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HEALTH

Q&A: What you need to know about Italy’s West Nile virus outbreak

As Italy records a surge in cases of West Nile fever, we look at what the disease is and where in the country it's spreading.

Mosquitoes held in a vial as scientific experiments are conducted in a Brazilian lab.
Cases of the West Nile Virus, which is transmitted by mosquitoes of the Culex species, keep increasing across northern Italy. Photo by Apu GOMES / AFP

Mosquitos are unfortunately one downside of summer in Italy. But as well as being a nuisance, they may also pose a health risk in the country – one of the few in Europe to record cases of West Nile virus (WNV)

READ ALSO: Cases of West Nile fever surge in northern Italy

Last week Italy recorded 50 more cases of the mosquito-borne virus, bringing the total number of infections to 144 according to the latest report from Italy’s Higher Health Institute (ISS).

This marked a 53-percent increase in cases against the previous week, while ten people have died so far.

As the number of infections continues to rise, here are the answers to the most pressing questions about the disease and the outbreak in Italy.

What is it?

The West Nile Virus (WNV) is a single-stranded RNA virus that can cause West Nile fever in humans.

It’s a member of the Flavivirus family together with other endemic viruses such as the Zika and Dengue viruses.

The virus was first identified in 1937 in Uganda’s West Nile district but has since spread to many other parts of the world, to the point that it is now considered indigenous to Africa, the Middle East, Asia and Australia. 

Carried by birds, West Nile virus is transmitted to humans by mosquitoes.

The West Nile virus is primarily transmitted by mosquitoes of the Culex species, which infect humans and other mammals through their bite, according to Italy’s health ministry.

There is no evidence that human-to-human transmission is possible.

Where are cases being reported in Italy?

Infections have been largely concentrated in the north of the country, especially in the Veneto region, where six people have now died of the disease. Other deaths were recorded in Lombardy, Piedmont and Emilia-Romagna.

The city of Padua, which is located in Veneto’s mainland, around 35 kilometres away from the Adriatic coast, is currently regarded as the hotspot of the virus. 

It isn’t yet clear why Veneto has been the worst-hit region so far, but experts fear that its marshy lowlands might be the perfect breeding ground for disease-carrying mosquitoes. 

A mosquito of the Culex species viewed under a microscope.

Mosquitoes of the Culex species, a specimen of which is pictured above, are responsible for transmitting the West Nile Virus to humans and other mammals. Photo by Jon CHERRY Getty Images / AFP

How severe is the outbreak in Italy?

West Nile virus is not new to Italy. However, this summer has brought the highest number of cases recorded yet.

National infection levels remain relatively low but the country has by far the largest number of cases in Europe.

According to the most recent report from the European Centre for Disease Prevention and Control (ECDC), dated August 3rd, 94 out of 120 recorded cases were in Italy.

Greece had 23 reported cases. Romania and Slovakia had two and one respectively. 

Italy is the only European country that has reported fatalities.

What are the symptoms?

According to the Italian Higher Health Institute (ISS), around 80 percent of infected people show no symptoms whatsoever.

In symptomatic cases, however, symptoms generally resemble those of a common flu and include fever, headaches, nausea and diarrhoea. 

The infection is usually only dangerous for people with weakened immune systems such as the elderly, and the most severe symptoms occur in fewer than one percent of infected people.

In healthy people, the virus is unlikely to cause more than a headache or sore throat, and symptoms generally last only a few days.

According to the data currently available, around one in 150 infected people can show symptoms as serious as partial vision loss, convulsions and paralysis. 

In very rare cases (around 0.1 percent, or one in 1000) the disease can cause brain infections (encephalitis or meningitis) which may eventually be fatal.

Brazilian biologists handle mosquito larvae.

There is currently no vaccine against West Nile disease, though several are being tested. Photo by Apu GOMES / AFP

Is there a cure?

There is no vaccine against West Nile fever. “Currently vaccines are being studied, but for the moment prevention consists mainly in reducing exposure to mosquito bites,” the ISS states.

There is also no specific treatment for the disease caused by the virus.

Patients showing the more serious symptoms are usually admitted to hospital and treated with IV fluids and assisted ventilation.

What should you do to protect yourself?

Seeing as there is currently no vaccine against the virus, the best way to protect oneself is by reducing exposure to mosquitoes as much as possible.

Italian health authorities have listed a number of official recommendations to help residents avoid mosquito bites. These include: 

  • Use repellent
  • Wear long-sleeved shirts and long trousers when being outdoors and especially during ​​mosquitoes’ peak activity times, i.e. sunrise and sunset
  • Use mosquito nets on your windows or sleep in rooms with air-conditioning and keep the windows closed
  • Make sure there are no pools of stagnant water around your house

See more information about West Nile virus in Italy on the health ministry’s website.

