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West Nile-Like Recombinant
Virus Infection Update
From Patricia Doyle, PhD
dr_p_doyle@hotmail.comA
10-4-2
10-4-2

A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
 
[Reports of infection of new hosts, extensions of geographical range, and
information of special significance are posted separately immediately on
receipt. There is some overlap in the following reports, but they are
collected together because of differences in emphasis and user
friendliness. - Mod.CP]
 
In these updates:
[1] Human case (Colorado, ex Kansas?)
[2] Humans, equines, dog (Nebraska)
[3] Equine (Canadian horse in quarantine in Australia)
[4] Human, probable (Vermont)
[5] Human, first, confirmed (Rhode Island)
[6] WHO report (as of 30 Sep 2002)
[7] ERAP report (latest news as of Fri 27 Sep 2002)
[8] USDA-APHIS report (as of Sun 29 Sep 2002)
[9] MMWR-ArboNET report (USA, 26 Sep to 2 Oct; transplantation/transfusion
recipients)
 
******
[1]
Date: Mon 30 Sep 2002
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: Kansas Department of Health and Environment, West Nile virus Update
and Summary, Sat 27 Sep 2002 [edited]
<http://www.kdhe.state.ks.us/news/web_archives/2002/09272002a.htm>
 
 
Kansas: Colorado border case employed in Kansas
-----------------------------------------------
No human cases of West Nile virus have been confirmed in Kansas, but a
Colorado man who works in Kansas has tested positive for West Nile virus
(WNV) encephalitis, according to the Colorado Department of Public Health
and Environment and the Centers for Disease Control and Prevention. The
victim is from Prowers County, Colorado, which borders Hamilton County,
Kansas. The man spends much of his time in Hamilton County for work and
recreation, and may have been infected in Kansas.
 
He has been released from a Colorado hospital and is recovering, according
to Colorado health officials. While it is not known whether the man was
infected in Colorado or Kansas, it is important to remember that infected
mosquitos and birds travel from state to state and county to county. So
far, Hamilton County, Kansas is not one of the state's 87 counties where
WNV has been confirmed in mosquitoes, birds, or horses.
 
"Whether or not this victim was infected in Kansas, residents should not
panic, but instead focus their attention on avoiding mosquitos and reducing
breeding grounds for mosquitos around their homes and communities," said Dr
Gail Hansen, assistant deputy state epidemiologist for the Kansas
Department of Health and Environment. WNV is transmitted when a mosquito
bites an infected bird and then bites another animal or a human. Infected
birds carry the disease for a short time, but only mosquitoes transmit it
to animals or humans. "We are getting very close to the time of year when
mosquitos aren't a problem in Kansas, and without mosquitos the virus does
not spread." Dr Hansen noted.
 
--
Marianne Hopp
<mjhopp12@yahoo.com>
 
******
[2]
Date: Tue 1 Oct 2002
From: ProMED-mail <promed@promedmail.org>
Source: Lincoln Journal Star, Tue 1 Oct 2002 [edited]
<http://www.journalstar.com/latest_reg.php?story_id=27899>
 
 
Nebraska: veterinarian confirms Scotts Bluff dog had WNV
--------------------------------------------------------
The number of animal cases of West Nile virus (WNV) infection in Nebraska
continues to rise, and now includes a 5 year old golden retriever, a local
veterinarian said. The dog recovered from WNV infection within 2 days of
being treated with fluids and antibiotics [role of antibiotic in a viral
infection not clear. - Mod.SH], said Gering veterinarian Jerry Upp. Its
owners, from Scotts Bluff, brought the dog in with a high temperature and
sore muscles. It also had experienced some behavioral changes, he said. It
is among the first confirmed cases of WNV in dogs. At least 2 dogs in
Illinois have had the disease. The virus was detected when blood samples
were sent to labs to rule out another illness, Upp said. Another lab test
confirmed the presence of WNV.
 
This rare diagnosis is not something that should worry dog owners. Upp said
he would be surprised if they saw another case. "People should just be
aware of it and avoid taking their dogs out in the evenings when more
mosquitoes are present," he said.
 
The Nebraska Department of Agriculture also said Monday the number of
horses with the disease has climbed to 1008. All have been reported since 6
Aug 2002. Scotts Bluff County has the most equine cases, with 88, more than
double the 41 reported cases in second-place Douglas County. Holt County
had 40 cases.
 
One of the state's 4 suspected human deaths of the virus [infection] was of
a Scotts Bluff County resident. The other suspected deaths were in Saline,
Lancaster, and Buffalo counties. In total, 63 people have been found to be
presumptively positive for WNV in Nebraska as of Thu 27 Sep 2002, the
Nebraska Department of Health and Human Services said, and 2 cases have
been confirmed by the Centers for Disease Control and Prevention.
 
