Sand fly fever: An important vector-borne diseases for travelers?


Context: Sand fly fever is a vector-borne viral infection and is endemic in many parts of the world, particularly in areas that are infected with different types of leishmaniasis. Clinical spectrum ranges from asymptomatic infection to very high fever and photophobia in patients. During the last decades, an increase in imported sand fly fever cases in developed and nonendemic countries have been pointed out from an international literature review. Among the possible causes are increasing international travelers, travel of immigrants from endemic area, and army operations. It has been noted that the main region for the diseases are west of Asia and east of Europe, and perhaps imported cases may be seen clinically in different parts of the world, either in developed or in developing countries. Materials and Methods: Two methods were used to gather the information for this article. First, PubMed was searched for English language references to published relevant articles. Second, the term sand fly fever was searched on Google Scholar too. Results: In PubMed, 156 articles and in Google Scholar, 70,400 articles mentioned the term sand fly fever. The most searched items in PubMed were epidemiology, treatment, prevention, and life cycle with incidences of 41.66, 20.51, 13.46, and 1.92%, respectively, and in terms of geographical distribution of the study, the maximum number of articles in PubMed were published from Europe, Asia, Australia, and America, with percentages being 26.92, 17.30, 17.0, 1.28, and 1.28%, respectively. Conclusion: Different countries have reported the disease either as an endemic or as an imported one. co-infection. Sand fly fever must be considered in the diagnostic assessment of patients presenting with a similar clinical syndrome and a history of travel to an endemic area, which are mentioned above. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas; these travelers should receive counseling regarding sand fly fever appropriate protective health measures. In this review article sand fly fever situation will be studied.

Keywords: Sand fly fever, travel, health measures, Iran, world

How to cite this article:
Tavana AM. Sand fly fever: An important vector-borne diseases for travelers?. Ann Trop Med Public Health 2017;10:13-5


How to cite this URL:
Tavana AM. Sand fly fever: An important vector-borne diseases for travelers?. Ann Trop Med Public Health [serial online] 2017 [cited 2017 Jun 6];10:13-5. Available from:



Sand fly fever, also called 3-day fever, phobeltomos fever, papatsi fever, is well described by scientists previously.[1] Nowadays the disease became as an important infection not only for mortality (because no cases has been reported so far) but also for very hard morbidity. In addition, the disease more prevalent in conflict and wars.[2],[3]

The epidemiology of disease related to many factors

Agent: Sand fly fever is arboviruses and belongs to Bunyaviridea family and genus of Narioviurses, and more than six serotypes of viruses including Karimabad, Salehabad, Sicilian, Naples, Tehran virus, and Toscana were introduced at present time.

Sources: Rodents may be the main source of infection and the virus could come from these animals and infected patients.[5],[6],[7],[8],[30]

Transmission: Via blood feeding either from rodents to human or from patients to susceptible populations and vertical transmission in sand flies. It is transmitted to humans by the bloodsucking female sand fly (notably Phlebotomus papatasiP. perniciosus, and P. perfiliewsi).[9],[10]

Susceptible population: People who are travelling to endemic area. The blood transfusion may be infected by virus and not identified.

Geographical distribution

The disease has been reported from Asia, Europe, and other continents as endemic form or imported cases. The disease mostly has been seen in conflicts and wars. Mehrabi Tavana’s study has shown the report of sand fly fever during Iraq-Iran imposed War 1980-1988. It has to be said that the disease was seen in the Persian Gulf during war between Iraq and the United State. During Operations Desert Shield and Desert Storm, the disease was seen among American Army. It must not forget that the disease also has been reported in World War II in the same region (Persian Gulf). It has to said that it is more prevalent in the moist subtropical countries, particularly around the Mediterranean Sea, in the Middle East, and many parts of world even in Europe and Africa. Its epidemic form may be occurred during the spring and summer season.[1],[2],[3],[4],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]

The sign and symptoms

Patients mostly experience high fever (>39°C) with back pain, muscle pain, and photophobia during acute period of the disease. During the febrile period, fatigue and weakness and a low blood pressure and pulse may also be seen.

Identification: Mostly could be done for measuring Abs by using ELISA by comparing acute and cove lance titrage.

Vaccine and immunity

No vaccine has been available so far but the patients become immune for at least for 2 years against specific sand fly fever serotypes. The people are living in the endemic area mostly are immune from their childhood for their own life.[6],[7],[8]


Prevention always is better than cure, including health education, using the bed nets and repellents are useful. The disease has no mortality fortunately and patients become healthy after a few days after high fever. Based on the sign and symptoms, there is no specific cure guideline for that. Nonspecific treatment including have rest for at least week and using painkiller and the drug in order to reduce fever and replacement of fluid by IV way could be useful anyway.[1],[2],[3],[4]

Materials and Methods

Two methods were used to gather the information for this article. First, PubMed was searched for English language references to published relevant articles. Second, the term sand fly fever was searched on Google Scholar too.


