title: A hypothesis for explaining single outbreaks (like the Black Death in European cities) of vector-borne infections.
abstract: We propose a mechanism by which single outbreaks of vector-borne infections can happen even when the value of the basic reproduction number, R(0), of the infection is below one. With this hypothesis we have shown that dynamical models simulations demonstrate that the arrival of a relatively small (with respect to the host population) number of infected vectors can trigger a short-lived epidemic but with a huge number of cases. These episodes are characterized by a sudden outbreak in a previously virgin area that last from weeks to a few months, and then disappear without leaving vestiges. The hypothesis proposed in this paper to explain those single outbreaks of vector-borne infections, even when total basic reproduction number, R(0), is less than one (which explain the fact that those infections fail to establish themselves at endemic levels), is that the vector-to-host component of R(0) is greater than one and that a sufficient amount of infected vectors are imported to the vulnerable area, triggering the outbreak. We tested the hypothesis by performing numerical simulations that reproduce the observed outbreaks of chikungunya in Italy in 2007 and the plague in Florence in 1348. The theory proposed provides an explanation for isolated outbreaks of vector-borne infections, ways to calculate the size of those outbreaks from the number of infected vectors arriving in the affected areas. Given the ever-increasing worldwide transportation network, providing a high degree of mobility from endemic to virgin areas, the proposed mechanism may have important implications for public health planning.
authors.affiliation: School of Medicine, University of São Paulo, Rua Teodoro Sampaio 115, CEP 05405-000, SP, Brazil.
authors.forename: M N
authors.initials: MN
authors.lastname: Burattini
authors.forename: F A B
authors.initials: FA
authors.lastname: Coutinho
authors.forename: E
authors.initials: E
authors.lastname: Massad
mesh_terms: D000818:Animals; D003141:Communicable Diseases / Q000453:epidemiology*; D003198:Computer Simulation; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004199:Disease Vectors; D006801:Humans; D008954:Models, Biological; D010930:Plague / Q000453:epidemiology*