******
[3]
Date: Tue 1 Oct 2002
From: Narelle Clegg <Narelle.Clegg@aqis.gov.au>
 
 
West Nile encephalitis in a Canadian horse quarantined in Australia
------------------------------------------
The following is a report of a horse which exhibited signs of encephalitis
5 days after it arrived in Australia. The horse was stabled at the Eastern
Creek quarantine station in Sydney completing the 14 day post-arrival
quarantine period (PAQ) that all horses imported from countries other than
New Zealand undergo. Once a provisional diagnosis of West Nile virus (WNV)
infection was made, the Australian Quarantine and Inspection Service (AQIS)
released the horse from quarantine, along with the other horses that PAQed
with it. AQIS received confirmation of WNV from the Arbovirus and emerging
Viral Diseases Unit at Westmead Hospital in Sydney on 6 Sep 2002. The lab
also tested the sample using the NY99 strain and obtained positive results
on 27 Sep 2002. Samples were forwarded onto Canada for confirmatory
testing, with positive results for NY99 strain using PRNT method on 1 Oct
2002. This case was briefly mentioned as part of a previous ProMED-mail
post concerning an outbreak of equine rhinopneumonitis virus type 1 [see:
Equine herpesvirus - Australia 20020907.5249] where some of the details
were incorrect.
 
--
Narelle Clegg
Manager Live Animal Imports
Australian Quarantine and Inspection Service
<narelle.clegg@aqis.gov.au>
 
******
[4]
Date: Wed 2 Oct 2002
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: Vermont Department of Health, news release, Sat 28 Sep 2002 [edited]
<http://www.healthyvermonters.info/admin/releases/100202westnile.shtml>
 
 
Vermont: second probable human case
-----------------------------------
Health officials today announced a second probable human case of West Nile
virus (WNV) infection in Vermont. The new probable case, an elderly Windham
County woman, was reported to the Health Department on 20 Sep 2002. The
first probable case, a Franklin County man, was reported earlier in the
same month. Health officials are still waiting for confirmation from the
Centers for Disease Control and Prevention (CDC) that the laboratory tests
on these 2 individuals are in fact positive for West Nile virus. The man
from Franklin County has recovered. The woman from Windham County recently
died; cause of death has not yet been determined.
 
"This does not change our advice to the public," said Dr Patsy Tassler of
the Vermont Department of Health. "People should continue to take
precautions to avoid mosquito bites." WNV is typically spread to humans by
the bite of an infected mosquito. To date, a small number of infected
mosquitoes have been identified in both Franklin and Grand Isle counties.
Tassler emphasized that the risk of any individual becoming ill from the
bite of a mosquito infected with WNV is very low. "Most people who contract
WNV have no symptoms and don't even get sick," said Tassler. "Only about 1
per cent of people who are infected develop illness that requires medical
attention." People over age 50 are the most at risk of becoming severely
ill from WNV. However, all Vermonters should take precautions to avoid
mosquito bites, Tassler said.
 
Routine surveillance trapping of mosquitoes has documented reduced numbers
of mosquitoes in recent weeks. According to Tassler, mosquito activity will
stop for the winter in Vermont after a couple of hard frosts. The Health
Department continues to ask residents who see a dead bird to report it by
calling their local Health Department office. Since August 49 birds have
tested positive for WNV (Chittenden, Franklin, Washington, Addison,
Lamoille, and Orange counties); 3 horses have tested positive (Franklin,
Addison, and Orleans counties); and mosquitoes have tested positive in
Franklin and Grand Isle county.
 
--
Marianne Hopp
<mjhopp12@yahoo.com>
 
******
[5]
Date: Thu 3 Oct 2002
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: Rhode Island Department of Health, news release, Wed 2 Oct 2002
[edited]
<http://www.health.state.ri.us/media/021002a.htm>
 
 
Rhode Island: first confirmed human case of WNV Infection
---------------------------------------------------------
Today [Wed], the Rhode Island Department of Health (HEALTH) confirmed the
state's first human case of West Nile virus (WNV) infection -- a 66 year
old woman with viral encephalitis, from Providence County. The HEALTH
Laboratory confirmed the presence of WNV in the patient's cerebrospinal
fluid (CSF) on Wed 2 Oct 2002. The patient survived the disease and was
discharged to home, completely recovered, after 5 days in hospital.
Confirmation of the disease as WNV does not materially affect the type of
treatment a patient receives.
 
