A Day in the Life

Slide 1: 

A Day in the Life of a State “Bug Doc” Rosmarie Kelly, PhD MPH Public Health Entomologist GDPH 1

Slide 2: 

“Georgia Division of Public Health, how can I help you?” “Excuse me, but the local health department gave me your number. They said you could help me.” “Yes ma’am, how can I help you?” “I have these bugs living under my skin. At night they come out, and when I can’t sleep I watch them dancing to the sound of my radio. Can you help me? I can send you some if you want to see them.” 2

Slide 3: 

Delusory Parasitosis 3 Delusory parasitosis is a real condition first described in the medical literature more than a century ago. It is described as an emotional disorder in which the patient has an unwarranted belief that live organisms, such as mites or insects, are present on or in his body. People with delusory parasitosis are otherwise reasonable, are not usually phobic about insects, and come from a variety of socioeconomic and occupational backgrounds. It is important to recognize that there are many potential causes of itching and irritation other than pests. http://health.state.ga.us/pdfs/epi/gers/ger1204.pdf http://health.state.ga.us/pdfs/epi/zvbd/Invisible%20Itches.pdf

Slide 4: 

“Georgia Division of Public Health, how can I help you?” “There’s a dead bird on my porch! Am I going to get the Swine Nile?” “It is a bit early for West Nile Virus ma’am. Was the bird acting sick? Do you have windows on the porch? Could the bird have flown into a window?” “Well, the cat dragged it up there so I don’t think it hit the window.” 4

Slide 5: 

Mosquito-borne Diseases 5 West Nile virus (WNV) WNV is a bird disease that can be spread by mosquitoes to humans and other animals. Horses can become infected with WNV and die. People over age 50 are most at risk for developing serious illness if infected. Eastern Equine Encephalitis (EEE) EEE is a bird disease spread by mosquitoes to humans and other animals. Horses can become infected with EEE and die. People over age 50 and under age 15 are most at risk for developing serious illness if infected. La Crosse Encephalitis (LAC) LAC is a disease of small mammals spread by mosquitoes to humans. LAC is primarily a disease of children age 16 and younger.

Slide 6: 

“Georgia Division of Public Health, how can I help you?” “Are you the mosquito control person?” “Yes sir, I am the entomologist, how can I help you?” 6 “It is flooding all over the place down here and FEMA and GEMA said to call you. What do we do?”

Slide 7: 

7 Collecting Data - Emergency Mosquito Surveillance Trailer (and the art of landing counts) The Georgia Department of Human Resources, Division of Public Health, using funds provided through a cooperative agreement with the Centers for Disease Control and Prevention, purchased a trailer and equipment to support surveillance of vector and nuisance mosquito species. The term "Landing Rate" should be used when an individual records the number of mosquitoes that land on the observer over a designated period of time. It is suggested that they be taken over either a 1 or 5 min. period.

Slide 8: 

“Georgia Division of Public Health, how can I help you?” “Are you that mosquito control person?” “Yes sir, I am the entomologist, how can I help you?” 8 “Why are you spraying?! You are killing all the animals and plants in my neighborhood! STOP IT!”

Slide 9: 

“Georgia Division of Public Health, how can I help you?” “Are you that mosquito control person?” “Yes ma’am, I am the entomologist, how can I help you?” 9 “Why aren’t you spraying?! The mosquitoes are terrible! My kids are covered with bites! I PAY MY TAXES! You need to spray!”

Slide 10: 

Mosquito Surveillance & Control 10 Integrated mosquito management (IMM) programs includes monitoring and treating mosquito breeding habitat such as occasionally flooded marshes, river backwater areas, swamps, and other low-lying areas, controlling larval populations with insecticides and biological control agents, and control of adult mosquito outbreaks based on light trap collections or mosquito landing counts.

Slide 11: 

“Georgia Division of Public Health, how can I help you?” “They transferred me to you. I have a tick question.” “Yes ma’am, I am the entomologist, how can I help you?” “My husband had this tick. Can I get it tested for Lyme Disease?” “We don’t test ticks ma’am, and Lyme Disease is actually rare in Georgia although we do have a number of tick-borne diseases. I can ID the tick for you and provide you with some information. Where did he get the tick?” “It was on his penis.” 11

Slide 12: 

Ticks and Tick-borne Diseases 12 Six tick-borne diseases are notifiable in Georgia: Rocky Mountain spotted fever (RMSF), human monocytic ehrlichiosis (HME), human granulocytic anaplasmosis (HGA), Lyme disease, Q fever, and tularemia.