Sand fly fever has been seen in the past in many parts of the world, particularly in the war time such as World War I and II, imposed war Iraq against Iran 1980−1988,[1],[2],[3],[4] and war that was named Operations Desert Shield and Desert Storm, which was beginning in August 1990 and approximately 800,000 coalition troops were deployed to the Persian Gulf.[2] It was mentioned that sand fly fever, and cutaneous leishmaniasis was seen.[2]

The disease also was reported from different countries in peace time from different continents too.[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37] In nonendemic area, the disease may be reported in the future by doing many research in this field.


There is no vaccine against sand fly fever at the present time. The report of the disease has been increased in the previous century and perhaps in the 21th century too. The research must be focused on sand fly fever with different aspects, in particular prevention and control the infection anyway in the next coming decade. Do not forget the main key for preventions are to avoid sand fly bites, use protective clothing and insect repellant. In this regard, the care must be taken by the travelers any way.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.



Tavana AM. Sand fly fever in the world. Ann Trop Med Public Health 2015;8:83-7.
Cope SE, Schultz GW, Richards AL, Savage HM, Smith GC, Mitchell CJ. et al. Assessment of arthropod vectors of infectious diseases in areas of U.S. troop deployment in the Persian Gulf. Am J Trop Med Hyg 1996;54:49-53.
Mehrabi Tavana A. The seroepidemiological studies of sand fly fever in Iran during imposed war. Iranian J Public Health 2001;30:145-46.
Mehrabi Tavana S, Mini review on sand fly fever. J Entomol 2007;4:401-3.
Depaquit J, Grandadam M, Fouque F, Andry P, Peyrefitte C. Arthropod-borne viruses transmitted by Phlebotomine sandflies in Europe: a review. Euro Surveill. 2010;15:pii=19507. Available online:
Tesh RB. The genus phlebovirus and its vectors. Annu Rev Entomol 1988;33:169-81.
Saidi S, Tesh R, 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.
Tesh RB, Saidi S, Gajdamovic SJ, Rodhain F, Vesenjak-Hirjan J. Serological studies on the epidemiology of sand fly fever in the Old World. Bull World Health Organ 1976;54:663-74.
Schmidt JR, Schmidt ML, Said MI. Phlebotomus fever in Egypt. Isolation of phlebotomus fever viruses from Phlebotomus papatasi. Am J Trop Med Hyg 1971;20:483-90.
Tesh RB, Lubroth J, Guzman H. Simulation of arbovirus overwintering: survival of Toscana virus (Bunyaviridae: Phlebovirus) in its natural sand fly vector Phlebotomus perniciosus. Am J Trop Med Hyg 1992;47:574-81.
Tesh RB, Modi GB. Maintenance of Toscana virus in Phlebotomus perniciosus by vertical transmission. Am J Trop Med Hyg 1987;36:189-93.
Peyrefitte CN, Devetakov I, Pastorino B, Villeneuve L, Bessaud M, Stolidi P. et al. Toscana virus and acute meningitis, France. Emerg Infect Dis 2005;11:778-80.
Hemmersbach-Miller M, Parola P, Charrel RN, Paul Durand J, Brouqui P. Sand fly fever due to Toscana virus: An emerging infection in southern France. Eur J Int Med 2004;15:316-7.
Navarro JM, Fernández-Roldán C, Pérez-Ruiz M, Sanbonmatsu S, de la Rosa M, Sánchez-Seco MP. Meningitis by Toscana virus in Spain: Clinical description of 17 cases. Med Clin (Barc) 2004;122:420-2. [in Spanish].
Sanbonmatsu-Gámez S, Pérez-Ruiz M, Palop-Borrás B, Navarro-Marí JM. Unusual manifestation of Toscana virus infection, Spain. Emerg Infect Dis 2009;15:347-8.
Sanbonmatsu-Gámez S, Pérez-Ruiz M, Collao X, Sánchez-Seco MP, Morillas-Márquez F, de la Rosa-Fraile M. et al. Toscana virus in Spain. Emerg Infect Dis 2005;11:1701-7.
Santos L, Simões J, Costa R, Martins S, Lecour H. Toscana virus meningitis in Portugal, 2002-2005. Euro Surveill 2007;12:715.
Pugliese A, Beltramo T, Torre D. Seroprevalence study of Tick-borne encephalitis, Borrelia burgdorferi, Dengue and Toscana virus in Turin Province. Cell Biochem Funct 2007;25:185-8.
