Arthropod-Borne Disease Program, NYSDOH

Arthropod-Borne Disease Program, NYSDOH
The Bugs of Summer! P. Bryon Backenson Geraldine S. Johnson Arthropod-Borne Disease Program, NYSDOH 5/2002

Mosquito-Borne Diseases
Tick Borne Diseases • Lyme Disease • Babesiosis • Ehrlichiosis • Rocky Mountain Spotted Fever Mosquito-Borne Diseases • Viral Encephalitides  West Nile Virus  Eastern Equine Encephalitis  St Louis Encephalitis  California Viruses--Lacrosse, JC, others • Malaria

Ticks and Tick-Borne Diseases

Tick-borne Diseases in New York State
Vector Lyme disease Ixodes scapularis (deer tick) Babesiosis I. scapularis (deer tick) Human granulocytic ehrlichiosis (HGE) Human monocytic ehrlichiosis (HME) Amblyomma americanum (Lone Star tick) Rocky Mountain spotted fever Dermacentor variabilis (American dog tick) Powassan encephalitis Ixodes cookei (woodchuck tick) Tularemia D. variabilis (American dog tick), A. americanum (Lone Star tick)

Lyme Disease Causative Agent: Borrelia burgdorferi, a bacteria
Reservoir: White footed mouse Vector: Deer tick - Ixodes scapularis Host: White tailed deer The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Lyme Disease: Clinical Symptoms
Early Lyme disease 3 to 30 days after bite of infected tick Erythema migrans (EM) rash (60-80%) Fatigue, fever, headache, muscle aches, joint pain and mild neck stiffness Late Lyme Disease weeks to years after tick bite arthritis, neurologic cardiac (rare) The symptoms of Lyme disease can appear from 3-30 days after the bite of an infected tick. The most common symptom is the Erythema migrans rash also known as the bulls-eye rash which appears in 60-80% of cases. Other common symptoms of early Lyme Disease are fatigue, fever, headache, muscle aches, joint pain and neck stiffness. Late Symptoms - May appear weeks to years after tick bite. Can include arthritis, neurologic complications and, rarely, cardiac complications.

Lyme Disease: Diagnosis and Treatment
Erythema migrans rash Testing Serologic antibody testing Screening: ELISA/EIA/IFA Secondary: Western Blot Proper antibiotic treatment Usually rapid and complete recovery, especially when treated early The presence of the erythema migrans rash alone can diagnose Lyme disease. Serologic antibody testing is also available. Testing can be done 3-4 weeks after the bite. If done early false negatives may result because antibody levels aren’t yet high enough to be detected.. There is a 2 tier screening test. The ELISA test is done first. If that is positive it is followed up with a secondary test called the Western Blot, which is more specific. With proper antibiotic treatment there is usually a rapid and complete recovery, especially when treated early.

LD - most common vector borne disease in the U.S.
Over 4000 cases annually in NYS, accounting for 36% of all US cases. Here is the characteristic Erythema migrans rash - appears in 60-80% of all LD cases. Caused by the bite of a deer tick infected with the Borrelia burgdorferi bacteria.

The EM rash appears 3-30 days after the bite
The EM rash appears 3-30 days after the bite. Usually occurs at or near the tick bite. No sensation - itching, pain etc. It slowly expands up to 6” outward. May be overlooked, especially if found on the back side of the body. More than one rash may appear as the result of one tick bite. This results from the bacteria spreading through the blood stream. In a dark skinned person the rash will look like a bruise. Photo: R. Dattwyler

Deer tick - vector From the left, the larva, a nymph, 2 engorged nymphal ticks, an adult female deer tick, an adult male deer tick. Immature ticks. The nymphs are most often involved in transmitting the Lyme bacteria to humans because they are so small, about the size of a poppy seed, are so hard to see and to feel. The nymphs are most common in spring.

