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Tarrant County . Diana Cervantes, MS, MPH Epidemiologist Tarrant County Public Health . Tarrant County: . ~ 1.8 million citizens Ecology Forrest to grassland prairies Urban to rural Culture Very little history of mosquito spraying WNV response began in 2002
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Tarrant County Diana Cervantes, MS, MPH Epidemiologist Tarrant County Public Health
Tarrant County: • ~ 1.8 million citizens • Ecology • Forrest to grassland prairies • Urban to rural • Culture • Very little history of mosquito spraying • WNV response began in 2002 • Mosquito surveillance/testing (2003) • Focus on surveillance and prevention • awareness and education
Historical WNV Human Case Data Tarrant County, 2002-2011 WNV associated mortality: 1 in 2002; 7 in 2006; 3 in 2009
2012 Human case counts in Tarrant County* • Total cases: 279 • WNF -178 • WNND - 101 • Deaths - 11 • Incidence rate per 100,000: 14.5 • Cities with cases - 24 *For 2012 Arboviral season; Based on data reported as of 5:00 PM 02/22/2013
WNV Cases by Onset of Illness, Tarrant County, 2012 Average time from when a person became ill until the case was reported to TCPH was 17.7 days. Data source: Tarrant County Public Health
Use of Insect Repellent While Outdoors among Tarrant County WNV Cases, 2012* *Regardless of time spent outdoors; 2012 Arboviral season; Based on data from Tarrant County cases reported as of 11:00 AM February 21, 2013
Tarrant County Response • Mosquito surveillance • Resurgence of interest in participation • TCPH LRN operated to capacity • Adulticide application • Varied among municipalities • No generalized aerial spraying • Targeted ground spraying effective • IR was average among the metroplex counties…not the highest or the lowest • Risk communication
Lessons learned • Limitations of using human case data to drive control efforts • Limitations of mosquito surveillance data • program implementation • No standard/structured trapping • No historical trap data • Effective communication is critical • Stakeholders • Media • Public • Local/regional partners
West Nile Neuroinvasive Disease CSTE Epidemiologic Case Definition Must meet Laboratory Criteria AND Clinical Criteria Clinical Criteria: Fever, (>100.4 or 38C) as reported by pt or HCP, AND Meningitis, encephalitis, acute flaccid paralysis, or other acute signs of central or peripheral neurologic dysfunction, as documented by a physician, AND Absence of a more likely clinical explanation
Recommendations for future response • Review/revise • response plans to increase mosquito pool surveillance • operational plans to reflect surveillance data (mosquito data to drive response) • communication plans • Communications with those in the position to make decisions
Acknowledgements • Tarrant County • Environmental Health • Epidemiology and Health Information • TX DSHS • Central • Region 2/3 • North Texas local public health