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Briefing on Mosquito-borne Illness: Surveillance and Response Plans

Joint Committee on Public Health


and

Joint Committee on Environment, Natural Resources and Agriculture


June 20, 2013
Acting Commissioner Cheryl Bartlett
Department of Public Health

Commissioner Gregory C. Watson


Department of Agricultural Resources

Core concepts
Massachusetts has had the longest experience with EEE in the nation, and is one of two states with the largest number of cases. The Commonwealths arbovirus response is seen across the country as a national model. 2012 saw extraordinarily widespread incidence of EEE and WNV human disease, possibly linked to a range of long-term ecological and biological factors. Recent experience suggests that EEE and WNV are likely to be annual realities in Massachusetts and require us to transition from an exceptional to a routine preparedness response.

An Interagency Effort: Arbovirus (ARthropod BOrne Virus) Surveillance and Response


Executive Office of Health and Human Services Department of Public Health Bureau of Laboratory Science Bureau of Infectious Disease Bureau of Environmental Health Executive Office of Energy and Environmental Affairs State Reclamation and Mosquito Control Board Department of Agricultural Resources Department of Conservation and Recreation Department of Environmental Protection Local Mosquito Control Projects Local Health Departments

Eastern Equine Encephalitis Human Disease


Rare, but severe disease Children are disproportionately affected Incubation period of 3-10 days Abrupt onset fever, chills, headache, muscle aches, nausea and vomiting, seizures, coma ~30-50% mortality ~80% of survivors have residual neurological deficits 23 MA cases (plus 2 exposures to non-residents) in the past decade, and 11 deaths We should expect EEE activity and a possible human case each year

Human EEE Cases by County of Residence, 1938-2011

2 14 1
Acquired in S.E. MA: 2010 RI Case 2011 MO Case

9 22 8 34 1 1

EEE Cases by County of Residence, 2012

1 2 1 1
= 2012 human case = 2012 horse case = 2012 alpaca case

West Nile Virus Infection Human Disease


More common, generally less severe Incubation period 3 to 14 days Highest risk of severe illness for those over 50 80% get mild, sub-clinical infection 20% get headache, sore throat, fatigue, muscle and joint aches, moderate to high fever <1% progress to aseptic meningitis, encephalitis, or meningoencephalitis 74 human cases in the past decade, and 4 deaths Widespread, endemic reality

Human WNV Cases by County of Residence, 2001-2012

3 41 1 1 5 17 9 6 19 1 1 1

104 cases

Viral Amplification Cycle and Transmission To Humans


Viral Amplification Cycle:
Between birds and certain mosquito species increases volume of virus in the environment

Transmission to humans:
By certain infected mosquito species (bridge vectors)

MDPH Arbovirus Program Overview


Surveillance Set and collect traps from long-term sites in southeastern MA
Collaborate supplemental trapping with local Mosquito Control Projects (MCPs)

Laboratory Testing and Correlation with Patient Information Test specimens for EEE/WNV infection
Mosquitoes, suspect animal and human clinical specimens

Risk Analysis and Communication Identify areas of risk for human disease Communicate findings with local health agents, local Mosquito Control Projects, and the public Provide information to guide the control actions to reduce the risk of disease

Massachusetts Department of Public Health

Massachusetts Arbovirus Surveillance and Response Plan

2013

Cheryl Bartlett Acting Commissioner Massachusetts Department of Public Health

Michael A. Pentella, Ph.D., D(ABMM) Director, Bureau of Laboratory Sciences Massachusetts Department of Public Health

Alfred DeMaria, Jr., M.D. State Epidemiologist Massachusetts Department of Public Health

Risk Analysis Allows for Phased Response


Risk Assessment EEE has 5 stages: remote to critical WNV reduced to 4 stages, low to critical Based on historical and current data Provides responsive set of recommendations for agencies and locals

EEE Risk Analysis

Routine Preparedness and Response Activities


DPH: Set and collect long-term mosquito traps Perform sorting by species and testing for virus Interpret mosquito abundance and infection rates Determine and report specific areas of risk Support public education on personal prevention (curtailing evening outdoor activity, covering exposed skin, using approved insect repellants) Support local health department activities (social media messages to be ready for season) DAR, State Reclamation and Mosquito Control Board (SRMCP) and local MCPs: Perform early season larvaciding Set and collect supplemental mosquito traps Conduct ground spraying to kill adult mosquitoes (both nuisance control and vector control)

Response Activities at Elevated EEE Risk


DPH: Information on specific areas of risk Emphasize need for personal prevention Support local health activities Recommend rescheduling evening outdoor events Begin consideration of aerial spraying DAR and State Reclamation and Mosquito Control Board (SRMCP): Conduct aerial spraying to kill adult mosquitoes when indicated

Response to Public Health Emergency


DPH: Characterization of risk area/potential spray zone Consult on extraordinary response with: State Reclamation and Mosquito Control Board Local Mosquito Control Projects DPH Commissioner Certification to permit aerial application of pesticide DPH and DAR: select pesticide for aerial application DAR: review waivers and ensure compliance with pesticide laws