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ITALIAN ELECTIONS

What will a right-wing election victory mean for abortion rights in Italy?

The right-wing parties poised to win Italy’s upcoming general elections have a history of denouncing abortion. Could a new conservative government threaten reproductive rights in Italy?

What will a right-wing election victory mean for abortion rights in Italy?

When Italians go to the polls on September 25th, a coalition of three right-wing parties – Giorgia Meloni’s Brothers of Italy, Matteo Salvini’s League and Forza Italia, led by former premier Silvio Berlusconi – are widely expected to win the vote and secure the opportunity to form Italy’s next government.

READ ALSO: Your ultimate guide to Italy’s crucial elections on Sunday

With all three parties to the right of centre – by quite some way, in the case of Brothers of Italy and the League – activists are concerned about what Italy’s most socially conservative government in years could mean for women seeking to access abortions, as they have had the legal right to do here for over four decades.

Here’s what Italian law says about abortion, what the right-wing alliance has promised it will – or won’t – change, and what all this could mean for people in need of abortion care in Italy.

What is Italy’s law on abortion now?

Abortion – formally referred to in Italian as interruzione volontaria di gravidanza or IVG, ‘voluntary termination of pregnancy’ – has been legal in Italy since 1978.

Passed after years of protests and several other failed bills, Legge 194 (‘Law 194’) decriminalized the procedure and entitled women to request it for any reasons of physical or mental health within the first 90 days after conception.

Women can continue to seek an abortion after 90 days if a significant foetal abnormality is present, or if continuing the pregnancy would endanger the woman’s life.

READ ALSO: The long road to legal abortion in Italy

The procedure is offered free of charge to those who qualify for public healthcare in Italy.

To access it, women first must consult a doctor and discuss options “to help her to overcome the factors which would lead her to have her pregnancy terminated”.

If the patient continues to affirm her original choice, she will be issued a certificate either stating that the termination is urgent and can be carried out immediately, or, if it is not deemed urgent, that she can seek the procedure after a obligatory seven-day wait.

Campaigners in front of a banner reading ‘Don’t touch law 194’. Photo by FABRIZIO VILLA / AFP

In reality, the wait for an appointment is likely to be far longer. Law 194 also affirms the right of health workers to refuse to carry out abortions on the grounds of “conscientious objection”. 

This has translated into serious gaps in coverage across Italy, with some facilities staffed mostly or even entirely by personnel who decline to deliver abortion services.  

READ ALSO: Why abortions in Italy are still hard to access – despite being legal

In fact, a majority of gynaecologists in Italy – 64.6 percent, according to 2020 figures from the Ministry of Health – are registered objectors, as well as 44.6 percent of anaesthesiologists and 36.2 percent of non-medical staff at health facilities. 

In several parts of the country, including the regions of Sicily, Basilicata, Abruzzo, Molise and the province of Bolzano, the percentage of gynaecologists refusing to perform abortions is over 80 percent.

These doctors are probably out of step with public opinion in Italy. A 1981 referendum gave voters the opportunity to reject the new abortion law; 68 percent of them voted to keep it. 

More recently, an Ipsos poll conducted earlier this year found that 73 percent of people surveyed in Italy said abortion should be legal in all or most cases.

What election promises has Italy’s right-wing alliance made about abortion?

No doubt sensing the lack of appetite for a full-scale repeal of Italy’s abortion law, the right-wing coalition has made clear that that’s not on its agenda. 

Abortion doesn’t get a single mention in the joint platform put forward by the Brothers of Italy, League and Forza Italia. 

Law 194 does appear in the Brothers of Italy programme, which promises “full application” of the legislation, “starting with prevention” of abortion.

To this end, it pledges the allocation of funds to support single and economically disadvantaged women to carry pregnancies to term, a proposal echoed by the League and presented by both parties as part of a broader drive to reverse Italy’s plummeting birth rate.

The League’s platform also calls for implementation of Law 194’s provisions on the “effective promotion of life”, including by involving non-profit groups – presumably Catholic and other pro-life ones – in pre-abortion counselling.

Forza Italia, historically the most centrist of the three, hasn’t broached the subject at all. 

READ ALSO: Salvini vs Meloni: Can Italy’s far-right rivals put differences aside?

Both Meloni and Salvini have faced questions on the campaign trail about their position on abortion, given previous comments calling abortion “a defeat for society” (Meloni), loudly professed Catholicism (Salvini) and support for European allies who have restricted access to abortion, such as Hungarian Prime Minister Viktor Orban (both). 

“Law 194 isn’t to be touched,” Salvini told reporters this week. “The last thing Italy needs is a country divided and arguing over the laws in place – which can be improved and updated, but certainly not scrapped.”

