ENVIRONMENTAL HEALTH PRESENTATION WEST NILE VIRUS AND YOU PRESENTED BY DARLINGTON ETUMNI, MPH WALDEN UNIVERSITY PUBH-6165 : ASPECT OF ENVIRONMENTAL HEALTH: LOCAL TO GLOBAL INSTRUCTOR: DR. REBECCA HEICK WINTER QUARTER, 2010 Welcome ladies and gentlemen to this public health presentation on West Nile virus and You. I am Darlington Etumni, an MPH student of Walden University, your presenter.

Objectives At the end of the presentation, I will have refreshed your minds on What West Nile virus is - The signs and symptoms and how to detect it How it is contracted and transmitted Who is at risk How it can be treated, prevented and controlled and - What the governments are doing about it This presentation was designed with the general public in mind and I am hoping to refresh your minds and to remind us that the virus is here with us and what we can do to continuously protect ourselves and our families from the virus.

West Nile Virus What is it? West Nile virus (WNV) is a viral disease - It is transmitted through the bite of a mosquito - It is a flavivirus and belongs to the Flaviviridae family - The most widely distributed Flavivirus worldwide (WHO, 2010) Reference World Health Organization (2010). Vector-Borne Viral Infections: West Nile Virus. Retrieved on January 08, 2010 from http://www.who.int/vaccine_research/diseases/vector/en/index3.html As the name implies, West Nile virus is a viral infection transmitted through the bite of a species of mosquito called Culex and the family where it belongs to (Flaviviridae family) is globally the most widely distributed.

Definition continued - First discovered in 1937 in Uganda (PHAC, 2004) - It is now a global disease found in many countries - First appeared in U.S and Canada in 1999 and 2002 respectively (PHAC, 2004; Medline Plus, 2008) References. MedlinePlus (2008). West Nile Virus. Retrieved on December 22, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/007186.htm Public Health Agency of Canada (2009). Infectious Diseases: West Nile Virus. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen-eng.php?option=print The virus has been around for a while. It was found in Uganda, an eastern African country in 1937, appeared in United States in 1999 and in Canada in 2002. The outbreak in 2002 according to Public Health Agency of Canada (PHAC) was considered to be the largest in North America. More than 4000 persons were affected.

How is it transmitted? - Mosquitoes that feed on the blood of infected birds bite humans, horses and other mammals. - Closely related to Yellow fever, Dengue fever and  St. Louis encephalitis (PHAC, 2009) - Other animals like dogs, cats, horses, birds, etc can also be infected by the virus Reference Public Health Agency of Canada (2009). Infectious Diseases: West Nile Virus. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen-eng.php?option=print. The virus has also been found in animals including birds, horses, dogs etc.

Transmission continued - About 140 different species of birds have been found to carry the virus (WHO, 2010). - Through blood transfusion and organ/tissue transplants though, the chances are very low - It can also be passed to unborn babies through pregnancy as well as breast milk. Reference World Health Organization (2010). Vector-Borne Viral Infections: West Nile Virus. Retrieved on January 08, 2010 from http://www.who.int/vaccine_research/diseases/vector/en/index3.html There are several different species of the birds now found to carry the virus. Apart from mosquito bites, the infection can be transmitted through transfusion, mother-to-child transmission happens through pregnancy and breastfeeding.

Transmission continued - Through infected needles or cuts. - No evidence of transmission from animals to humans - Also no evidence that infection can be contracted by touching or kissing an infected person or being around a health care worker (CDC, 2009; PHAC 2009). References. Public Health Agency of Canada (2009). Infectious Diseases: West Nile Virus. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen-eng.php?option=print Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile You can also contract the infection by using needles that are infected with the virus. It is worth mentioning that being around a health care worker, kissing or touching an infected person is not a means of transmission. Also animals do not infect humans.

Incidence and Prevalence. - As at the end of 2009, there were 663 cases reported in the U.S (CDC, 2009). -Of this number, 335 cases (51%) reported symptoms of meningitis and encephalitis (CDC, 2009). - 302 cases or 46% reported fever and 26 cases or 4% had unspecified symptoms (CDC, 2009). Reference. Center for Disease and Prevention (2009). West Nile Virus: Statistics, Surveillance, and Control. Retrieved on December 22, 2009 from http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount09_detailed.htm The incidence and prevalence of the disease has been on a steady decline due to improved awareness on the virus and good medical services.

Incidence and Prevalence continued -In Canada there were 8 cases reported in 2009. 25% of the cases had neurological symptoms while the other 75% had non-neurological symptoms (PHAC, 2009). - No deaths were reported. Reference. Public Health Agency of Canada (2009). West Nile Virus National Surveillance Report. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen-eng.php?option=print. Also greater surveillance on the virus has contributed to fewer cases of the infections.

