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West Nile For PECs


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Safety Presentation 2007

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West Nile For PECs

  1. 1. Ready for Summer . . . and The West Nile Virus? <ul><li> </li></ul><ul><li>Presented by Mitchell Kidd, Ph.D. </li></ul><ul><li>AEP WPEC/IH Meeting, Abilene, TX </li></ul><ul><li>April 10-11, 2007 </li></ul>
  2. 2. Origin of the West Nile Virus <ul><li>The West Nile virus was first isolated in the West Nile district of Uganda in 1937. </li></ul><ul><li>It later spread throughout Africa, Eastern Europe, the Middle East, and West Asia. </li></ul><ul><li>The virus then reached the United States in 1999. </li></ul>
  3. 3. WNV – The Conspiracy
  4. 4. WNV Enters the U.S. (Homeland Security Cam)
  5. 5. Classification <ul><li>The West Nile virus belongs to the family Flaviviridae, genus Flavivirus. </li></ul><ul><li>What are Flaviviruses? </li></ul><ul><ul><li>Groups of pathogenic viruses transmitted by insects such as mosquitoes and ticks. </li></ul></ul><ul><ul><li>Other flaviviruses include yellow fever, dengue, Murray Valley and St. Louis encephalitis, and the Kunjin virus. </li></ul></ul><ul><li>The West Nile virus is classified within the Japanese encephalitis complex. </li></ul>
  6. 6. Virology (for the biologist in all of us) <ul><li>“ 50 nm spherical, lipid-enveloped virus enclosing a single-stranded positive sense RNA genome of approximately 11,000 nucleotides that lacks a 3-prime poly A tract” </li></ul><ul><li>SOURCE: U.S. Department of Health and Human Services, FDA </li></ul><ul><li>Courtesy of </li></ul><ul><li>Pasteur Institute, Paris </li></ul>
  7. 7. Virology <ul><li>Courtesy of </li></ul><ul><li>Centers for Disease Control and Prevention </li></ul><ul><li>West Nile Virus in brain tissue of a crow found in New York </li></ul>
  8. 8. Transmission <ul><li>Primary hosts: birds </li></ul><ul><li>Over 130 species infected </li></ul><ul><li>40 different species of mosquitoes can transfer the virus </li></ul><ul><li>Other pathways include: </li></ul><ul><ul><li>Blood transfusions </li></ul></ul><ul><ul><li>Organ transplants </li></ul></ul><ul><ul><li>Mother-to-child </li></ul></ul>
  9. 9. Bird Flyways
  10. 10. Transmission Courtesy of Centers for Disease Control and Prevention
  11. 11. Disease Presentation <ul><li>Four Possible Types of Diseases: </li></ul><ul><ul><li>West Nile Fever </li></ul></ul><ul><ul><li>West Nile Encephalitis </li></ul></ul><ul><ul><li>West Nile Meningitis </li></ul></ul><ul><ul><li>West Nile Meningoencephalitis </li></ul></ul>
  12. 12. Symptoms <ul><li>Most People –No Symptoms </li></ul><ul><li>20% present mild symptoms: </li></ul><ul><ul><li>fever, headache, nausea, eye pain, vomiting, swelling of the lymph glands, skin rashes </li></ul></ul><ul><li>1 in 150 people develop severe symptoms: </li></ul><ul><ul><li>Headache, high fever, neck stiffness, numbness, vision loss, disorientation, respiratory failure, coma, tremors, convulsions, muscle weakness, mental status changes, paralysis, seizures, and even death </li></ul></ul>
  13. 13. Laboratory and Clinical <ul><li>Patient examination reveals </li></ul><ul><ul><li>High levels of protein </li></ul></ul><ul><ul><li>High counts of leukocytes </li></ul></ul><ul><ul><li>Normal levels of glucose </li></ul></ul><ul><ul><li>Abnormally low number of lymphocytes in blood (lymphocytopenia) and decreased number of red blood cells (anemia) </li></ul></ul>
  14. 14. Laboratory and Clinical <ul><li>Computer Tomography Scans reveals </li></ul><ul><ul><li>Irregular lesions and persistent variations in brain tissue </li></ul></ul><ul><ul><li>Enhancement of periventricular areas consistent with inflammation </li></ul></ul>MRI of the brain’s horizontal plane, just above the ears. Periventricular white matter lesions can be seen (the white spots towards the bottom).
  15. 15. Diagnosis Techniques <ul><li>Serologic and virologic testing </li></ul><ul><ul><li>Detection of IgM antibody levels to the West Nile virus </li></ul></ul><ul><ul><li>Plaque reduction neutralization test </li></ul></ul>
  16. 16. Treatments <ul><li>Supportive therapy </li></ul><ul><ul><li>Hospitalization </li></ul></ul><ul><ul><li>Airway Management </li></ul></ul><ul><ul><li>Intravenous Fluids </li></ul></ul><ul><ul><li>Respiratory Support </li></ul></ul><ul><ul><li>Prevention of Secondary Infections </li></ul></ul>
  17. 17. Drug Treatments <ul><li>Ribavirin </li></ul><ul><ul><li>High concentrations inhibit the replication and cytopathogenicity of West Nile virus in vitro (i.e., laboratory) </li></ul></ul><ul><li>Interferon alpha-2b </li></ul><ul><ul><li>Protects the spinal cord cells from infection with the West Nile virus </li></ul></ul>
  18. 18. Drug Treatments <ul><li>Immunoglobulin G antibodies </li></ul><ul><ul><li>Concentrated antibodies extracted from the human plasma from individuals previously exposed to the virus </li></ul></ul><ul><ul><ul><li>Exogenous to patient, i.e., doesn’t require the patient’s immune system to develop immunity </li></ul></ul></ul><ul><ul><li>Vaccines are in development </li></ul></ul>
  19. 19. Susceptibility <ul><li>Who’s at risk? </li></ul><ul><li>What do you know about protecting yourself against West Nile virus? </li></ul><ul><li>Are you as smart as you think? </li></ul>
  20. 20. True or False? <ul><li>There's not much I can do about West Nile virus. </li></ul><ul><li>False. There is a lot that you, personally, can do to reduce your chance of West Nile virus infection. </li></ul>
