Aedes-borne arboviral human infections in Europe from 2000 to 2023: A systematic review and meta-analysis

Introduction: Aedes-borne arboviral infections, both imported and autochthonous, are reported in Europe. We evaluated the landscape of these infections in Europe over 23 years and attempted to pre-empt the trajectory of impact of these infections in the climatic context of Aedes mosquito expansion in Europe. Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered in Prospero (CRD42023360259). PubMed, Embase, Web of Science, IEEE Xplore, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and the European Centre for Disease Prevention and Control (ECDC) websites were searched for publications reporting on cases of Aedes-borne infection in Europe between January 1st, 2000, and December 31st, 2023. Results: Some 353 papers were included, covering 59,589 cases of infection in Europe by seven arboviruses: dengue, Zika, chikungunya, yellow fever, Mayaro, Ross River, and Rift Valley. Most cases (55,924) were travel related, while 5 % were autochthonous. There were 59 cases of non-vector-borne transmission, primarily Zika-related sexual transmissions. Nineteen deaths were reported, of which three were associated with chikungunya virus infection, 12 with dengue, and four with yellow fever. Notable sequelae included persistent arthralgia from chikungunya and neurological effects in Zika-infected infants. The meta-analysis of 31 studies revealed a pooled prevalence of 0.047 (95 % CI: 0.03–0.07) in symptomatic returning travelers. Conclusion: The systematic review provides a comprehensive overview of over 20 years of Aedes -borne infections in Europe, highlighting the dynamic nature of virus transmission influenced by global travel patterns, climate change, the expanding spread of Aedes populations, and evolving public health campaigns.