From: Subject: West Nile Virus Activity --- United States, 2007 Date: Mon, 7 Jul 2008 15:12:40 -0700 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0002_01C8E043.E63AE830" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3198 This is a multi-part message in MIME format. ------=_NextPart_000_0002_01C8E043.E63AE830 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5726a2.htm West Nile Virus Activity --- United States, = 2007
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West Nile Virus Activity --- United States, 2007

West Nile virus (WNV) is the leading cause of arboviral = encephalitis in=20 the United States. Originally identified in Africa in 1937, WNV = was first=20 detected in the western hemisphere in 1999 in New York City. Since = then,=20 WNV has caused seasonal epidemics of febrile illness and = neurologic=20 disease in the United States. This report summarizes national WNV=20 surveillance data for 2007. WNV transmission to humans or animals = expanded=20 into 19 counties that had not reported transmission previously and = recurred in 1,148 counties where transmission had been reported in = previous years. A total of 1,227 cases of WNV neuroinvasive = disease (WNND)=20 and 117 deaths were reported. These findings highlight the need = for=20 ongoing surveillance, mosquito control, promotion of personal = protection=20 from mosquito bites, and research into additional prevention = strategies,=20 including a WNV human vaccine.

WNV data are reported to CDC through ArboNET, an Internet-based = arbovirus surveillance system managed by state health departments = and CDC.=20 State and local health departments 1) collect reports from = health-care=20 providers and clinical laboratories regarding cases of WNV disease = in=20 humans; 2) collect reports of WNV presumptive viremic blood donors = (PVDs)*=20 from blood collection agencies; 3) collect and test dead birds, = often=20 focusing on corvids (e.g., crows, jays, and magpies), which have = high=20 mortality attributed to WNV infection; 4) collaborate with = veterinarians=20 to collect reports of WNV infection in nonhuman mammals; and 5) = collect=20 mosquitoes to test for evidence of WNV infection. Human WNV = disease cases=20 are classified as 1) WNND (i.e., meningitis, encephalitis, or = acute=20 flaccid paralysis); 2) West Nile fever (WNF), which is symptomatic = WNV=20 disease that does not affect the nervous system; or 3) an = unspecified=20 clinical syndrome. WNF reporting is highly variable by = jurisdiction,=20 depending on the level of interest in reporting and use of = diagnostic=20 testing; therefore, most of this report focuses on WNND cases, = which are=20 thought to be more consistently identified and reported because of = the=20 severity of the illness.=20

Human Surveillance

During 2007, a total of 3,630 cases of WNV disease in humans = were=20 reported from 775 counties in 44 states (i.e., 25% of the 3,142 = counties=20 in the United States). Of these cases, 1,227 (34%) were WNND, = 2,350 (65%)=20 were WNF, and 53 (1%) were unspecified clinical syndromes. A total = of 352=20 PVDs were identified through routine screening of the blood = supply. Of=20 these PVDs, 281 (80%) were asymptomatic, five (1%) subsequently = developed=20 WNND, and 66 (19%) subsequently had WNF.

Overall, the incidence of WNND in the United States was 0.4 per = 100,000=20 population. The highest incidence of WNND occurred primarily in = the=20 west-central United States (Figur= e=20 1); the five states with highest incidence were North Dakota = (7.7=20 cases per 100,000 residents), South Dakota (6.2), Wyoming (4.6), = Montana=20 (4.0), and Colorado (2.2). Among all states, WNND peaked during = the first=20 week in August, and 1,086 (89%) cases were reported during = July--September=20 (Figur= e=20 2). This seasonality was consistent with trends observed in = the=20 preceding 7 years.

Of the 1,227 WNND cases, 729 (59%) occurred in males. The = median age of=20 patients was 57 years (range: 1 month--97 years), with increasing=20 incidence among older age groups (Figur= e=20 3). Overall, 1,089 (89%) patients were hospitalized (median = age: 59=20 years; range: 1 month--97 years), and 117 (10%) died (median age: = 77=20 years; range: 43--96 years). A total of 765 (62%) WNND cases were=20 classified as encephalitis, 452 (37%) as meningitis, and 63 (5%) = as acute=20 flaccid paralysis; 53 of these cases were classified as acute = flaccid=20 paralysis coincident with encephalitis or meningitis.=20

Animal Surveillance

In 2007, a total of 2,182 dead WNV-infected birds were reported = from=20 315 counties in 35 states and Puerto Rico; 157 counties in 28 = states and=20 Puerto Rico reported infected birds but no clinically apparent = human=20 disease. The number of reported WNV-infected birds peaked during = the first=20 week of September. Corvids accounted for 1,690 (77%) of the birds; = most=20 states targeted corvids for surveillance. Since 1999, WNV = infection has=20 been reported in 321 avian species, including four species = (Bronzed=20 Cowbird, Cackling Goose, Le Conte's Thrasher, and Northern = Pintail) in=20 which WNV was identified for the first time during 2007.