Meloni, meanwhile, told a recent interviewer that “I never said I want to modify Law 194, but that I want to apply it”. That includes supporting women who feel obliged to abort for economic or practical reasons, she said – as well as supporting health workers who refuse to provide the procedure. 

Why are activists worried a new right-wing government could threaten abortion rights in Italy?

The problem is that Law 194 perhaps does need an overhaul if it is to guarantee access to safe, legal abortions across Italy. 

Those who support women’s right to choose have long complained that the 44-year-old law – whose primary objective, the Italian Health Ministry’s website states, “is the social protection of motherhood and the prevention of abortion” – is not fit for purpose.

A demonstrator holds a sign reading ‘free to choose’ at a rally in defence of Italy’s abortion law. Photo by FABRIZIO VILLA / AFP

Law 194 “does not establish in a strong sense women’s right to choice and self-determination: it establishes when access to it is permitted and granted,” Chiara Lalli, a writer and academic with a focus on abortion, told Il Post

The multiple doctor visits, mandatory counselling session and seven-day “reflection” period are attempts to interfere with women’s decisions, activists say. 

READ ALSO: ‘Ugly act’: Outrage in Italy over discovery of foetus graves marked with women’s names

Separately, watchdogs including the United Nations Human Rights Committee, Human Rights Watch and the Council of Europe’s committee of social rights have flagged the high rates of conscientious objectors as a persistent barrier to abortion access in Italy.

While authorities are supposed to ensure that women can access terminations and that objecting doctors can’t refuse care beyond the procedure itself, with no mechanisms to enforce these requirements specified in the existing law, in practice women report facing long delays or being denied assistance altogether. 

In the past, both Brothers and Italy and the League have resisted attempts to help the problem, such as by recruiting specifically non-objecting doctors.

While these problems are longstanding, there have been attempts in recent years to put more obstacles between women and abortions – mainly from regional or municipal politicians, who tend to be more explicit in their opposition than those on the national stage.

Many of these have come from members of the three main right-wing parties, which together have governed 14 of Italy’s 20 regions for the past two years.

And with each region largely in charge of managing its own public health service, regional governments have the power to make decisions that significantly affect how and where women can access abortions.

In Le Marche, headed by the Brothers of Italy, the regional government refused to implement 2020 national guidelines from the Ministry of Health that would have extended the window for medical abortions from seven to nine weeks and made it possible for women to obtain abortion pills in outpatient clinics and family planning centres instead of going into hospital. 

Abruzzo, whose council is also led by Brothers of Italy, as well as Piedmont and Umbria, two regions governed by the League, resisted the change too.

Priests join an anti-abortion demonstration on May 21st 2022 in central Rome. The placard reads “Human Rights are born in the womb”. Photo by Alberto PIZZOLI / AFP

Piedmont has further allowed anti-abortion groups to set up stands in public hospitals, and councillors have proposed funnelling public funds to groups that would pay women not to abort

The League-run council in Verona declared it a “pro-life city” and called for funding for anti-abortion projects to be written into the town budget, as well as authorizing anti-abortion groups to display promotional material in council buildings. 

In the wider region of Veneto, such groups are allowed to offer family counselling services alongside those providing neutral information – a move the League’s manifesto suggests extending when it talks about involving non-profits in “the promotion of life”. 

To those who support abortion, it all starts to look like a pattern. “As soon as a right-wing council takes charge, it seems like these issues are at the top of the agenda,” Beatrice Brignone, head of the small left-wing party Possibile, told L’Espresso back in 2020.

READ ALSO: Why an Italian woman was forced to go to 23 hospitals to have an abortion

With threats to abortion access in Italy emerging locally and unchecked at national level, some activists say they would in fact welcome putting Law 194 up for debate under the next government.

“As much to better implement it as to make the necessary modifications … it is time to begin an informed discussion on abortion and free ourselves from the prejudice that the law is untouchable,” comments the Luca Coscioni Association, which advocates for freedom of scientific research and backs abortion rights.

Meloni and her allies have already made clear that such a discussion will not be among their priorities if they win this weekend. 

What do other parties say about abortion?

Abortion isn’t an issue for either the centrists Italia Viva or Azione, nor for the populist Five Star Movement.

The centre-left Democratic Party promises the full application of Law 194 throughout the country, without going into further details.

The only concrete proposals come from much smaller parties on the left: Possibile proposes establishing a quota of at least 60 percent of non-objecting staff in each health facility, as well as tracking the service provided by each region and punishing those who fail to meet minimum standards. 

The Greens and Left Alliance wants to change recruitment rules to hire more non-objecting medical staff, while +Europa suggests partnering with private clinics to expand access and making medical abortion more widely available as an outpatient procedure.

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