Epidemiology- How it all started - WNV is of African, Asian, European and Australian origin - First outbreak in humans recorded in 1990 in Europe and Mediterranean with largest outbreak in Russia, Romania and Israel. - First recorded in the U.S in 1999 As earlier mentioned, the virus was first identified in Uganda, an African country and it is a global infection found in several countries of the world.

Epidemiology continued - Largest outbreak in Western Hemisphere recorded  in 2002 (CDC, 2004). - The virus has now been reported in 44 states including the District of Columbia. References. Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile As mentioned before, the 2002 outbreak was the largest in North America and in the U.S, many states have reported its occurrence.

When is exposure greatest? - Infection is highest from April to October.   - Visiting areas or living in countries where the virus has been found increases your risk of being infected. Exposure to the West Nile virus is greatest in spring through fall.

Who is at risk? You may be at risk of contracting the virus if you are: - elderly which includes those 50 years and above - have a chronic disease like cancer, diabetes, heart disease (PHAC, 2009). Reference Public Health Agency of Canada (2009). Infectious Diseases: West Nile Virus. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen-eng.php?option=print The outcome of the infection depends on what category of individual you are. If you 50 years of age and above, have diseases like cancer, diabetes, heart disease, you need to be extra cautious because you are a high risk person.

Risk continued - pregnant - nursing -spending a great deal of time outside - immunocompromised like in HIV and transplant patients, those on chemotherapy Also , if you are pregnant, breastfeeding, spend a lot of time outdoors especially from spring through fall or have a weak immune system, the risk of infection is high.

How do you know you are sick? - Most people (about 80%) do not develop any symptoms when infected and do not get sick. - Infection takes about 2 to 14 days to develop. - Mild symptoms occur in 20% of cases and include     -  fever - headache and body aches     - nausea and vomiting     - mild skin rash - swollen lymph glands If you are having high fever, headache, nausea, swollen gland, stiff neck, muscle weakness, feeling generally sick, you need to contact your doctor immediately.

Signs and symptoms continued - Severe symptoms which occur in very few people include - high fever     - severe headache     - stiff neck     - difficulty swallowing     - confusion - muscle weakness and paralysis     - lack of coordination and loss of consciousness     - loss of vision, numbness.     - in rare cases, it can lead to death Very few people develop severe symptoms and they include high fever, stiff neck, difficulty swallowing, confusion, loss of vision and in few occasions, it can lead to death.

What tests and exams can be done? Apart from the signs and symptoms, the following tests can done to confirm if you have the virus or not; - Complete blood count (CBC) (Medline Plus, 2008). - Complete scan or MRI of the head (Medline Plus, 2008). - Lumber puncture and cerebrospinal fluid (CSF) testing (Medline Plus, 2008). - Polymerase chain reaction (PCR) (Medline Plus, 2008). - Serology test which checks for antibodies in blood or CSF (most accurate test so far) (Medline Plus, 2008) References. MedlinePlus (2008). West Nile Virus. Retrieved on December 22, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/007186.htm There are several tests and exams that can be performed to confirm the presence or absence of the virus. This could as simple as a blood test or head scan to MRI scan.

How is West Nile virus treated? - No treatment is available for the disease. - Milder symptoms like fever and pain resolve on their own. - In healthy persons, illness may last for weeks to months (CDC, 2004). References. Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile Unfortunately, there is no treatment for the infection. Most symptoms resolve on their own.

Treatment continued - In severe infections, affected persons may end up in the hospital where they receive     - supportive treatments like IV fluids (CDC, 2004). - nursing care and  (CDC, 2004). - help with breathing (CDC, 2004). References. Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile In severe case, supportive care including the use of IV fluids are provided.

If you think you have the West Nile virus If in doubt? If you think you have the West Nile virus - seek immediate medical attention - if you are breastfeeding or pregnant, talk to your doctor. If are feeling sick and you are not sure what might be wrong with you, it is advisable to contact your heath care provider as soon as possible.

Any vaccine available? - No! there is no vaccine presently available for the virus. Unfortunately, there is no vaccine available for the virus. It is the reality of things.

What can I do to protect myself and my family? There are several things that you can do to protect yourself and your family from being infected with the virus and they are; - avoid mosquito bites to prevent infections(CDC, 2004) - ensure stagnant water is gotten rid of around your homes. References. Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile It is very important and highly recommended that you protect yourself and your family from the virus. Several things you could do include, spending less time outside during the peak exposure periods, if you must be outdoors wear protective clothes like long sleeves and pants, get rid of non-moving water, this could be a breeding ground for the mosquitoes.