Of 507 reported cases of WNV disease among nonhuman mammals, = 471 (93%)=20 occurred in equines, and 36 (7%) occurred in other species = (squirrels=20 [27], canines [five], and unspecified species [four]). Equine = cases were=20 reported from 320 counties in 35 states and Puerto Rico; Texas = reported=20 20% of all equine cases. The number of reported WNV-infected = equines=20 peaked in mid-August.=20

Mosquito Surveillance

A total of 8,215 mosquito pools=86 from 371 counties = in 39=20 states, the District of Columbia, and Puerto Rico tested positive = for WNV.=20 Among the WNV-positive pools, 6,286 (77%) were made up of = Culex=20 mosquitoes thought to be the principal vectors of WNV transmission = (e.g.,=20 Cx. pipiens, Cx. quinquefasciatus, Cx. = restuans,=20 Cx. salinarius, and Cx. tarsalis). Unidentified or = other=20 species of Culex mosquitoes made up 1,746 (21%) pools, and=20 non-Culex species (e.g., Aedes spp., = Anopheles spp.,=20 Coquillettidia perturbans, Culiseta spp., and = Uranotaenia sapphirina) made up 106 (1%) pools. Data = from=20 2007 included the first report of WNV infection in Culex=20 bahamensis, which was collected in Puerto Rico. The number = of=20 reported WNV-infected mosquito pools peaked during mid-August. =

Reported by: NP Lindsey, MS, JA Lehman, JE Staples, = MD, N=20 Komar, ScD, E Zielinski-Gutierrez, DrPh, EB Hayes, MD, RS Nasci, = PhD, M=20 Fischer, MD, Div of Vector-Borne Infectious Diseases, National = Center for=20 Zoonotic, Vector-Borne, and Enteric Diseases; M Duffy, DVM, EIS = Officer,=20 CDC.=20

Editorial Note:

In 2007, the reported incidence of WNND in the United States = was 0.4=20 per 100,000 population. This incidence is similar to that reported = in 2004=20 (0.4), 2005 (0.4), and 2006 (0.5), but substantially lower than = the=20 reported incidence for 2002 (1.0) and 2003 (1.0) (1,2). The = relative stability in the number of reported WNND cases during the = past 4=20 years likely represents endemic WNV transmission in the = continental United=20 States. However, because of variation in vectors, avian amplifying = hosts,=20 human activity, and environmental factors (e.g., temperature and=20 rainfall), predicting future WNV transmission intensity is = difficult=20 (3,4).

Reported cases of WNND are thought to be the most accurate = indicator of=20 WNV activity in humans. WNND reporting is thought to be more = complete=20 because of substantial associated morbidity and mortality, whereas = WNF=20 likely is underdiagnosed and underreported. Serologic surveys = indicate=20 that approximately 20% of WNV infections result in WNF and 0.7% of = WNV=20 infections result in WNND (5). Based on these estimates,=20 approximately 175,000 WNV infections and 35,000 WNF cases occurred = in the=20 United States in 2007. Only 2,350 WNF cases were reported to = ArboNET in=20 2007, representing <10% of the estimated number of WNF cases. =

In 2007, evidence of WNV human disease again was detected in = all=20 geographic regions of the continental United States. Although the = highest=20 incidence of WNND continued to occur in the west-central United = States=20 (6), Idaho reported only 10 WNND cases in 2007, a 93% = decrease from=20 the 139 cases reported in 2006 (7)= .=20 This illustrates the wide annual variability and focality of WNV=20 transmission. Human WNV infection was identified for the first = time in=20 Puerto Rico in 2007 among three asymptomatic blood donors (8)= .=20

