What you need to know about West Nile Virus Hale Nashed, MPH Walden University PUBH 6165-1 Instructor Name: Dr. Rebecca Heick 2010 term 3 My name is Hala Nashed I am a Walden University student , preparing for a Master of Public Health

Target Audience Nursing staff Community members living in the endemic areas. The target audiences are the nursing staff and community members who are living in the endemic areas.

The Purpose To increase knowledge about West Nile virus To learn about prevention To learn about care of the hospitalized West Nile Virus patient The purpose of the presentation is to increase the knowledge about West Nile virus, to learn about prevention, and if you work in a hospital what measures that should be taken to care for patient diagnosed with WNV.

Overview History of West Nile virus Geographic distribution of the virus West Nile virus in California Symptoms of West Nile virus Risk of getting West Nile virus Mode of transmission Infection control measures in hospital Preventive measures Agencies’ efforts to prevent West Nile virus In this presentation we will cover the history of the virus, distribution of the virus, WNV in Los Angeles County, signs & symptoms, risk of getting the disease , Infection Control measures, preventive measures and efforts made by agencies to prevent the WNV.

History of West Nile Virus(WNV) West Nile virus is an emerging infectious disease that was first discovered in the African country of Uganda in 1937. In recent years the disease has spread beyond its traditional boundaries, causing illness in birds, horses, and humans in Europe and now the United States. The disease was first discovered in the U.S. in 1999 in New York City. Since that time, WNV has been detected in humans, animals, and mosquitoes in 47 states from coast to coast. Source: Emerging Disease Issues, Michigan state from http://www.michigan.gov/emergingdiseases- In this slide I will introduce the history of WNV, it is started in Uganda in 1937 then spread to Europe and now in the U.S. In 1999 the disease was first discovered in /new York city and later on spread from coast to coast.

West Nile Virus Activity in 2009 From January 2009 to December 2009 , there were 663 case of West Nile virus reported , 51% were reported as severe cases (meningitis), 46% were reported as mild cases, 4% were asymptomatic. There were more severe cases reported than mild cases. Data from a population- based survey indicated that among people who become ill, less than 1% will develop severe illness (Mostashari F…et al, 1999) Source: Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/Mapsactivity/surv&control09Maps.htm Mostashari, Bunning , Kitsutani , et al. Epidemic West Nile Encephalitis, New York, 1999: Results of a household-based seroepidemiological survey. Lancet 2001;358:261-264. This slide represents the activity in the US in 2009. There were 663 cases reported for the year; however, there is a surveillance biased indicated because most of the cases reported were severe. Serious cases were more likely to be reported than mild cases. Another set of data was presented and indicated that among all the cases reported, mild and severe, less than 1% will develop severe neuroinvasive disease. .

West Nile Virus in California, 2009 human cases YTD: 110 cases Counties: 19 Four fatalities have been reported in Fresno (1), Los Angeles (1), Merced (1) and Stanislaus (1) counties.   horses YTD: 18 cases Counties: 12 12-18 horses from 12 counties have tested positive for WNV in 2009. dead birds YTD: 515 Counties: 36 515 dead birds from 36 counties have tested positive for WNV in 2009. Source: California Department of public Health from http://www.westnile.ca.gov WNV in California , there were 110 human cases in 19 counties in 2009, 18 horses and 515 among birds.

West Nile Virus in California, 2009 Mosquito samples YTD: 1,068 Counties: 27 1,068 mosquito samples from 27 counties have sentinel chickens YTD: 442 Counties: 23 442 sentinel chickens from 23 counties have tested positive for WNV in 2009.   squirrels YTD: 10 Counties: 7 10 squirrels from 7 counties have tested positive for WNV in 2009 Source: California Department of public Health http://www.westnile.ca.gov This slide also discusses the prevalence of the WNV. From the numbers it shown that the highest numbers was among Mosquito followed by birds This explains the mode of transmission that we will discuss later.

Mode of Transmission Infected Mosquitoes. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite. Transfusions, Transplants, and Mother-to-Child. WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby. Not through touching. WNV is not spread through casual contact such as touching or kissing a person with the virus Source: Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm Mode of transmission. breastfeeding, an Mosquitoes become infected when they feed on an infected bird and bite humans and other animals. WNV can spread through blood transfusion during pregnancy.

Symptoms of West Nile Virus Serious Symptoms in a Few People About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent. Source: Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm Patient who develops sever cases a usually over 50 years and symptoms varied from high fever to coma .

Symptoms of West Nile Virus..cont Milder Symptoms in Some People. Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for for just a few days, though even healthy people have become sick for several weeks. No Symptoms in Most People. Approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all. Source : Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm The symptoms of WNS divided into milder, no symptoms and sever 80% of people show no symptoms, milder cases represent 20% and they are fever headache, nausea , vomiting.

Risk of Getting Sick with WNV People over 50 are at higher risk of getting a severe illness. People whose jobs require them to be outdoors. Risk through blood transfusion or organ transplant is minimal. Source: Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm Who is at risk of getting sick with WNV? Considering the mode of transmission people whose job requires to stay outdoor longer, people over 50years of age are at risk of developing sever illness and very rarely organ

Infection Control Measures West Nile virus is transmitted by a vector-borne route. This means that: There is no person to person transmission, so standard precautions should be implemented for all patients admitted to the hospital with a diagnosis of West Nile Virus disease. WNV is transmitted by vector borne route, which means there is no person to person transmission, so standard precautions should be used when caring for patient admitted with WNV diagnosis.

How to protect yourself When you are outdoors, use insect repellent. Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours. Make sure you have good screens on your windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out.. Source: Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm Now is the question how can you protect yourself and your children , use repellent, wear long sleeves and pants during the hours of increasing the activity of mosquitoes. Get rid of mosquito breeding sites by emptying standing water in flower pots. Picture from the CDC

Agencies’ Initiatives to Prevent West Nile Virus CDC: Helping states carry-out program to prevent WNV, co-ordinate an electronic nation-wide data base for surveillance, develop a better lab diagnostic test. Phone no # 1-800-CDC-INFO NIOSH: the National institute of Occupational Safety and Health, instituted a brochure for workers who spend their time outdoors. 1- 800-CDC-INFO California Department of Public Health: Develop policies, surveillance, and educational brochures regarding prevention. (916)- 558-1784 LA County Department of Public Health: Developed methods of reporting mosquito breed areas, method of reporting a dead bird and provide surveillance. (213) 240-7941 Agencies like the CDC, local public health department and NIOSH are working together to help increase the public awareness to the virus.

References For more information: Los Angeles County Department of public Health http://publichealth.lacounty.gov/acd/VectorWestNile.htm California Department of Public health http://www.cdph.ca.gov/HealthInfo/discond/Pages/WestNileViru s.aspx Center for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm Mostashari , Bunning , Kitsutani . Epidemic West Nile Encephalitis, New York, 1999: Results of a household-based seroepidemiological survey. Lancet 2001;358:261-264 .