Arboviral Diseases: Arboviral Diseases Presented by : Kathi Rose Malloy, RN, BSN
Slide2: Information courtesy of:
Department of Health and Human Service Centers for Disease Control and Prevention
Background: Arthropod-borne Viruses (Arbovirus): Background: Arthropod-borne Viruses (Arbovirus) Viruses spread via the bite of an arthropod, most commonly a tick or mosquito
Approximately 80 arboviruses known to cause human disease
In the Eastern region of the United States the two most important types of arboviruses include Eastern Equine Encephalitis (EEE) West Nile Virus (WNV)
Background : Eastern Equine Encephalitis: Background : Eastern Equine Encephalitis EEE first isolated in the US in 1933
Most commonly found in North America, Central and South America, and the Carribean
In the US, most cases reported from the eastern seaboard states, the Gulf Coast, and some inland midwestern states
Background: West Nile Virus: Background: West Nile Virus West Nile virus was first recognized in the US in 1999 in metropolitan New York City
More commonly found in Africa, West and Central Asia, and the Middle East
It is unknown how the virus arrived in the US
EEE in the United States: EEE in the United States
Spread of West Nile virus by state, 1999-2002. : Spread of West Nile virus by state, 1999-2002. West Nile Virus Activity in the U.S. in Birds, Horses,
Mosquitoes, Animals, or Humans.
West Nile Virus in the United States as of October 15, 2003: West Nile Virus in the United States as of October 15, 2003
Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) : Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) Avian
West Nile virus was established as endemic in Maryland in 2002. Therefore, the Maryland Department of Health and Mental Hygiene (DHMH) discontinued pickup and testing of dead birds in 2003.
Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) : Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) Equine:
One-hundred and eighty (180) Maryland horses tested positive for West Nile Virus (WNV) infection in 20 jurisdictions in 2003.
Sixty-six (66) of the 180 horse cases were fatal.
Maryland Jurisdictions with WNV in horses - 2003: Maryland Jurisdictions with WNV in horses - 2003 Anne Arundel 16
Baltimore 6
Calvert 3
Caroline 10
Carroll 40
Cecil 2
Charles 8
Dorchester 2
Frederick 24
Harford 5 Howard 8
Kent 4
Montgomery 14
Prince George’s 9
Queen Anne’s 10
St. Mary’s 7
Somerset 1
Talbot 7
Washington 3
Worcester 1
Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04): Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) Mosquitoes:
Over 195,000 mosquitoes were tested in Maryland between June 1 and October 31, 2003. A total of 62 mosquito pools in 13 jurisdictions tested positive for West Nile Virus during that time. One pool of Culiseta melanura mosquitoes collected in Worcester County tested positive for both WNV and EEE.
Maryland Jurisdictions with WNV in mosquitoes - 2003: Maryland Jurisdictions with WNV in mosquitoes - 2003 Alleghany 1
Anne Arundel 10
Baltimore Co 15
Caroline 1
Carroll 3
Charles 1
Dorchester 5 Frederick 3
Prince Georges 3
Somerset 3
Talbot 1
Wicomico 2
Worcester 11
Baltimore City 3
Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) : Maryland's Arbovirus Surveillance Testing Results 2003 (Updated 01/08/04) Humans
Seventy-three (73) human WNV cases (63 confirmed, 10 probable) have been reported this year in 13 jurisdictions.
Five (5) WNV – related fatalities have been reported to date.
Maryland Jurisdictions with WNV in humans- 2003: Maryland Jurisdictions with WNV in humans- 2003 Anne Arundel 7
Baltimore City 14
Baltimore Co 17
Caroline 1
Carroll 2
Charles 1
Frederick 3 Harford 2
Howard 3
Montgomery 10
Prince George’s 4
Queen Anne’s 5
Washington 4
Total 73
Eastern Equine Encephalitis Surveillance in MD, 2003 : Eastern Equine Encephalitis Surveillance in MD, 2003 Mosquitoes - Ten (10) pools of Culiseta melanura mosquitoes in two jurisdictions (Wicomico and Worcester Counties) have tested positive for EEE in Maryland. A single pool of C. melanura mosquitoes collected in Worcester County tested positive for both WNV and EEE.
Horses - Three horses in Worcester County have tested positive for EEE. All three were fatal cases. None of the horses had received the EEE vaccine.
