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Lyle R. Petersen, M.D., M.P.H.. Division of Vector-Borne Infectious Diseases Fort Collins, Colorado
Order of Topics
What is it? What is different now? How did it get here? How it is spreading? How big is the problem? What will happen next? How do we prevent it?
Clade
Egypt 1951 France 1962 South Africa 1974 Eg 101
LINEAGE
NE United States U.S./Israel Israel 98/99/2000 Romania 1996 Europe/Russia Italy 1998 Volgograd 1999 Israel 2000 India Kunjin Madagascar Uganda 1937 Central African Republic India Kunjin
An exotic arbovirus in NYC was surprising and unexpected: Should it have been?
International Animal Importations Into New York August 1998 July 1999 N = 2,873,144
Animals
Top Ten Countries of Origin Passengers arriving into NY Airports July 1998 June 1999 N = 4,850,090
Country DOMINICAN REPUBLIC UNITED KINGDOM CANADA FRANCE MEXICO ITALY JAPAN BRAZIL ISRAEL BAHAMAS GERMANY BERMUDA Passengers Percent 539,740 11% 456,540 9% 350,510 7% 312,400 6% 310,330 6% 215,040 4% 177,810 4% 157,220 3% 153,540 3% 143,390 3% 129,690 3% 114,750 2%
Incidental infections
Incidental hosts
Humans Horses Other mammals
Amplifying hosts
Passerine birds
?
* With possible epidemic potential
WNV Surveillance
Dead birds (especially crows) Human surveillance Mosquitoes Horse surveillance Live captive sentinels (e.g. chickens) Live wild birds Zoo animals
# States
4 12**
# Counties
28 145
Date Range
9 AUG 15 NOV 6 FEB 17 NOV
2001
2002 2003
27**
44** 45
359
2,531 1,954
8 APR 26 DEC
3 JAN 19 DEC 1 JAN 29-SEP
** Plus D.C.
1999
2000 2001 2002 2003
62
21 66 4,156 5,722
1
3 10 39** 41
6
10 39 740 730
2 AUG 24 SEP
20 JUL 27 SEP 13 JUL 7 DEC 19 MAY 19 DEC 28 MAR 26 SEP
* Reported as of 09/30/2003
** Plus D.C.
Clinical Epidemiology
Incubation period 2-14 days May be longer in immunosuppressed Approximately 20% mild febrile illness <1% severe neurological disease Meningitis, encephalitis, AFP Advanced age primary risk factor for encephalitis AFP patients may be younger Immunosuppressive drugs and hematological malignancies risk factors Approximate 10% mortality Long-term morbidity common
~400,000 asymptomatic
~80% Asymptomatic
# cases
Ma y
ly
Au g
Month of Onset
Ju
Se p
Ju
No v
De c
Oc t
ne
50 40 30 20 10 0
0-9
-1 9 0 1
-29 0 2
-39 0 3
-49 0 4
-59 0 5
-69 0 6
-79 0 7
-89 0 8
-9 9 0 9
Fatality Rate among Persons with WNV Meningoencephalitis, by Age Group, United States, 2002
40
35 30 25 20 15 10 5 0
0-9
-1 9 0 1
-29 0 2
-39 0 3
-49 0 4
-59 0 5
-69 0 6
-79 0 7
-89 0 8
-9 9 0 9
Human WNV Disease Cases, by Age Group and Clinical Category, United States, 2003*
Proportion of disease cases (%)
30
WNME
WNF
20
10
0
0-9 -19 0 1 -2 9 0 2 -3 9 0 3 -49 0 4 -59 0 5 -69 0 6 -79 0 7 -89 0 8 -99 0 9
2500
Reported and Estimated Number of St. Louis Encephalitis Cases, U.S., 1932- Sept 12, 2003
2000
1500
1000
500
0 1932
1942
1952
1962
1972
1982
1992
2002
Reported Number of West Nile Meningoencephalitis Cases, U.S., 1932- Sep 30, 2003
2500
2000
1500
1000
500
0 1932
1942
1952
1962
1972
1982
1992
2002
SLE 1975
DC
Reported Incidence in Humans: SLE 1975 vs. WNME 2002 WNME 2002*
1 9.9
0 0.9
DC
* Reported as of 11/01/2002
Prevention
Repellants DEET (up to 50% concentration); 10% in children Permethrin on clothing and fabrics Reduce mosquito breeding sites Long sleeves and pants Stay indoors when mosquitoes are biting (dawn and dusk) Bug zappers, sonic devices, CO2 devices (mosquito magnet): no proven efficacy
Habitat elimination
Larviciding
Adulticiding