Conclusions

The main conclusions are as follows:

1. The disease appearance reflects the population distribution, while the risk tends to escalate around urban areas that are characterized by an urban heat island.

2. Constant positive anomalies of the minimum and maximum temperatures during the study period appear to have facilitated the mosquito abundance and consequently the disease emergence in humans.

3. An important finding is the potential influence of extreme heat in the early spring on the vector population increase and on the disease's appearance weeks later (Paz and Albersheim, 2008). Awareness of such situations at the very beginning of the spring may help authorities to reduce the disease risk before it becomes a real danger.

Climate models project a continuing temperature increase over the next decades in the Mediterranean basin (IPCC, 2007). Despite future uncertainty, the warming tendency has to be considered in predicting further WNV outbreaks in Israel and in the whole eastern Mediterranean basin.

Usually, interactions between climatologists, entomologists, and physicians are limited. They do not exchange information that can be readily employed in vector management. By raising the awareness of the relation between WNV eruptions and extreme heat conditions, the spread of the disease could be halted before it grows into a full-blown outbreak.

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