Response to Public Health Emergency


Department of Environmental Protection (DEP) and Division Fish and Wildlife (DFW): review priority habitats (e.g. organic farms, public water supplies) which cannot be sprayed DAR and SRMCP: initiate and coordinate aerial spray operation according to the SRMCP Operational Response Plan DEP, DAR, and DPH: plan for post-spray environmental and human health monitoring DPH and DAR: notification to public, local boards of health, emergency departments, poison control centers

Communication Plan
Daily positive mosquito results Bi-weekly risk level changes:
Notification of EOHHS Secretariat (and, in turn, the Governors Office) Notification of EHS and EEA partners Notification of MCP(s) Notification of local health department(s) Website updates Media only for first positives and extraordinary mosquito/risk results

Preliminary positive animal or human results:


Same intra-governmental notifications as above, plus Notification of ordering clinicians/veterinarians Notification of MCP(s) Notification of local health department(s) No media or website announcement

Confirmed positive animal or human results:


Same as above, plus Notification of affected legislators Media announcement

Overviewof MDARMosquitoControl Operations

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The State Reclamation and Mosquito Control Board


Oversee Mosquito Control In Massachusetts
Legal Authority Chapter 252, Massachusetts General Laws 3 Members

- MDAR, Chairman - DCR - DEP

Appoints Mosquito Control District/Project Commissioners

(Carry Out Mosquito Control in various Geographic Regions of MA)

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MassachusettsRegional/Organized MosquitoControlDistricts/Projects
196Citiesand Townsthatare Members 155Citiesand Townsthatare NonMembers
PercentofCommonwealthMunicipalities thatareMemberCommunities

44%

56%

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WNV KEY MOSQUITO HABITAT

PhotobyGaryGonyea,StateReclamationandMosquitoControlBoard

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EEEV KEY MOSQUITO HABITAT

PhotobyGaryGonyea,StateReclamationandMosquitoControlBoard

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EEEV AND WNV Planning and Response

Two Principal Guidance Documents


DPH Arbovirus

Surveillance and Response Plan


MDAR/State Reclamation

and Mosquito Control Board Operational Response Plan

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Both plans
Reviewed and updated annually Highlight a phased response for EEEV and WNV Include a Multi-Agency Response Flowchart Outline activities, program goals, agency roles Made available online to the public

http://www.mass.gov/eea/agencies/agr/pesticides/ mosquito/arbovirus-response-plans.html

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EEEV AND WNV Planning and Response

MDAR/SRMCB ROLE
Conduct Aerial Adult

Mosquito Control Operation Secure Aircraft and Product Select Base of Operation Prepare GIS Mapping Conduct Environmental Monitoring Determine Efficacy

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AIRCRAFT

Twin Engine Turbine

Powered -King Air 90 Fly 300 feet above ground Quick (170 mph) Quiet Night

PhotobyClarke Mosquito
Photo by Gary Gonyea, SRMCB

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PRODUCT
ANVIL 10 + 10 ULV Active Ingredients
Sumithrin 10.00% Piperonyl Butoxide 10.00%

EPA Classification: Non-

restricted (General Use Chemical) fluid ounces per acre or equivalent to 0.0036 pounds of active ingredient per acre
Photo by Mark S. Buffone

Max Rate of Application: 0.62

Non-persistent

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Base of Operation/Staging Area Operational decisions are made Pilot and ground crew briefings Spray Equipment Testing

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Base of Operation/Staging Area Pesticides loaded on aircraft Aircraft and Pesticide Pesticide Storage Aircraft Fueled MA Environmental Police
Calibration Photos by Gary Gonyea, State Reclamation and Mosquito Control Board

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MDAR-GIS Mapping
Coordinate GIS Spray

Map process Develop Data Map For Aerial Applicator Develop no spray or exclusion map of sensitive areas Review and evaluate post-spray flight paths

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No Spray/Exclusion Areas

Certified Organic Farms and Commercial Fish Hatcheries/AquacultureMDAR Priority Habitats (PH) for spray sensitive statelisted rare speciesDFG/NHESP Surface Water SupplyDEP

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Environmental Monitoring
Honey Bees-MDAR Water Supplies DEP Cranberries Residue

Evaluation- DPH

Pesticide Illness

Surveillance ProtocolDPH or State listed rare species-DFG /(NHESP)

Non-Target Species/Rare

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Efficacy Results Comparison of mosquito abundance before and after the aerial adult mosquito control operation

PhotobyWayneAndrews,BristolCountyMosquitoControl Project

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Questions/Discussion
DO WHAT WE CAN, SUMMER WILL HAVE ITS FLIES, IF WE WALK IN THE WOODS, WE MUST FEED MOSQUITOES. Ralph Waldo Emerson

Borderland State Park , Sharon, Mansfield, and North Easton, MA

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Summary
EOHHS and EEA agencies are very experienced, well coordinated and nationally recognized around arbovirus surveillance and control Nothing we can do will wholly eliminate individual human cases of mosquito-borne disease Through consistent surveillance and prevention activities and enhanced response to rising risk, human impacts can be minimized We look to the Legislature to assist with communication and coordination to maximize the benefits of the scientific and technical tools we have available to address arbovirus risk across the Commonwealth