1. West Nile Virus North Dakota Presented by: Larry Sailer CLCP Tracy K. Miller, MPH Epidemiology and Surveillance Program Manager Michelle Feist WNV Surveillance Coordinator tkmiller@nd.gov -- mafeist@nd.gov – 800.472.2180

2. West Nile Virus History Commonly found in Africa, West and Central Asia and the Middle East First recognized in U.S. in 1999 New York –7 deaths By 2003, found in all but three states Alaska, Hawaii and Oregon

3. WNV Activity in the Continental US YearHumanHorsesStates 199962254 2000316312 20016673327 20024,15614,90144 20039,8625,14547 20042,5391,38647 20053,0001,18148 20064,2691,08650 20073,63047143 20081,35618145 200972027538

4. What is West Nile Virus? Arbovirus Arthropod-borne disease Transmitted by mosquitoes Can cause encephalitis Inflammation of the brain

5. Incidental Infections Photo courtesy of Jim Gathany, CDC Virus Mosquito Vector Bird Reservoir Hosts Arboviral Transmission Cycle

6. What are the other Modes of Transmission? Organ Transplants Blood Transfusions Mother to Fetus Breastfeeding Laboratory Exposure

7. Who is at risk for West Nile Virus? Northern States Summer months –virus circulates in nature Severe infections People >50 years Immunocompromised Transplant recipients

8. What are symptoms of West Nile Virus Infection? Most people will not develop symptoms 80% Mild symptoms Headache Slight fever Body aches Swollen glands Nausea Vomiting Skin rash

9. What are symptoms of West Nile Virus Infection? Severe infection High Fever Severe Headache Muscle Weakness Vision problems Stiff Neck Altered Mental State/Confusion Paralysis

10. How is West Nile Virus Infection Treated? No specific therapy For West Nile virus encephalitis Intensive supportive therapy –Hospitalization –IV Fluids –Respiratory Support –Prevention of secondary infections –Good nursing care

11. Q. Can you get WNV from another person? A.WNV is not transmitted from person-to-person. Q. Can you get WNV directly from birds? A.No evidence of this type of transmission. However, avoid bare-handed contact with any dead animal. Q. Can you get WNV from eating game birds or animals that have been infected? A. No evidence of this type of transmission. Always follow procedures for fully cooking meat from either birds or mammals. Frequently Asked Questions Transmission…

12. Q. Can WNV be transmitted through blood transfusions? A.Yes; however, all blood banks began screening blood in 2003. Donors are screened for symptoms prior to donation. More info from CDC at: www.cdc.gov/ncidod/dvbid/westnile/qa/transfusion.htm

13. West Nile Virus Surveillance Summary North Dakota

14. WNV Activity 2002 17 Human Cases –Sept.8 peak activity Female Cx. tarsalis counts –Aug. 4 peak count

15. WNV Activity 2003 617 Human Cases –Aug.30 peak activity Female Cx. tarsalis counts –July 26 peak count

16. WNV Activity 2004 20 Human Cases –Aug.6 peak activity Female Cx. tarsalis counts –July 30 peak count

17. WNV Activity 2005 86 Human Cases –Aug.27 peak activity Female Cx. tarsalis counts –July 23 peak count

18. WNV Activity 2006 137 Human Cases –Aug. 5 peak activity Female Cx. tarsalis counts –Aug. 5 peak count

19. WNV Activity 2007 369 Human Cases –Aug.18 peak activity Female Cx. tarsalis counts –July 21 peak count

20. WNV Activity 2008 37 Human Cases –Aug.16 peak activity Female Cx. tarsalis counts –Aug. 2 peak count

21. Mosquito Surveillance, 2009 North Dakota no positive mosquito pools identified United States 6,646 positive mosquito pools identified

22. Equine Surveillance, 2009 North Dakota 1 positive case identified United States 275 equine cases identified 23 WNV cases found in other species

23. 2009 Positive Equine Cases by county

24. Dead Bird Surveillance, 2009 North Dakota No positive birds identified Focused on crows, blue jays, ravens, magpies, hawks, eagles and owls. 116 dead birds were reported on the health department’s online dead bird report form United States 759 avian cases identified

25. Human Surveillance, 2009 United States 720 positive cases identified 32 deaths reported North Dakota 1 positive case identified no deaths

26. 2009 Positive Human Cases by county

27. 2009 West Nile Virus Activity in the United States (reported to CDC’s ArboNET system)

28. Frequently Asked Questions Humans… Q. If I am pregnant or breastfeeding, should I use insect repellent with DEET? A. DEET helps reduce exposure to mosquito bites. No reported adverse events following use of DEET in pregnant or breastfeeding women. Q. Are infants at higher risk than other groups for illness with WNV? A.Illness in children <1 year old is rare. 1999-2000: 0 cases 2002: 6 cases

29. Frequently Asked Questions Humans… Q. Should people avoid donating blood? A.No. Donation is safe. Q. Should people avoid getting blood transfusions? A.If a blood transfusion is needed, the benefits outweigh risk. However, be aware of the risk and speak to your physician.

30. Frequently Asked Questions Humans… Q. What happens to blood collected from donors that test positive for WNV? A. Removed from blood supply and destroyed. Q. If a person has had WNV in the past can they still donate blood? A. Yes. 28 days from the start of their symptoms OR until 14 days after they recover, whichever date is later.

31. Frequently Asked Questions Pets… Q. Can WNV make my dog or cat sick? A.Unlikely to notice unusual symptoms or behavior. Small number of positive dogs and one positive cat in 2003. Q. Is there treatment for my pet? A.No specific treatment. Full recovery is likely. Treatment is supportive. Q.Can an infected pet cause illness in me or my family? A.No evidence of dog or cat-to-person transmission. Q. How is my pet infected? A.Bitten by an infected mosquito.

32. Frequently Asked Questions Pets… Q. Can I become infected from a dog bite? A. Virus not detected in saliva of infected dogs. Bites pose low risk. Q. Is there a vaccine for pets? A. No, there is only vaccine available for horses. Q.Should an infected pet be destroyed? A. No.

33. Frequently Asked Questions Hunting… Q. Are duck and other wild game hunters at risk for WNV infection? A.May be at risk due to outdoor exposure. WNV presence in wild game is unknown. Q. What should hunters do to protect themselves? A.Usual precautions for wild game. Insect repellent with DEET. No bare-hand contact. Cook meat thoroughly.

34. WNV Prevention Protect yourself and your family: Use insect repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus. Follow the manufacturer’s direction. –For Insect Repellent Use and Safety: http://www.cdc.gov/ncidod/dvbid/westnile/qa/insect_re pellent.htm Wear light colored, long pants and long sleeved shirts. Place mosquito netting over infant carriers when outdoors. Consider staying indoors during peak mosquito times (dawn, dusk and early evening).

35. WNV Prevention Control Mosquito Breeding: Get rid of buckets, toys and other water holding containers. Empty birdbaths, wading pools and potted plant drip trays every 4-5 days. Remove old tires from your yard. Clean roof gutters and downspout screens. Keep grass cut short and shrubbery well trimmed around the house. Cover trash cans to keep out rainwater. Repair holes in door and window screens. For stagnant ponds, rain barrels and low lying wet areas, contact your local vector control office or local public health unit.

36. More Information on WNV North Dakota Department of Health www.ndhealth.gov/wnv Centers for Disease Control and Prevention www.cdc.gov/ncidod/dvbid/westnile/index.htm Environmental Protection Agency (EPA) Pesticides and Mosquito Control http://www.epa.gov/pesticides/health/mosquitoes/

37. Questions?? www.ndhealth.gov/wnv