The invasions of Aedes aegypti and Aedes albopictus in Cyprus: current situation, risk modelling and public health implications for the wider Eastern Mediterranean region.

The Asian tiger mosquito, Aedes albopictus and the yellow fever mosquito, Aedes aegypti have been spreading worldwide and are reshaping the distribution of arboviruses. Both Aedes species have recently been observed in densely populated cities of Cyprus, a touristic island that is a historic bridge between Europe and Asia. Given the high public health stakes for Cyprus and the wider East Mediterranean region, the objectives of this study are three-fold. First, we present a novel delimitation strategy using spatially dense networks of ovitraps deployed in 500x500m cells in Limassol and Larnaca following the detection of Aedes species. Second, we use a dynamical vector model to estimate the potential of both species to spread further over Cyprus. Finally, we employ a basic reproduction number (R0) model to assess the potential transmission risk of arboviruses for the wider East Mediterranean region. Our results underline our delimitation strategys usefulness in delineating Ae. albopictus populations in Limassol and indicate the need for increased surveillance efforts for Ae. aegypti in Larnaca. Our vector model reveals that cities such as Nicosia, Paphos and Ayia Napa are climatically suitable for the establishment of both Ae. aegypti and Ae. albopictus. Finally, the R0 model captures historical hotspots of dengue transmission over the East Mediterranean region, with large R0 values simulated over Cyprus, Greece, Turkey, southern Italy and southern Spain. We recommend stringent vector surveillance at entry points in Greece and a rapid elimination in Cyprus to prevent the return of Ae. aegypti to the European continent.