ArboNET integrates arboviral diagnostic testing and reporting = to=20 produce timely, actionable data that public health professionals = use to=20 tailor effective prevention and control messages at the local = level.=20 Continued surveillance is important in monitoring potential = changes in WNV=20 epidemiology and for providing early warning for local WNND = outbreaks. In=20 addition, ArboNET is well positioned to help identify and manage = future=20 introductions of exotic arboviruses. For example, cases of ill = travelers=20 entering the United States who are likely viremic with nonendemic=20 arboviruses (e.g., dengue virus and chikungunya virus) are = reported to=20 ArboNET (9)= .=20

WNV vaccines are licensed for use in horses and are being = evaluated=20 currently in phase 2 human clinical trials (10). Because no = WNV=20 vaccine is available currently for use in humans, prevention = depends on=20 personal protective measures. Use of repellents containing DEET,=20 picaridin, oil of lemon eucalyptus, or IR3535 provides effective=20 protection against mosquitoes. Long-sleeved shirts, long pants, = and socks=20 provide barrier protection against mosquito bites, and many = fabrics can be=20 treated with permethrin to provide an additional level of = protection.=20 Avoiding outdoor exposure during dusk and dawn, when Culex = mosquito=20 species are more active, will decrease the likelihood of WNV = exposure.=20 Household measures, such as installing and repairing window = screens and=20 covering or draining water-holding containers to reduce mosquito = breeding=20 sites, can decrease further the risk for WNV exposure.

Additional information on effective prevention of WNV infection = is=20 available from CDC at http://www.cd= c.gov/ncidod/dvbid/westnile/index.htm.=20 An overview of current year WNV transmission activity is available = at http://diseasemaps= .usgs.gov/wnv_us_human.html.=20

Acknowledgments

This report is based, in part, on data provided by ArboNET = surveillance=20 coordinators in local and state health departments and ArboNET = technical=20 staff, Div of Vector-Borne Infectious Diseases, National Center = for=20 Zoonotic, Vector-Borne, and Enteric Diseases, CDC.=20

References

  1. CDC. West Nile virus: maps and human cases. Atlanta, GA: US=20 Department of Health and Human Services, CDC; 2008. Available at = http://www.cd= c.gov/ncidod/dvbid/westnile/index.htm.=20
  2. US Census Bureau. Annual population estimates 2000 to 2007.=20 Washington, DC: US Census Bureau; 2008. Available at http://www.= census.gov/popest/states/NST-ann-est.html.=20
  3. Komar N. West Nile virus: epidemiology and ecology in North = America.=20 Adv Virus Res 2003;61:185--234.=20
  4. Hayes EB, Komar N, Nasci RS, Montgomery SP, O'Leary DR, = Campbell GL.=20 Epidemiology and transmission dynamics of West Nile virus = disease. Emerg=20 Infect Dis 2005;11:1167--73.=20
  5. Mostashari F, Bunning ML, Kitsutani PT, et al. Epidemic West = Nile=20 encephalitis, New York, 1999: results of a household-based=20 seroepidemiological survey. Lancet 2001;358:261--4.=20
  6. Lindsey NP, Kuhn S, Campbell GL, Hayes EB. West Nile virus=20 neuroinvasive disease incidence in the United States, = 2002--2006. Vector=20 Borne Zoonotic Dis 2008;8:35--9.=20
  7. CDC.=20 West Nile virus activity---United States, 2006. MMWR = 2007;56:556--9.=20
  8. CDC.=20 Detection of West Nile virus in blood donations---Puerto Rico, = 2007.=20 MMWR 2008;57:577--80.=20
  9. CDC.=20 Update: chikungunya fever diagnosed among international=20 travelers---United States, 2006. MMWR 2007;56:276--7.=20
  10. Monath TP, Liu J, Kanesa-Thasan N, et al. A live, attenuated = recombinant West Nile virus vaccine. Proc Natl Acad Sci U S A=20 2006;103:6694--9.

* A PVD is a person whose blood tested positive when screened = for the=20 presence of WNV. PVDs are followed up by the blood collection = agency with=20 additional tests to verify their infection. Some PVDs go on to = develop=20 symptoms after donation, at which point they are considered to = have WNV=20 disease.

=86 A sample of mosquitoes (usually no more than 50) = of the=20 same species and sex, collected within a defined sampling area and = period.=20

Figure 1

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Use of trade names and commercial sources is for=20 identification only and does not imply endorsement by the = U.S.=20 Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as = a=20 service to MMWR readers and do not constitute or = imply=20 endorsement of these organizations or their programs by CDC = or the=20 U.S. Department of Health and Human Services. CDC is not = responsible=20 for the content of pages found at these sites. URL addresses = listed=20 in MMWR were current as of the date of = publication.

