Abstract Background West Nile (WNV) and Usutu (USUV) virus are vector-borne flaviviruses causing neuroinvasive infections in both humans and animals. Entomological surveillance is a method of choice for identifying virus circulation ahead of the first human and animal cases, but performing molecular screening of vectors is expensive, and time-consuming. Methods We implemented the MX (Molecular Xenomonitoring) strategy for the detection of WNV and USUV circulation in mosquito populations in rural and urban areas in Nouvelle-Aquitaine region (France) between July and August 2023, using modified BG Sentinel traps. We first performed molecular screening and sequencing on excreta from trapped mosquitoes before confirming the results by detecting, sequencing and isolating viruses from individual mosquitoes. Findings We identified WNV and USUV-infected mosquitoes in 3 different areas, concurrently with the first human cases reported in the region. Trapped mosquito excreta revealed substantial virus co-circulation (75% of traps had PCR+ excreta for at least one of both viruses). Cx. pipiens was the most common species infected by both WNV and USUV. Genomic data from excreta and mosquitoes showed the circulation of WNV lineage 2 and USUV lineage Africa 3, both phylogenetically close to strains that circulated in Europe in recent years. Four WNV and 3 USUV strains were isolated from trapped mosquitoes. Interpretation MX strategy is easy and rapid to implement on the field, and has proven its effectiveness in detecting WNV and USUV circulation in local mosquito populations. Funding This study received funding from the Direction Générale de l’Armement (PDH 2 NBC-5-B-2212) and ARBOGEN (funded by MSDAVENIR). Research in context Evidence before this study WNV and USUV circulate through complex transmission cycles involving mosquitoes as vectors, birds as amplifying hosts and several mammal species as dead-end hosts. Transmission to humans primarily occurs through mosquito bites for both viruses. Notably, WNV can also be transmitted through blood donations and organ transplants. It is estimated that a significant proportion of both WNV and USUV infections in vertebrate hosts remain unreported due to their predominantly asymptomatic nature or nonspecific clinical presentation. Nevertheless, neuroinvasive and potentially fatal disease can occur, in particular among vulnerable populations such as elderly and immunocompromised patients. In France, after its first detection in 2015, USUV has been sporadically found in eastern and southern departments, with confirmed infections in birds, mosquitoes and mammals, and few human cases described. WNV has recently caused annual outbreaks of varying intensities involving humans, equids and avifauna in French departments mainly located in the Mediterranean area. Because of low viral loads and/or brief viremia, diagnosis of both pathogens is often based on serological evidence, and few genomic data are available on strains having circulated in France. Entomological surveillance can be used as an early warning method for WNV and USUV surveillance, but is costly to implement as it requires the collection of large numbers of mosquitoes to detect virus circulation when infection rates in mosquito populations are low. Therefore, viral surveillance in France still heavily relies on human and animal surveillance, i.e. late indicators of viral circulation. Added value of this study This study describes the implementation of the MX (Molecular Xenomonitoring) strategy for the effective surveillance of WNV and USUV circulation within mosquito populations. MX uses of modified BG Sentinels that allow (i) trapped mosquitoes to survive for several days and (ii) corresponding mosquito excreta to be collected and preserved on filter paper. MX has demonstrated many advantages over traditional entomological surveillance. Firstly, screening excreta collectively deposited by a community of trapped mosquitoes for the presence of viruses in the first instance is time and cost efficient, as one sample is tested for viral RNA, regardless of the number and species diversity in the trap. Second, filter papers with mosquito excreta can be transported from the field to the laboratory at room temperature by regular postal mail, bringing real-time detection within reach. WNV and USUV RNA have been detected and sequenced directly from the mosquito excreta shortly after collection. Thirdly, MX adapters increase the longevity of trapped mosquitoes, thereby allowing extension of the time between trap collections and increasing the likelihood of virus shedding by infected mosquitoes. Fourthly, this approach is easy to implement in the field and requires neither a strong entomological background nor specific technical skills. All these aspects make the MX strategy a powerful, non-invasive and cost-effective tool for real-time monitoring of enzootic WNV and USUV circulation. Authors should describe here how their findings add value to the existing evidence. WNV was never detected on the Atlantic seaboard of France until October 2022. Molecular evidence of WNV circulation was obtained in 3 symptomatic horses in the Nouvelle Aquitaine region in October 2022, concomitantly with an USUV human case with no recent travel history outside the region. This was a harbinger of an increase in cases over the next year. In 2023, MX succeeded in detecting the enzootic co-circulation of WNV and USUV in rural and urban areas of Nouvelle Aquitaine, simultaneously with the first cases of WNV detected by human and animal surveillance and the first human case of USUV diagnosed in the end of July 2023. Genomic and phylogenetic information was obtained directly from trapped mosquito excreta, before information derived from animal or human surveillance. Mosquitoes from traps with PCR-positive excreta were analysed individually, which allowed to calculate infection rates in mosquitoes. WNV and USUV were isolated from single Cx. pipiens mosquitoes. Cx. pipiens was the species most commonly found positive for either viruses although WNV was also detected in Ochlerotatus and Aedes mosquitoes, including one tiger mosquito ( Ae. albopictus ) in the urban environment. We argue that the MX approach is a major asset in the early warning detection of WNV and USUV circulation to alert health policy makers and take suitable control measures.

Molecular Xenomonitoring (MX) allows real-time surveillance of West Nile and Usutu virus in mosquito populations.