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Human cases of West Nile virus reported to the CDC

When a 75-year-old man who liked to take naps on his front porch hammock became the second person in California to die from West Nile virus Aug. 1, his wife said, “You can’t believe that a mosquito could do that. We need to get word out to everybody and anybody. Wear a long-sleeved shirt and don’t leave any water out.” This advice has become a Centers for Disease Control and Prevention mantra in educating people about the mosquitoborne virus.

This year, the virus, which originated in Africa and spread through countries in Eastern Europe before the first U.S. invasion in 1999, has established its strongest hold in the western United States, and the number of reported cases so far is considerably ahead of the five cases reported at this time last year.

With Arizona reporting 247 new human cases and two deaths as of Aug. 3, Maricopa County has been designated the epicenter of WNV for the United States. California follows with 69 reported cases and two deaths, and there is concern that this year’s cases will outpace last year’s record-setting numbers, when nearly 10,000 illnesses were reported.

As of this writing, the CDC Surveillance Program has reported 406 cases of West Nile with seven deaths.

In weighing the situation nationally, CDC spokeswoman Christine Pearson gave cautionary advice. “It is extremely difficult to make any predictions,” she said. “West Nile started out very targeted in New York. Look at last year — most of the area west of the Rockies had a handful of cases, with Washington and Oregon being the exceptions. Given the activity we have seen in years past, it would not be a surprise to see more cases this year.”

Asked why he thought Arizona was leading statistically this year, Michael Murphy, Arizona Department of Health Services’ public information officer said, “It’s our turn. Last summer, we had just 15 cases.” He recalled that Florida started out the same way a few years ago, and then increased significantly. Murphy also noted that historically the second year of WNV is worse for most states.

Murphy said that although Arizona is primarily dry desert, the state has many artificial sources of water, especially in and around Phoenix, where swimming pools in residents’ back yards are common and ponds on golf courses are poorly maintained. “It turns into a green cesspool in our back yards, an ideal breeding place for mosquitoes,” he said.

More mosquitoes

With the emerging monsoon season, Murphy anticipates even more mosquitoes because humidity increases with the afternoon thunderstorms. “The season lasts through August and we could easily have 3,000 to 5,000 cases.”

His department is conducting “emergency larviciding” for swimming pools, even throwing larvicide over fences of suspicious looking pools, encouraging residents to use repellent and wear protective clothing when outdoors, and developing an educational videotape for distribution to physicians and other health care professionals.

Assistant director for Arizona’s Public Health Services Rose Conner, RN, MEd, believes it is critical for nurses to take the lead in educating family, friends, and neighbors about West Nile. “Nurses must be aware of public health messages and use their knowledge and skills to make sure people are safe. People expect nurses to know about West Nile and will approach you because you are a nurse.”

Conner said that based on the numbers of reported cases, it is probable that about 15,000 cases will never be diagnosed because of the flulike signs and symptoms of WNV. “Only people who get very sick go to their doctor, who will test them for West Nile,” she said. “In Arizona, we don’t expect WNV to start decreasing until October.”