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Mosquito-borne

1. Mosquito-borne. Diseases. In Washington. 2. Mosquito-borne Diseases. Western equine encephalitis and St. Louis encephalitis Both have occurred in Washington but no reported cases since early 1980’s West Nile virus Detected in 1999 in New York City

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Mosquito-borne

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  1. 1 Mosquito-borne Diseases In Washington

  2. 2 Mosquito-borne Diseases • Western equine encephalitis and St. Louis encephalitis • Both have occurred in Washington but no reported cases since early 1980’s • West Nile virus • Detected in 1999 in New York City • Detected in Washington and 43 other states in 2003 • Continued surveillance effort in Washington

  3. 3 Mosquito-borne Disease Surveillance • Pre-1960’s No record of state activity • 1960’s First statewide mosquito survey published in 1966 • 1960’s Mosquito Control Districts formed in Eastern Washington • 1970’s Sentinel flocks used in Benton County and Grant County

  4. 4 Mosquito-borne Disease Surveillance • 1980’s Last confirmed human and horse cases of mosquito-borne encephalitis • 1990’s Zoonotic Disease program established in DOH • 2001 DOH initiates WNV surveillance

  5. 5 Yakima Valley Encephalitis Outbreaks • 1939 31 cases • 1940 58 cases 13 fatal • 1941 26 cases 3 fatal • 1942 28 cases 2 fatal (Reported in August 1945 Journal of American Medical Association)

  6. Reported Human Cases of Mosquito-borne Disease (1970-1982) Island SanJuan Whatcom Pend Oreille Ferry Skagit Okanogan Stevens Snohomish Clallam Chelan Jefferson Spokane Douglas Kitsap King Lincoln Grays Harbor Mason Grant Kittitas Whitman Adams Pierce Thurston Yakima 7 Cases ( 6 WEE, 1 SLE) Franklin Lewis Garfield Pacific Columbia Skamania WallaWalla Cowlitz Benton Asotin Klickitat Wahkiakum Clark Western Equine Encephalitis St. Louis Encephalitis 6 Total cases = 12

  7. Western Equine Encephalitis Horse Cases (1953-1983) Island SanJuan Whatcom Pend Oreille Ferry Okanogan Skagit Stevens Snohomish Clallam Chelan Jefferson Spokane Douglas Kitsap King Lincoln Grays Harbor Mason Grant Adams Kittitas Whitman Pierce Thurston Yakima Franklin Lewis Garfield Pacific Columbia WallaWalla Cowlitz Benton Skamania Asotin Klickitat Wahkiakum Clark Suspect cases Confirmed cases 7

  8. 8 West Nile VirusIn the United States

  9. 9 WNV Background • First isolated in the West Nile District of Uganda, 1937 • Recognized as a cause of inflammation of the spinal cord and brain with outbreak in elderly patients, Israel, 1957 • Equine disease noted in Egypt and France in the early 1960s • 1999 “Old World” virus arrives in the “New World”

  10. 10 West Nile Outbreaks Israel 1951-1954, 1957, 2000-2002 France 1962, 2000 South Africa 1974 Romania 1996-1997 Italy 1997 Czech Republic 1998 Republic of the Congo 1998 Russia 1999 United States 1999-2002

  11. 11 Outbreak Timeline Encephalitis Condition Identified Equine Disease Identified Uganda 1937 Israel 1951-54 Israel 1957 France 1962 South Africa 1974 Romania 1996 Italy 1997 Czech Rep. 1998 Congo 1998 Russia 1999 US 1999-2002 Israel 2000-2002 France 2000

  12. West Nile Virus Transmission Cycle 12 Mosquito vector Incidental infections Incidental infections Bird reservoir hosts

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  14. 14 WNV in the US Speculated Pathways of Introduction • Human-transported bird • Legal • Illegal • Human-transported mosquitoes • Storm-transported bird • Intentional introduction (terrorist event)-not likely • Infected human traveler-not likely

  15. 15 WNV Symptoms • High Fever • Headache and body aches • Skin rash • Swollen lymph glands • Neck stiffness • Disorientation • Convulsions • The incubation period for West Nile Virus is generally 3-14 days following a bite from an infected mosquito.

