Arbovirus Case Investigation

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Arbovirus Case Investigation
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Purpose

• Determine mode of transmission
• Characterize the clinical picture of disease
• Identify risk factors for infection and severe
  disease
• Feedback recommendations to patient and family

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Part I Clinical Investigation
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Possible Exposure/ Transmission Information

• Yellow fever vaccination
• Transfusion/organ transplant
• Given blood
• Pregnancy
• Breastfeeding
• Outdoor activities

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Travel History

• What are dengue endemic regions?
• Why focus on dengue endemic regions?
• Determine possible exposure setting
• Determine if case is imported

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Symptoms

• Onset date
• Meningitis (CSF white blood cell count gt5)
• Encephalitis (Evidence of brain involvement)
• West Nile Fever
• Other (movement disorders, flaccid paralysis,
  rhabdomyolysis,etc.)
• Treatment

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Part II Environmental Investigation
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Environment Around the Home

• Man-made mosquito breeding sites
• Containers
• Tires
• Tarps
• Natural mosquito breeding sites
• Ponds
• Wooded areas (Hardwoods)

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Recommendations

• Personal protection
• Get rid of tires and containers
• Drain birdbaths and pots weekly
• Clean gutters
• Fill Ditches
• Use Larvacidal dunks

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Latitude and Longitude

• Exact location of case
• Determine if there is clustering in neighborhoods
• Look for patterns and focus area of transmission
• Connects human data with bird and mosquito data

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Completing the Case Investigation

• Yellow Card
• Attach all lab results
• Blood and/or CSF arbovirus panel
• CSF cell count, protein and glucose
• Viral cultures if done
• Get blood or CSF sent to OLS for confirmatory
  testing
• Complete clinical and environmental investigation