  21. 21. Facts <ul><li>Reduce the number of mosquito bites you get. Make a habit of using insect repellent with DEET when outdoors. Spray repellent on exposed skin and clothing. </li></ul><ul><li>Prime mosquito-biting hours are usually dusk to dawn. Pay special attention to protection during these hours, or avoid being outdoors. </li></ul>
  22. 22. Facts <ul><li>Reduce the number of mosquitoes around your home. Mosquitoes breed in standing water, so check your yard once a week: get rid of containers that aren't being used, empty water from flower pots, change water in bird baths or dog bowls and maintain clean gutters. </li></ul><ul><li>Make sure window and door screens are in good condition. See if older neighbors or family members need help installing or repairing screens. </li></ul>
  23. 23. True or False? <ul><li>Kids are at the most danger of getting sick from West Nile virus. </li></ul><ul><li>False: People over 50 are at the highest risk for developing severe West Nile disease. </li></ul>
  24. 24. Fact <ul><li>Relatively few children have been reported with severe West Nile Virus disease. By contrast, most deaths due to WNV are among people over 50 years old. Half of those deaths are among people over 77 years old. </li></ul><ul><li>It is always a good idea for children to avoid mosquito bites, but it's also important for adults -- especially older adults -- to take steps to avoid mosquito bites. </li></ul>
  25. 25. True or False? <ul><li>It's only people who are already in poor health who have to worry about West Nile virus. </li></ul><ul><li>False. Healthy, active older adults who spend time working and exercising outdoors have been affected by severe West Nile virus infection. </li></ul>
  26. 26. Fact <ul><li>Being over 50 is a risk factor for developing severe West Nile disease, if infected with the virus. There is a risk of anyone getting mosquito bites while leading an active life outdoors. This doesn't mean you have to stay inside; it does mean that it's important to use repellent when you go outside. </li></ul>
  27. 27. True or False? <ul><li>Repellents containing DEET are not safe. </li></ul><ul><li>False. Repellents containing DEET are very safe when used according to directions. </li></ul>
  28. 28. Fact <ul><li>Because DEET is so widely used, a great deal of testing has been done. When manufacturers seek registration with the US Environmental Protection Agency (EPA) for products such as DEET, laboratory testing include both short-term and long-term health effects must be carried out. </li></ul>
  29. 29. Fact <ul><li>There are products with different strengths (percentages of DEET) available. The longer the protection you need, the higher percent of DEET needed. </li></ul><ul><li>Repellent with DEET can be used for both adults and children, according to directions. </li></ul>
  30. 30. True or False? <ul><li>As long as my area has a mosquito control program, I don't have to worry about using a repellent. </li></ul><ul><li>False. Mosquito control activities don't eliminate every mosquito, so personal protection is still important. </li></ul>
  31. 31. Fact <ul><li>Public activities, such as using products to kill mosquito larvae and adult mosquitoes, are one part of control. Personal protection, such as using repellent, keeping window screens in good condition, and control of household mosquito breeding sites are other important steps. </li></ul><ul><li>Collaboration between the community, the family and the individual is needed to achieve the best prevention of West Nile virus infection. </li></ul>
  32. 32. Susceptibility <ul><li>Who’s at risk? </li></ul><ul><ul><li>People who spend lots of time outdoors </li></ul></ul><ul><ul><li>People over the age of 50 </li></ul></ul><ul><ul><li>People with weakened immune systems </li></ul></ul><ul><ul><li>French investigators suggest genetics might be a factor </li></ul></ul>
  33. 33. Prevention Against Mosquitoes <ul><li>Limit time outdoors at dusk, dawn and early evening </li></ul><ul><li>Wear long sleeve shirts and long pants </li></ul><ul><li>Wear light colored clothing </li></ul>
  34. 34. Prevention Against Mosquitoes <ul><li>Spray skin and clothing with insect repellent containing DEET </li></ul><ul><li>Install or repair window screens </li></ul><ul><li>Limit mosquito breeding sites by draining standing water </li></ul>
  35. 35. West Nile Virus in the U.S. <ul><li>First traces of disease appeared in New York in summer of 1999 </li></ul><ul><li>WNV is now considered endemic in North America </li></ul>
  36. 36. West Nile Virus Activity 2006
  37. 37. 2006 Cumulative Disease Map for Humans Courtesy United States Geological Survey
  38. 38. West Nile Virus Human Neuroinvasive Disease 2006
  39. 39. Viremic Blood Donors 2006
  40. 40. West Nile Virus in the U.S. <ul><li>CDC reports: </li></ul><ul><ul><li>2002: 4,156 human cases, including 284 deaths </li></ul></ul><ul><ul><li>2003: 9,862 human cases, including 264 deaths </li></ul></ul><ul><ul><li>2004: 2,539 human cases; including 100 deaths </li></ul></ul><ul><ul><li>2005: 3,000 human cases; including 119 deaths </li></ul></ul><ul><ul><li>2006; 4,180 human cases; including 149 deaths </li></ul></ul>
  41. 41. Departing notes… <ul><li>More current Information on the West Nile Virus can be found at: </li></ul><ul><ul><li>Center for Disease Control & Prevention </li></ul></ul><ul><ul><li>Food and Drug Administration </li></ul></ul><ul><ul><li>National Institute of Health </li></ul></ul>