Francisci D, Papili R, Camanni G, Morosi S, Ferracchiato N, Valente M. et al. Evidence of Toscana virus circulation in Umbria: First report. Eur J Epidemiol 2003;18:457-9.
Ozbel Y, Ertabaklar H, Ciufolini MG, Marchi A, Fiarentino C, Erensoy S. et al. A neglected vector-borne disease: Papatasi fever and its vectors in Turkey. ISOPS V 5th International Symposium on Phlebotomine Sandflies Tunis, 17-21 April, 2005. Arch Inst Pasteur Tunis 2005;82:55-6.
Tesh R, Saidi S, Javadian E, Nadim A. Studies on the epidemiology of sandfly fever in Iran. I. Virus isolates obtained from phlebotomus. Am J Trop Med Hyg 1977;26:282-7.
Gligic A, Miscevic Z, Tesh RB, Travassos da Rosa A, Zivkovic V. First isolation of Naples sandfly fever in Yugoslavia. Acta Biol Jug Mikrobiol 1982;19:167-75.
Ciufolini MG, Maroli M, Guandalini E, Marchi A, Verani P. Experimental studies on the maintenance of Toscana and Arbia viruses (Bunyaviridae:Phlebovirus). Am J Trop Med Hyg 1989;40:669-75.
Verani P, Ciufolini MG, Caciolli S, Renzi A, Nicoletti L, Sabatinelli G. et al. Ecology of viruses isolated from sand flies in Italy and characterization of a new Phlebovirus (Arbia virus). Am J Trop Med Hyg 1988;38:433-9.
Charrel RN, Izri A, Temmam S, de Lamballerie X, Parola P, Toscana virus RNA in Sergentomyia minuta flies. Emerg Infect Dis 2006;12:1299-300.
Fouque F, Gaborit P, Issaly J, Carinci R, Gantier JC, Ravel C. et al. Phlebotomine sand flies (Diptera: Psychodidae) associated with changing patterns in the transmission of the human cutaneous leishmaniasis in French Guiana. Mem Inst Oswaldo Cruz 2007;102:35-40.
Dhanda V, Rodrigues FM, Ghosh SN. Isolation of Chandipura virus from sandflies in Aurangabad. Indian J Med Res 1970;58:179-80.
Geevarghese G, Arankalle VA, Jadi R, Kanojia PC, Joshi MV, Mishra AC. Detection of Chandipura virus from sand flies in the genus Sergentomyia (Diptera: Phlebotomidae) at Karimnagar District, Andhra Pradesh. Indian J Med Entomol 2005;42:495-6.
Ba Y, Trouillet J, Thonnon J, Fontenille D. Phlebotomus of Senegal: survey of the fauna in the region of Kedougou. Isolation of arbovirus. Bull Soc Pathol Exot 1999;92:131-5.[in French].
Tesh R, Saidi S, Javadian E, Loh P, Nadim A. Isfahan virus, a new Vesiculovirus infecting humans, gerbils, and sandflies in Iran. Am J Trop Med Hyg 1977;26:299-6.
Gligic A, Tesh RB, Miscevic Z, Travassos da Rosa A. Zivkovic V. Jug Bogdanovac virus: A new of the vesicular virus serogroup (Rhabdoviridae:Vesiculovirus) isolated from Phlebotomine sandflies in Yugoslavia. Acta Biol Jug Mikrobiol 1983;20:97-105.
Fontenille D, Traore-Lamizana M, Trouillet J, Leclerc A, Mondo M, Ba Y. et al. First isolations of arboviruses from Phlebotomine sand flies in West Africa. Am J Trop Med Hyg 1974;50:570-4.
Antoniou M, Haralambous C, Mazeris A, Pratlong F, Dedet JP, Soteriadou K. Leishmania donovani leishmaniasis in Cyprus. Lancet Infect Dis 2008;8:6-7.
Antoniou M, Haralambous C, Mazeris A, Pratlong F, Dedet JP, Soteriadou K. Leishmania donovani leishmaniasis in Cyprus. Lancet Infect Dis 2009;9:76-7.
Léger N, Depaquit J. Leishmania donovani leishmaniasis in Cyprus. Lancet Infect Dis 2008;8:402.
Dachraoui K, Fares W, Bichaud L, Barhoumi W, Beier JC, Derbali M. et al. Phleboviruses associated with sand flies in arid bio-geographical areas of Central Tunisia. Acta Trop 2016;158:13-9.
Tavana AM. Sand fly fever: The disease which must be introduced to doctors, health care workers and public now. Health Med 2012;6:3657-9.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196521

Paul Mies has now been involved with test reports and comparing products for a decade. He is a highly sought-after specialist in these areas as well as in general health and nutrition advice. With this expertise and the team behind, they test, compare and report on all sought-after products on the Internet around the topics of health, slimming, beauty and more. The results are ultimately summarized and disclosed to readers.


Please enter your comment!
Please enter your name here