All MMWR HTML versions of articles are electronic = conversions from typeset documents. This conversion might result = in=20 character translation or format errors in the HTML version. Users = are=20 referred to the electronic PDF version (http://www.cdc.gov/mmwr) = and/or=20 the original MMWR paper copy for printable versions of = official=20 text, figures, and tables. An original paper copy of this issue = can be=20 obtained from the Superintendent of Documents, U.S. Government = Printing=20 Office (GPO), Washington, DC 20402-9371; telephone: (202) = 512-1800.=20 Contact GPO for current prices.

**Questions or messages = regarding errors in formatting should be addressed to mmwrq@cdc.gov.=20

Date last=20 reviewed: 7/3/2008

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vh.length-1,vh.length)=3D=3D'|')vh=3Dvh.substring(0,vh.length-1);vh=3Dv +'=3D[PCC]'+(vh?'|'+vh:'');s_c_w(c,vh,e);if(s_vh_gt(k,v)!=3D'[PCC]') return 0;vh=3Ds_rep(vh,'[PCC]',st);s_c_w(c,vh,e)}return 1} /************* DO NOT ALTER ANYTHING BELOW THIS LINE ! **************/ var = s_un,s_ios=3D0,s_q=3D'',s_code=3D'',code=3D'',s_bcr=3D0,s_lnk=3D'',s_eo=3D= '', s_vb,s_pl,s_tfs=3D0,s_etfs=3D0,s_wd=3Dwindow,s_d=3Ds_wd.document,s_ssl=3D= ( s_wd.location.protocol.toLowerCase().indexOf('https')>=3D0),s_n=3D navigator,s_u=3Ds_n.userAgent,s_apn=3Ds_n.appName,s_v=3Ds_n.appVersion, s_apv,s_i,s_ie=3Ds_v.indexOf('MSIE '),s_ns6=3Ds_u.indexOf('Netscape6/') if(s_v.indexOf('Opera')>=3D0||s_u.indexOf('Opera')>=3D0)s_apn=3D'Opera';v= ar s_isie=3D(s_apn=3D=3D'Microsoft Internet = Explorer'),s_isns=3D(s_apn=3D=3D 'Netscape'),s_isopera=3D(s_apn=3D=3D'Opera'),s_ismac=3D(s_u.indexOf('Mac'= )>=3D0) if(s_ie>0){s_apv=3DparseInt(s_i=3Ds_v.substring(s_ie+5));if(s_apv>3)s_apv= =3D parseFloat(s_i)}else if(s_ns6>0)s_apv=3DparseFloat(s_u.substring(s_ns6 +10));else s_apv=3DparseFloat(s_v);function s_fl(s,l){return (s+'' ).substring(0,l)}function s_co(o){if(!o)return o;var n=3Dnew Object for(x in o)n[x]=3Do[x];return n}function s_num(x){var = s=3Dx.toString(),g=3D '0123456789',p,d;for(p=3D0;p0?n.length:1;while(s&&i>=3D0){s=3Ds.substring(0= ,i) +n+s.substring(i+o.length);i=3Ds.indexOf(o,i+l)}return s}function s_ape( s){return s?s_rep(escape(''+s),'+','%2B'):s}function s_epa(s){ return s?unescape(s_rep(''+s,'+',' ')):s}function s_pt(s,d,f,a){var t=3D s,x=3D0,y,r;while(t){y=3Dt.indexOf(d);y=3Dy<0?t.length:y;t=3Dt.substring(= 0,y) r=3Df(t,a);if(r)return = r;x+=3Dy+d.length;t=3Ds.substring(x,s.length);t=3Dx< s.length?t:''}return ''}function = s_isf(t,a){if(t.substring(0,2)=3D=3D's_') t=3Dt.substring(2);return (t!=3D''&&t=3D=3Da)}function = s_fsf(t,a){if(s_pt(a, ',',s_isf,t))s_fsg+=3D(s_fsg!=3D''?',':'')+t;return 0}var s_fsg function s_fs(s,f){s_fsg=3D'';s_pt(s,',',s_fsf,f);return s_fsg}var 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