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1 This review synthesizes the current data on emergence, dynamics and molecular epidemiology of USUV in Europe within the multidisciplinary 'One Health' context. + 1163 word(s) 1163 2020-09-03 05:28:17 |
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Vilibic-Cavlek, T.; Petrovic, T.; Savic, V.; Barbic, L.; Tabain, I.; Stevanovic, V.; Klobucar, A.; Mrzljak, A.; Ilic, M.; Bogdanic, M.; et al. Usutu virus in Europe. Encyclopedia. Available online: (accessed on 27 May 2024).
Vilibic-Cavlek T, Petrovic T, Savic V, Barbic L, Tabain I, Stevanovic V, et al. Usutu virus in Europe. Encyclopedia. Available at: Accessed May 27, 2024.
Vilibic-Cavlek, Tatjana, Tamas Petrovic, Vladimir Savic, Ljubo Barbic, Irena Tabain, Vladimir Stevanovic, Ana Klobucar, Anna Mrzljak, Maja Ilic, Maja Bogdanic, et al. "Usutu virus in Europe" Encyclopedia, (accessed May 27, 2024).
Vilibic-Cavlek, T., Petrovic, T., Savic, V., Barbic, L., Tabain, I., Stevanovic, V., Klobucar, A., Mrzljak, A., Ilic, M., Bogdanic, M., Benvin, I., Santini, M., Capak, K., Monaco, F., Listes, E., & Savini, G. (2020, September 11). Usutu virus in Europe. In Encyclopedia.
Vilibic-Cavlek, Tatjana, et al. "Usutu virus in Europe." Encyclopedia. Web. 11 September, 2020.
Usutu virus in Europe

Usutu virus (USUV) is an emerging arbovirus isolated in 1959 (Usutu River, Swaziland). Previously restricted to sub-Saharan Africa, the virus was introduced in Europe in 1996. While USUV has received little attention in Africa, the virus emergence has prompted numerous studies with robust epidemiological surveillance programs in Europe. Epizootics and genetic diversity of USUV in different bird species as well as detection of the virus in mosquitoes suggest repeated USUV introductions into Europe with endemization in some countries. The zoonotic potential of USUV has been reported in a growing number of human cases. Clinical cases of neuroinvasive disease and USUV fever, as well as seroconversion in blood donors were reported in Europe since 2009. Since spreading trends of USUV are likely to continue, continuous multidisciplinary interventions ('One Health' concept) should be conducted for monitoring and prevention of this emerging arboviral infection.

Usutu virus Epidemiology Europe "One Health"

1. Introduction

Usutu virus (USUV) is an emerging arbovirus that belongs to the family Flaviviridae, genus Flavivirus, Japanese encephalitis serocomplex. Similar to other flaviviruses, USUV is a spherical, small, enveloped virus with a single stranded positive-sense RNA genome of ~12 kb. Phylogenetic analyses of the NS5 gene have shown that USUV strains clustered into eight genetic lineages: three African (Africa 1–3) and five European (Europe 1–5) [1]. In nature, USUV is maintained in a bird–mosquito–bird cycle, however the virus or antibodies detection were reported sporadically in humans, horses and other mammals (Figure 1).

USUV was isolated in 1959 from Culex neavei mosquito caught near the Usutu River in Swaziland [2]. After that, the virus was confined to Africa with only few human cases with fever, rash and jaundice reported [3]. In Africa, the USUV host range includes mosquitoes, birds, equids and dogs [4][5]. The virus was also isolated and nucleotide sequenced from five asymptomatic small mammals in Senegal that belong to two rodent species (black rat; Rattus rattus and multimammate rat; Mastomys natalensis) and a single species of shrew (Crocidura sp.) (Figure 1) [6].

A retrospective analysis of archived tissue samples originating from a bird die-off showed that USUV emerged in Europe in 1996 (Tuscany region, Italy), five years before the advent of USUV-associated bird deaths in Austria which has been generally assumed as the starting point of the virus spread in Europe [7]. In 2001, the virus caused the first large outbreak in several bird species in the region of Vienna (Austria) [8]. In the following years, continuous geographic expansion of the USUV in Europe has been shown by reports of epizootics or small outbreaks as well as serologic detection in different wild and captive bird species [9][10][11][12]. In addition, the virus was detected in different native (mainly Culex pipiens) and invasive mosquito species (Aedes albopictus, Ae. japonicus) [13][14][15][16][17][18]. USUV RNA was also found in bats (Pipistrellus pipistrellus) in Germany and Belgium [19][20]. Moreover, USUV antibodies were sporadically detected in horses [21][22][23], dogs [24], squirrels [25], wild boar, roe deer [26] and lizards [27] (Figure 1), expanding the USUV host range (Figure 1), however these species are considered incidental hosts.

Figure 1. Usutu virus (USUV) transmission cycle involves birds (amplifying hosts) and mosquitoes (vectors). Infection can be transmitted to humans and horses which are generally considered incidental or “dead-end” hosts. USUV isolation/detection (black symbols) and serologic evidence (blue symbols) were reported in different animal species, expanding the incidental host range.

The zoonotic potential of USUV has been reported in a limited number of human cases. Few cases of neuroinvasive disease and USUV fever, as well as seroconversion in blood donors were reported in Europe since 2009 [11][28][29][30][31][32][33]. Phylogenetic analyses showed that the majority of USUV strains detected in humans, birds and mosquitoes belong to European USUV lineages, however several reports indicated the presence of African lineages as well [18][34][35][36].