Control and prevention continued - ensure there are no clogs that could trap water - use insect repellent that contains DEET or approved ingredients - wear light colored clothes, protective clothings like long-sleeved shirts, pants and hats (PHAC, 2004) Reference. Public Health Agency of Canada (2004). Protect yourself from mosquito bites. Retrieved on December 22, 2009 from www.westnilevirus.gc.ca. Also avoid as much as possible mosquito bites, you can also use approved insect repellents etc.

Control and prevention continued   - ensure that door and window screens are in good order - clear mosquito breeding sites around your surroundings - take extra caution from dusk to dawn which are peak mosquito hours. It is also important to make sure that your doors and windows are in proper order. You can visit the CDC or Public Health Agency of Canada websites for more information on how to protect your yourself and your family. The link to the websites are also provided at the end of this presentation.

What actions are being taken? In Canada, Public Health Agency of Canada in collaboration with her partners are - involved in West Nile virus surveillance across the country - ensuring that blood donated is free from West Nile virus - continuously testing for the virus Both the governments of Canada and United States through their agencies are collaborating with their partners to continuously work on how to prevent future outbreaks.

Actions continued   - ensuring that the pesticides and insect repellents used are safe and effective  - coordinating a national approach to the virus in collaboration with First Nations communities on reserves. These they are able to do by ensuring that there are safe and effective pesticides available, giving guidelines on how to protect yourself and your family,

Actions continued In the United States, CDC is working states and local health department as well other partners to  - develop a nation-wide database for easy information sharing  - assist states in developing prevention and control programs Having a nationwide database for easy sharing of information

Actions continued   - developing better test methods to enhance diagnosis  - more test laboratories are been opened for virus  - contentiously working with partners to develop vaccines (CDC, 2005) Reference Center for Disease and Prevention (2005). West Nile Virus: Fact Sheet. Retrieved on December 22, 2009 from www.cdc.gov/westnile Assisting states in developing effective prevention programs, making sure that diagnostic procedures are better and more efficient , and working to develop the vaccine of the future with her partners.

Where can I get more information? - Health Canada: West Nile Virus Information website- http://www.westnilevirus.gc.ca - Division of Vector-Borne Infectious Diseases, U.S. Centers for Disease Control and Prevention (CDC) - www.cdc.gov/ncidod/dvbid/westnile For more information on West Nile virus, you can always access these links. They would provide you with everything you need to know about the virus and what you can do to protect yourself and your family.

Sources of information continued - National Institute of Allergy and Infectious Diseases (NIAID),National Institutes of Health website – http//www3.niaid.nih.gov

THE END QUESTION ???? I wish to thank you for taking out the time to attend this presentation on this very important issue that affects all of you. I hope I have been able to provide you with all the information that you need to protect yourself, your family and your environment from the menace of West Nile virus and hoping that you and your family would live and infectious free lives. If you have any question please kindly ask. Once again thank you for your attention.

References. -Center for Disease and Prevention (2004). West Nile Virus. Retrieved on December 22, 2009 from www.cdc.gov/westnile -Center for Disease and Prevention (2005). West Nile Virus: Fact Sheet. Retrieved on December 22, 2009 from www.cdc.gov/westnile -Huhn, G. D et al (2003). West Nile Virus in the United States: An Update on an Emerging Infectious Disease. American Family Physician, 68(4), 653-659

Reference continued -MayoClinic.com (2008). West Nile Virus. Retrieved on January 10, 2010 from http://www.mayoclinic.com/health/west-nile- virus/DS00438/METHOD=print - MedlinePlus (2008). West Nile Virus. Retrieved on December 22, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/00 7186.htm

Reference continued - Public Health Agency of Canada (2009). Infectious Diseases: West Nile Virus. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen- eng.php?option=print - Public Health Agency of Canada (2009). West Nile Virus National Surveillance Report. Retrieved on December 22, 2009 from http://www.phac-aspc.gc.ca/wn-no/gen- eng.php?option=print. - Public Health Agency of Canada (2004). Protect yourself from mosquito bites. Retrieved on December 22, 2009 from www.westnilevirus.gc.ca

Reference continued - WebMD (2008). West Nile Virus. Retrieved on January 08, 2010 from http://www.webmd.com/a-to-z-guides/west- nile-virus-topic-overview - World Health Organization (2010). Vector- Borne Viral Infections: West Nile Virus. Retrieved on January 08, 2010 from http://www.who.int/vaccine_research/diseases/v ector/en/index3.html