1. Infectious Disease in Mesa County Plague Plague West Nile Virus West Nile Virus Colorado Tick Fever Colorado Tick Fever Hantavirus Hantavirus

2. Plague Bacteria: Yersinia pestis Bacteria: Yersinia pestis Flea bite (78%),Direct animal contact (20%), Aerosolized animal Urine/Feces (2%) Flea bite (78%),Direct animal contact (20%), Aerosolized animal Urine/Feces (2%) Human cases Human cases April-November (93%) April-November (93%) Increased activity of fleas and hosts Increased activity of fleas and hosts

3. Types Bubonic Plague= 80-90% of cases Bubonic Plague= 80-90% of cases Signs: Fever, malaise, chills, headache, “Bubos” and possibly vomiting, abdominal pain, nausea, petechiae Septicemic Plague- Systemic spread Septicemic Plague- Systemic spread Signs: Similar to bubonic, plus Prostration, circulatory collapse, septic shock, organ failure, hemorrhage, Necrosis of extremities, Microthrombi blocking capillaries Pneumonic Plague Pneumonic Plague Incubation: 1-6 days Primary - Y. pestis inhaled Secondary - septicemic form spreads Signs: Fever, chills, headache, septicemia Respiratory distress, hemoptysis Person-to-person possible

4. Treatment Prevention With early treatment – Survival ~100% With early treatment – Survival ~100% Supportive treatment Supportive treatment Antibiotics treatment Antibiotics treatment Aminoglycosides Aminoglycosides Streptomycin, kanamycin Streptomycin, kanamycin Doxycycline, tetracycline, chloramphenicol Doxycycline, tetracycline, chloramphenicol Penicillins and cephalosporins are NOT effective Penicillins and cephalosporins are NOT effective Don’t handle dead animals Report animal die-offs Rodent-proof home Use insect repellent Treat pets for fleas Treat rodent sites Take pet to vet if symptoms develop Redness or swelling around mouth See a health care provider if human symptoms develop

6. The West Nile Virus Flavivirus- a virus, NOT a bacteria. Antibiotics are ineffective. Flavivirus- a virus, NOT a bacteria. Antibiotics are ineffective. Infects humans, birds, mosquitoes, horses and other mammals Infects humans, birds, mosquitoes, horses and other mammals Ecology & Transmission Ecology & Transmission Culex species(43 species) of mosquito is cause of human cases. Culex species(43 species) of mosquito is cause of human cases. Isolated number of cases from ticks Isolated number of cases from ticks Human Disease: Human Disease: Incubation: 3-14 days Incubation: 3-14 days 80% asymptomatic or mild flu-like illness 80% asymptomatic or mild flu-like illness 20% develop sudden fever, weakness, headache, myalgia, nausea, vomiting 20% develop sudden fever, weakness, headache, myalgia, nausea, vomiting Symptoms last 3-6 days in mild cases Symptoms last 3-6 days in mild cases Severe illness develops in less than 1% (1:150) infected with the neurological component- Encephalitis (meningoencephalitis) Severe illness develops in less than 1% (1:150) infected with the neurological component- Encephalitis (meningoencephalitis)

7. Incidental hosts Vectors Humans, horses, and other animals Amplifying hosts Birds Culex sp., Aedes sp., Ochlerotatus sp.

8. Prevention Protection Eliminating larval habitats Eliminating larval habitats Tires, bird baths, containers, rain gutters, unused swimming pools Tires, bird baths, containers, rain gutters, unused swimming pools Avoid mosquito habitats during dawn and dusk when they are most active Avoid mosquito habitats during dawn and dusk when they are most active Adjust watering times and sprinkler heads to prevent water pooling Adjust watering times and sprinkler heads to prevent water pooling Reduce time outdoors Especially evening hours Wear long pants and sleeves Use mosquito repellent 30% DEET, Picaridin, or Oil of Lemon Eucalyptus Do not use DEET on your animals- check with a vet. Make sure all window screens are intact Use yellow “bug” light bulbs in outdoor light fixtures

9. Mosquito Control Mesa County Health Department Mesa County Health Department Larviciding outside of district boundaries Larviciding outside of district boundaries FREE larvicide samples for home use FREE larvicide samples for home use Grand River Mosquito Control District Grand River Mosquito Control District Expanded control area Expanded control area Increased staff and budget Increased staff and budget City of Grand Junction City of Grand Junction Treating catch basins Treating catch basins Treating ponds and drainage areas Treating ponds and drainage areas