Lyme Disease Cases Reported by State Health Departments*, 1990-1999
* Centers for Disease Control and Prevention

Distribution of Ixodes scapularis In New York State (1977 – 2002)
CLINTON FRANKLIN ST LAWRENCE ESSEX JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS WASHINGTON NIAGARA WAYNE HERKIMER ONEIDA MONROE ONONDAGA FULTON GENESEE SARATOGA ERIE ONTARIO MADISON MONTGOMERY CAYUGA SCHENECTADY WYOMING RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS ALLEGANY SCHUYLER CATTARAUGUS STEUBEN GREENE COLUMBIA CHAUTAUQUA TIOGA DELAWARE CHEMUNG BROOME ULSTER Counties with confirmed distribution (one or more locally acquired specimens submitted) DUTCHESS SULLIVAN PUTNAM ORANGE WESTCHESTER Counties with no confirmed distribution (No locally acquired specimens submitted) ROCKLAND SUFFOLK NEW YORK CITY NASSAU

Lyme Disease Cases by Year of Report New York State (Excluding New York City) 1986-2001
Number of Cases

NYS Lyme Disease Cases by month of onset, n = 5303 (‘96), 3325 (‘97), 4554 (‘98), 4403 (‘99), 4330 (‘00), 3479 (‘01)*

Average Annual Lyme Disease Incidence Rate
Average Annual Lyme Disease Incidence Rate* by Sex and Age Group in New York State (Excluding New York City) Incidence Rate per 100,000 Population * Number of cases per 100,000 population

Lyme Disease Cases by Sex and Age Group New York State (Excluding New York City) 1986 - 2001
Number of Cases

Average Annual Lyme Disease Incidence*
by County in New York State (Excluding New York City) *Per 100,000 population

Lyme Disease Incidence*
by County in New York State CLINTON (Excluding New York City) FRANKLIN 2000 ST LAWRENCE ESSEX <= 9 JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS HERKIMER WASHINGTON WAYNE ONEIDA NIAGARA MONROE ONONDAGA FULTON GENESEE SARATOGA ERIE ONTARIO MADISON MONTGOMERY SCHENECTADY WYOMING CAYUGA RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS CATTARAUGUS ALLEGANY SCHUYLER STEUBEN GREENE COLUMBIA CHAUTAUQUA DELAWARE CHEMUNG TIOGA BROOME ULSTER DUTCHESS SULLIVAN PUTNAM ORANGE WESTCHESTER ROCKLAND SUFFOLK NEW YORK CITY NASSAU * Per 100,000 population

Annual Proportion of Lyme Disease Cases by Region in New York State (Excluding New York City) Elsewhere Dutchess & Westchester, Percent of Cases Columbia Putnam & Rockland Nassau & Suffolk

Lyme Disease Incidence (per 100,000 population)
12 Selected Counties in New York State – 1990 vs. 2000 Rensselaer 0.6 / 44.6 Albany 1.4 / 23.4 Greene / 207.5 Columbia 6.3 / 936.7 Ulster 4.8 / 112.0 Dutchess / 376.2 Orange / 166.1 Putnam / 283.0 Westchester / 28.4 Rockland 0.4 / 20.2 Suffolk / 43.2 Nassau 6.4 / 6.4

Babesiosis Causative Agent: Babesia microti, a protozoan parasite
Reservoir: White footed mouse Vector: Deer tick - Ixodes scapularis Host: White tailed deer The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Babesiosis: Disease Characteristics
Malaria-like illness Occasionally transmitted through blood transfusion Symptoms: Fever, chills, headache, muscle aches, fatigue. Can be severe and require hospitalization. Potentially fatal. Incubation period typically 1-8 weeks. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

Babesiosis Cases by Sex and Age Group
New York State (excluding New York City) Number of Cases

NYS Babesiosis Cases by month of onset, n =37 (‘96), 26 (‘97), 107 (‘98), 61 (‘99), 72 (‘00), 78 (‘01)*

Geographic Distribution
of Babesiosis Cases in New York State* by County of Residence CLINTON FRANKLIN ST LAWRENCE Reported Babesiosis Case in County ESSEX JEFFERSON LEWIS WARREN 1 HAMILTON No Reported Babesiosis Case in County OSWEGO ORLEANS WASHINGTON 1 NIAGARA WAYNE HERKIMER ONEIDA MONROE 1 2 ONONDAGA FULTON GENESEE SARATOGA 2 ERIE ONTARIO MADISON MONTGOMERY CAYUGA SCHENECTADY WYOMING 1 RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO 1 ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS 1 SCHUYLER CATTARAUGUS ALLEGANY STEUBEN GREENE 3 COLUMBIA CHAUTAUQUA CHEMUNG TIOGA DELAWARE BROOME 1 Excluding New York City ULSTER 6 DUTCHESS SULLIVAN BRONX 2 1 PUTNAM NEW YORK ORANGE 1 12 QUEENS WESTCHESTER ROCKLAND * 28 464 SUFFOLK KINGS NEW YORK CITY RICHMOND NASSAU N=528