HEALTH officials estimated that exposure to a WNV infected mosquito
probably occurred during Labor Day weekend. Officials could not confirm
where the critical exposure took place. A review of medical records
indicated a history of multiple mosquito bites especially during outdoor
excursions in Massachusetts and Connecticut around Labor Day.
 
This case represents the first confirmed human case in the state. As of Wed
2 Oct 2002, US public health officials reported 2430 human cases and 125
deaths nationwide. In response to this case, HEALTH will continue its
stepped up monitoring for other cases with local hospitals and infectious
disease experts. HEALTH plans to contact health care providers, hospital
emergency units, and urgent care centers to advise them about the diagnosis
of possible cases. Officials do not plan to recommend other environmental
measures or restrictions this late in the season, but will keep the public
informed if any new events develop. Human WNV happens only after a bite
from an infected mosquito. It is not possible to get WNV directly from
birds or from person-to-person contact. Although mosquito activity is low,
it still exists during this warm fall weather. Bites are less common, and
no new mosquitoes are being produced, but there will be some mosquito
activity, particularly during periods of warmer daytime temperatures. This
will continue until the weather returns to its seasonal low temperatures
and hard frosts.
 
--
Marianne Hopp
<mjhopp12@yahoo.com>
 
******
[6]
Date: Tue 1 Oct 2002
From: Marianne Hopp <mjhopp12@yahoo.com>
Source:World Health Organisation (WHO) Disease Outbreaks Report, Tue 1 Oct
2002 [edited]
<http://www.who.int/disease-outbreak-news/n2002/october/1october2002.html>
 
 
West Nile Virus in the United States - WHO update 5
---------------------------------------------------
As of Mon 30 Sep 2002, the WHO Collaborating Centre for Arthropod-Borne
Viruses, Western Hemisphere, at the Centers for Disease Control and
Prevention (CDC) has reported 2405 human cases of West Nile virus
infection, with 117 deaths occurring in 32 states and the District of
Columbia. During 2002, West Nile virus activity (evidence of infections in
birds, humans, mosquitoes, and other animals -- primarily horses) has been
documented in 42 states and the District of Columbia (see previous report
<http://www.who.int/disease-outbreak-news/n2002/september/24september2002.html>.
 
--
Marianne Hopp
<mjhopp12@yahoo.com>
 
******
[7]
Date Wed 25 Sep 2002
From: ProMED-mail <promed@promedmail.org>
Source: Environmental Risk Analysis Program, Cornell University Center for
the Environment, Mon 23 Sep 2002 [edited]
<http://www.cfe.cornell.edu/erap/WNV/>
 
 
West Nile virus news - as of Fri 27 Sep 2002
--------------------------------------------
West Nile Virus was discussed at a 24 Sep 2002 Senate Committee hearing.
Top health officials from several agencies (CDC, National Institutes of
Health, Food and Drugs Administration) reported to legislators about status
of a WNV vaccine and extent of risks to the nation's blood supply. A
nucleic acid blood test may be ready by next summer and a vaccine based on
the yellow fever vaccine may be ready in 3 years.
 
WNV has been detected in 42 states in the US in 2002 and 5 provinces in
Canada. It is on both sides of the divide in Colorado and has been
confirmed in California, on the Pacific Coast, and in Nova Scotia, Canada,
in the Atlantic. In many states it has been detected in all, or nearly all,
counties. CDC's 24 Sep 2002 MMWR report [see: West Nile virus update 2002-
(USA) (23)] states that 480 new lab-positive human cases of WNV-associated
illness occurred during the week 19 to 25 Sep 2002, including the first
case in North Carolina, for a total of 2121 confirmed or probable cases as
of 25 Sep 2002 (95 fatalities). This number is far higher than the
prediction reported in newspapers across the country last month that there
would be 1000 human cases this year, based solely on extrapolating from
data in previous years.
 
Largest numbers of cases are in Illinois (518), Michigan (270), Louisiana
(261), Ohio (232), Mississippi (157), Missouri (114), Indiana (104), and
Texas (91). The 2002 reported caseload continues to increase, although it
is difficult to tell if this is primarily due to the lag time between
disease onset and confirmation, or to new infections.
 