10. Colorado Tick Fever Most common tick-borne disease in Colorado Most common tick-borne disease in Colorado Caused by virus Caused by virus Maintained in rodent-tick cycle Maintained in rodent-tick cycle Transmitted by bite of infected tick Transmitted by bite of infected tick Attached for several hours to transmit enough virus to cause illness Attached for several hours to transmit enough virus to cause illness

11. Symptoms Treatment Fever Fever Headache Headache Body aches Body aches Nausea Nausea Abdominal pain Abdominal pain Lethargy Lethargy Currently no treatment Treat symptoms Recovery will take 2-3 weeks Not life threatening Infection produces life- long immunity

12. Hantaviruses A “viral hemorrhagic fever” A “viral hemorrhagic fever” Hantavirus Pulmonary Syndrome (HPS) Hantavirus Pulmonary Syndrome (HPS) Hemorrhagic Fever with Renal Syndrome (HFRS) Hemorrhagic Fever with Renal Syndrome (HFRS) Recent Cases: Recent Cases: Four Corners Outbreak Four Corners Outbreak May 2003: Montana, 3 cases May 2003: Montana, 3 cases

13. Cotton Rat Sigmodon hispidus Deer Mouse Peromyscus maniculatus House Mouse Mus musculus L.L. Masters

14. Chronically infected rodent Virus is present in aerosolized excreta, particularly urine Horizontal transmission of infection between same species by contact Secondary aerosols, mucous membrane contact, and skin breaches are also a consideration Transmission of Hantaviruses

15. Signs Incubation period 14-17 days Incubation period 14-17 days Early stage: Fatigue, fever, myalgia, headache and lasts 3-5 days Early stage: Fatigue, fever, myalgia, headache and lasts 3-5 days Later stage 4 to 10 days after initial signs: Later stage 4 to 10 days after initial signs: Coughing and shortness of breath Coughing and shortness of breath Rapidly progressive, non-cardiogenic pulmonary edema and severe hypotension Rapidly progressive, non-cardiogenic pulmonary edema and severe hypotension Hospitalization and ventilation required usually within 24 hours Hospitalization and ventilation required usually within 24 hours Patients can recover with early supportive care Patients can recover with early supportive care

16. Prevention Limit exposure to mouse excrement Limit exposure to mouse excrement Control rodents indoors Control rodents indoors Control rodents outdoors Control rodents outdoors Use safety precautions when cleaning rodent infested areas Use safety precautions when cleaning rodent infested areas Minimize your exposure when enjoying outdoor activities Minimize your exposure when enjoying outdoor activities Prevent access to food sources Prevent access to food sources Keep food preparation and cooking areas clean Keep food preparation and cooking areas clean Cover pet and human food overnight Cover pet and human food overnight Store garbage in tightly covered or elevated container Store garbage in tightly covered or elevated container Rodent trapping Rodent trapping

17. Internet Resources CDC All About Hantavirus CDC All About Hantavirus www.cdc.gov/ncidod/diseases/hanta/hps/noframes/phys/clinical.htm www.cdc.gov/ncidod/diseases/hanta/hps/noframes/phys/clinical.htm CDC Infectious Disease Pathology Activity CDC Infectious Disease Pathology Activity www.cdc.gov/ncidod/diseases/hanta/hps/noframes/printgenlsect ion.htm www.cdc.gov/ncidod/diseases/hanta/hps/noframes/printgenlsect ion.htm www.cdc.gov/ncidod/diseases/hanta/hps/noframes/printgenlsect ion.htm www.cdc.gov/ncidod/diseases/hanta/hps/noframes/printgenlsect ion.htm CDC - Plague information CDC - Plague information www.bt.cdc.gov/agent/plague/index.asp www.bt.cdc.gov/agent/plague/index.asp www.bt.cdc.gov/agent/plague/index.asp CDC - Division of Vector-borne Infectious Diseases CDC - Division of Vector-borne Infectious Diseases www.cdc.gov/ncidod/dvbid/index.htm www.cdc.gov/ncidod/dvbid/index.htm www.cdc.gov/ncidod/dvbid/index.htm Mesa County Health Department Website Mesa County Health Department Website http://health.mesacounty.us/ http://health.mesacounty.us/ http://health.mesacounty.us/