Human Granulocytic Ehrlichiosis (HGE)
Causative Agent: Anaplasma phagocytophila, a rickettsia Reservoir: Unknown, probably white- footed mouse or other small mammal Vector: Deer tick - Ixodes scapularis Host: Unknown, probably white-tailed deer or other mammal The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Human Monocytic Ehrlichiosis (HME)
Causative Agent: Ehrlichia chaffeensis, an ehrlichia Reservoir: Unknown, probably small mammal Vector: Lone Star tick – Amblyomma americanum Host: Unknown, probably medium-large mammal The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Ehrlichiosis: Disease Characteristics
Symptoms: Fever, chills, headache, muscle aches, fatigue. Can be severe and require hospitalization. Sometimes confused with RMSF, but ehrlichiosis typically lacks a prominent rash. Incubation period typically 1-3 weeks. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

Human Granulocytic Ehrlichiosis (HGE)
by Sex and Age Group in New York State* Number of Cases * Excluding New York City

Geographic Distribution Ehrlichiosis (HGE) Cases
of Human Granulocytic Ehrlichiosis (HGE) Cases in New York State* by County of Residence CLINTON FRANKLIN ST LAWRENCE ESSEX Reported Ehrlichiosis (HGE) Case in County JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS WASHINGTON WAYNE HERKIMER ONEIDA NIAGARA MONROE ONONDAGA FULTON No Reported Ehrlichiosis (HGE) Case in County GENESEE SARATOGA ERIE ONTARIO MADISON MONTGOMERY WYOMING CAYUGA SCHENECTADY RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS 7 CATTARAUGUS ALLEGANY SCHUYLER STEUBEN GREENE CHAUTAUQUA DELAWARE CHEMUNG TIOGA BROOME 1 COLUMBIA 107 Excluding New York City ULSTER SULLIVAN 5 BRONX DUTCHESS 39 PUTNAM NEW YORK 214 ORANGE QUEENS ROCKLAND WESTCHESTER 85 * 3 SUFFOLK KINGS NEW YORK CITY RICHMOND NASSAU N=461

Human Monocytic Ehrlichiosis (HME)
by Sex and Age Group in New York State* Number of Cases * Excluding New York City

Geographic Distribution Ehrlichiosis (HME) Cases
of Human Monocytic Ehrlichiosis (HME) Cases in New York State* by County of Residence CLINTON FRANKLIN ST LAWRENCE 1 ESSEX Reported Ehrlichiosis (HME) Case in County JEFFERSON 1 LEWIS WARREN HAMILTON OSWEGO ORLEANS WAYNE HERKIMER 1 WASHINGTON ONEIDA NIAGARA MONROE ONONDAGA FULTON No Reported Ehrlichiosis (HME) Case in County GENESEE SARATOGA ERIE ONTARIO MADISON MONTGOMERY CAYUGA SCHENECTADY WYOMING 1 RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS 2 SCHUYLER CATTARAUGUS ALLEGANY STEUBEN GREENE CHAUTAUQUA CHEMUNG TIOGA DELAWARE BROOME COLUMBIA 30 Excluding New York City ULSTER SULLIVAN BRONX DUTCHESS 13 PUTNAM NEW YORK 19 ORANGE QUEENS ROCKLAND WESTCHESTER 15 * SUFFOLK KINGS NEW YORK CITY RICHMOND NASSAU N=83

NYS Ehrlichiosis Cases by month of onset, n = 51 (‘96), 81 (‘97), 117 (‘98), 76 (‘99), 103 (‘00), 17 (‘01)*

Rocky Mountain Spotted Fever
Causative Agent: Rickettsia rickettsii, a rickettsia Reservoir: typically maintained through tick-tick passage Vector: American dog tick – Dermacentor variabilis The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Rocky Mountain Spotted Fever: Disease Characteristics
Rash for which it is named occurs only in 40-60% of cases. Rash spreads from palms and soles. Symptoms: Fever, nausea, vomiting, muscle pain, lack of appetite, headache. Majority of cases require hospitalization. Potentially fatal. Incubation period typically 3-14 days. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