[The remainder of the ERAP report is superceded by the following USDA-APHIS
and ArboNET-MMWR report. - Mod.CP]
 
******
[8]
Date: Thu 3 Oct 2002
From: ProMED-mail <promed@promedmail.org>
Source: United States Department of Agriculture, Animal and Plant
Inspection Service, Update on the Current Status of West Nile Virus, as of
Sun 29 Sep 2002 [edited]
<http://www.aphis.usda.gov/oa/wnv/wnvstats.html>
 
 
Equine cases of West Nile virus illness: 1 Jan to 29 Sep 2002
-------------------------------------------------------------
The total number of equine cases of illness caused by West Nile virus (WNV)
confirmed at the USDA's National Veterinary Services Laboratories (NVSL) or
reported by state officials so far this year is 7462. That is an increase
of 1239 cases from 7 days ago.
 
The cases are from 36 states: Alabama (39), Arkansas (64), Colorado (296),
Delaware (1), Florida (180), Georgia (26), Illinois (415), Indiana (358),
Iowa (576), Kansas (299), Kentucky (328), Louisiana (324), Maryland (3),
Massachusetts (1), Michigan (145), Minnesota (642), Mississippi (214),
Missouri (252), Montana (99), Nebraska (988), New Jersey (13), New Mexico
(24), New York (13), North Dakota (553), Ohio (246), Oklahoma (73),
Pennsylvania (28), South Carolina (2), South Dakota (613), Tennessee (79),
Texas (443), Vermont (3), Virginia (17), West Virginia (3), Wisconsin (45),
and Wyoming (57).
 
******
[9]
Date: Thu 3 Oct 2002
From: ProMED-mail <promed@promedmail.org>
Source: MMWR Morb Mortal Wkly Rep 2002; 51(39): 884,895 (4 Oct) [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5139a5.htm>
 
 
This report summarizes [1] West Nile virus (WNV) surveillance data reported
to CDC through ArboNET and by states and other jurisdictions as of Wed 2
Oct 2002, and [2] updates preliminary demographic and clinical information
on cases of WNV infections in recipients of blood transfusion and organ
transplantation reported to CDC during the period 28 Aug to 2 Oct 2002.
 
[1] West Nile Virus Activity; United States, Thu 26 Sep to Wed 2 Oct 2002
-------------------------------------------------
During the reporting period of Thu 26 Sep to Wed 2 Oct 2002, a total of 409
laboratory-positive human cases of West Nile virus (WNV)-associated illness
were reported from Illinois (81), Michigan (73), Ohio (56), Indiana (53),
Nebraska (32), Louisiana (26), Missouri (17), Kentucky (13), Pennsylvania
(8), Iowa (7), Minnesota (7), Mississippi (6), Alabama (5), New York (5),
Tennessee (5), Wisconsin (5), Maryland (4), Colorado (2), New Jersey (2),
South Dakota (1), and Texas (1).
 
During the same period, WNV infections were reported in 684 dead crows and
441 other dead birds. A total of 1027 veterinary cases were reported (1026
equine and one other species). During the same period, 521 WNV-positive
mosquito pools were reported.
 
During 2002, a total of 2530 human cases with laboratory evidence of recent
WNV infection have been reported from Illinois (599), Michigan (343), Ohio
(288), Louisiana (287), Mississippi (163), Indiana (157), Missouri (131),
Texas (92), Nebraska (80), New York (51), Kentucky (40), Tennessee (31),
Alabama (30), Minnesota (26), Pennsylvania (26), Iowa (25), South Dakota
(24), Georgia (19), Wisconsin (19), Virginia (16), North Dakota (15),
Arkansas (11), Maryland (10), Massachusetts (10), Florida (8), Connecticut
(7), the District of Columbia (6), New Jersey (6), Oklahoma (4), Colorado
(3), California (1), North Carolina (1), and South Carolina (1). Among the
2132 patients for whom data were available, the median age was 56 years
(range: 1 month to 99 years); 1150 (54 per cent) were male, and the dates
of illness onset ranged from 10 Jun to 23 Sep 2002. A total of 116 human
deaths have been reported (median age 79 years (range: 27 to 99 years); 70
(60 per cent) deaths were among men.
 
In addition during 2002, 5633 dead crows and 4216 other dead birds with WNV
infection were reported from 42 states, New York City, and the District of
Columbia; 4377 WNV infections in mammals (4369 equines, 3 canines, and 5
other species) have been reported from 33 states (Alabama, Arkansas,
Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas,
Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi,
Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, North
Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota,
Tennessee, Texas, Vermont, Virginia, and Wyoming). During 2002, WNV
seroconversions have been reported in 310 sentinel chicken flocks from
Florida, Iowa, Nebraska, Pennsylvania, and New York City; 3874 WNV positive
mosquito pools have been reported from 26 states (Alabama, Arkansas,
Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kentucky,
Maryland, Massachusetts, Mississippi, Missouri, Nebraska, New Hampshire,
New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island,
South Carolina, South Dakota, Texas, Vermont, and Virginia), New York City,
and the District of Columbia.
 
