Danuta Trojanowski believes she will be able to walk someday. The Polish immigrant living with relatives in Port Chester, N.Y., contracted West Nile virus almost two years ago, sustaining severe neurological damage that affected her ability to walk. She spent more than a year in an acute care hospital, followed by several months at a rehabilitation center.

Because she is unable to afford continuing rehab services and is ineligible for state coverage, the Visiting Nurse Services in West chester has provided Trojanowski physical and occupational therapy services without charge, while attempting to secure other coverage.

While cases like Trojanowski's are rare-less than 1 percent of those infected with West Nile virus sustain neurological damage, according to the CDC-the disease can be deadly for humans, horses and certain domestic and wild birds.

As the virus moves slowly westward to more temperate climates, some nurse leaders are advising nurses to become familiar with symptoms and treatment guidelines. Nurses also should keep in mind that travelers may contract the disease while visiting temperate areas and end up in hospital emergency rooms or urgent care centers at home.

Assuring that nurses have access to the latest information on West Nile is a major goal for Sister Rosemary Donley, Ph.D., NP, RN, FAAN, a nursing professor at The Catholic University of America in Washington, D.C.

"Nurses treating ER patients need to continually update their assessment skills, using the Internet to access CDC and other Web sites," Donley said.

Her concerns extend to other community health nurse educators who, she believes, no longer can rely on last semester's notes, but must update syllabuses for each new class. Donley also worries about public complacency and advocates a call to action.

"There is no good treatment for West Nile virus," she said. "We have to rely on people's natural resources [to combat the disease], spend more money on sprays and contact people, usually the poor, who live near stagnant bodies of water."

Since its arrival on the East Coast in 1999, the mosquitoborne virus has re-emerged stronger each year. This year, for the first time, the infestation crossed the Mississippi River. As of Sept. 3, at least 32 people have died from the virus, according to the CDC's Web site.

Some scientists predict it will be endemic in most, if not all, states by the end of the year.

But don't panic, CDC press officer Rhonda Smith says. "Only 1 percent of people bitten by infected mosquitoes have a very small chance of becoming infected, even in areas where the virus is circulating, and those infected run an even smaller risk of becoming seriously ill," she said.

New CDC Director Julie Gerberding, MD, MPH, announced, "We're not in crisis mode," according to a Newsweek article Aug. 26.

That's the good news.

The bad news: West Nile can cause encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord) in some people, particularly those older than 50, the elderly and individuals with compromised immune systems-leading to neurological damage, coma and, in rare instances, death.

'Serious, not overwhelming'

West Nile generally occurs during warm weather months, when mosquitoes are active-the peak incidence is the last week of August through the first week of September-prolonged warm spells can extend the time for mosquito activity through the end of the year.

Last year, for example, cases occurred through December because of a prolonged fall season. Warm weather mixed with the right climate, like the swamplands of Louisiana, creates a breeding ground in the summer months for West Nile mosquitoes. Not surprisingly, Louisiana was hardest hit this year, with 147 cases and eight deaths.

Jan Boatright, RN, associate director of Priority Mobile Health in New Orleans, believes that many more cases probably have not been reported. "This is a serious epidemic, but not a new or overwhelming one," she said. "We will probably see much more of a problem this year from influenza and hepatitis."

Still, Boatright strongly recommends that everyone follow the same protective guidelines that Louisiana residents have been provided through public service announcements on radio and television and from numerous billboard notices placed along highways.

Other affected states include Mississippi with 55 cases, Texas with 25, Illinois with nine, Missouri with five and one death, Ohio with two, and single instances reported in Arkansas, Washington, D.C., Florida, Indiana, Massachusetts and New York City. Governors in Louisiana and Mississippi have declared a state of emergency and virtually all of the lower 48 are responding through enhanced surveillance, prevention and mosquito control.

Meanwhile, some communities are finding shelves emptied of mosquito repellent and control agents, such as larvacides. Also compounding local governments' efforts toward managing the disease with targeted spraying are protests from residents against the effects of the insecticides.

Ruth Jenkins, Ph.D., RN, associate professor at Barnes College of Nursing, University of Missouri in St. Louis, noted that a 9-year-old boy was recently diagnosed with West Nile in Franklin, Mo., the youngest confirmed victim to date. The child, hospitalized for four days, missed only two days of school.

"The boy had been visiting in the state of Mississippi within the last two weeks, so it is not known if the infected mosquito is from here or there," Jenkins said. To determine where the infection occurred is another reason for nurses to take a good travel history on potential West Nile symptoms, she said.

The virus has taken another kind of toll in St. Louis, Jenkins said. "Fewer people are going to a popular fishing lake, usually packed this time of year-now with only five or so people. Parents are going out only in the middle of the day, while frequently spraying their children with bug spray," she said.

According to a fact sheet published by the New York City Department of Health & Mental Hygiene, most people either manifest no symptoms or develop mild, flulike symptoms such as fever, headache or body ache before fully recovering.

Others may have swollen lymph nodes, a maculopapular rash to neck, trunk and extremities or gastrointestinal problems such as abdominal pain, nausea and vomiting. Symptoms of >> encephalitis include rapid onset of severe headache, high fever, stiff neck, confusion, loss of consciousness or muscle weakness, out of proportion to physical findings, and may be fatal.

To protect themselves against West Nile virus, health officials say people should take special precautions from April to October, the months when mosquitoes are most active. Individuals should avoid going out at dawn or dusk in areas where mosquitoes frequent, including tall grass, weeds or bushes.

Health officials recommend that, when outside, people should wear protective clothing, such as loose-fitting long-sleeved shirts, socks and pants, and spray their clothing with a repellent containing safe levels of DEET. People also should check stagnant bodies of water, such as ponds or swimming pools for mosquito breeding.

To assist in surveillance efforts, the CDC is asking nurses and other clinicians to report cases to their local health jurisdictions and properly submit clinical specimens to laboratories with clinical information that includes dates of collection, symptom onset, travel and immunization history and adherence to confidentiality requirements.

Recommended laboratory tests include cerebrospinal fluid (CSF), which should be frozen and shipped in ice for preservation, a complete blood count, CT scan and MRI.

Other CDC surveillance efforts include monitoring public dead bird reports, dead and live bird collection and testing, mosquito testing and close monitoring of reported equine and human cases.

Nurses can educate patients and others through promoting state response goals, which include the elimination of residential mosquito breeding places, instruction on personal protection against bites and the correct application of repellent on clothing and body.

They also can access the CDC's Morbidity and Mortality Weekly Report for updates, read health department mailings, use state and local health-focused Web sites. Nurses can encourage proper handling of collected animals, and caution patients with suppressed immune systems to use special precautions to avoid exposure.

Contact Alicia Hugg at rosewind09@earthlink.net.