Proportion of outbreaks were located in predicted at-risk areas. On the

Proportion of outbreaks were located in predicted at-risk areas. On the other hand, enzootic transmission could have maintained a sufficient level of immunity in cattle in the high risk area restraining the outbreak magnitude in these regions. RVF could have been introduced in low risk areas through cattle trade and because of the low level of cattle immunity in these zones, trigger outbreaks. Nevertheless, as RVF cases were suspected to be under-reported, it was not possible to assess the relationship between the prediction of the herd immunity and the case notifications. Using satellite measurements (sea surface temperatures, rainfall and NDVI) and human cases as model output, Anyamba et al. [29] identified mainly the east-coast and some small areas of northern and north-western parts as at-risk for 2008?009 RVF outbreaks in Madagascar.PLOS Neglected Tropical Pristinamycin IA site Diseases | DOI:10.1371/journal.pntd.July 14,12 /Rift Valley Fever Risk Factors in MadagascarConsidering that, during the 2008?9 outbreaks, several human cases occurred from the contact with infected fresh meat from traded ruminants [15], all the human infections could not be attributed to local infection [15]. Moreover, the detection of human cases depends on the intensity of the local circulation between ruminants and vectors, the probability of human exposure, the presence of clinical signs and the declaration to health services. Then, the human case data were probably not an optimum indicator of spatial distribution of RVF cases as suggested by Anyamba et al. [29]. Our prediction map is based on cattle for which the infection could be attributed to a local infection and identifies larger at-risk areas on western part of Madagascar than Anyamba et al. [29]. The discrepancy between results of Anyamba et al. study [29] and our study may be due the methodological differences: environmental variables included in both models and human clinical cases as model output on one side, bovine serological results on the other hand. The estimated overall human seroprevalence was 9.5 (IC95 [8.2?1.0]). This seroprevalence is higher than adult seroprevalence observed in the island of Mayotte (2011) and Tanzania (2007?8) [24,53] but lower than adult seroprevalence in Kenya or Saudi Arabia [54,55]. Additionally, this seroprevalence is higher than the seroprevalence estimated for Madagascar in Gray et al [21]. The difference in the sampling area could explain this difference. Indeed, sera from the study of Gray et al. [21] were mainly sampled in south where RVF seroprevalence in human is low. Because of the different eco-epidemiological contexts and survey settings it is difficult to compare our results with the studies performed in Mayotte, Tanzanian, Kenya and Saudi Arabia [24, 53?5]. Human RVF seropositivity increased with age, suggesting an endemic transmission in human populations. As observed in cattle, human seropositivity was positively associated with the presence of temporary and artificial water points. In addition, 24 seropositive individuals declared no contact with ruminant or ruminant products, and the 3 mosquito species considered as potential vectors in Madagascar are zoo-anthropophilic purchase Biotin-VAD-FMK feeders [25,52]: these results strongly suggest the existence of a vectorial transmission from ruminant to humans. Our analysis showed that frequent contact with raw milk contributed to explain human infection as previously suspected in Kenya [31]. Direct contact with fresh blood was not identifie.Proportion of outbreaks were located in predicted at-risk areas. On the other hand, enzootic transmission could have maintained a sufficient level of immunity in cattle in the high risk area restraining the outbreak magnitude in these regions. RVF could have been introduced in low risk areas through cattle trade and because of the low level of cattle immunity in these zones, trigger outbreaks. Nevertheless, as RVF cases were suspected to be under-reported, it was not possible to assess the relationship between the prediction of the herd immunity and the case notifications. Using satellite measurements (sea surface temperatures, rainfall and NDVI) and human cases as model output, Anyamba et al. [29] identified mainly the east-coast and some small areas of northern and north-western parts as at-risk for 2008?009 RVF outbreaks in Madagascar.PLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.July 14,12 /Rift Valley Fever Risk Factors in MadagascarConsidering that, during the 2008?9 outbreaks, several human cases occurred from the contact with infected fresh meat from traded ruminants [15], all the human infections could not be attributed to local infection [15]. Moreover, the detection of human cases depends on the intensity of the local circulation between ruminants and vectors, the probability of human exposure, the presence of clinical signs and the declaration to health services. Then, the human case data were probably not an optimum indicator of spatial distribution of RVF cases as suggested by Anyamba et al. [29]. Our prediction map is based on cattle for which the infection could be attributed to a local infection and identifies larger at-risk areas on western part of Madagascar than Anyamba et al. [29]. The discrepancy between results of Anyamba et al. study [29] and our study may be due the methodological differences: environmental variables included in both models and human clinical cases as model output on one side, bovine serological results on the other hand. The estimated overall human seroprevalence was 9.5 (IC95 [8.2?1.0]). This seroprevalence is higher than adult seroprevalence observed in the island of Mayotte (2011) and Tanzania (2007?8) [24,53] but lower than adult seroprevalence in Kenya or Saudi Arabia [54,55]. Additionally, this seroprevalence is higher than the seroprevalence estimated for Madagascar in Gray et al [21]. The difference in the sampling area could explain this difference. Indeed, sera from the study of Gray et al. [21] were mainly sampled in south where RVF seroprevalence in human is low. Because of the different eco-epidemiological contexts and survey settings it is difficult to compare our results with the studies performed in Mayotte, Tanzanian, Kenya and Saudi Arabia [24, 53?5]. Human RVF seropositivity increased with age, suggesting an endemic transmission in human populations. As observed in cattle, human seropositivity was positively associated with the presence of temporary and artificial water points. In addition, 24 seropositive individuals declared no contact with ruminant or ruminant products, and the 3 mosquito species considered as potential vectors in Madagascar are zoo-anthropophilic feeders [25,52]: these results strongly suggest the existence of a vectorial transmission from ruminant to humans. Our analysis showed that frequent contact with raw milk contributed to explain human infection as previously suspected in Kenya [31]. Direct contact with fresh blood was not identifie.