West Nile Virus Overview, CY 03

LTC David West, Deputy Director

Proponency Office for Preventive Medicine

Fort Sam Houston, TX

FEB 04

david.west2@amedd.army.mil

Agenda

1. Significant Events, 2003

2. 2003 WNV Surveillance Overview

3. 2004 WNV Surveillance & Prevention

1. Significant Events, CY 03

– Expansion of range: to the plains states of the US, prairie provinces of Canada (87% from Sask & Alb), Mexico (21/31 states & DF) and the Caribbean; often rural distribution

– Possible role of alligators as reservoirs

– All three CHPPM Subordinate Commands involved in mosquito ID and testing

Significant Events, CY 03

– Screening donors and testing of donated blood began on 4 AUG (USA, USAF) 8 AUG (USN). 64/42,213 (0.015%) + for WNv (as of 25 JAN).– Equine vaccine. Killed virus product given conditional license by APHIS on 1 AUG 01, renewed 2002; full license FEB 03. Administration: 2 doses IM 3-6 weeks apart; one annual booster. Vaccination of DOD equines required by VETCOM.

2. WNV Surveillance Overview

4 components:

• Equines

• Birds

• Mosquitoes

• Humans

-VETCOM policy: Decision to test horses for WNv delegated to DVC Cdr. Recommend limited use (e.g. establish diagnosis or screening for procurement)

- 1 + horse reported from Fort Meade, MD

- Mexico: WNv detected in horses in 21 states & DF

Equine Surveillance

Equine Surveillance, 2002

Equine Surveillance, 2003

Avian Surveillance

• Dead Bird Surveillance: – Dead birds are the most valuable indicator of viral

presence, sensitive species: crows, jays, raptors– Suitable specimens submitted to appropriate diagnostic

lab by installation vets (State/Federal Health & Wildlife agencies)

– Dead birds + for WNv from 24 installations

• Sentinel Chicken Flock surveillance: Fort Polk, LA, Langley AFB, VA; + sentinel chickens at both installations

• Issues: VETCOM involvement; reporting of negative results (esp from state labs)

Avian Surveillance 2002 Avian Surveillance 2003

Mosquito Surveillance

• Installation PVNTMED/DPW

– Mosquito collection, public education, notification, control

• CHPPM-Subordinate Commands

– Installation collection support

– Mosquito identification & testing

– Rapid response for enhanced surveillance

– Data dissemination

• POPM-SA Entomologist MEDCOM policy memo; collect info from CHPPM sub cmds, RMCs; weekly EXSUMS to OTSG

• Results. >222K F mosquitoes (~22K pools) were tested by CHPPM labs; 160 + for WNv and 3 + for EEE (29 installations +)

Mosquito Surveillance, 2002

Mosquito Surveillance, 2003

Human Surveillance & Case Reporting

• MTF/Clinic Personnel - WNV diagnosis, education• State labs (vice USAMRIID) - serology of suspected

cases• Donated blood testing• Issue: reporting human cases very uneven

0

2000

4000

6000

8000

10000

1999 2000 2001 2002 2003

Human casesHuman deaths

62(7)

21(2)

66 (9)

4156(284)

9122(223)

Reported human cases and deaths in the USAdue to WNv, 1999 - 2003

West Nile Virus in the United States as of January 28, 2004

Human cases, 2002 Human cases, 2003

0

500

1000

1500

1-Sep 1-Oct 1-Nov 1-Dec

Number of New Cases of WNv in the USA, SEP – NOV 03

25 human cases treated at military MTFs:

- Fort Riley, KS: 1 F spouse of retiree- Fort Carson, CO: 23 (age range: 9 – 83, mean 42.7)- Walter Reed Army Medical Center: 1 AD USAF, travel history to Colorado

Issues from 2003• Cost & level of effort required to estimate threat to

military, dependents and retirees versus “payoff”• Human case definitions and reporting uneven• Impact of PVNTMED deployments on CHPPM,

RMCs and MEDDACs• Number of mosquitoes submitted to CHPPM for

ID/testing overwhelmed system• State laboratory support (birds & mosquitoes):

Turn-around time, Lab capacity, Result reporting, Negative Data?