[2] Investigations of WNV infections in recipients of blood transfusion and
organ transplantation
-----------------------------------------------
CDC, the Food and Drug Administration, and the Health Resources and
Services Administration, in collaboration with blood collection agencies
and state and local health departments, continue to investigate WNV
infections in recipients of blood transfusion and organ transplantation.
From 28 Aug to 2 Oct 2002, CDC received reports from 10 states of 15
patients with confirmed West Nile virus meningoencephalitis (WNME) or
meningitis diagnosed after receiving blood components within 1 month of
illness onset.
 
CDC has been notified of additional cases among transfusion recipients, but
demographic and clinical information is pending. All 15 of these patients
resided in areas with high levels of WNV activity. Investigations are
ongoing to determine whether transfusion was the source of WNV transmission.
 
Of the 15 cases, 8 (53 percent) were reported since 25 Sep 2002. One
patient, an organ donor from Georgia, was positive for WNV at the time of
organ recovery following receipt of multiple blood transfusions (1). The
onset of symptoms for the remaining 14 patients began in July (2 patients),
August (5 patients), and September (7 patients). The reasons for hospital
admission included a surgical procedure or obstetric delivery (4 patients)
and solid organ transplantation (3 patients who received an organ from
different donors who did not have evidence of WNV infection at the time the
organs were recovered). A total of 5 patients had hematologic conditions, 3
patients had myelodysplasia, and 2 patients had acute myelogenous leukemia.
These 15 patients received blood components from a median of 18 donors
(range: 2 to 185 donors). WNME was the probable cause of death for at least
3 of the 4 patients who died.
 
Some of these investigations provide evidence that WNV can be transmitted
through blood transfusion; 2 patients tested positive for WNV infection
after receiving different blood products derived from a single blood
donation subsequently found to have evidence of WNV (2). In another case,
WNV was isolated from a unit of frozen plasma that had been withdrawn as a
result of the investigation, indicating that the virus can survive in some
blood components (1). In addition to these patients, investigations in
Georgia and Florida have demonstrated transmission of WNV in 4 recipients
of solid organs from a single donor (1,3,4).
 
Patients with WNV infection who have received blood transfusions or organs
within the 4 weeks preceding the onset of symptom should be reported to CDC
through local public health authorities. Serum or tissue samples should be
retained for later studies. In addition, the Public Health Service is
expanding an earlier recommendation (1) to request that cases of WNV
infection in patients who had onset of symptoms within 2 weeks of blood or
organ donation be reported. Prompt reporting of these cases will facilitate
withdrawal of potentially infected blood components.
 
References:
(1) CDC. Update: investigations of West Nile virus infections in recipients
of organ transplantation and blood transfusion. MMWR Morb Mortal Wkly Rep
2002; 51: 833--6.
(2) CDC. Update: Investigation of West Nile virus infections in recipients
of organ transplantation and blood transfusion --Michigan 2002. MMWR Morb
Mortal Wkly Rep 2002; 51: 879.
(3) CDC. West Nile virus infection in organ donor and transplant recipients
-- Georgia and Florida, 2002. MMWR Morb Mortal Wkly Rep 2002; 51: 790.
(4) CDC. Investigation of blood transfusion recipients with West Nile virus
infections. MMWR Morb Mortal Wkly Rep 2002; 51: 823.
 
--
ProMED-mail
<promed@promedmail.org>
 
[see also:
West Nile virus update 2002- (USA) (23) 20020926.5406
West Nile virus update 2002 - USA (22) 20020919.5360
West Nile virus update 2002 - USA (20) 20020907.5252
West Nile virus update 2002 - USA (19): non-human 20020901.5213
West Nile virus update 2002 - USA (18): human 20020901.5212
West Nile virus update 2002 - USA (17) 20020823.5124
West Nile virus - USA 2001: final report 20020613.4491
West Nile virus update 2002 - USA (01) 20020506.4109
West Nile virus, predicted spread in 2002 - USA 20020109.3206
2001
---
West Nile virus surveillance 2001 - USA (34) 20011130.2914
West Nile virus surveillance - USA 2000 final report 20010423.0792
West Nile virus surveillance - USA 20010129.0207]
 
...................mpp/tg/cp/pg/sh
 
 
 
Patricia A. Doyle, PhD
Please visit my "Emerging Diseases" message board at:
http://www.clickitnews.com/emergingdiseases/index.shtml
Zhan le Devlesa tai sastimasa
Go with God and in Good Health





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