Slide 13: 

“Georgia Division of Public Health, how can I help you?” “So, are you busy next month? We need you to give a talk at our meeting.” “I am sure I can fit it in. What would you like me to talk about?” “What is it you do again? 13

Slide 14: 

14 Meetings, Meetings, Meetings American Mosquito Control Association Mid-Atlantic Mosquito Control Association Georgia Mosquito Control Association Alabama Vector Management Society North Carolina Mosquito & Vector Control Association South Carolina Mosquito Control Association Florida Mosquito Control Association

Slide 15: 

“Georgia Division of Public Health, how can I help you?” “You are about the 10th person I have had to talk to today. The flies are just horrible! What can I do about them?” “I’m sorry sir. You have gotten to the right person. I will see what I can do to help you.” “I hope you can do something. I have had to talk to 50 people already and no one knew anything! … You probably won’t either.” 15

Slide 16: 

16 Nuisance Insect Species Several species of flies can be seen in and around homes during late summer and fall as they seek sheltered sites to overwinter. When spring arrives, these flies emerge from their overwintering sites. Some successfully find their way outside, while others are trapped indoors and die. cockroaches bed bugs beetles ants fleas etc

Slide 17: 

17 “This is Rosmarie Kelly, public health entomologist with the Georgia Division of Public Health. I am not available to talk at this time, but please leave a message and I will get back to you as soon as possible. Thank you.” “… Uhmm, my wife and I stayed in a hotel last night and now my wife has these bites all over her and we were wondering if you might know what it is. Could you call me back at…?” Hi, this is Rosmarie Kelly returning your call. Let me ask you a few questions and we will see if we can figure out what is causing your problem…

Slide 18: 

18 Bed Bugs Bed bugs, small wingless insects that feed solely on blood, are increasingly becoming a problem within residences of all kinds, including homes, apartments, hotels, cruise ships, dormitories and shelters. While bed bugs do not carry disease, their bite can cause allergic skin reactions in susceptible individuals.

Dealing with the Public : 

Dealing with the Public “GDPH, Ros Kelly speaking, how can I help you?” “My kids came home from camp and I am afraid they have bed bugs. Can I send you a picture of what they brought back?” “Sure, send it to rmkelly@dhr.state.ga.us and I will call you back.” You’ve Got Mail!

Dealing with the Public : 

Dealing with the Public “Ummm, that picture is kind of blurry but I don’t think it is a bed bug. Why don’t you send it to me and I will double check.” I am so worried about this I am going to drive up and bring you the bug tonight! Your office gave me your address and said you have access to a microscope.” “Ummmm, well…” “Good, I will see you in 4 hours” “Wait!” CLICK “That will be 11 PM … oh *&^%”

Slide 21: 

21

Slide 22: 

22 Q. Just a quick question about repellent...  I have a 19 month old toddler that I had been using a DEET-containing repellent on (spraying on my hands and then putting on child).  I try to use the lowest % of DEET (around 7% I think).  The nurse practitioner at my pediatrician's office almost yelled at me when I asked what was best to use and told her that I'd been using DEET.  However, what I thought I read on the CDC website sounded like DEET was OK for that age.  What do you think? Public Education A. DEET-based repellents can be used on children over the age of 2 months, and you are applying the repellent correctly. We do, however, recommend that parents check with their health care advisor before using any repellent on children under 2 years of age. That being said, the other repellent that actually work can not be used on kids over 3. Natural repellents mostly do not work. Also, contrary to popular belief, just because something is natural, does not mean it is safe. It might be useful to find out why your health care provider is anti-DEET. The 2 months and older label is fairly new so maybe she is uninformed. We have some links to repellent info web sites on the GDPH website. Hope this helps.

Slide 23: 

23

Slide 24: 

24 Arboviral Summaries

Slide 25: 

25

Slide 26: 

26 Q. Just a quick question for you.  In so many of the articles I see regarding mosquito control in GA, there is a huge reliance on spraying.  As you well know, IPM is the best form of longer term management so while I understand the need to spray for a short term impact, I believe that larviciding is really critical to any long term program (although I know it does not have the public "glamour" of a spray mission!).  Do the programs in Georgia incorporate larviciding? Public Education A. Some programs do and some are larvicide only. We have a few good IMM programs but most have no active surveillance at all. It is really a mixed bag and there is very little funding. The GMCA website has a map of known programs and what the do. There is no State oversight, which further complicates matters. We have 2 or 3 mosquito control programs located in environmental health, 2 stand-alone programs, one county (maybe more) that contracts with an independent company, a few county worker programs, and the rest of mosquito control is done by public works.

Slide 27: 

“Georgia Division of Public Health, how can I help you?” “This is the Office of Communications. Do you have time to talk to a reporter about our predictions for WNV this year?” “Sure, why not.” “Hi, I’m with the AJC and we are interested in what WNV is going to do this year?” “Well it depends on rain patterns and how the Culex quinquefasciatus populations do this summer.” “Uhm, could you spell that?” “Oh just call them quincs, it’s easier.” 27 They call ‘em quincs ‘cause it’s easier!

