Annals of Tropical Medicine and Public Health

: 2017  |  Volume : 10  |  Issue : 4  |  Page : 1085--1086

Can sandfly fever be mistaken with influenza?

Ali Mehrabi Tavana 
 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Correspondence Address:
Ali Mehrabi Tavana
Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran

How to cite this article:
Tavana AM. Can sandfly fever be mistaken with influenza?.Ann Trop Med Public Health 2017;10:1085-1086

How to cite this URL:
Tavana AM. Can sandfly fever be mistaken with influenza?. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Oct 22 ];10:1085-1086
Available from:

Full Text

There are at least three types of influenza virus (A, B, and C) that belong to family Orthomyxoviridae.[1] A fourth family of influenza virus has also been proposed-influenza D, which was first isolated in 2012.[2]

The type A has several subtypes based on two enzymes that are located on the virus surface: hemagglutinin (HA) and neuraminidase (NA). The disease has been seen as a pandemic and an epidemic in humans and animals.[3] The genetic mutation in shift and drift of viruses on the two enzymes mentioned above may be the base of pandemic or epidemic circulation of the virus. It has to be said that different types of HA and NA form the basis of the H and N distinctions in, for example, H5N1. There are only 16 H and nine N subtypes known, but only H 1, 2, and 3 and N 1 and 2 are commonly found in humans.[4],[5] The type B is mostly seen as an epidemic form in winter season and type C is mostly seen in the birth population and less in humans.[6],[7] Nowadays, the effective vaccine is prepared annually and recommended for high-risk groups like asthma, diabetes, heart disease, and immune-compromised patients.[8]

The disease was seen in many parts of the world in all seasons of the year.[9]

The other disease is sandfly fever, also known as phlebotomus fever, three-day fever, or pappataci fever. It is an arbovirus disease and caused by different types of phleboviruses belonging to family Bunyaviridae and transmitted by female phlebotomine sandflies.[10],[11] Sandfly fever occurs in tropical and semitropical countries, particularly in the west of Asia. The disease has been reported from the Balkans, Russia, Iraq, Pakistan, India, Iran, and Persian Gulf regions.[12],[13],[14],[15],[16],[17] The main signs and symptoms of the disease are fever-like influenza (>39- 40°C).[18] However, other clinical symptoms like photophobia and muscle ache, malagia may be different from influenza. The difference between the disease in endemic areas is mostly difficult and may need an expert physician to first find out differences in clinical symptoms differences and then do extra par clinical tests to help the patients. You suppose that influenza is a predominant disease in the populations that are exposed to sandfly fever disease too. How the fever could be differentiated? How signs and symptoms, which are very similar to each other, could be diagnosed?[19],[20] In fact, highly expert physicians along with serological and molecular techniques are needed in order to find the exact disease, particularly in endemic areas. Therefore, in this letter to editor, I would like to emphasize that any similar patients must be together considered as two diseases, which is mentioned above. Of course, the patients with both infections that are mentioned above need more monitoring and care than others.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Kawaoka Y, Influenza virology: current topics. Caister Academic Press. 2006.
2Hause BM, Collin EA, Liu R, Huang B, Sheng Z, Lu W. Characterization of a novel influenza virus in cattle and swine: proposal for a new genus in the Orthomyxoviridae family. MBio 2014;5:e00031-14.
3Ghedin E, Sengamalay NA, Shumway M, Zaborsky J, Feldblyum T, Subbu V. et al. Large-scale sequencing of human influenza reveals the dynamic nature of viral genome evolution. Nature 2005;437:1162-6.
4Hilleman M. “Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control”. Vaccine 2002;20:3068-87.
5Lynch JP, Walsh EE. “Influenza: evolving strategies in treatment and prevention”. Semin Respir Crit Care Med 2007;28:144-58.
6Nobusawa E, Sato K. “Comparison of the mutation rates of human influenza A and B viruses”. J Virol 2006;80:3675-8.
7Matsuzaki Y, Sugawara K, Mizuta K, Tsuchiya E, Muraki Y, Hongo S. “Antigenic and genetic characterization of influenza C viruses which caused two outbreaks in Yamagata City, Japan, in 1996 and 1998”. J Clin Microbiol 2002;40:422-9.
8Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. “Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP)”. MMWR Recomm Rep 2006;55:1-42.
9Shaman J, Kohn M. “Absolute humidity modulates influenza survival, transmission, and seasonality”. Proc Natl Acad Sci USA 2009;106:3243-8.
10Tavana AM, Sand fly fever in the world. Ann Trop Med Public Health 2015;8:830-7.
11Dionisio D, Esperti F, Vivarelli A, Valassina M. Epidemiological, clinical and laboratory aspects of sand fly fever. Curr Opin Infect Dis 2003;16:383-8.
12Tavana AM. Sand fly fever: the disease which must be introduced to doctors, health care workers and public now. Health Med 2012;6:3657-9.
13Tavana AM. The seroepidemiological studies of sand fly fever in Iran during imposed war. Iran J Public Health 2001;30:145-6.
14Brett-Major DM, Claborn DM. Sand fly fever: what have we learned in one hundred years? Mil Med 2009;174:426-31.
15Tavana AM. Minireview on sand fly fever. J Entomol 2007;4:401-3.
16Saidi S, Tesh RB, Javadian E, Sahabi Z, Nadim A. Studies on the epidemiology of sand fly fever in Iran. II. The prevalence of human and animal infection with five Phlebotomus fever virus serotypes in Isfahan province. Am J Trop Med Hyg 1977;26:288-93.
17Eitrem R, Vene S, Niklasson B. Incidence of sand fly fever among Swedish United Nations soldiers on Cyprus during 1985. Am J Trop Med Hyg 1990;43:207-11.
18Eitrem R, Niklasson B, Weiland O. Sand fly fever among Swedish tourists. Scand J Infect Dis 1991;23:451-57.
19Tavana AM. Pandemic influenza A H1N1 in Iran and lessons learnt. Ann Trop Med Public Health 2012;5:295-7.
20Tavana Ali M. Avian and swine flu infections in human need more care in national and international levels. IRCMJ 2010;12:82-3.