Sunday, April 13, 2003

Mosquitoes to bring us West Nile?

Health officials will fight disease by attacking pest

By Tim Bonfield
The Cincinnati Enquirer

[IMAGE] Dave Zanitsch on his back deck in Green Township.
(Glenn Hartong photos)
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Bridgetown resident Dave Zanitsch didn't take the public health warnings about West Nile virus seriously last year.

After surviving 12 days in intensive care, a month in the hospital and weeks at home barely able to get out bed, Zanitsch wants to make sure that this year, people actually wear mosquito repellent and check their backyards for stagnant water.

"I never thought it could happen to me," he said. "There weren't any other cases here at the time. So I thought, 'Why buy flippers when there isn't any water around?' "

Zanitsch, 62, was Hamilton County's first confirmed victim of West Nile virus, the worst mosquito-borne disease outbreak to strike the nation in decades. Ohio suffered the nation's third-highest number of illnesses.

Last year, West Nile virus sickened 4,161 people nationwide, killed 277, and made millions of Midwesterners think twice about spending summer evenings outside. New swarms of mosquitoes are starting to hatch this year, ready to spread the potentially deadly virus once again.

Federal, state and local public health agencies spent much of the winter studying and debating what can be done to reduce the threat.

Intensified public education campaigns will begin within weeks. Stepped-up efforts to wipe out breeding sites and to trap mosquitoes for analysis start in May and are expected to peak in June.

"June will be the test. We're encouraging health departments throughout the state to be proactive," said Bob Restifo, chief of the vector-borne disease program for the Ohio Department of Health. "I fully expect there to be West Nile activity in birds, mosquitoes, horses and humans again this year. It could take three to five years before we see a sharp drop-off."

[IMAGE] Sanitarian Jeremy Hessel of Hamilton County demonstrates a mosquito trap.
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West Nile virus was unheard of in the United States until people in New York started getting sick in 1999. Ever since, the virus has been moving west, affecting 28 states in 2001 and 44 states in 2002.

Locally, officials reported 44 cases in Southwest Ohio and Northern Kentucky, including four deaths. No deaths were reported for Southeast Indiana.

Experts say the virus probably started in birds, then was spread to people and horses by infected mosquitoes. It remains unclear exactly how the virus survives the winter - when most mosquitoes die off - but survive it does.

While the deaths linked to West Nile pale in comparison to influenza, which kills about 36,000 people a year, the virus is a much more direct threat to Greater Cincinnati residents than the recently emerging SARS virus that has caused many travelers to rethink flights to Asia.

The case count, the number of deaths and the death rate (6.6 percent) all are worse from West Nile virus than what has been reported so far from the SARS outbreak, according to CDC figures.

A survivor's warning

Zanitsch is much better than he was a year ago, but surviving a nearly fatal, brain-swelling case of encephalitis takes a lasting toll.

For weeks, Zanitsch lacked the strength to get out of bed. He walks without a cane now but still struggles to raise himself from the floor.

He suffered double vision and spots in his field of view. He lost his sense of taste for two months.

He still suffers a loss of gripping strength in three fingers of his left hand. And for weeks after leaving the hospital, his facial muscles were so slack he couldn't smile.

"I looked like I had a stroke," Zanitsch said. "I had to learn how to walk again."

West Nile virus is commonly found in Africa, West Asia and the Middle East. It is closely related to the St. Louis encephalitis virus found in the United States. West Nile can infect humans, birds, mosquitoes, horses and some other mammals.

Until 1999, West Nile virus had not previously been documented in the Western Hemisphere. It is not known from where the U.S. virus originated, but it is most closely related genetically to strains found in the Middle East.

West Nile fever is a mild disease in people, characterized by flu-like symptoms. It typically lasts only a few days and does not appear to cause any long-term health effects.

More severe forms are West Nile encephalitis, West Nile meningitis and West Nile meningoencephalitis. Encephalitis is an inflammation of the brain, meningitis is an inflammation of the membrane around the brain and the spinal cord, and meningoencephalitis refers to inflammation of the brain and the membrane.

Source: Centers for Disease Control and Prevention Web site

Most of the people who become infected with West Nile virus won't get this bad. In fact, many survive an infection with little more than flu-like symptoms that don't require seeing a doctor.

Zanitsch has made a public health video and scheduled talks to senior groups to urge people to take self-protection seriously.

"I went outside all the time for walks, but didn't protect myself. You've got to use the mosquito protection. It doesn't cost that much. For a few pennies, I could have avoided this," he said.

Mosquito repellent with DEET is preferred.

This year's plan

In Hamilton County, officials say mosquito season generally runs from May through October. They can start biting in April, but a recent cold snap has most likely limited mosquito activity.

This week, county health officials will be launching a beefed-up version of its "Bite Back" mosquito-control campaign, said Tim Ingram, Hamilton County health commissioner. The county plays a leading role among 20 agencies from three states in the Southwest Area Regional Mosquito Task Force (SWARM).

• Dunk patrols: Since last summer, nearly two dozen more county, village and township workers have been certified to place larvae-killing "dunks" when they find stagnant water in sewers, parks and other public properties. Much of this work will focus on Delhi, Green and Colerain townships, Blue Ash and Montgomery - where the highest concentrations of infected mosquitoes were found last year.

• Education campaigns: A state program will pump $400,000 into billboards and public announcements about West Nile slated to appear in May. County public health officials are lining up presentations to be made to local governments and civic groups. Officials also are asking local veterinarians to help track the virus in horses and for owners to have their horses vaccinated.

• Disease surveillance: Local health departments will collect dead birds again for testing, focusing on raptors (such as hawks), crows and blue jays. The state health department will test them - but will stop testing after confirming two infected birds in an area. More emphasis this year will be placed on using 18 scattered traps to catch mosquitoes for testing as the main way of tracking the disease.

• Spraying programs: Hamilton County's health department plans to buy a few backpack-style mosquito poison-spraying devices - not the fog-emitting trucks that communities near Cleveland and in Louisiana used last year. Even the backpacks would be used only as a last resort.

Sprays that kill adult mosquitoes are expensive and range widely in effectiveness, Ingram said. It will be up to individual municipalities to use adult mosquito poison, he said. Homeowners can commercially buy the larvae-killing dunks.

In Northern Kentucky, mosquito trapping is expected to begin in June. Educational materials will be distributed to local governments later this month, said health department spokeswoman Peggy Patterson.

The health department expects to have a limited supply of dunks but predicts that some local governments also will have them. No spraying is planned, Patterson said.

Who's at risk?

West Nile infections struck people of all ages last year. Even so, older people face the highest risk of serious problems if they are afflicted.

Nationwide, 95 percent of West Nile-related deaths last year involved people over 50. The median age among fatalities was 78.

Will this summer really be worse than last year? One school of thought predicts the virus will be a bigger problem this year for Western states while Midwest numbers might drop because people bitten last year by virus-carrying mosquitoes have built up an immunity to the virus.

Communitywide immunity would be nice, but don't bet your health on it, Restifo said.

"Those who were exposed last year will have an immunity that could last several years. However, the actual number of people who were exposed is relatively small," he said. "Most people probably do not have immunity."


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