West Nile Virus: Local Response, Research Paper Example

Outbreaks like that of the mosquito-borne West Nile Virus (WNV) are the primary reason the U.S. government first began fighting infectious diseases, in 1879, following a bout of Yellow Fever that followed the Mississippi River up from New Orleans. From then on, the states (reluctantly, in the case of Louisiana) largely ceded multistate quarantine powers to the federal government (Smillie, 1943).  From the Public Health Service (1912) to the National Institutes of Health (1930) to the Communicable Disease Center (1946, and since renamed the Centers for Disease Control) to the Epidemic Intelligence Service (1951), the U.S. government’s disease-fighting responsibilities to local communities have expanded relentlessly (Duesberg, 1996).

Describe the type of outbreak and how it is identified. When individuals in a given community come down with the known symptoms of WNV disease, their infection is among the only 20% that show any symptoms at all. Since the disease itself is not communicable from person to person, the most important epidemiological event occurs when an infected person reports to a doctor or clinic and the symptoms are confirmed as matching that of the WNV. That information is then reported to the CDC, and so up the chain of medical command. State and local health agencies are notified as well, and may take action (“Innovative State Legislation”).

Describe the characteristics of the disease and the symptoms presented. Characteristics and symptoms are very familiar to doctors by now. At the initial stage, if anything is felt at all, then a general body ache, diarrhea, fever, headache, myalgias, pain around the joints, lymphadenopathy, nausea, vomiting, and rashes are typical. More serious symptoms include muscle weakness, neck stiffness, confusion, convulsions, high fever, stupor, tremors, vision loss, numbness, paralysis, and finally, coma. The virus is transmitted by the Culex mosquito, which is partial to bird and human blood. As an infected Culex first feeds on a bird, the virus then multiplies in the bird’s body to the point where it can be picked up by other mosquitoes (mammalian bodies do not appear to provide such amplification). As infected birds die from the virus, the mosquitoes carry the virus to humans. Culex thrives in hot and dry climes.

How can you prepare for this type of outbreak in your community? Since there is no human vaccine for this disease, community preparation must come principally in the form of timely spraying and monitoring of dirty pools of water, and collecting dead birds for examination. Failure to plan ahead (as early as the previous December) can lead to desperate ad hoc measures, as in the extreme case of North Texas, where spraying is being resorted to even when scientists agree that August is “way too late” for spraying to be effective (Weise, 2012).  Educating citizens (particularly those over 50) on the necessity of using mosquito repellent (containing DEET); consulting their doctors promptly upon feeling the classic symptoms; and maintaining the public’s funding of timely anti-mosquito control and eradication. Much of the cost of local implementation must be paid by local and state governments, which, due to the current economic recession, have cut back many of their WNV preventative measures.

How can local communities increase their WNV surge capacity?  For the purposes of this paper, I will define a surge as a medical event  that exceeds the limits of the normal medical infrastructure of an affected community. The CDC and US Department of Agriculture met in November of 1999 to write a comprehensive National Response Plan after a case West Nile Virus in a human patient was discovered the previous summer. In 2000, then-President Clinton issued two emergency declarations under the Stafford Act giving financial assistance to New Jersey and New York to help control an imminent epidemic of WNV (Lister, 2007). States and counties have their own emergency declaration programs as well, which are typically invoked before asking for federal assistance. Local authorities can only increase their surge capacity by invoking emergency state and federal funding under existing law, and by calling on volunteers.

Will the hospitals and laboratories be able to handle the increased number of patients? If not, where will the patients go? The incubation period of WNV is 2–15 days, and symptoms generally last for only a few days, thus ample time is available to gear up in the event of a likely outbreak, and few will need to do more than stay home from work.  As noted, only 20% of those infected with the virus become ill. Personal and community protection and prevention  is relatively easy, and media outlets will make sure that word is gotten out to the public. Thus, local facilities are unlikely to be strained as they would be after a sudden genuinely catastrophic event.

What type of surveillance system will you put in place to monitor the status of the outbreak? As noted, the monitoring and collection of dead birds is one line of defense in the fight against the WNV. Doctors also can routinely test their patients’ blood for exposure to the virus. Community willingness to undergo timely spraying this December will be made easier by less successful outcomes this August. Publication of vital statistics will encourage action.

What initiatives can be taken by your community to become better prepared for future outbreaks? Clearly, preventative measures are best. This is particularly difficult when local and state budgets are strained, and expenses deemed more urgent than the chance of a WNV outbreak will often get priority, lead by the knowledge that exposure to WNV leads to immunity and so may progressively reduce future epidemics. But such hope is poor epidemiological policy.

In conclusion, it must be remembered that WNV might have been much worse, given the low rate of symptomatic infections and the relative ease of prevention, but current warming trends in parts of the U.S. foretell continued local epidemics among those not naturally inoculated. WNV promises to be an annual event until mass vaccination becomes feasible.

Duesberg, P. (1996). Inventing the AIDS Virus. (pp. 69-70, 134-135). Washington, D.C.: Regnery Publishing. Retrieved from http://www.regnery.com/catalogGJ.html

Innovative State Legislation: West Nile Virus. (n.d.). Retrieved from http://www.serconline.org/westNile.html

Lister, S. Congressional Research Service, Domestic Social Policy Division. (2007). CRS Report for Congress (RL33579). Retrieved from website: http://www.fas.org/sgp/crs/misc/RL33579.pdf

Smillie, W. G. (1943). The National Board of Health: 1879-1883. American Journal of Public Health, 33(8), 925-930. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1527526/pdf/amjphnation00698-0009.pdf

Weise, E. (2012, August 23). Michigan in Top 10 States for West Nile Illness, Deaths; U.S. Health Officials Brace for Spike. Lansing State Journal. Retrieved from http://www.lansingstatejournal.com/article/20120823/NEWS01/308230038/Michigan-top-10-states-West-Nile-illness-deaths-U-S-health-officials-brace-spike?odyssey=tab|topnews|text|FRONTPAGE