1. Preparing for WNV: Montana’s Experience Jim Murphy, Health Specialist Montana Department of Public Health & Human Services (406) 444-0274 jmurphy@state.mt.us

2. Objective By the end of this presentation participants will be able to: List three specific activities that can be implemented at the local level to prepare for the emergence of WNV. List three specific activities that can be implemented at the local level to prepare for the emergence of WNV.

3. Presentation Overview 1. Montana’s preparation prior to the arrival of WNV 2. Impact of WNV in Montana 3. Critique of performance & improving our response

4. Montana’s Preparation for WNV (CDC Epidemiology & Laboratory Capacity (ELC) funds in mid-2001) Developed partnerships with state counterparts in Livestock, Agriculture & the University/Extension system. Developed partnerships with state counterparts in Livestock, Agriculture & the University/Extension system. –Offered funding to support testing efforts of birds, horses & mosquitoes. –Distributed brochures & fact sheets to local partners. –Promoted passive clinical surveillance through mailings to providers.

5. 2 Human Cases diagnosed in Fall 2002 Human cases (2) Equine (134) West Nile Virus Infections, by County, Montana 2002 1 1

6. Year 1 (2002) Results/Critique Lab & partners well prepared Lab & partners well prepared Low/Moderate level of worry among public & press Low/Moderate level of worry among public & press Horses best sentinel indicator in sparsely populated states Horses best sentinel indicator in sparsely populated states –Bird & mosquito testing not highly organized?

7. Year 1 (2002) Results/Critique Needs: Needs: –Better educational resources –Better bird & mosquito monitoring –Plan for higher volume in coming year

8. West Nile Virus Infections, by County, Montana 2003 228 Cases and 4 deaths in late summer 2003 Counties with >5 cases detailed above Human cases (228) Equine (193) 11 7 10 14 9 6 9 10 12 23 12 17 35

9. Year 2 (2003) Results/Critique What went well? What went well? – Most agencies responded well – Mosquito monitoring improved but still of limited use – Press & PIO very helpful in promoting prevention and getting updates out

10. Year 2 (2003) Results/Critique Lab & partners not prepared for volume Lab & partners not prepared for volume –Unable to quickly test human & mosquito specimens. »Providers, mosquito controllers angry with lab delays. –Partners unable to keep up with “dead bird” calls. –Regional medical centers heavily impacted: »15 to 25 people hospitalized for WNV in 2 to 3 facilities on any given day during peak of season –Guidance on who & when to test challenging to develop.

11. Year 2 (2003) Results/Critique Information Issues: Information Issues: –Attempts to respond daily to press were noble, but unrealistic. –Difficulty determining severity of illness and residency issues based on lab reporting. –Lack of consensus on the detail of information to release to public/press. –Data entry into several CDC systems burdensome.

12. Improving our Response in Year 3 Addressing “Volume” Issues Addressing “Volume” Issues –Automate Serology tests. –Simplify bird testing. –Provide guidance, forms & expectations to reporting sources ASAP. –Improve coordination of sample submission. –Support local seminars & distribute WNV materials to increase the knowledge level.

13. Improving our Response in Year 3 Addressing “Information” Issues Addressing “Information” Issues –Use or designate a PIO to coordinate with press, “pre-draft” releases. –Review/establish procedures regarding info release ASAP. –Review/draft reporting forms & the flow of reports. –Evaluate data tracking/submission to CDC.

14. Lessons Learned: In our experience, most issues came down to: In our experience, most issues came down to: –Clarifying roles –Clarifying expectations –Preparing for surge capacity –Anticipating the worst…

15. Questions?