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DoD West Nile Virus Surveillance Program Entomological Value, Implications, & Lessons Learned

DoD West Nile Virus Surveillance Program Entomological Value, Implications, & Lessons Learned. Ben Pagac, Army Center for Health Promotion & Preventive Medicine, Fort Meade, MD. Most rapidly-spreading arboviral disease ever documented. 1999. 2000. 2001. 2002. 2003. 2004. 2005. 2006.

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DoD West Nile Virus Surveillance Program Entomological Value, Implications, & Lessons Learned

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  1. DoD West Nile Virus Surveillance Program Entomological Value, Implications, & Lessons Learned Ben Pagac, Army Center for Health Promotion & Preventive Medicine, Fort Meade, MD

  2. Most rapidly-spreading arboviral disease ever documented

  3. 1999

  4. 2000

  5. 2001

  6. 2002

  7. 2003

  8. 2004

  9. 2005

  10. 2006

  11. WNV Human Disease* *Military-associated: 2006 - 7AD; 2004 - 3 (1 AD, 2 dep/ret)

  12. DoD Installations/facilities

  13. Since North American WNV Onset Key DoD Surveillance Objectives 1. Rapid, open communication 2. Blend multi-agency efforts 3. Early detection 4. Implement PREVENTIVE vector management 5. Implement measured response planning based on surveillance findings 6. Reduce the human disease threat

  14. Field, Lab, Data, Response, Collaboration, Readiness

  15. Field…. • Trapping – type, habitat, frequency • Specimen ID – tools, keys, guides • Adjusted duties – based on resources (mosquito and dead bird collection) • Specimen handling – cold-chain, shipping • Training - on site & regional, with realistic expectations

  16. That’s so… yesterday WOW! …. A gravid Coquilletidia perturbans with symbiotic acarines attached antepronotally

  17. Lab…. • Mission expansion – Regional lab expansion • Specimen processing – volume, tracking, cold-chain • ID verification – spot check, reliability feedback (comm. loop) • Testing – RT PCR • Turn-around: Supplies for field • Turn-around: Results (mosquito trap numbers…immediate!) Average intervals: 2004 (73k fm / 10k pools) 10d post-collection / 6d post-receipt 2006 (6.5k fm / 890 pools) 9d post-collection / 5d post-receipt

  18. Data Reporting…

  19. Response…..

  20. Response…..

  21. VecTest Kit - -

  22. Trend: positive pools tended to show up when installation TIs exceed 10. TIs and positive pools - tangible basis for triggering systematic intervention Is abbreviated surveillance worth doing? In 2006 guidance for 13 sensitive DC sites; 2 - 4 gravid traps, 1 night/week *14% reduction

  23. Trap indices at army-supported DC area installations during week of first WNv-positive pool detection and two-weeks after response was initiated. Does intervention have an impact?

  24. Collaboration…. Examples: • Intra-DOD – Military Services, DEH, MED, VET, CHPPM, GEIS, WRAIR, USAMRIID, AFIP • Inter-agency/institution – NPS, USGS, CDC, States, COG, Academia

  25. Current Mosquito Trapping Sites ( Each site = 1 to 20 traps) NPS Nat. Zoo Army Navy Air Force Arling/Alex. DC N

  26. Readiness…. West Nile Virus: approximate geographic range

  27. Conclusions • Military Med, Vet, and Engineering resources quickly adapted to the establishment of a comprehensive National surveillance and response program for a threat of unknown magnitude • Vocational boundaries were sometimes willingly stretched to accomplish mission • Military efforts blended with, bolstered, and sometimes were the sole source of National epidemiologic information on the WNV threat • Health threat response measures were data driven • Value of data was maximized by broad & rapid distribution • Trap indices can be predictive of viral activity • Field-expedient wicking assays work • Targeted interventions work • 2006 – Lean DoD Surveillance at sensitive Military (DC) sites proved valid & valuable; to continue in 2007 • Principles & experience gained are being applied OCONUS • Elevated diagnostic capabilities with quick turn-around, large sample capacity, great accuracy, appropriate equipment, and adaptability are poised to address other potential threats • Enhanced domestic military field vector surveillance experience, capability, and infrastructure are in place to tackle future potential threats (natural or malicious)

  28. ACKNOWLEDGEMENTS: DOD Global Emerging Infectious Disease System (CDR Clara Witt) Army Proponency Office for Preventive Medicine (LTC David West) Centers for Disease Control & Prevention (Drs. D. Gubler, C. Moore, R. Wirtz, R. Nasci) US Geological Survey Nat. Wildlife Hlth. Ctr. (Drs. R. McLean, L. Glaser, E. Saito, G. McGlaughlin) NY State Health Department (Dr. Dennis White) State & Municipal Health Departments Collaborating Universities DC Department of Health (Dr. Peggy Keller, Ms. J. Hinson) US National Park Service (Ms. Jil Sweringen) Smithsonian Institution National Zoological Park (Drs. R. Yates, R. Montalli) Walter Reed Army Institute of Research (LTC J. Ryan) Army/Navy/Air Force Preventive Medicine Personnel Army/Navy/Air Force Public Works, Pest Management Personnel Army Medical Research Institute for Infectious Diseases (MAJ J. Blow, Dr. Michael Turell) Army Veterinary Clinics (MAJ Felicia Langel) Army Veterinary Command Food Analysis and Diagnostic Lab Air Force Institute of Env., Safety, Occ. Health Risk Analysis (Dr. Chad McHugh) Navy Disease Vector Ecology Center (CDR David Claborn) Army CHPPM–N,S,W (E. Stanwix, D. Kuhr, W. Irwin, J. Harrison, M. Miller, S. Spring) Army CHPPM-N,S,W Survey Officers and Technicians Armed Forces Retirement Home (T. Bechtol, Andy Dietz)

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