Preparing for WNV: Montana

1
Preparing for WNV Montanas Experience
Jim Murphy, Health Specialist Montana Department
of Public Health Human Services [phone]
jmurphy_at_state.mt.us
2
Objective

• By the end of this presentation participants will
  be able to
• List three specific activities that can be
  implemented at the local level to prepare for the
  emergence of WNV.

3
Presentation Overview

• Montanas preparation prior to the arrival of WNV
• Impact of WNV in Montana
• Critique of performance improving our
  response

4
Montanas Preparation for WNV

• (CDC Epidemiology Laboratory Capacity (ELC)
  funds in mid-2001)
• Developed partnerships with state counterparts in
  Livestock, Agriculture the University/Extension
  system.
• Offered funding to support testing efforts of
  birds, horses mosquitoes.
• Distributed brochures fact sheets to local
  partners.
• Promoted passive clinical surveillance through
  mailings to providers.

5
West Nile Virus Infections, by County, Montana
2002
1
1
Human cases (2)
2 Human Cases diagnosed in Fall 2002
Equine (134)
6
Year 1 (2002) Results/Critique

• Lab partners well prepared
• Low/Moderate level of worry among public press
• Horses best sentinel indicator in sparsely
  populated states
• Bird mosquito testing not highly organized?

7
Year 1 (2002) Results/Critique

• Needs
• Better educational resources
• Better bird mosquito monitoring
• Plan for higher volume in coming year

8
West Nile Virus Infections, by County, Montana
2003
17
9
12
7
23
12
9
10
10
6
12
11
14
11
35
Human cases (228)
228 Cases and 4 deaths in late summer
2003 Counties with gt5 cases detailed above
Equine (193)
9
Year 2 (2003) Results/Critique

• What went well?
• Most agencies responded well
• Mosquito monitoring improved but still of
  limited use
• Press PIO very helpful in promoting prevention
  and getting updates out

10
Year 2 (2003) Results/Critique

• Lab partners not prepared for volume
• Unable to quickly test human mosquito
  specimens.
• Providers, mosquito controllers angry with lab
  delays.
• Partners unable to keep up with dead bird
  calls.
• Regional medical centers heavily impacted
• 15 to 25 people hospitalized for WNV in 2 to 3
  facilities on any given day during peak of season
• Guidance on who when to test challenging to
  develop.

11
Year 2 (2003) Results/Critique

• Information Issues
• Attempts to respond daily to press were noble,
  but unrealistic.
• Difficulty determining severity of illness and
  residency issues based on lab reporting.
• Lack of consensus on the detail of information to
  release to public/press.
• Data entry into several CDC systems burdensome.

12
Improving our Response in Year 3

• Addressing Volume Issues
• Automate Serology tests.
• Simplify bird testing.
• Provide guidance, forms expectations to
  reporting sources ASAP.
• Improve coordination of sample submission.
• Support local seminars distribute WNV materials
  to increase the knowledge level.

13
Improving our Response in Year 3

• Addressing Information Issues
• Use or designate a PIO to coordinate with press,
  pre-draft releases.
• Review/establish procedures regarding info
  release ASAP.
• Review/draft reporting forms the flow of
  reports.
• Evaluate data tracking/submission to CDC.

14
Lessons Learned

• In our experience, most issues came down to
• Clarifying roles
• Clarifying expectations
• Preparing for surge capacity
• Anticipating the worst

15
Questions?