Ratites (Flightless birds) - One (1) emu in Wicomico County has tested positive for EEE.
Transmitting WNV infection: Transmitting WNV infection
Additional Transmission: Additional Transmission Blood Transfusions
Additional evidence shows WNV can be spread via blood transfusions
CDC, FDA, HRSA, State and local Health Departments have ongoing investigations
A blood screening test has been developed
Breast milk
Health benefits of breastfeeding are well established
Risk of WNV transmission via breast milk unknown
No suggested changes in breast feeding recommendations
Symptoms : EEE: Symptoms : EEE Most people have no symptoms
Central Nervous system symptoms develop 4-10 days after being bitten
Sudden onset of fever, muscle aches, headache
May progress to more severe symptoms such as seizure and coma (encephalitis)
30 to 50% of patients with encephalitis die of the disease
Symptoms : West Nile virus: Symptoms : West Nile virus Most people do not develop symptoms
An estimated 20% become ill 3-15 days after being bitten
Mild illness: fever, headache, body aches, and sometimes skin rash and swollen glands
An estimated 1 in 150 persons infected develop a more severe form of the disease
West Nile encephalitis: inflammation of the brain, high fever, stiff neck, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis; few cases have been fatal
Geographic Risks: Geographic Risks People are only at risk when EEE and West Nile Viruses are circulating in nature
Northern states at risk during summer
Southern states at risk year round
Maryland’s Eastern Shore is in a moderate climate and therefore at risk until the first “killing frost”
Killing frost is defined as 27-28° Fahrenheit for at least 4 hours
High Risk Persons: High Risk Persons Risk of arboviral encephalitis is higher for the youngest and oldest (50+) segments of the population
People living in an area where the disease is common
People who work outside or participate in outdoor activities in areas where disease is common
Human Illness: Human Illness EEE – fewer than 5 cases are reported in most years. Last human death in Maryland was in 1989 (Dorchester County)
WNV – in the most affected areas of New York City only 2.6% population infected
Treatment: Treatment No specific therapy for infection of EEE or West Nile viruses
Arboviral encephalitis treated by hospitalization, intravenous fluids, respiratory support, prevention of secondary infections, and good nursing care
Vaccine: Vaccine Not available for humans
Horse vaccine is available – generally recommended annually in March, may booster mid-late summer in years where disease activity present
Prevention and Control FIGHT THE BITE !: Prevention and Control FIGHT THE BITE ! AVOID MOSQUITO BITES
Apply insect repellent to exposed skin when outdoors. The most effective contain DEET. Higher concentrations equals longer protection. Over 50% does not increase length of protection.
Use care in applying repellent to children: don’t put repellent on their hands and avoid their mouths and eyes. Products containing 10% DEET or less recommended for children 2-12.
When possible, wear protective clothing while outdoors
Slide27: Spray clothing with repellents
Consider staying indoors between dusk and dawn to avoid peak mosquito biting time
Avoid areas where mosquitoes are prevalent
Fix or install window or door screens to keep mosquitoes out of buildings
Slide28: AVOID CREATING MOSQUITO BREEDING AREAS; DRAIN STANDING WATER WHERE POSSIBLE
MOSQUITO SPRAYING
Community based
Public Health Emergency
Summary: Summary EEE and West Nile encephalitis are NOT transmitted person to person
There is no evidence that a person can get the virus from handling live or dead infected birds. However, persons should avoid bare-handed contact when handling any dead animals and use gloves or double plastic bags to place the carcass in a garbage can.
There is no evidence that the virus can be transmitted to humans through consuming infected birds or animals, but procedures for fully cooking meat should always be used.
Although the vast majority of infections have been in birds; horses, and other mammals may be infected
If you think you are infected and display any of the symptoms, contact your health care provider or doctor immediately.
Additional Info: Additional Info Websites:
Worcester County Health Department www.worcesterhealth.org
Department of Health and Mental Hygiene – Disease control
www.edcp.org
Centers for Disease Control
www.cdc.gov
Maryland Department of Agriculture
www.mda.state.md.us
Reporting concerns: Reporting concerns Standing Water Reports – Worcester County Dept of Development @ 410-632-1200
Mosquito Spraying – Worcester County Mosquito Control @ 410-632-3767
Dead bird Disposal – State Health Topics Hotline @ 1-866-866-2769