Geographic Distribution and Exposure
History of New York State* Residents with Rocky Mountain Spotted Fever 1 CLINTON FRANKLIN ST LAWRENCE 1 3 ESSEX Local exposure JEFFERSON 1 LEWIS Travel history to endemic area 1 WARREN HAMILTON 2 1 1 1 OSWEGO ORLEANS 2 1 2 1 1 2 1 WASHINGTON 1 1 HERKIMER NIAGARA ONEIDA 1 ONONDAGA FULTON GENESEE WAYNE MONROE 1 2 1 SARATOGA 1 ERIE 1 3 ONTARIO MADISON MONTGOMERY RENSSELAER No travel history available WYOMING CAYUGA SCHENECTADY ALBANY 1 Residence in endemic area 1 LIVINGSTON YATES CORTLAND OTSEGO 1 1 1 SENECA CHENANGO SCHOHARIE 1 TOMPKINS 1 1 1 CATTARAUGUS ALLEGANY GREENE SCHUYLER 1 1 2 1 STEUBEN BROOME DELAWARE 2 CHEMUNG 1 COLUMBIA CHAUTAUQUA 2 TIOGA 1 1 1 2 * Excluding New York City ULSTER DUTCHESS 2 3 SULLIVAN 2 BRONX 2 2 4 6 PUTNAM NEW YORK 1 ORANGE 11 QUEENS WESTCHESTER 2 ROCKLAND 199 KINGS 3 SUFFOLK 1 NASSAU RICHMOND NEW YORK CITY 47 N=353 10

NYS Rocky Mountain Spotted Fever Cases by month of onset, n =34 (‘96), 14 (‘97), 13 (‘98), 14 (‘99), 9 (‘00), 3 (‘01)*

Powassan Encephalitis
Causative Agent: Powassan virus, a flavivirus Reservoir: Rodents, possibly other small mammals, birds Vector: woodchuck tick - Ixodes cookei The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Powassan: Disease Characteristics
Symptoms: Fever, chills, headache, muscle aches, fatigue, epilepsy, flaccid paralysis. Can be severe—meningitis and encephalitis--and require hospitalization. Potentially fatal. Incubation period typically 1-2 weeks. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

Tularemia Causative Agent: Francisella tularensis, a bacteria
Reservoir: numerous animals, particularly rabbits, voles, muskrats, beavers. Can also be maintained in tick population. Vector: American dog tick – Dermacentor variabilis, Lone Star tick – Amblyomma americanum The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Tularemia: Disease Characteristics
Variety of presentations, depending on route of inoculation. Symptoms will vary. Potentially fatal—case fatality rate also varies with route of inoculation. Potential bioterrorism agent, when aerosolized. Incubation period typically 1-14 days. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

NYS Tularemia Cases by month of onset, n = 2 (‘96), 0 (‘97), 5 (‘98), 1 (‘99), 0 (‘00), 1 (‘01)*

Mosquitoes and Mosquito-Borne Diseases

Public Health Importance of West Nile Virus
Transmitted by mosquitoes May cause serious, sometimes fatal, illnesses in humans Outbreaks in Israel (‘50s),Algeria (‘94), Romania (‘96-’97), Czech Republic (‘97), Congo (‘98), Russia (‘99), Israel (‘00) , NYC (‘99-00) 1st in Western Hemisphere WNV is of pubic health importance because it can be transmitted by over 20 species of mosquitoes. It may cause serious, and sometimes fatal, illnesses in humans. WNV originated in the West Nile region of Uganda, East Africa.Since then it has spread to the Middle East, Europe, Russia, and, in 1999, first appeared in the Western Hemisphere, in NYC.

West Nile Virus: Symptoms
Occur from 5-15 days after exposure Mild- slight fever and/or headache Severe - high fever, head and body aches, disorientation, convulsions, rash Most severe - paralysis or death Persons most at risk - over 50 years of age 1/150 persons infected becomes seriously ill See slide text.