Slide 28: 

28 Dealing with Reporters Preparing for the interview – Ask who will do the interview – Ask what information is needed – Ask for general idea of the questions – Ask who else will be interviewed on topic – Ask about length of interview and format – Set time limit Conducting the Interview – Deliver your message – Redeliver your message – Offer to get information you don’t have – Explain why you can’t discuss something – Don’t raise issues you don’t want to explain – Don’t speak for others or get off message

Slide 29: 

29 Permission has FINALLY come through for the 2 adult mosquito ID classes being held in May.  If you are interested in this class and have NOT signed up, please send me an email and I will get you on the list.  If you are on the list and WILL NOT be able to come, please let me know as we bring in lunch for both days and I need to get an accurate head count.  REMEMBER, these classes are free.  I am currently working on pesticide license CEUs for Georgia.  If you need CEUs from a different state, let me know.  I am going to try to get public work and EH CEUs, but I may not be able to do so.If you have a dissecting microscope you plan to use to ID mosquitoes, please bring it along.  If you have dietary restrictions, please let me know.  If you have any questions, please call or email me and I will try to answer them.  Looking forward to seeing you. April 15

Slide 30: 

30 Ordering Supplies Dealing with Procurement January - I have to fill out what?! February - You needed the other forms? March – You LOST the forms! April – you do realize that the class is in early May, don’t you?

Slide 31: 

31 April – You ordered WHAT, from WHO? Why? April – My supplies are WHERE? Why? 2 days before the class – Since my earlier email, we had identified that “the company you didn’t want us to order from” did not have the comparable products and have since placed the order with “the company you requested in the first place”. I apologize that the clarification was required before we could proceed.  I hope you understand and have a very successful class as a result.

Slide 32: 

32 Mosquito ID Courses

Slide 33: 

33 WE WANT TRAINING!!!!!

Slide 34: 

34 Training Programs bed bug training environmental health training surveillance training GIS …

The DeKalb County Board of Health and the Georgia Division of Public Health Certificate of CompletionBed Bug Training : 

is hereby granted to: Decatur GA June 11, 2009 The DeKalb County Board of Health and the Georgia Division of Public Health Certificate of CompletionBed Bug Training Rosmarie Kelly, PhD MPH Public Health Entomologist

Slide 36: 

36

Slide 37: 

37 Public Information Q. Mosquito Spray...Worth a try? I was at a deck party and the bugs were having a ball biting everyone. A man at the party sprayed the lawn and deck floor with Listerine, and the little demons disappeared. The next summer I filled a spray bottle and used it around my seat whenever I saw mosquitoes. And voila! It worked!!  It worked at a picnic where we sprayed the area around the food table, the children's swing area, and the standing water nearby. During the summer, I don't leave home without it.....Pass it on. A. THIS DOES NOT WORK!  Every year this shows up online, and if it were that easy, there would be no mosquito-borne diseases or any need for mosquito control.  And, Listerine would cost a whole lot more than it does now.

Slide 38: 

“Georgia Division of Public Health, how can I help you?” “This is the District Environmental Health Director. We have a big mosquito problem here – lots of complaints. Do you think you could come out and do some surveillance?” “I would be happy to. Would next Tuesday and Wednesday work for you? It would. Great, I will see you then.” 38

Slide 39: 

39 Mosquito Surveillance Program - Complaints http://www.rci.rutgers.edu/~insects/complain.htm TABLE 2. A sample complaint data form Ocean County Mosquito Commission Complaint/Service Request Request Date:_______________________________________________ Municipality:________________________________________________ Name:____________________________________________________ Address:__________________________________________________ Telephone:________________________________________________ Problem:_________________________________________________ ________________________________________________________ ________________________________________________________ Received By:______________________________________________ Inspection Report:__________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Treatment(Y/N):___________________________________________ Add to route (Y/N):_________________________________________ Inspected by:______________________________________________ Inspection Date:___________________________________________

Slide 40: 

“Georgia Division of Public Health, how can I help you?” “Hey, how are you doing? Just checking to see when you plan to start our surveillance this year.” “I hope to get out to set traps next week and will try to get out every week if at all possible. Let me know if you have any new sites you want me to trap. 40

Slide 41: 

41 Arboviral Surveillance Program

Slide 42: 

“Hey, it’s Ros. I was just calling to see if you had any idea what might have happened to my surveillance trap.” “Haven’t heard a thing. Did you get another trap stolen?” “Not this time. This one is sort of … blown up. 42 POLICE REPORT Local Fire Rescue was first dispatched to an unknown type fire at about 10:15 p.m. When they arrived, they did not find a fire but what was described as some sort of electronic device with a light. Firefighters called the County Sheriff’s Office to the scene to investigate. The object was described by authorities as having a battery powered light attached to a tree, and a rope or string leading from the light to a cooler. Deputies called narcotics investigators to the scene, thinking that the setup may have been related to illegal drugs. From the shoulder of the road, only a faint light could be seen glowing just off the ground a few feet into the woods.

Slide 43: 

43 Just When You Thought You Had Seen It All Things that happen to traps: stolen – not quite sure what use traps are to anybody else, but… damaged – I guess people get bored blown up – yes, by the bomb squad, who either have nothing better to do or see it as a fine chance to practice swept away in freak storms – be careful of placement blown over – at least the trap is still there switched battery cables – at least once a year, usually by the trap setter ANTS – they love to eat mosquitoes etc

Slide 44: 

44 Thanks to Everyone Who Have Made This Presentation Possible!

Slide 45: 

45 Any Questions?