West Nile Virus

1. West Nile Virus Miyuki Horie, MPH student Walden University PUBH 6165-3 Dr. Howard Rubin Winter Qrt., 2012/13

2. Introduction • First West Nile virus cases in the world … Uganda, 1937 • West Nile virus in the US … New York, 1999 • Continue to re-emerge every year during the summer • Worst outbreaks in the US record … 2012 • Involved 48 states • Killed 89 people • 1 death in Washington, DC

3. Objectives • Know about West Nile virus (WNV) infection • Route of Transmission • Vectors • Clinical Symptoms • People at Risk • Treatment • Prevention • Around You • Around Homestead • Where to contact • If contracted WNV • For additional Information

4. West Nile VirusFacts • Arthropod-borne virus = Arbovirus • Transmitted by mosquitos • Can infect people, birds, horses, and other mammals • Causes mild-flu like symptoms or sever symptoms in some • Seasonal epidemic between Summer –Fall (CDC, 2012c; DOH, 2012b; Winn et al., 2006)

5. WNVRoute of Transmission • Primary Transmission Cycle = Birds   Mosquitos • Incidental Transmission = Mosquitos  Human, Horses • Birds = Reservoir • Mosquitos = Vector • Human, Horses = Incidental host/Dead-end (CDC, 2012a; DOH, n.d.; Huhn et al., 2003; Winn et al., 2006)

6. WNVBirds / Reservoir • Primary host/reservoir of West Nile virus • 200+ species affected • Infected birds become ill, die, or survive with permanent immunity • Develops infectious viremiafor 1-4 days • Migrant birds “ferry” WNV (CDC, 2012a; DHMH, 2013; Rappole, Derrickson, & Hubálek, 2000; Winn et al., 2006)

7. WNVMosquitos / Vector • Life cycle Eggs (in swamp/standing water) • Larvae (in water) Pupae  • Adult • Males • Live up to 7-10 days • Feed on plant juice • Females • Live 30+ days • Feed on animal blood • Become infected with WNV when feed on infected birds • Transmit WNV when feed on other animal (CDC, 2012a; DOH, n.d.; EPA, 2012b; EPA, 2012c) female male

8. WNVMosquitoes /Vector Culex mosquito Asian Tiger mosquito • Originally from Asia • Large size • Black & white stripes on legs and abdomen • Feed on mammals • Active all day • Attracted by CO2, humidity • “Common house mosquito” in North America • Yellow body + brown stripes on abdomen • Feed on birds, other mammals • Active at dusk and down • Attracted by swampy/stagnant water (cdc, 2005; DOH, n.d.)

9. WNVClinical Significance • No symptoms – 80% • Mild symptoms – 20% • Full-like symptoms • Fever • Headache • Body ache • Nausea • Skin rashes (torso) • Sever symptoms – Approx. 1 in 150 cases • “Neuroinvase WNV”: Encephalitis, Meningitis • Disorientation, Comma, Convulsion, Tremors, Numbness, Paralysis • High fever • Headache + Neck stiffness • Death (3-15%) (CDC, 2012c; Huhn et al., 2003; Salinas & Steiner, 2012)

10. WNVWho’s at Risk? • People who are risk are: • 0ver 50 years old • Immunocompromised • Working/spending many hours outside • Pregnant or nursing women do NOThave increased risk for WNV • Only 1 case of mother-fetus transmission • No report/data on WNV infection through Breastfeeding (CDC, 2012b; CDC, 2012c; Huhn et al., 2003) She’s Okay!

11. WNVTreatment • No specific treatment for WNV • Self-limiting – Mild symptoms last only a few days • No/Rare chronic case – person infected with WNV most likely to acquire immunity • Sever cases (Neuroinvasive WNV) should seek medical attention • Hospitalization • Supportive care: IV fluids, Respiratory support • Secondary prevention to reduce morbidity • Notification to Department of Health (DOH) (CDC, 2012b; DOH, 2012b)

12. WNVPrevention • No WNV Vaccine • Primary prevention = Avoid mosquito bite • Use mosquito repellant (e.g. DEET) when outside • Wear long-sleeve clothes • Apply permethrin on to the clothes • Stay inside during the mosquito-feeding hours (at dusk & dawn) (CDC, 2012b; DOH, 2012a; EPA, 2012b) Anti Mosquito (F5106)

