West Nile Virus Overview, CY 03 LTC David West, Deputy Director Proponency Office for Preventive Medicine Fort Sam Houston, TX FEB 04

Agenda 1. Significant Events, WNV Surveillance Overview WNV Surveillance & Prevention

1. Significant Events, CY 03 –Expansion of range: to the plains states of the US, prairie provinces of Canada (87% from Sask & Alb), Mexico (21/31 states & DF) and the Caribbean; often rural distribution –Possible role of alligators as reservoirs –All three CHPPM Subordinate Commands involved in mosquito ID and testing

Significant Events, CY 03 – Screening donors and testing of donated blood began on 4 AUG (USA, USAF) 8 AUG (USN). 64/42,213 (0.015%) + for WNv (as of 25 JAN). – Equine vaccine. Killed virus product given conditional license by APHIS on 1 AUG 01, renewed 2002; full license FEB 03. Administration: 2 doses IM 3-6 weeks apart; one annual booster. Vaccination of DOD equines required by VETCOM.

2. WNV Surveillance Overview 4 components: Equines Birds Mosquitoes Humans

-VETCOM policy: Decision to test horses for WNv delegated to DVC Cdr. Recommend limited use (e.g. establish diagnosis or screening for procurement) horse reported from Fort Meade, MD - Mexico: WNv detected in horses in 21 states & DF Equine Surveillance

Equine Surveillance, 2002 Equine Surveillance, 2003

Avian Surveillance Dead Bird Surveillance: –Dead birds are the most valuable indicator of viral presence, sensitive species: crows, jays, raptors – Suitable specimens submitted to appropriate diagnostic lab by installation vets (State/Federal Health & Wildlife agencies) –Dead birds + for WNv from 24 installations Sentinel Chicken Flock surveillance: Fort Polk, LA, Langley AFB, VA; + sentinel chickens at both installations Issues: VETCOM involvement; reporting of negative results (esp from state labs)

Avian Surveillance 2002Avian Surveillance 2003

Mosquito Surveillance Installation PVNTMED/DPW –Mosquito collection, public education, notification, control CHPPM-Subordinate Commands –Installation collection support –Mosquito identification & testing –Rapid response for enhanced surveillance –Data dissemination POPM-SA Entomologist MEDCOM policy memo; collect info from CHPPM sub cmds, RMCs; weekly EXSUMS to OTSG Results. >222K F mosquitoes (~22K pools) were tested by CHPPM labs; for WNv and 3 + for EEE (29 installations +)

Mosquito Surveillance, 2002 Mosquito Surveillance, 2003

Human Surveillance & Case Reporting MTF/Clinic Personnel - WNV diagnosis, education State labs (vice USAMRIID) - serology of suspected cases Donated blood testing Issue: reporting human cases very uneven

62 (7) 21 (2) 66 (9) 4156 (284) 9122 (223) Reported human cases and deaths in the USA due to WNv,

West Nile Virus in the United States as of January 28, 2004

Human cases, 2002 Human cases, 2003

Number of New Cases of WNv in the USA, SEP – NOV 03

25 human cases treated at military MTFs: - Fort Riley, KS: 1 F spouse of retiree - Fort Carson, CO: 23 (age range: 9 – 83, mean 42.7) - Walter Reed Army Medical Center: 1 AD USAF, travel history to Colorado

Issues from 2003 Cost & level of effort required to estimate threat to military, dependents and retirees versus “payoff” Human case definitions and reporting uneven Impact of PVNTMED deployments on CHPPM, RMCs and MEDDACs Number of mosquitoes submitted to CHPPM for ID/testing overwhelmed system State laboratory support (birds & mosquitoes): Turn-around time, Lab capacity, Result reporting, Negative Data?

CHPPM Surveillance Program Costs: : $562K ($200K from CDC, 362K from CHPPM Budget) (est.): $871.5K Benefits: - Predict risk of human illness, allow timely and targeted prevention - Develop capability to detect other pathogens (lab infrastructure, trained techs/officers, etc.; example: EEE)

WNV Surveillance & Prevention Dead bird surveillance –Remains a cornerstone –Discontinue collection after 5 WNV positives –Continue to use the USGS Laboratory –Negative Results from State diagnostic labs generally were not reported above installation level; we must improve result reporting (installation chain of command as well as to DOD level).

