1. 1 West Nile Virus Washington State Department of Health The 2004 Picture West Nile Virus

2. Washington State Department of Health 2 First isolated from in the West Nile District of Uganda, 1937 Recognized as a cause of inflammation of the spinal cord and brain with outbreak in elderly patients, Israel, 1957 Equine disease noted in Egypt and France in the early 1960s 1999 “Old World” virus arrives in the “New World” WNV Background

3. Washington State Department of Health 3 Incidental infections Bird reservoir hosts Incidental infections Mosquito vector Transmission Cycle

4. Washington State Department of Health 4 Some Speculated Pathways of Introduction Human-transported bird Human-transported mosquitoes Storm-transported bird Intentional introduction (terrorist event) - not likely Infected human traveler - not likely WNV in the US

5. Washington State Department of Health 5 Human infection with WNV ~80% No symptoms ~20% West Nile fever <1% WNND Fatal WNV infection: <0.1% of all infections 10% of WNND 1/150 of all infections cause West Nile neuroinvasive disease (WNND) Very rough estimates

6. Washington State Department of Health 6

7. 7 W ashington &WNV 2002 Washington goes positive... RavenPend Oreille County CrowSnohomish County HorseIsland County HorseWhatcom County

8. Washington State Department of Health 8 A Tale of Two Years 20032004 US Total9,8622,313 “The West”3,7731,562 As of November 16

9. Washington State Department of Health 9 20032004* Arizona13389 California3737 Colorado2,947276 Idaho12 Montana2226 Nevada244 New Mexico20986 Oregon03 Utah111 Washington00 Wyoming3759 *As of Nov 23, 2004 A Tale of Two Years

10. Washington State Department of Health 10 2004 WNV Cases as of November 23

11. 11 The Northwest Experience Washington State Department of Health West Nile Virus

12. Washington State Department of Health 12 I daho 20032004 Humans12 Horses023 Birds06

13. Washington State Department of Health 13 I daho Human Case Locations 2004

14. Washington State Department of Health 14 I daho Horse Case Locations 2004

15. Washington State Department of Health 15 I daho Bird Case Locations 2004

16. Washington State Department of Health 16 O regon 20032004 Humans03 Horses031 Birds019

17. Washington State Department of Health 17 O regon Human Case Locations 2004

18. Washington State Department of Health 18 O regon Horse Case Locations 2004

19. Washington State Department of Health 19 O regon Bird Case Locations 2004

20. Washington State Department of Health 20 W ashington Bird Locations 2004 536 birds tested

21. Washington State Department of Health 21 W ashington Surveillance Testing 2004 Humans23 Horses53 Birds551 Mosquito Pools829

22. Washington State Department of Health 22 L asting Effects 47% required physical therapy after hospitalization Only 37% fully recovered after 1 year Cognitive loss reported = 41.2% Functional loss reported = 42.9% Physical loss reported = 45.7% Source: Emerging Infectious Diseases, Vol. 10, No. 8, August 2004 (http://www.cdc.gov/ncidod/EID/vol10no8/03-0879.htm)

23. Washington State Department of Health 23 Thanks to Our Partners Mosquito Control Districts Local Health Jurisdictions USACHPPM-West Veterinarians Health Care Providers State agencies and others W est Nile Virus Surveillance

24. 24 Only Time Will Tell Washington State Department of Health Washington State Update 2004 West Nile Virus