West Nile Virus Surveillance Training

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West Nile Virus Overview, CY 03
LTC David West, Deputy Director Proponency Office
for Preventive Medicine Fort Sam Houston, TX FEB
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david.west2_at_amedd.army.mil
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Agenda

• 1. Significant Events, 2003
• 2. 2003 WNV Surveillance Overview
• 3. 2004 WNV Surveillance Prevention

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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

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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.

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2. WNV Surveillance Overview

• 4 components
• Equines
• Birds
• Mosquitoes
• Humans

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Equine Surveillance

• 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

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Equine Surveillance, 2002
Equine Surveillance, 2003
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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)

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Avian Surveillance 2002
Avian Surveillance 2003
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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. gt222K F mosquitoes (22K pools) were
  tested by CHPPM labs 160 for WNv and 3 for
  EEE (29 installations )

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Mosquito Surveillance, 2003
Mosquito Surveillance, 2002
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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

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Reported human cases and deaths in the USA due to
WNv, 1999 - 2003
62 (7)
21 (2)
66 (9)
4156 (284)
9122 (223)
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West Nile Virus in the United States as of
January 28, 2004
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Human cases, 2002
Human cases, 2003
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Number of New Cases of WNv in the USA, SEP
NOV 03
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• 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

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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?

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• 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)

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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).

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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

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2004 WNV Surveillance Prevention

• 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)

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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.
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ARMY INSTALLATIONS   Installation Detected
In Source   Aberdeen Proving Ground, MD M,
B CHPPM-N Carlisle Barracks, PA B CHPPM-N,
USGS Fort Belvoir, VA B CHPPM-N, USGS Fort
Benning, GA B USGS Fort Bliss, TX B TX Dept
of Health Fort Bragg, NC M, B CHPPM-N,
USGS Fort Carson, CO M, B, H CHPPM-W, CO Dept
of Health, MEDDAC PM Fort Detrick,
MD B CHPPM-N Fort Eustis, VA B CHPPM-N Fort
Hamilton, Brooklyn, NY B CHPPM-N Fort Hood,
TX M TX Dept of Health Key M
mosquitoes, B birds, H humans, C sentinel
chickens
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ARMY INSTALLATIONS Fort Jackson,
SC M CHPPM-S Fort Knox, KY B USGS Fort
Lee, VA M CHPPM-N Fort Meade,
MD B CHPPM-N Fort Monmouth, NJ B CHPPM-N For
t Myer, VA M CHPPM-N Fort Polk, LA M, C LA
Dept of Health Fort Riley, KS M, H CHPPM-W
MEDDAC PM Fort Sill, OK B USGS Fort
Stewart, GA M CHPPM-S Pinon Canyon Maneuver
Site, CO M, H CHPPM-W USMA, West Point,
NY B CHPPM-N Walter Reed Army Med Ctr,
DC H AMSA Yuma Proving Ground, AZ M CHPPM-W
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NAVY/USMC INSTALLATIONS   Annacostia Annex,
DC M CHPPM-N Carderock Navy Center,
MD M CHPPM-N Marine Barrackes,
DC M CHPPM-N Naval Meritime Intell Center,
DC M CHPPM-N National Naval Med Ctr, Bethesda,
MD M CHPPM-N Naval Observatory,
DC M CHPPM-N Naval Security, DC M CHPPM-N New
London Sub Base, CT B CHPPM-N Newport Naval
Air Stn, RI B CHPPM-N Parris Island, SC B,
H CHPPM-S Pensacola Naval Air Stn,
FL M CHPPM-S Quantico Marine Corps Base,
VA B CHPPM-N Washington Naval Yard,
DC M CHPPM-N
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AIR FORCE INSTALLATONS   Andrews Air Force Base,
MD M, B CHPPM-N Bolling AFB, DC B CHPPM-N Buckl
ey AFB, CO M CHPPM-N Dover AFB,
DE M CHPPM-N Goodfellow AFB, TX M CHPPM-N
CHPPM-S Hanscom AFB, MA B CHPPM-N Langley AFB,
VA C USGS Maxwell AFB, AL B USGS Moody AFB,
GA M CHPPM-S    
DOD INSTALLATIONS   Armed Forces Retirement
Home, DC M CHPPM-N Arlington Service Center,
VA M CHPPM-N Def Dist Depot Susquehanna, New
Cumberland, PA B CHPPM-N Pentagon,
VA M CHPPM-N