  16. Distribution of WNV Before 1999 16 States with WNV (0)

  17. Distribution of WNV as of November 1999 States with WNV (4) 17

  18. Distribution of WNV as of November 2000 States with WNV (12 + DC) 18

  19. Distribution of WNV as of November 2001 States with WNV (27 + DC) 19

  20. Distribution of WNV as of November 2002 States with WNV (44 + DC) 20

  21. 21 WNV 1999-2002 by County

  22. 22 Distribution by County December 7, 2002 Source: Dr. Henry Huang, Washington U. School of Medicine

  23. Counties Detecting West Nile Virus 2002 Whatcom San Juan Island Okanogan Pend Oreille Ferry Skagit Stevens Clallam Snohomish Chelan Jefferson Douglas Spokane Kitsap Lincoln King Mason Grays Harbor Grant Kittitas Pierce Adams Whitman Thurston Pacific Lewis Garfield Franklin Yakima Columbia Asotin Cowlitz Benton Walla Walla Skamania Wahkiakum Klickitat Clark 23

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  27. Case Summary 1999-2002 27

  28. WNV Case-Patient Demographics & Mortality United States, 1999-2002* 28 *As of Dec 19

  29. 30 2001 25 2000 1999 20 Number of cases 15 10 5 0 7/7 8/4 9/1 9/29 10/27 11/24 12/23 Week ending Date of Symptom Onset, West Nile VirusUnited States, 1999-2001 29

  30. Protecting Public Health • Surveillance • Personal Protection and Education • Mosquito Control 30

  31. 31 WNV Surveillance • Mosquitoes • Dead birds (especially crows, jays, ravens and magpies) • Veterinary surveillance • Human surveillance

  32. 32 Mosquito Surveillance • Review information on species in your jurisdiction • Establish system for recording “mosquito complaints” • Identify and map breeding locations • Conduct larval/adult surveillance (May-Sep)

  33. 33 Dead Bird Surveillance • Establish system for recording dead bird reports • Message to public on reporting sightings • Submit corvids for analysis (May-Oct) • Response protocol for positive birds

  34. 34 Horse Case Surveillance • Encourage reporting by local veterinarians • Identify major stables, training facilities and establish contact • Track cases as they occur • Response protocol for sick, dead horses

  35. 35 Human Case Surveillance • Enhanced passive surveillance May-Sep • Active surveillance when cases result • Case investigation to help define probable exposure • Response protocol for illness or death in humans

  36. 36 Mosquito Control • Assessment of local capability • Designation of lead agency, person (where, when, how) • Develop local action plan • Training and licensing of personnel to use mosquito control compounds • Keep community involved and informed in the decision process, especially if adulticiding is considered

  37. 37 Aedes cinereus Aedes vexans Culex pipiens Culex restuans Culex tarsalis Anopheles punctipennis Coquilletidia perturbans Ochlerotatus canadensis Ochlerotatus japonicus Counties (39) 22 27 28 1 35 26 10 5 1 WNV Mosquito Species in Washington

  38. Estimated Sensitivity of WNV Surveillance Methods Human cases Veterinary cases Mosquitoes Disease Activity Sentinel hosts Dead birds Time 38

  39. 39 Personal Protection • Wear long sleeves & pants in mosquito-infested areas • Use repellant containing DEET (N,N-diethyl-3-methylbenzamide) and follow directions carefully • Limit outdoor activities at dawn and early evening • Repair holes in door & window screens

  40. 40 Habitat Reduction • Eliminate standing water (flower pots; tires; wheelbarrows; wading pools) • Change the water in birdbaths at least weekly • Aerate and chlorinate swimming pools and hot tubs; cover if possible • Consider mosquito-eating fish for your pond • Keep gutters clean to prevent standing water • Spread the word: educate your friends and neighbors

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  42. 42 Want More? • www.doh.wa.gov/wnv • www.cdc.gov • www.cfe.cornell.edu/erap/WNV/ • www.mrsc.org/subjects/governance/spd/mosquito.aspx • Your local health department

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