1 / 36

Eastern Equine Encephalitis (EEE) in New Hampshire

Eastern Equine Encephalitis (EEE) in New Hampshire. Dianne Donovan, BSc Arboviral Surveillance Coordinator Ddonovan@dhhs.state.nh.us (603) 271-5927. EEE Transmission Cycle. Mosquito vector. Bird reservoir hosts. EEE History. 1831 – Horses in MA afflicted with an unknown encephalitis virus

yazid
Télécharger la présentation

Eastern Equine Encephalitis (EEE) in New Hampshire

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Eastern Equine Encephalitis (EEE)in New Hampshire Dianne Donovan, BSc Arboviral Surveillance Coordinator Ddonovan@dhhs.state.nh.us (603) 271-5927

  2. EEE Transmission Cycle Mosquito vector Bird reservoir hosts

  3. EEE History • 1831 – Horses in MA afflicted with an unknown encephalitis virus • 1933-1935 – Multiple equine outbreaks along the eastern seaboard • 1938 – 1st human case in NE reported. MA: 34 human cases, 248 equine • 1955-1959 – MA reported 16 human cases; NJ reported 33 human cases

  4. EEE

  5. NH Historical Perspective (EEE) • 1973 – 75 equine deaths; 12,000 pheasant deaths • 1978 – 28 equine deaths • 1980 – 1 human case reported (not confirmed), 1 equine death • 1982 – 1 equine death

  6. NH Historical Perspective (EEE) • 2004: EEE detected in horses, birds, and mosquitoes • 2005: Human cases - 7 reported human cases (2 died) - EEE detected in numerous non-human mammals, birds, and mosquitoes

  7. NH Historical Perspective (EEE) • 2006: EEE detected in horse, birds, and mosquitoes • 2007: 3 reported human cases - EEE detected in mosquitoes, a horse, an alpaca

  8. EEE Symptoms &Clinical Features

  9. EEE - Symptoms • Incubation 4-10 days • No symptoms in some people infected • Severe symptoms in others - short prodrome, ~5 days (fever, headache, abdominal distress) • Progresses to disorientation, seizures, muscle weakness, paralysis, coma, death

  10. EEE - Clinical Features • Common: F (83%), HA (75%), N/V (61%) < 50%: confusion, myalgia, abd pain < 10%: sore throat, diarrhea, CN palsies • Imaging (CT, MRI) abnormal in two-thirds of patients Source: Deresiewicz NEJM 1997

  11. Laboratory Findings(severe neurological disease) Peripheral Blood • Normal or elevated total leukocyte count • Lymphocytopenia • Anemia • Hyponatremia

  12. Laboratory Findings(severe neurological disease) Cerebrospinal Fluid • Pleocytosis (usually with a predominance of lymphoctyes) • Elevated protein • Normal glucose levels

  13. EEE - Diagnosis and Prognosis • Diagnosis by IgM serum/CSF • Confirmation by PRNT • Mortality rate 35% • Neurological sequelae in 30% of survivors • Lifetime expenses = $3 million/case

  14. EEE Treatment • There is NO specific treatment. • Care of patients centers around supportive treatment of symptoms and complications. • Vaccine – only available for horses.

  15. NH EEE PATIENTSDemographic & Clinical Characteristics

  16. Demographic & Clinical Characteristics Age: Mean = 40 years Range = 4-80 years Gender: 8 males; 2 females Onset Date: Earliest = August 3 Latest = October 1

  17. Demographic & Clinical Characteristics Prodromal Signs & Symptoms: Fever 9/10 Weakness 9/10 Fatigue 9/10 Headache 8/10 Myalgias 7/10 N/V 7/10

  18. Demographic & Clinical Characteristics Prodrome Duration (Days): Mean – 7 days Range - <1 to ~15 days SEIZURES: 4/10 COMA: 5/10 DEATHS: 2/10

  19. Suspect Case Reporting

  20. Criteria for Report (a, b, or c) • Any patient with viral encephalitis with - Fever > 100 F - CNS involvement - Abnormal CSF profile suggesting a viral etiology • Any patient with presumptive aseptic meningitis c. Guillain-Barre syndrome

  21. Criteria for Report • Severe arboviral disease has occurred in patients of all ages. • Consider patient travel history in off-season months. Year-round transmission is possible in some areas of the country.

  22. PREVENTION

  23. Personal Protection Works • Wear long sleeves and pants in light colors to minimize the opportunities for mosquitoes to bite. • Limit outside activity between evening and dawn when mosquitoes are most likely to bite. • Consider using an effective insect repellent.

  24. Insect Repellents

  25. Mosquito Repellents: CDC Recommendations • DEET - Used for >50 years, with millions of doses applied - Long-term safety established - In children: American Academy of Pediatrics affirms use of DEET (up to 30%) over 2 months of age

  26. Mosquito Repellents: CDC Recommendations • Picaridin - Used for years in Australia and Europe - Concentration available in US less - No serious toxicity reported • Oil of Lemon Eucalyptus - plant derived compound - No serious toxicity reported - Recommended for children >3 years

  27. The Bottom Line • Repellent adverse reactions, when used appropriately are extremely rare • EEE (and other mosquito-borne diseases) are definite, recognized threats to human health - Certain situations (risk factors for severe disease, outbreak situations) increase risk - Problems following arboviral neuroinvasive disease can be permanent

  28. Repellent Resources U.S. Environmental Protection Agency http://www.epa.gov/pesticides/health/mosquitoes/insectrp.htm National Pesticide Information Center http://npic.orst.edu/wnv/

  29. The 2008 Season?

  30. 2008 Season? • Unable to forecast the exact level of risk • NH communities with prior year’s EEE activity should consider mosquito-borne illness to be a human health risk for 2008

  31. Questions?

More Related