Perceptions and practices of mosquito-borne diseases in Alabama – is concern where it should be?

Morse et al. BMC Public Health (2019) 19:987 https://doi.org/10.1186/s12889-019-7308-x RESEARCH ARTICLE Open Access Perceptions and practices of mosquitoborne diseases in Alabama – is concern where it should be? Wayde Morse1* , Katie Izenour2, Benjamin McKenzie1, Sarah Lessard1 and Sarah Zohdy1,2 Abstract Background: The Gulf Coast of the United States is home to mosquito vectors that may spread disease causing pathogens, and environmental conditions that are ideal for the sustained transmission of mosquito-borne pathogens. Understanding public perceptions of mosquito-borne diseases and mosquito prevention strategies is critical for the development of effective vector control strategies and public health interventions. Here, we present a survey conducted in Mobile, Alabama along the Gulf Coast to better understand public perceptions of mosquitoborne diseases, mosquito control activities, and potential risk factors. Methods: Using Knowledge, Attitude, and Practice (KAPs) assessments, we surveyed populations living in 12 zip codes in Mobile, Alabama using a 7-point Likert scale and frequency assessments. Survey participants were asked about vector control efforts, knowledge of mosquito-borne diseases, and understanding of mosquito ecology and breeding habitats. Results: One hundred twenty-six surveys were completed in Mobile, Alabama, revealing that 73% of participants reported being bitten by a mosquito in the last 30 days and mosquitoes were frequently seen in their homes. Ninety-four percent of respondents had heard of Zika Virus at the time of the survey, and respondents reported being least familiar with dengue virus and chikungunya virus. Conclusions: Chikungunya virus, dengue virus, malaria, West Nile virus, and Zika virus have been documented in the Gulf Coast of the United States. The mosquitoes which vector all of these diseases are presently in the Gulf Coast meaning all five diseases pose a potential risk to human health. The results of this survey emphasize knowledge gaps that public health officials can address to empower the population to reduce their risk of these mosquito-borne diseases. Each species of mosquito has specific preferences for breeding and feeding and there is no one size fits all prevention approach, educating people on the need for a variety of approaches in order to address all species will further empower them to control mosquitoes where they live and further reduce their risk of disease. Keywords: KAP survey, Zika, Chikungunya, West Nile virus, Malaria, Vector control, Mosquito ecology * Correspondence: 1 Auburn University School of Forestry and Wildlife Sciences, 602 Duncan Dr, Auburn, AL 36849, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Morse et al. BMC Public Health (2019) 19:987 Page 2 of 9 Background The sub-tropical climate of the US Gulf Coast, as well as an abundance of habitat for Aedes, Culex and Anopheles mosquitoes and the proximity of trade and travel hubs, put the Gulf Coast at risk for the establishment or re-establishment of mosquito-borne pathogens in the US [1]. Until the implementation of vigorous vector control efforts in the mid-twentieth century, the Gulf Coast experienced regular outbreaks of malaria and yellow fever [2, 3]. In more recent years, the Gulf Coast has been under threat of endemic transmission of mosquito-borne RNA viruses such as West Nile virus (WNV), dengue fever virus (DENV), chikungunya virus (CHIKV) and Zika virus (ZIKV) [4–7]. Vector control efforts have been stymied by the growing prevalence of insecticide resistance among many mosquito taxa as well as funding cuts due to a public perception that mosquito-borne pathogens no longer present much threat in the US [8, 9]. The potential for emergence and re-emergence of mosquito-borne diseases in this geographic region points to a growing need to develop strategies to combat the transmission of mosquito-borne pathogens. A few mosquito-borne pathogens that pose potential threats in the region due to the distribution of their mosquito vectors include CHIKV, DENV [10], malaria (MAL) [11], WNV [12, 13] and ZIKV. All of these pathogens have been detected in Gulf Coast states in recent years, though many of these cases have been considered to be imported cases, not acquired locally (Table 1). WNV, which is transmitted by Culex mosquitoes, is the most prevalent mosquito-borne disease in the US, with an average of 2,000 and up to 9,800 cases per year (between 1999 and 2017) [16]. Symptoms range from mild febrile illness, to severe encephalopathy to death [17]. Meanwhile, ZIKV, DENV and CHIKV, all transmitted by Aedes mosquitoes, have recently emerged and re-emerged in Gulf States, mostly in travel-related cases, but achieving autochthonous transmission in Florida [5, 6, 18]. Historically, MAL was prevalent in the southeastern US, with parasites transmitted by Anopheles mosquitoes. Malaria symptoms typically include cyclical fevers, anemia, and fatigue and are often fatal in pregnant women and children under the age of 5 [19]. Following massive mosquito control efforts in the US, including the use of DDT as pesticide, MAL was eliminated from the region [2]. While MAL transmission is not endemic to the southeastern US, there are still a handful of reported human cases annually, typically attributed to travel. A well-known mosquito vector of MAL (An. quadrumaculatus) remains around the US Gulf Coast and is a very common nocturnal mosquito. It is important to note that these pathogens are transmitted by different genera of mosquitoes, each with different ecologies and thus requiring different strategies for vector control (Table 2). While many public health strategies exist to combat the spread of mosquito-borne pathogens, including insecticide use, gene drives and reduction of breeding habitat, none of these methods is entirely effective on its own and all of these methods benefit from the aid of public education [20–22]. A populace educated in the transmission cycles of mosquito-borne pathogens, as well as common steps taken to interrupt this cycle, can be invaluable to public health efforts [20, 21]. Thus, an informed private citizenry could be an important tool for vector control strategies in the region. To gauge residents’ current level of understanding surrounding mosquito-borne pathogens present in the Gulf Re (...truncated)