West Nile Virus Surveillance Training

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DoD West Nile Virus Surveillance
Program Entomological Value, Implications,
Lessons Learned
Ben Pagac, Army Center for Health Promotion
Preventive Medicine, Fort Meade, MD
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Most rapidly-spreading arboviral disease ever
documented
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1999
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2000
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2001
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2002
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2003
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2004
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2005
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2006
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WNV Human Disease
Year Rank Cases Fatalities Hotest States
1999 7 62 7 NY
2000 8 21 2 NY, NJ, CT
2001 6 66 9 NY, NJ, FL
2002 3 4,156 284 IL, MI, OH
2003 1 9,862 264 CO. NE, SD
2004 5 2,539 100 CA, AZ, CO
2005 4 3,000 119 CA, IL, SD
2006 2 4,189 149 ID, CO, CA
Total - 23,895 934
Military-associated 2006 - 7AD 2004 - 3 (1
AD, 2 dep/ret)
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DoD Installations/facilities
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Since North American WNV Onset Key DoD
Surveillance Objectives

• 1. Rapid, open communication
• 2. Blend multi-agency efforts
• 3. Early detection
• 4. Implement PREVENTIVE vector management
• 5. Implement measured response planning based
  on surveillance findings
• 6. Reduce the human disease threat

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Field, Lab, Data, Response, Collaboration,
Readiness
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Field.

• Trapping type, habitat, frequency
• Specimen ID tools, keys, guides
• Adjusted duties based on resources
• (mosquito and dead bird collection)
• Specimen handling cold-chain, shipping
• Training - on site regional, with realistic
  expectations

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Thats so yesterday
WOW! . A gravid Coquilletidia perturbans with
symbiotic acarines attached antepronotally
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Lab.

• Mission expansion Regional lab expansion
• Specimen processing volume, tracking,
  cold-chain
• ID verification spot check, reliability
  feedback (comm. loop)
• Testing RT PCR
• Turn-around Supplies for field
• Turn-around Results (mosquito trap
  numbersimmediate!)
• Average intervals
• 2004 (73k fm / 10k pools) 10d post-collection /
  6d post-receipt
• 2006 (6.5k fm / 890 pools) 9d post-collection /
  5d post-receipt

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Data Reporting
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Response..
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Response..
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VecTest Kit
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-
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Is abbreviated surveillance worth doing?

• In 2006 guidance for 13 sensitive DC sites 2 - 4
  gravid traps, 1 night/week

Year Trap Nights Ave. Trap Nights Trap Index pos. pools MIR (X1000) positive installations Range positive pools per installation
2005 623 50 12.6 15 2.2 4/13 0-8
2006 534 41 11 27 4.0 8/13 0-6
14 reduction
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Does intervention have an impact?
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Collaboration.

• Examples
• Intra-DOD Military Services, DEH, MED, VET,
  CHPPM, GEIS, WRAIR, USAMRIID, AFIP
• Inter-agency/institution NPS, USGS, CDC,
  States, COG, Academia

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Current Mosquito Trapping Sites ( Each site 1
to 20 traps) NPS Nat. Zoo Army Navy Air
Force Arling/Alex. DC
N
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Readiness.
West Nile Virus approximate geographic range
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Conclusions

• Military Med, Vet, and Engineering resources
  quickly adapted to the establishment of a
  comprehensive National surveillance and response
  program for a threat of unknown magnitude
• Vocational boundaries were sometimes willingly
  stretched to accomplish mission
• Military efforts blended with, bolstered, and
  sometimes were the sole source of National
  epidemiologic information on the WNV threat
• Health threat response measures were data driven
• Value of data was maximized by broad rapid
  distribution
• Trap indices can be predictive of viral activity
• Field-expedient wicking assays work
• Targeted interventions work
• 2006 Lean DoD Surveillance at sensitive
  Military (DC) sites proved valid valuable to
  continue in 2007
• Principles experience gained are being applied
  OCONUS
• Elevated diagnostic capabilities with quick
  turn-around, large sample capacity, great
  accuracy, appropriate equipment, and adaptability
  are poised to address other potential threats
• Enhanced domestic military field vector
  surveillance experience, capability, and
  infrastructure are in place to tackle future
  potential threats (natural or malicious)

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ACKNOWLEDGEMENTS

• DOD Global Emerging Infectious Disease System
  (CDR Clara Witt)
• Army Proponency Office for Preventive Medicine
  (LTC David West)
• Centers for Disease Control Prevention (Drs. D.
  Gubler, C. Moore, R. Wirtz, R. Nasci)
• US Geological Survey Nat. Wildlife Hlth. Ctr.
  (Drs. R. McLean, L. Glaser, E. Saito, G.
  McGlaughlin)
• NY State Health Department (Dr. Dennis White)
• State Municipal Health Departments
• Collaborating Universities
• DC Department of Health (Dr. Peggy Keller, Ms. J.
  Hinson)
• US National Park Service (Ms. Jil Sweringen)
• Smithsonian Institution National Zoological Park
  (Drs. R. Yates, R. Montalli)
• Walter Reed Army Institute of Research (LTC J.
  Ryan)
• Army/Navy/Air Force Preventive Medicine Personnel
• Army/Navy/Air Force Public Works, Pest Management
  Personnel
• Army Medical Research Institute for Infectious
  Diseases (MAJ J. Blow, Dr. Michael Turell)
• Army Veterinary Clinics (MAJ Felicia Langel)
• Army Veterinary Command Food Analysis and
  Diagnostic Lab
• Air Force Institute of Env., Safety, Occ. Health
  Risk Analysis (Dr. Chad McHugh)
• Navy Disease Vector Ecology Center (CDR David
  Claborn)
• Army CHPPMN,S,W (E. Stanwix, D. Kuhr, W. Irwin,
  J. Harrison, M. Miller, S. Spring)

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