13. WNVMosquito Repellant 2 types of mosquito repellant recommended are… • DEET(N, N-dimethyl-m-toluamide) • Most effective & Widely available • Directly apply onto the skin • Select appropriate % for your need • <30% DEET for children • 23.8% DEET… 5-hr protection • 6.65% DEET… 2-hr protection • 4% DEET… ~90-min protection • Permethrin • Apply onto clothes for additional protection • No health concerns at low level (CDC, 2005; DOH, 2012a; DOH, 2012b; EPA, 2012a; FDACS, 2012)

14. WNVControl • “West Nile virus program” • Reduce mosquito-breeding sites in all 8 Wards in DC • Dispose of old tires, cans and bottles and other containers • Clean roof gutters • Clear garbage area – Close the lid • Place tarp over grills, firewood piles, tires, boats • Turn over wading pools • Clean & Chlorinate swimming pools • Notify DOH for suspected West Nile virus outbreaks – Clinicians (DOH, 2005; DOH, n.d.)

15. WNVFor Your Information • For Mosquito control… • If you find a dying bird… • Contact  • If you find a dead bird… • Do not touch it by bare hand • Report to  • For pick-up of dead animal… • For any questions/concerns about WNV… Animal Disease Control Program Phone: (202) 535-2323 DC Animal Shelter Phone: (202) 576-6664 West Nile Virus Call Center Phone: (202) 535-2323 Call #311 Department of Health Phone: (877) 672-2174 Office Hours: M - F 8:15 am – 4:45 pm www.doh.dc.gov

16. WNVReview • Mosquito-borne disease • Birds are the primary host of WNV • Mosquitos are the vector of WNV • become infected through infected birds through bite • transmit the infection to humans through bite • Usually mild, flu-like symptoms for a few days • Neuroinvasive WNV is rate and sever condition • People older than 50 years are at higher risk!! • Primary prevention for WNV is use of Mosquito repellant! • Control of WNV is clearing mosquito’s breeding site! • Contact DOH @(877) 672-2174 for questions & Concerns

17. References • Centers for Disease Control and Prevention. (2005). What you need to know about mosquito repellant. Retrieved January 14, 2013,from CDC website: http://www.cdc.gov/ncidod/dvbid/westnile/mosquitorepellent.htm • Centers for Disease Control and Prevention. (2012a). Fight the bite! Retrieved January 14, 2013, from CDC website: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm • Centers for Disease Control and Prevention. (2012b). West Nile virus: Epidemiologic information for clinicians. Retrieved January 14, 2013,from CDC website: http://www.cdc.gov/ncidod/dvbid/westnile/clinicians/epi.htm • Centers for Disease Control and Prevention. (2012c). West Nile virus: What you need to know. Retrieved from http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factSheet.htm • Department of Health. (2012a). Controlling and repelling mosquitoes. Retrieved January 14, 2013, from DOH website: http://doh.dc.gov/node/164922 • Department of Health. (2012b). West Nile virus. Retrieved January 14, 2013, from DOH website: http://doh.dc.gov/service/west-nile-virus • Department of Health. (n.d.). West Nile virus brochure [pdf format]. Retrieved January 14, 2013, from DOH website: http://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/West-Nile-Virus-Brochure.pdf

18. References • Department of Health and Mental Hygiene. (2013). West Nile virus. Retrieved January 19, 2013, from DHMH website: http://ideha.dhmh.maryland.gov/oideor/czvbd/sitepages/west-nile.aspx# • Florida Department of Agriculture & Consumer Services. (2012). Frequently asked questions about permethrin [pdf format]. Retrieved January 19, 2013, from http://www.flaes.org/pdf/Permethrin%20QA%20final%208-25-11.pdf • Howell, T. Jr. (August, 2012). D.C. resident contracts West Nile virus. Times. Retrieved January 14, 2013 from http://www.washingtontimes.com/news/2012/aug/22/dc-resident-contracts-west-nile-virus/ • Huhn, G. D., Sejvar, J., Montgomery, S. P., & Dwokin, M. S. (2003). West Nile virus in the United States: An update on an emerging infectious disease. American Family Physician, 68(4), 653-661. Retrieved from AAFP website: http://www.aafp.org/afp/2003/0815/p653.html • Medical News Today. (2012, September). West Nile virus, Worst year ever says CDC, USA. Retrieved January 19, 2013, from MNT website: http://www.medicalnewstoday.com/articles/249974.php • National Center for Biotechnology Information, U.S. National Library of Medicine. (2012). West Nile virus. Retrieved February 1, 2013 from PubMed Health website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004457/

