1. Introduction
Chikungunya is an arboviral disease caused by an alphavirus and transmitted by mosquitoes (Aedes species). Pending vaccine development, the only effective preventive measures at individual level are those based on protection against mosquito bites. 1 A chikungunya outbreak was reported in Emilia-Romagna, a northern Italy Region of some 4 million inhabitants, in the summer of 2007; it was the first ever outbreak that occurred in a temperate area of the Northern Hemisphere. 2 In a report published in 2006, 3 the European Centre for Disease Prevention and Control (ECDC) had already highlighted the potential risk for autochthonous chikungunya transmission in Europe. After the 2007 outbreak, ECDC also pointed out the need to increase preparedness for the re-emergence of the virus, urging strengthened surveillance and control systems in European countries. 4
The Emilia-Romagna outbreak mainly affected two small, neighbouring villages: Castiglione di Cervia and Castiglione di Ravenna. An active surveillance system for the identification of all suspected cases and specific measures for controlling vectors were implemented during the event.2 Between three and five months after the end of the epidemic, a seroprevalence survey aimed at estimating the extent of the spread of chikungunya infections was conducted in Castiglione di Cervia, one of the two affected villages; this survey showed a higher prevalence of infection in older people and males.5 During the prevalence survey, data concerning knowledge, attitudes and practices (KAP) of village residents regarding chikungunya were collected, with the aim of understanding potentially modifiable individual factors in order to promote the adoption of effective protective measures. For chikungunya infection, individual behaviours are important for preventing exposure. Behaviour and behavioural change are closely related to the perception of the risk6 and of the efficacy and feasibility of intervention,7 as recently underlined by the Brewer's meta-analysis where a high degree of consistency and strong association between risk perceptions and behaviour was found.8 In the context of vector-borne diseases, Raude and Setbon recently reported how populations perceived and responded to the risk of chikungunya infection and Dengue during large outbreaks in tropical countries.9 The present paper reports the results of a similar survey, but after a chikungunya outbreak occurring in a temperate area in the Northern Hemisphere.