Coming to America: Immigrant Viruses and the Emergence of West Nile Fever

Once upon a time, miners took canaries into the mines in order to use them as living gas detectors. If the birds keeled over, it was time for the miners to clear out. Something similar happened in New York City in 1999. Crows started dropping out of the trees and exotic zoo birds began to die. Unlike the 19th century miners, however, no one in the New York boroughs paid much attention to these disoriented, dying birds. But then a handful of disoriented, elderly people began showing up in a Queens hospital. They had what was then described as "encephalitis of unknown etiology," which means brain inflammation of an unknown cause. Doctor Deborah Asnis began working on these patients at Flushing Hospital in Queens while veterinarian Tracey McNamara began working on dead birds at the Bronx Zoo. Without knowing it, they were actually trying to solve the same puzzle. In late August of 1999, these two curious, sharp-eyed women had caught the first glimpses of a new disease loose in the United States. The West Nile virus was first identified in the West Nile district of Uganda in 1937. The virus is transmitted between birds by mosquitoes. But some mosquitoes bite both humans and birds, so the virus is able to jump between species. Over the intervening decades the virus has caused outbreaks in various parts of Africa, the Middle East and a few European countries. That it suddenly appeared in the U.S. in the summer of 1999 came as a complete shock to infectious disease experts.

How it got here is a bit of a mystery. Maybe a jet landed in New York with an infected mosquito in the cargo hold. (Malaria-infected mosquitoes sometimes do this.) Or maybe someone imported an already infected bird that later got bit by a local mosquito. However it arrived, it's here to stay. In five years the virus has been carried by birds and mosquitoes across forty-five states, and is working its way down into Mexico. Last year the U.S. recorded 9,862 serious cases of West Nile fever and 264 deaths. Maryland had 73 such cases and eight deaths. Infections with the West Nile virus are characterized by fever, headache, weakness and sometimes mental confusion. The elderly and the immunocompromised are the usual victims, and they are the ones mostly likely to succumb to fatal cases of West Nile encephalitis or meningitis. Acute flaccid paralysis--a polio-like syndrome-also has been seen in a handful of patients since 2002. Fortunately, most of us are not likely to notice that we even have the infection. According to the Centers for Disease Control and Prevention in Georgia, eight out of ten people infected with the virus will never show any symptoms. Those who do show symptoms tend to have mild flu-like symptoms. Less than one percent of infections will lead to serious neurologic disease and hospitalization. Still, no one wants to be in that one percent. There are no specific drugs or treatments for West Nile fever. A vaccine is in development, but its testing, licensing and marketing are years away. (The USDA recently licensed a vaccine for horses, but its effectiveness is unclear. In 2003, seventy-five horses died in Maryland.) Prevention remains the best strategy for dealing with West Nile virus. Avoid the dusk-to-dawn feeding times of mosquitoes and wear a DEET-containing repellent when

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outside. Repair any holes in window and door screens and get rid of any standing water in gutters, tires, and other containers where mosquitoes like to breed. Watch for dead birds and report them; it's a sign that the virus may be in the area. Maryland's Department of Health & Mental Hygiene has a good web page on West Nile virus, mosquitoes and prevention methods (www.edcp.org/html/west_nile.html). At this writing, fourteen human cases of West Nile fever have been diagnosed from New Mexico, Arizona, California, South Dakota, and Wyoming. Maryland has not reported any cases, but that will almost certainly change over the course of the summer. Once upon a time, malaria and yellow fever were common in the U.S. Both infections have since been banished, but we still have plenty of other mosquito-borne diseases, including Eastern Equine Encephalitis, Western Equine Encephalitis, St. Louis Encephalitis, and La Crosse Encephalitis. West Nile is just the latest virus to add to the list of summertime headaches. Unfortunately, it probably won't be the last. Viruses and mosquitoes, like birds and people, travel far and travel fast.

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