of black fly (Diptera: Simuliidae) hosts as measured by differences in prevalence, abundance and fecundity. Reasons for this differential occurrence and fecundity in hosts are unclear but might include fungal responses to variations in host morphology, physiology, distribution or behavior. Variable fitness of Smittium spp., within a suite of available hosts, could be a factor in the diversity of this fungal group.

Summary We systematically reviewed the clinical outlook of West Nile virus (WNV)-related illness in North America and western Europe. As of March, 2015, more than 45 000 cases of WNV-related illness have been reported in North America. Unlike acute morbidity and mortality, the long-term physical, cognitive, and functional sequelae associated with WNV-related illness are not well characterised. An understanding of WNV-related sequelae and their prognostic factors can support physicians with early diagnosis and tertiary prevention efforts. We searched Ovid Medline, Embase, Scopus, and Environment Complete for studies published between 1999 and 2015. We included 67 studies in our Review. Although muscle weakness, memory loss, and difficulties with activities of daily living were among the most common physical, cognitive, and functional sequelae, respectively, some population groups were reported to be at greater risk of severe neurological disease or death (ie, older men with underlying illnesses such as cardiovascular disease or cancer). A high level of heterogeneity was reported among studies included in this Review, suggesting a need for consistent methods for collecting data and reporting findings. Further, more than half of the studies reporting sequelae relied exclusively on subjective assessment and only two studies used matched control groups. Therefore, opportunities exist for more robust primary studies in future research.

To the Editor: Coxiella burnetii, the agent of Q fever, is a bacterium and a potential agent of bioterrorism. The most frequent signs of infection in domestic animals are abortion and reduced fertility (1). Clinical signs of Q fever in humans vary from mild fevers to pneumonia, hepatitis, or death; atypical cases occur as other disorders, such as cholecystitis (1,2). Aerosols are the most common route of exposure, but oral transmission occurs (1). Some flies feed on the feces, milk, carcasses, or blood of domestic animals that can be infected with C. burnetii. These flies regurgitate and defecate when feeding and are mechanical vectors of bacteria (3,4). Flies have been shown to harbor, mechanically transport, and even support the growth of C. burnetii (4–6). It is known that house flies (Musca domestica) are possible mechanical vectors of C. burnetii because this organism survived 32 days in house flies and viable bacteria were shed by flies for 15 days (4). There are no studies of C. burnetii in field-collected flies. To examine the prevalence of C. burnetii in field-collected flies, we tested flies from farms, forests, ranches, and zoos. Flies that develop on animal dung, carcasses, feces, blood, or garbage are often called filth flies. Adult Calliphoridae, Hippoboscidae, Muscidae, and Sarcophagidae were collected from forests, zoos, ranches, and farms (Table). Flies were killed in 95% ethanol or by freezing. DNA was extracted from individual flies as described (7,8). A distilled water negative control was used for each extraction. Table Flies from the United States and Dominica assayed for Coxiella burnetii, 2004–2007 Individual DNA samples were tested, in duplicate, with a previously described TaqMan assay with a lower limit of detection of 1 C. burnetii organism (8). Positive and negative controls were used for all assays. Positive flies were verified by PCR and sequencing of 16S rRNA gene as described (9). Vouchers for each insect species were deposited in the Clemson University Arthropod Collection (Clemson, SC, USA), the University of Georgia Museum of Natural History (Athens, GA, USA), or the University of Wyoming Insect Collection (Laramie, WY, USA). Five of 363 flies were positive for C. burnetii DNA (Table). These flies included Stomoxys calcitrans, in which the adults feed on animal and human blood, and the blowflies Lucilia coeruleiviridis and L. sericata. C. burnetii–positive flies were obtained from carrion (1/12, 8.3%), a garbage bin of elephant feces (3/18, 16.7%), and a barn at a ranch (1/55, 1.8%). We sequenced 1,100 bp of the 16S rRNA gene from select DNA extracts, which were 99% identical with that of C. burnetii strain NC 002971. We detected DNA from C. burnetii in flies from a zoo, a ranch, and carrion in a forest. Laboratory data on house flies, which shed live C. burnetii for 15 days after exposure, suggest that related flies (e.g., S. calcitrans and Lucilia spp.) might also harbor viable C. burnetii. On the basis of our field data, S. calcitrans and Lucilia spp. should be studied as mechanical vectors of C. burnetii. Unlike many enteric bacteria, which require large inocula to cause disease, C. burnetii can be infectious at the level of 1 bacterium (10). If flies transmit C. burnetii, they pose an additional threat to human and animal health. The role of the sheep ked (Melophagus ovinus) in maintenance or transmission of C. burnetii is unknown. This fly is an obligate ectoparasite of sheep. It feeds on sheep blood, and feces from sheep keds can accumulate in the wool of sheep. Testing of sheep keds from infected sheep would help understand whether keds play a role in the epidemiology of C. burnetii.