The USUV diversity in Europe appeared in the last decade, however, the phylogenies suggest a long-term virus circulation in this region [37]. The presence of USUV was documented by virus isolation/detection or serologically in Austria, Belgium, Croatia, the Czech Republic, France, Germany, Greece, Hungary, Italy, the Netherlands, Poland, Serbia, Slovakia, Spain, Switzerland and the United Kingdom.

The emergence and geographic distribution of USUV infections in European countries is presented in Table 1 and Figure 2.

Table 1. Emergence of Usutu virus (USUV) in Europe: clinical cases/seroconversion/RNA detection/serologic evidence. In Europe, USUV emerged in 1996 in the Tuscany region (Italy) when it was detected by retrospective analysis of archived tissues from dead birds. In mosquitoes, USUV was discovered for the first time in 2006 (Spain) in a pool of Cx. pipiens. Seroconversion in horses was reported in 2008 (Italy), following the first two human clinical cases in 2009. In 2013, the virus was detected in two dead bats (Pipistrellus pipistrellus) in Germany. Until 2018, USUV infections were reported in 16 European countries.

Country Pathogens 09 00699 i001 Pathogens 09 00699 i002 Pathogens 09 00699 i003 Pathogens 09 00699 i004 Pathogens 09 00699 i005 Reference
Austria 2016* 2001   2017   [8][17][37][38][39]
Belgium   2012   2016 2017 [1][20][40]
Croatia 2012 2018 2011 2016   [15][22][30][32]
Czech Republic   2004   2013   [41][42]
France 2016 2015   2015   [31][43][44]
Germany 2012* 2011   2010 2013 [9][13][19][45]
Greece   2010       [46]
Hungary 2018 2005       [34][47]
Italy 2009 1996 2008 2009   [7][21][28][29][48]
Netherlands   2016       [49]
Poland   2006 2012     [50][51]
Serbia 2015 2012 2009 2014   [52][53][54]
Slovakia   2010       [23][55]
Spain   2011 2011 2006   [56][57][58][59]
Switzerland   2006       [60]
United Kingdom   2001       [61]
Pathogens 09 00699 i006Clinical cases/RNA detection/seroconversion; Pathogens 09 00699 i007serologic evidence; *asymptomatic blood donors/blood donations.


Figure 2. Geographic distribution of Usutu virus in Europe (clinical cases/RNA detection/seroconversion/serologic evidence).

2. Conclusion

Circulation of different European and African USUV lineages (Table 2, Figure 3), suggests multiple introduction events to Europe from Africa. The Europe 2 lineage is the most commonly detected USUV lineage in the European countries [16][32][62][63]. The Europe 3 USUV lineage was predominantly circulating in Southern Belgium in 2017 and 2018 [20]. Recent studies from Germany [64] and the Netherlands [65] showed an increase in the USUV Africa 3 lineage detection during the same period. The genetic diversity of European lineages is most likely shaped by enzootic maintenance (in situ evolution) rather than by extensive migration, while African lineages are driven mostly by extensive migration and repeated introduction of viral variants from different geographic origins [37]. In addition to data from the published articles, the sequences retrieved from the GenBank suggest for certain European countries broader host range as well as USUV lineage diversity within a specific host.

Table 2. Molecular epidemiology of Usutu virus (USUV) in Europe. USUV Europe 2 lineage is the most prevalent genetic lineage detected in birds, mosquitoes and humans. In birds, Europe lineage 1, 3-5 and Africa 2 and 3 lineages were detected as well. Europe 3 and 4 and Africa 2 and 3 lineages were detected in mosquitoes. In bats, only Europe 3 lineage was documented so far.                                                      

Country Pathogens 09 00699 i008 Pathogens 09 00699 i009 Pathogens 09 00699 i010 Pathogens 09 00699 i011 Reference
Austria Europe 2*
Africa 3*
Europe 1,2
Africa 3
Europe 2**   [34][35][64][66]
Belgium   Europe 1,3
Africa 3
Europe 3 Europe 3 [20][36][64][66]
Croatia Europe 2 Europe 2 Europe 2   [32]
Czech Republic   Europe 1,2,3
Africa 3
Europe 2   [18][42]
France Africa 2 Europe 3 Europe 2
Africa 2,3
Germany Europe 3 Europe 2,3,5
Africa 2,3
Africa 3-like
Europe 3
Africa 3
Europe 3 [9][19][64][67][68][69]
Hungary Europe 2 Europe 1,2     [34][39][47][70]
Italy Europe 1,2*,3*,4* Europe 2,4 Europe 2,4   [16][29][64][71][72]
Netherlands Europe 3 Europe 3
Africa 3
Serbia     Europe 1,2   [75][76]
Slovakia     Europe 2   [55]
Spain   Africa 2 Africa 2   [1][77]
Switzerland   Europe 1     [60]
*Blood donors/donations; **based on nucleotide sequences retrieved from the GenBank.


Figure 3. Neighbor-Joining tree of USUV sequences based on 495 nucleotides of the NS5 gen illustrating phylogenetic and host diversity of USUV strains detected in European countries. Taxon information includes the GenBank accession number, country in which the virus was detected, host and isolation/detection year. Colour codes for different hosts are shown in the upper left corner. USUV genetic lineages are indicated on the right. Scale bar indicates the mean number of nucleotide substitutions per site.

The integrated veterinary and human surveillance system ('One Health') based on the viruses detection in mosquitoes, migratory and resident birds as well as horses and poultry was proved to be useful for estimating the public health risk for other flaviviruses such as WNV. This enables the effective and timely control of the diseases in humans [78][79][80]. Since spreading trends of USUV are likely to continue, continuous multidisciplinary interventions in accordance with the 'One Health' concept, should be conducted to increase the awareness of USUV and implement appropriate monitoring and prevention methods for this emerging arboviral infection.


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