West Nile Virus Transmission Cycle
Mosquito vector Incidental infections West Nile Virus WNV exists primarily in mosquito and bird populations. In the spring, infected over-wintering mosquitoes feed on birds who then become infected. Uninfected mosquitoes then feed on the infected birds and become infected and the cycle continues. The virus amplifies in birds and mosquitoes until it spills over to mammals and humans through mosquitoes who feed on them. WNV is not thought to be transmitted from person-person, bird-person, mammal-person. The chances of being bitten by a WNV infected mosquito are very low. Persons at greatest risk for serious illness from WNV are those over 50 years old. Incidental infections Bird reservoir hosts

Laboratory Confirmed WNV Infections, NYS, 1999-2001
2000 2001 Humans (Deaths) 62 (7) 14 (1) 15 (2) Mosquito Pools 15 400 300 Birds 142 1263 731 dead, 71 live Mammals 20 Horses 28 Horses, 5 others 22 Horses See slide text.

NYS WNV Encephalitis Cases by month of onset, n = 0 (‘96), 0 (‘97), 0 (‘98), 59 (‘99), 14 (‘00), 15 (‘01)*

West Nile Virus Positive Specimens, 1999
No Confirmed Activity Birds &/or Mosquitoes Humans (and Birds &/or Mosquitoes) West Nile Virus Positive Specimens, 1999 CLINTON FRANKLIN ST LAWRENCE ESSEX JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS NIAGARA WASHINGTON WAYNE HERKIMER ONEIDA MONROE ONONDAGA GENESEE FULTON SARATOGA ERIE ONTARIO MADISON MONTGOMERY WYOMING CAYUGA SCHENECTADY RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS CATTARAUGUS ALLEGANY SCHUYLER STEUBEN GREENE COLUMBIA CHAUTAUQUA CHEMUNG TIOGA DELAWARE BROOME This map shows the geographic distribution of WNV in NYS in 1999. Red areas are where positive birds and/or mosquitoes were located.Yellow areas are where positive humans and birds and/or mosquitoes were located. As you can see, viral activity was concentrated in the NYC metropolitan area and surrounding counties. ULSTER DUTCHESS SULLIVAN BRONX PUTNAM NEW YORK ORANGE QUEENS WESTCHESTER ROCKLAND SUFFOLK KINGS NEW YORK CITY NASSAU RICHMOND

West Nile Virus Positive Specimens, 2000
No Confirmed Activity Birds &/or Mosquitoes Humans (and Birds &/or Mosquitoes) West Nile Virus Positive Specimens, 2000 CLINTON FRANKLIN ST LAWRENCE ESSEX JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS NIAGARA WASHINGTON WAYNE HERKIMER ONEIDA MONROE ONONDAGA GENESEE FULTON SARATOGA ERIE ONTARIO MADISON MONTGOMERY WYOMING CAYUGA SCHENECTADY RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS CATTARAUGUS ALLEGANY SCHUYLER STEUBEN GREENE COLUMBIA CHAUTAUQUA CHEMUNG TIOGA DELAWARE BROOME In 2000, viral activity spread to virtually the whole state. Human cases were again concentrated in the NYC metro area. ULSTER DUTCHESS SULLIVAN BRONX PUTNAM NEW YORK ORANGE QUEENS WESTCHESTER ROCKLAND SUFFOLK KINGS NEW YORK CITY NASSAU RICHMOND

West Nile Virus Positive Specimens 2001
No Confirmed Activity Birds &/or Mosquitoes Humans (and Birds &/or Mosquitoes) CLINTON FRANKLIN ST LAWRENCE ESSEX JEFFERSON LEWIS WARREN HAMILTON OSWEGO ORLEANS NIAGARA WASHINGTON WAYNE HERKIMER ONEIDA MONROE ONONDAGA GENESEE FULTON SARATOGA ERIE ONTARIO MADISON MONTGOMERY WYOMING CAYUGA SCHENECTADY RENSSELAER LIVINGSTON YATES CORTLAND OTSEGO ALBANY SENECA CHENANGO SCHOHARIE TOMPKINS CATTARAUGUS ALLEGANY SCHUYLER STEUBEN GREENE COLUMBIA CHAUTAUQUA CHEMUNG TIOGA DELAWARE BROOME 2001 showed a varied pattern of WNV activity. Human cases were found on Long Island as well as in the NYC metro area. ULSTER DUTCHESS SULLIVAN BRONX PUTNAM NEW YORK ORANGE QUEENS WESTCHESTER ROCKLAND SUFFOLK KINGS NEW YORK CITY NASSAU RICHMOND

In 2001, WNV spread beyond the Northeastern U. S
In 2001, WNV spread beyond the Northeastern U.S. to as far south as the Florida Keys, as far west as Louisiana and Arkansas, and north west into Canada. The salmon color represents counties with positive bird and or mosquito activity. The red represents human cases and the blue dots represent infected birds in Canada. There were 59 human cases of WNV in 10 states.