We examined malaria cases reported to Ontario’s public health surveillance systems from 1990 through 2009 to determine how temporal scale (longitudinal, seasonal), spatial scale (provincial, health unit), and demography (gender, age) contribute to Plasmodium infection in Ontario travellers. Our retrospective study included 4,551 confirmed cases of imported malaria reported throughout Ontario, with additional analysis at the local health unit level (i.e., Ottawa, Peel, and Toronto). During the 20-year period, Plasmodium vivax accounted for 50.6% of all cases, P. falciparum (38.6%), Plasmodium sp. (6.0%), P. ovale (3.1%), and P. malariae (1.8%). During the first ten years of the study (1990–1999), P. vivax (64% of all cases) was the dominant agent, followed by P. falciparum (28%); however, during the second ten years (2000–2009) the situation reversed and P. falciparum (55%) dominated, followed by P. vivax (30%). The prevalence of P. falciparum and P. vivax cases varied spatially (e.g., P. falciparum more prevalent in Toronto, P. vivax more prevalent in Peel), temporally (e.g. P. falciparum incidence increased during the 20-year study), and demographically (e.g. preponderance of male cases). Infection rates per 100,000 international travellers were estimated: rates of infection were 2× higher in males compared to females; rates associated with travel to Africa were 37× higher compared to travel to Asia and 126× higher compared to travel to the Americas; rates of infection were 2.3–3.5× higher in June and July compared to October through March; and rates of infection were highest in those 65–69 years old. Where exposure country was reported, 71% of P. falciparum cases reported exposure in Ghana or Nigeria and 63% of P. vivax cases reported exposure in India. Our study provides insights toward improving pre-travel programs for Ontarians visiting malaria-endemic regions and underscores the changing epidemiology of imported malaria in the province.

Botulism is a neuroparalytic condition, typified by cranial nerve palsies that may be followed by descending symmetrical flaccid paralysis, which can lead to respiratory arrest and, in some instances, death (1). Intestinal toxemia botulism is an infectious form of botulism in which illness results from ingesting spores, which is followed by spore germination and intraluminal production of botulinum neurotoxins over an extended period (2). Intestinal toxemia botulism is rarely reported in adults

Biting midges of the genus Culicoides (Diptera: Ceratopogonidae) were collected during the summer of 2007 at the Greenville and Riverbanks Zoos in South Carolina with Centers for Disease Control and Prevention (CDC) traps equipped with ultraviolet or incandescent lights and baited with carbon dioxide. Sixteen species of Culicoides were collected, four of which represented more than 80%. They were Culicoides guttipennis (Coquillett), Culicoides mulrenanni Beck, Culicoides obsoletus (Meigen), and Culicoides sanguisuga (Coquillett). C. guttipennis was found on a dead colobus monkey and a dead golden-headed lion tamarin; Culicoides husseyi Wirth & Blanton was collected from an unidentified, abandoned bird's nest. Ultraviolet light-equipped traps captured significantly more Culicoides specimens than traps with incandescent light. Half of the collected species previously have been associated with vertebrate pathogens, indicating a potential risk to captive animals.

Standard surveillance traps in North America for adult Aedes albopictus (Skuse) (Diptera: Culicidae), an invasive mosquito with public health implications, are currently ineffective. We compared the efficacy of the BG-Sentinel trap (BGS) with and without lures (BG-lure, octenol, and CO2), the Centers for Disease Control and Prevention light trap (CDC) with and without lures, and the gravid trap (GT) for Ae. albopictus collection in two urban sites in New Jersey. The BGS with or without lures collected more Ae. albopictus compared with other trap configurations and was more specific for Ae. albopictus. In Camden County, the BGS with lures collected three times more Ae. albopictus than the CDC (with CO2 only) and five times more than the GT. In Mercer County, BGS with lures collected the most mosquitoes, with 3 times more Ae. albopictus than the CDC with all lures and 50 times more than the GT. The BGS collected more male Ae. albopictus than other traps in both counties, providing further population monitoring. The GT and BGS provided a relative measure of the enzootic activity of West Nile virus in Culex spp. and the potential epidemic activity of WNV in Ae. albopictus. The BGS provides effective chemical and visual cues for host-seeking Ae. albopictus and should be used as a part of existing surveillance programs and new initiatives targeting this mosquito.