2004 WNV Surveillance & Prevention Mosquito surveillance –Surveillance guide on the CHPPM Web site –Larval site surveys & larval control – begins April-June regionally –Adult mosquito surveillance: Based on regional conditions may begin early June. Trap a minimum of 2 nights per week (CDC gravid trap and/or CDC light trap), 3 traps/night to 10 traps/night. Submit mosquito pools by genus/and or species to respective CHPPM Subordinate Command

The road ahead: - Predict that WNv will become part of the “disease landscape” of North America; expect to see declining emphasis in DOD (remember Lyme disease?) - Anticipate PPM will become part of military culture (due to WNv, leish, malaria experiences) 2004 WNV Surveillance & Prevention

QUESTIONS? Please submit all questions in triplicate, routed through the first GO in your chain of command. All questions will be promptly ignored in the order received.

ARMY INSTALLATIONS InstallationDetected In* Source Aberdeen Proving Ground, MDM, BCHPPM-N Carlisle Barracks, PABCHPPM-N, USGS Fort Belvoir, VABCHPPM-N, USGS Fort Benning, GABUSGS Fort Bliss, TXBTX Dept of Health Fort Bragg, NCM, BCHPPM-N, USGS Fort Carson, COM, B, HCHPPM-W, CO Dept of Health, MEDDAC PM Fort Detrick, MDBCHPPM-N Fort Eustis, VABCHPPM-N Fort Hamilton, Brooklyn, NYBCHPPM-N Fort Hood, TXMTX Dept of Health * Key: M = mosquitoes, B = birds, H = humans, C = sentinel chickens

ARMY INSTALLATIONS Fort Jackson, SCMCHPPM-S Fort Knox, KYBUSGS Fort Lee, VAMCHPPM-N Fort Meade, MDBCHPPM-N Fort Monmouth, NJBCHPPM-N Fort Myer, VAMCHPPM-N Fort Polk, LAM, CLA Dept of Health Fort Riley, KSM, HCHPPM-W & MEDDAC PM Fort Sill, OKBUSGS Fort Stewart, GAMCHPPM-S Pinon Canyon Maneuver Site, COM, HCHPPM-W USMA, West Point, NYBCHPPM-N Walter Reed Army Med Ctr, DCHAMSA Yuma Proving Ground, AZMCHPPM-W

NAVY/USMC INSTALLATIONS Annacostia Annex, DCMCHPPM-N Carderock Navy Center, MDMCHPPM-N Marine Barrackes, DCMCHPPM-N Naval Meritime Intell Center, DCMCHPPM-N National Naval Med Ctr, Bethesda, MDMCHPPM-N Naval Observatory, DCMCHPPM-N Naval Security, DCMCHPPM-N New London Sub Base, CTBCHPPM-N Newport Naval Air Stn, RIBCHPPM-N Parris Island, SCB, HCHPPM-S Pensacola Naval Air Stn, FLMCHPPM-S Quantico Marine Corps Base, VABCHPPM-N Washington Naval Yard, DCMCHPPM-N

AIR FORCE INSTALLATONS Andrews Air Force Base, MDM, BCHPPM-N Bolling AFB, DCBCHPPM-N Buckley AFB, COMCHPPM-N Dover AFB, DEMCHPPM-N Goodfellow AFB, TXMCHPPM-N & CHPPM-S Hanscom AFB, MABCHPPM-N Langley AFB, VACUSGS Maxwell AFB, ALBUSGS Moody AFB, GAMCHPPM-S DOD INSTALLATIONS Armed Forces Retirement Home, DCMCHPPM-N Arlington Service Center, VAMCHPPM-N Def Dist Depot Susquehanna, New Cumberland, PABCHPPM-N Pentagon, VAMCHPPM-N