CHPPM Surveillance Program Costs:

- 2003: $562K ($200K from CDC, 362K from CHPPM Budget) - - 2004 (est.): $871.5K

Benefits:

- Predict risk of human illness, allow timely and targeted prevention- Develop capability to detect other pathogens (lab infrastructure, trained techs/officers, etc.; example: EEE)

3. 2004 WNV Surveillance & Prevention

• Dead bird surveillance– Remains a cornerstone– Discontinue collection after 5 WNV positives– Continue to use the USGS Laboratory – Negative Results from State diagnostic labs

generally were not reported above installation level; we must improve result reporting (installation chain of command as well as to DOD level).

2004 WNV Surveillance & Prevention

• Mosquito surveillance– Surveillance guide on the CHPPM Web site– Larval site surveys & larval control – begins

April-June regionally– Adult mosquito surveillance: Based on regional

conditions may begin early June. Trap a minimum of 2 nights per week (CDC gravid trap and/or CDC light trap), 3 traps/night to 10 traps/night. Submit mosquito pools by genus/and or species to respective CHPPM Subordinate Command

The road ahead:

- Predict that WNv will become part of the “disease landscape” of North America; expect to see declining emphasis in DOD (remember Lyme disease?)

- Anticipate PPM will become part of military culture (due to WNv, leish, malaria experiences)

2004 WNV Surveillance & Prevention

QUESTIONS?

Please submit all questions in triplicate, routed through the first GO in your chain of command.

All questions will be promptly ignored in the order received.

ARMY INSTALLATIONS Installation Detected In* Source 

Aberdeen Proving Ground, MD M, B CHPPM-NCarlisle Barracks, PA B CHPPM-N, USGSFort Belvoir, VA B CHPPM-N, USGSFort Benning, GA B USGSFort Bliss, TX B TX Dept of HealthFort Bragg, NC M, B CHPPM-N, USGSFort Carson, CO M, B, H CHPPM-W, CO Dept of Health, MEDDAC PMFort Detrick, MD B CHPPM-NFort Eustis, VA B CHPPM-NFort Hamilton, Brooklyn, NY B CHPPM-NFort Hood, TX M TX Dept of Health

* Key: M = mosquitoes, B = birds, H = humans, C = sentinel chickens

ARMY INSTALLATIONS

Fort Jackson, SC M CHPPM-SFort Knox, KY B USGSFort Lee, VA M CHPPM-NFort Meade, MD B CHPPM-NFort Monmouth, NJ B CHPPM-NFort Myer, VA M CHPPM-NFort Polk, LA M, C LA Dept of HealthFort Riley, KS M, H CHPPM-W & MEDDAC PMFort Sill, OK B USGSFort Stewart, GA M CHPPM-SPinon Canyon Maneuver Site, CO M, H CHPPM-WUSMA, West Point, NY B CHPPM-NWalter Reed Army Med Ctr, DC H AMSAYuma Proving Ground, AZ M CHPPM-W

NAVY/USMC INSTALLATIONS 

Annacostia Annex, DC M CHPPM-NCarderock Navy Center, MD M CHPPM-NMarine Barrackes, DC M CHPPM-NNaval Meritime Intell Center, DC M CHPPM-NNational Naval Med Ctr, Bethesda, MD M CHPPM-NNaval Observatory, DC M CHPPM-NNaval Security, DC M CHPPM-NNew London Sub Base, CT B CHPPM-NNewport Naval Air Stn, RI B CHPPM-NParris Island, SC B, H CHPPM-SPensacola Naval Air Stn, FL M CHPPM-SQuantico Marine Corps Base, VA B CHPPM-NWashington Naval Yard, DC M CHPPM-N

AIR FORCE INSTALLATONS 

Andrews Air Force Base, MD M, B CHPPM-NBolling AFB, DC B CHPPM-NBuckley AFB, CO M CHPPM-NDover AFB, DE M CHPPM-NGoodfellow AFB, TX M CHPPM-N & CHPPM-SHanscom AFB, MA B CHPPM-NLangley AFB, VA C USGSMaxwell AFB, AL B USGSMoody AFB, GA M CHPPM-S  DOD INSTALLATIONS 

Armed Forces Retirement Home, DC M CHPPM-NArlington Service Center, VA M CHPPM-NDef Dist Depot Susquehanna,

New Cumberland, PA B CHPPM-NPentagon, VA M CHPPM-N