Semenza et al. Norway) reported surveillance of Lyme bor‑ reliosis at least on a regional level; and three countries reported surveillance of hantavirus infections (France, Hungary, and Latvia). Other pathogens covered by nonmandatory surveillance activities in at least one coun‑ try included Crimean‑Congo hemorrhagic fever, dengue fever, echinococcosis, human granulocytic anaplasmosis, hemorrhagic fever with renal syndrome, Mediterranean spotted fever, Naegleria fowleri infections, norovirus infections, Rift Valley fever, Q fever, rotavirus infections, and yellow fever. Government officials also assessed cur‑ rent surveillance programs, diagnostic sup‑ port, collaboration with the veterinary sector, and outbreak response (Figures 4D and 5). A number of respondents reported the need for at least some improvement in these pro‑ grams, particularly in current surveillance sys‑ tems (83%) and collaboration with veterinary services (69%). Affected Not affected West Nile fever Discussion In the absence of scientific certainty, expert assessment pools informed opinion and can add support for findings it corroborates while reducing support for findings it does not. Thus, expert judgment can help policy makers prioritize areas for action and make informed decisions (Weir et al. 2010). This is especially important for the epidemiology of climate change, for which large methodological chal‑ lenges and research gaps exist (Xun et al. Chikungunya N 0 175 350 700 1,050 1,400 Kilometers Turalemia 0 175 350 700 1,050 1,400 Kilometers – 0 0 0 0 0 0 N Affected Not affected No data Dengue Changes in Geographic distribution Seasonality Altitude Latitude No change N No data 0 175 350 700 1,050 1,400 Kilometers N 0 175 350 700 1,050 1,400 Kilometers 2009/2010.a Disease Borreliosis (Lyme disease) Chikungunya fever Hantavirus infections Leishmaniasis TBE West Nile fever Figure 2. Responses from national infectious disease experts from EEA countries, 2009–2010, as to whether specific vector­borne diseases would be affected or not affected by climate change, 2009/2010. (A) West Nile fever. (B) Chikungunya fever. (C) Dengue. (D) Tularemia. No data on changes in the geographic range were collected for nonendemic diseases (dengue and tularemia). Table 2. General changes in insect­ , tick­ , or rodent­ borne diseases in European countries over the last decade, according to infectious disease experts, Geographic distribution Seasonality Total 22 12 17 18 17 16 + 11/22 2/12 8/17 8/18 11/17 6/16 No change 11/22 10/12 9/17 10/18 6/17 10/16 – 0 0 0 0 0 1/18 Total 21 12 16 17 17 14 + 9/21 2/12 3/16 3/17 5/17 2/14 No change 12/21 10/12 13/16 14/17 12/17 12/14 Total 16 11 14 15 14 12 + 5/16 0 1/14 1/15 5/14 2/12 Altitude No change 11/16 11/11 13/14 14/15 9/14 10/12 – 0 0 0 0 0 0 Total 17 12 12 14 13 13 + 3/17 1/12 2/12 3/14 3/13 3/13 Latitude No change 14/17 11/12 10/12 11/14 10/13 10/13 – 0 0 0 0 0 0 Abbreviations: +, range expansion; –, range contraction. Values shown are number of countries reporting change or no change/total number of respondents for each survey item. Data are based on the following survey question: “Have you observed general changes of insect­, tick­, or rodent­borne disease in your country over the last 10 years?” Responses were recorded on a scale with five response options: strong increase; increase; no change; decrease; strong decrease. The first two responses (strong increase and increase) were grouped to reflect a positive response and the last two responses (decrease and strong decrease) were grouped to reflect a negative response. Both range expansion and contraction were documented for leishmaniasis in Portugal. Data were not available for 2007. 388 ovlume 120 | number 3 | March 2012 • Environmental Health Perspectives