Lessons Learned from the West Nile Virus Outbreak Pamela ward-demo, Lt Col, USAF, DVM, MD Infectious disease physician U. S. Africa Command, office of the command surgeon

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Outline Course of the West Nile Virus Outbreak Lessons learned Military coordination with civil authorities Cornell University

General Accounting Office independent, nonpartisan agency works for Congress “congressional watchdog” mission “to improve the performance and ensure the accountability of the federal government for the benefit of the American people”

Distribution of West Nile Virus (American Family Physician 2003) By 2008 28,000 human cases 11,000 encephalititis 1,000 died

The West Nile Outbreak Timeline GAO West Nile Report

GAO Lessons Identified Local Surveillance and Response Capabilities What to report and to whom (initial undiagnosed cases) Systems that rely on physicians have poor sensitivity and lack timeliness Local Public health resources quickly overwhelmed Communication among Public Health Agencies lack of sufficient/secure channels for communication prevented sharing Capabilities of Laboratories only 3 labs in country able to run WNV (broaden capabilities) ensuring adequate staffing and surge capacity to accommodate testing needs 10-20 samples/year vs 1,200 samples/year Concern about laboratory capability to handle second concurrent outbreak

Coordination between Public Health and Animal Health Agencies “Communication between public and animal health communities had not worked well and indicated that the West Nile events pointed to a need for better partnership between these communities.” “This opinion was voiced even by those who at first disregarded animal health official’s views and questions about the potential links between the animal and human outbreaks.” Demonstrated the importance of the “One Health” concept

One Health Changes Implemented as a Result of the Lessons Learned Archived blood samples from zoo were tested by the CDC CDC acceptance of samples for testing by pre-identified zoos across the country South Dakota Department of Public Health Dallas News

Military Support of Civilian Authorities Case reporting to Public Health Authorities Close working relationship with local PH allowed real time sharing of information Collection and submission of dead birds on military installations U.S. Army Medical Research Institute of Infectious Diseases Mosquito trapping, species identification and viral testing results shared with state authorities (worked both directions) Coordinated spraying with state and local authorities guided by our trapping data as well as the state/local data Education for persons living on military installation U.S. Army

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