Mosquitoes, Viruses and Seasonal Threats

For decades in the United States, the pesky mosquito has been little more than a summertime pest. Deadly mosquito-borne yellow fever disappeared from the South over a hundred years ago. Malaria was officially eradicated in 1949. But the sudden appearance of West Nile Virus, first in New York in 1999 and then in other states, quickly reacquainted people with the notion of the mosquito as a vector of disease and death. Yet, even without the introduction of a novel virus like West Nile, these whining little vampires have been spreading viruses and causing diseases at regular intervals. In the U.S., these mosquito-borne viral infections include St. Louis Encephalitis, Eastern Equine Encephalitis, Western Equine Encephalitis, and LaCrosse Encephalitis. Eastern Equine Encephalitis (EEE), or “Triple-E,” is particularly interesting because of recent cases in New Hampshire, Massachusetts, Virginia, Florida, New Jersey and South Carolina. As the name suggests, EEE is an infection of the nervous system (encephalitis) that affects horses and is common to the eastern United States. Of course, it’s more complex than a “mosquito bites horse” story. The story actually begins with the EEE virus circulating among birds and a type of mosquito that feeds almost exclusively on birds. That largely invisible cycle of birds and their mosquitoes can be interrupted by other types of mosquitoes that can acquire the virus from infected birds and then bite horses and people. That’s where the story takes a dramatic turn. It’s dramatic because EEE is frequently fatal to horses. In Florida last year, there were about 50 cases of EEE among horses. Almost half of the animals died or had to be euthanized.

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Two years ago in Virginia, an 18-month-old thoroughbred was also euthanized because of EEE. Maryland’s Eastern Shore also lost three horses to EEE in 2003. The infection is just as bad in people as it is in horses. The mortality rate is more than thirty percent. About one third to one half of those who survive a bout of EEE will suffer from some degree of permanent neurological damage. Those terrible numbers are due, in part, to the difficulty in diagnosing this uncommon infection and to the speed at which a patient will deteriorate. The symptoms of EEE are not specific, and include headache, fever, nausea, confusion, stiffness of the neck, malaise, sensitivity to light, and seizures. Given the degree of morbidity and mortality for this infection we are lucky there have been only about 200 confirmed cases in the last forty years. Still, even the appearance of a single case can set parents and public health officials on edge. Last summer, New Hampshire had an outbreak of six cases of EEE; two of them were fatal. Those cases prompted state officials to consider mosquito spraying and public education efforts to help prevent any new cases this summer. Massachusetts was also hard hit in 2005. The four cases ranged in age from three months to eighty-three years. A five-year-old girl and an eighty-three year-old man died. In 2004, Massachusetts had the same number of cases (4) and fatalities (2). In 2003, New Jersey’s first case in twenty years was a two-year-old girl who survived with severe neurological damage. Virginia reported one fatal case in 2003. Maryland has had no confirmed human cases in recent years. Unlike the West Nile virus which typically causes fatalities and neurlogical complications among the elderly, EEE strikes young and old alike. August and September are

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when most human cases are identified along the East Coast. Experts suggest that the virus tends to strike in cycles, and most often from freshwater marshes. Not surprisingly, there is no human vaccine for this rare but deadly virus. (There is a veterinary vaccine for horses.) There also are no specific drug treatments for EEE. Control measures such as draining swamps, spraying insecticides, and placing mosquito larvicides are expensive and sometimes controversial. At this time, the best defense is to wear mosquito repellent and avoid areas where mosquitoes breed and feed. Survivors of EEE infections are thought to have life-long immunity to re-infection, though that may be small comfort given the likelihood of permanent neurological damage from this infection.

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