19. References • Rappole, J. H., Derrickson, S. R., & Hubálek, Z. (2000, August). Migratory birds and spread of West Nile virus in the Western Hemisphere. Emerging Infectious Disease, 6(4). Retrieved from CDC website: http://wwwnc.cdc.gov/eid/article/6/4/00-0401_article.htm • Salinas, J.D., & Steiner, M.L. (2012). West Nile virus. Retrieved January 19, 2013, from Medscape Reference website: http://emedicine.medscape.com/article/312210-overview • Ticinfo.com. (2000). Permethrin repellant. Retrieved January 19, 2013, from http://www.tickinfo.com/permethrin.htm • U.S. Environmental Protection Agency. (2012a). Alphabetical list of pesticide fact sheets. Retrieved January 14, 2013, from EPA website: http://www.epa.gov/pesticides/factsheets/alpha_fs.htm • U.S. Environmental Protection Agency. (2012b). Joint statement on mosquito control in the United States from the U.S. Environmental Protection Agency (EPA) and the U.S. Centers for Disease Control and Prevention (CDC). Retrieved January 19, 2013, from EPA website: http://www.epa.gov/pesticides/health/mosquitoes/mosquitojoint.htm

20. References • U.S. Environmental Protection Agency. (2012d). The insect repellent DEET. Retrieved January 14, 2013, from EPA website:http://www.epa.gov/pesticides/factsheets/chemicals/deet.htm • Washington Examiner. (2012, September). West Nile virus kills D.C. resident. Retrieved from: http://washingtonexaminer.com/west-nile-virus-kills-d.c.-resident/article/2507261#.UPvmR2_hrZI • Winn, W. C., Jr., Allen, S. D. A., Janda, W. M., Koneman, E. W., Procop, G. W., Schreckenberger, P. C., & Woods, G. L. (2006). Koneman’s color atlas and textbook of diagnostic microbiology (6th ed.). Philadelphia: Lippincott Williams & Wilkins.

21. Images Cited • Bentley, T. (2007). Mosquito - Culex territans - Male [Photo]. Retrieved January 20, 2013, from Bugguide website: http://bugguide.net/node/view/141495 • Eastern Idaho Public Health District. (n.d.) Fight the bite [Image]. Retrieved January 20, 2013, from EIPHD website: http://www.phd7.idaho.gov/Infectious%20Disease/WNV/wvnmain.html • Centers for Disease Control and Prevention. (2007). Number of West Nile virus neuroinvasive disease cases, by week of illness onset -- United States, 2007 [Figure]. Retrieved from Medscape website: http://www.medscape.com/viewarticle/577372 • Centers for Disease Control and Prevention. (2012). West Nile virus (WNV) activity reported to ArboNET, by county, United States, 2012 (as of December 11,2012)[Figure]. Retrieved from CDC website: http://www.cdc.gov/ncidod/dvbid/westnile/Mapsactivity/surv&control12MapsAnybyCounty.htm • Clark, G. (n.d.). Shoo fly [Photo]. Retrieved January 20, 2013, from ScienceNewsforKIDSwebsite: http://www.sciencenewsforkids.org/2008/06/bug-bug-go-away/

22. Images Cited • Firstyle Products Ltd. (n.d.) Anti Mosquito (F5106) [Product photo]. Retrieved January 20, 2013, from http://www.made-in-china.com/showroom/firstyle/product-detailDqMxQeEJjGVn/China-Anti-Mosquito-F5106-.html • Gathany, J. (n.d.) Culex quinquefasciatus, a representative of the Culex genus of mosquitoes [Photo]. Retrieved January 20, 2013, from University of California, Riverside website: http://newsroom.ucr.edu/2434 • Goldsmith, C. (n.d.). West Nile virus [Image]. Retrieved January 20, 2013, from News-Medical.Net website: http://www.news-medical.net/health/West-Nile-Virus.aspx • Kane Country Health Department. (n.d.). West Nile cycle [Figure]. Retrieved January 20, 2013, from: http://kanehealth.com/west_nile_info.htm • Klemm, D. (2003). Transmission cycle of West Nile virus [Figure]. Retrieved from AAFP website: http://www.aafp.org/afp/2003/0815/p653.html • TomMyersPhoto.com. (n.d.). 5 Asian Tiger mosquito 640 [Photo]. Retrieved January 20, 2013, from AllRite Pest Control website: http://www.allritepest.com/?publications=pr-management-3