Constructing human risk maps for West Nile Virus in New York
Human population*Infected bird risk = population-weighted WNV Risk Map WNV hot-spots

West Nile Virus Mapping Projects:
CONSIDERATIONS METHODOLOGICAL: Will more precise lat/long geolocations change the maps? Initial analyses for tested birds were done with ZIP5 data. METHODOLOGICAL: Can we combine this analysis with others, such as dead crow sightings, to make a better predictive model? Can other anthropomorphic features, such as infrastructure, be included? INSTITUTIONAL: What is the best way to translate these data for end users? Will it support their decision making? BOTH: What obstacles will be faced in making this a real-time system? To make this completely real-time, the following is needed on a real-time basis:  Satellite images  Lab results, and geocoded locations on birds, mammals, and mosquitoes.  Final risk maps

WNV Take-Home Messages
At least 27 states Over 75 species of bird Over 25 species of mosquito 149 human cases Report viral encephalitis Report dead bird sightings Reduce mosquito breeding habitats Educate about how to reduce risk of WNV infection

Other Notable Mosquito-borne Viral Encephalitides in NYS
Eastern Equine Encephalitis Virus transmitted to horses and humans by infected mosquitoes. Symptoms - sudden onset of fever, muscle aches, headache. Severe - seizures, coma, encephalitis. Fatality rate - 33% Sporadic isolations from Long Island, around Oneida Lake EEE is caused by a virus transmitted to horses and humans by the bite of an infected mosquito. Symptoms - sudden onset of fever, muscle aches, headache. More severe symptoms include seizures, coma, encephalitis - inflammation of the brain. Fatality rate is approximately 33%. The 2 most recent cases were in CNY and both were fatal. No case since Treatment - same as for WNV.

Other Notable Mosquito-borne Viral Encephalitides in NYS
St Louis Encephalitis LaCrosse Encephalitis Jamestown Canyon Encephalitis Virus transmitted to horses and humans by infected mosquitoes. Symptoms – typical symptoms leading to encephalitis All potentially fatal Historic isolations EEE is caused by a virus transmitted to horses and humans by the bite of an infected mosquito. Symptoms - sudden onset of fever, muscle aches, headache. More severe symptoms include seizures, coma, encephalitis - inflammation of the brain. Fatality rate is approximately 33%. The 2 most recent cases were in CNY and both were fatal. No case since Treatment - same as for WNV.

Malaria Causative Agent: Plasmodium spp., a protozoan parasite
4 different Plasmodia cause malaria Reservoir: Humans Vector: mosquitoes of the genus Anopheles The LD agent is the bacteria, Borrelia burgdorferi. The source, or resevoir, of the Lyme bacteria is the white footed mouse. The deer tick feeds on the mouse and becomes infected with the bacteria. The tick then transmits the bacteria when it takes a blood meal from another host I.e. humans, pets, rodents, birds.. The deer tick infects its hosts with the Lyme bacteria through biting to take a blood meal. The white tailed deer serves as host by providing a food source for the deer tick. The deer also transport the tick.

Malaria: Disease Characteristics
Most cases in New York are associated with travel to endemic areas. Potential transmission through transfusion. Millions of infections yearly worldwide. Symptoms: Fever, chills, cough, sweats, diarrhea, respiratory distress. Can be severe and require hospitalization. Potentially fatal. Severity will vary with species of plasmodium. Incubation period typically 7-30 days, can be up to 8 months. Malaria - like illness caused by a protozoa parasite transmitted by the bite of an infected deer tick. Reservoir - white footed mouse. Symptoms- fever, chills, myalgia, fatigue, nausea, vomiting, anemia. Treated with anti-malarial drugs cases per year. Highly endemic areas - Long Island. Recently 5 locally acquired cases outside L.I. - all in the Hudson valley. Can be fatal.

NYS Malaria Cases by month of onset, n = 365 (‘96), 393 (‘97), 333 (‘98), 329 (‘99), 308 (‘00), 75 (‘01)*

For More Information P. Bryon Backenson Geraldine Johnson
Arthropod-Borne Disease Program New York State Department of Health

Arthropod-Borne Disease Program, NYSDOH

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