As the West Nile virus count rises in the Tristate, Butler County has reported its first probable case.

        Initial testing indicates that a 46-year-old man who recently visited the emergency department at Fort Hamilton Hospital, but was not hospitalized, was infected by the mosquito-borne virus.

VIRUS IN OHIO

Total cases: 66    Total fatalities: 4    County-by-county cases:    Cuyahoga: 41    Hamilton: 4    Clark: 4    Stark: 3    Clinton: 2    Franklin: 2    Licking: 2    Athens: 1    Butler: 1    Clermont: 1    Erie: 1    Lorain: 1    Union: 1    Trumbull: 1    Wood: 1    Source: Ohio Department of Health

        The Ohio Department of Health listed the man as the state's 57th of 66 reported cases of West Nile virus, up from 39 cases reported through Aug. 30.

        Tristate residents face the chance of more infections for about a month — until the first hard frost comes along to kill off this summer's mosquitoes, according to the Ohio Department of Health.

        “We haven't peaked yet,” said Richard Berry, chief of the health department's insect-borne disease program.

        As of Thursday, Ohio has reported 65 probable victims, one confirmed victim, and four deaths from West Nile virus, which makes the state the nation's fourth-leading site of infections behind Louisiana, Illinois and Mississippi. Kentucky has reported 10 cases and two deaths. Indiana has reported 10 cases and no deaths.

        Nationwide, the Centers for Disease Control and Prevention reports 854 cases and 43 deaths through Thursday in 28 states and the District of Columbia.

        Locally, eight human cases, including two deaths, have been reported: four in Hamilton County; two in Clinton County, including one fatal case; one fatal case in Clermont County and the single Butler County case. No human cases have been reported in Northern Kentucky or Southeast Indiana.

        The Butler County case was reported to the city of Hamilton's health department on Sept. 3, said Susan Irvine, public health nursing administrator. She said she could not release further details.

        Once the mosquito season ends, the federal Centers for Disease Control and Prevention will huddle with state health departments nationwide to study the sharp increase in West Nile cases reported this year. Already, some trends have emerged that will likely change the content of public health warnings about the virus next year.

        The age of victims has been getting younger. Last year, a clear majority of cases involved people over 50. As of Thursday in Ohio, 48 percent of the cases have involved people younger than 50.

        Forty-one of Ohio's 66 cases have been concentrated in Cuyahoga County, with no more than 4 cases in any other county.

        That disparity reflects last year's trend in bird infections, which were much higher in Cuyahoga County than elsewhere in the state. Now that the virus has established itself in other urban areas, cities such as Cincinnati and Columbus could see increases next year, Mr. Berry said.

        Public education and limited mosquito control efforts appear to have helped limit the infections. In 1975, Ohio reported a surge of mosquito-borne St. Louis encephalitis cases that resulted in 416 cases and 29 fatalities, far more than have been reported this year, Mr. Berry said. The West Nile virus is spread in much the same way as St. Louis encephalitis, by the same type of mosquito, he said.

        Between now and next summer, expect much more discussion at state and local levels about expanded mosquito control efforts and who would pay.

        Traditionally in Ohio, mosquito control has been a purely local responsibility.

        For example, Lucas County, which includes Toledo, has the state's most comprehensive mosquito control program, state health officials say. And so far, no human cases of West Nile virus have been reported in Lucas County. That means the program could be a model for other parts of the state.

        “The extent of local mosquito control programs vary all over the map,” Mr. Berry said.

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