Risk assessment and perspectives of local transmission of chikungunya and dengue in Italy, a European forerunner

Abstract To address the growing frequency, extension, and size of local arboviral outbreaks in Europe we retrospectively analyzed dengue and chikungunya transmission in Italy from 2006 to 2023. We applied generalized additive models to the records of travel-related cases to highlight the spatiotemporal patterns of disease importation, calculated reproduction numbers for six local outbreaks based on autochthonous case data and mapped current transmission risks by applying a computational model that integrates human density, entomological, and climate data. Outbreak locations appear driven by case importation, which is notably higher for dengue – especially from June to October - rather than local transmission risks. Although reporting delays and favorable temperatures allowed onward transmission for several generations from mid-August to mid-November, upon outbreak detection control of transmission was achieved within 15 days. In high-risk areas, significantly longer epidemic risks were found for chikungunya (over 4 months). However, considering observed importation trends, increasingly frequent local dengue outbreaks are expected. Case detection should be prioritized focusing on areas, and in times, where environmental and climate conditions are permissive, regardless of prior outbreaks.