- New York 99 isolate of West Nile LIKE Virus is transmitted
by non-vectored means, i.e. no mosquito bites. Another significant and
quirky aspect of NY 99 West Nile LIKE Virus.
- Wisconsin - West Nile Virus Infection Among Turkey Farm
Workers In 2002
- From ProMED-mail
- Morbidity and Mortality Weekly Report
- Fri 24 Oct 2003
- /52(42);1017-1019 [edited]
- In 2002, Wisconsin public health officials were notified
of 2 cases of febrile illness in workers at a commercial turkey breeder
farm (farm A) in county A. The Wisconsin Division of Public Health (WDPH)
initiated an investigation that found a high prevalence of West Nile virus
(WNV) antibody among farm A workers and turkeys. An associated high incidence
of febrile illness among farm A workers also was observed.
- This report summarizes the results of this investigation,
which indicate possible non-mosquito transmission among birds and subsequent
infection of humans at farm A. Because the mode of transmission in this
outbreak is unknown, turkey handlers should take appropriate precautions,
including use of DEET-containing mosquito repellents, protective clothing
and gloves, respiratory protection, and proper hand hygiene. Suspected
occupationally acquired WNV infections should be reported immediately to
local and state health departments.
- During November 2002, WDPH and the Wisconsin State Laboratory
of Hygiene (WSLH) confirmed that 2 ill residents of county A had been infected
with WNV. Before these reports, only one human WNV infection had been reported
in this county. Both persons worked at farm A and had febrile illness with
rash during late September to early October 2002. These human illnesses
occurred after a suspected fowl pox outbreak among farm A turkeys in September.
Workers were concerned the pox outbreak might be associated with their
- Farm A is one of 6 turkey breeder farms in county A owned
by a company that also operates non-breeder farms and a turkey meat processing
plant in county A. The 5 other turkey breeder farms are located within
10 miles of farm A, and multiple private residences are within 1/4 mile.
In February 2003, county and state public health staff, in collaboration
with the company, identified workers at the 6 turkey breeder farms, the
non-breeder farms, and the plant, and requested their consent to participate
in a serosurvey. Serum samples were collected from participating workers
(N = 93) to identify persons infected recently. A questionnaire was administered
to identify persons who had a febrile illness during August to October
2002. Serum samples also were collected from residents (N = 14) who lived
within 1/4 mile of farm A. All serum samples were tested for WNV-specific
IgM antibody at WSLH (ref. 1). IgM-positive specimens were confirmed by
plaque-reduction neutralization tests at CDC (ref. 2). Of 107 total participants,
10 (9 percent) were seropositive. Of approximately 90 workers at the 6
breeder farms, 57 (63 percent) participated; of these, 10 (18 percent)
were infected recently with WNV. None of the meat processing workers or
other area residents was infected. Of 11 persons who worked exclusively
at farm A, 6 (55 percent) were WNV IgM-positive, compared with 2 (25 percent)
of 8 who worked at both farm A and other breeder farms and 2 (5 percent)
of 38 who worked only at other breeder farms. Of the 10 IgM-positive workers,
6 (60 percent) reported febrile headaches during August to October 2002
(all occurring during the last week of September), compared with 7 (7 percent)
of 97 IgM-negative persons sampled (p = 0.0002 by Fisher exact test). All
6 IgM-positive persons who reported febrile headache had worked at farm
A. All 6 noted a skin rash, and one had meningoencephalitis and was hospitalized;
no deaths occurred.
- Reported mosquito exposures and bites were similar for
IgM-positive (9 [90 percent] and 8 [80 percent] of 10, respectively) and
IgM-negative workers (67 [85 percent] and 54 [68 percent] of 79, respectively).
Only one (2 percent) of 57 breeder farm workers reported using insect repellent
- Farm A includes 2 breeder bird barns and a juvenile flock
barn. The breeder barns separate uncaged females from male turkeys with
a solid plywood wall. The sides of the barns housing the female turkeys
are covered with 1 in. x 1 in. mesh wire fencing and plastic curtains that
can be adjusted to lower the temperature during warm months. Sera from
farm A turkeys and turkeys from the nearest breeder farm were collected
in late January 2003. The farm A flock sampled was the group of birds housed
in the juvenile flock barn from mid-June to early December 2002, at which
time this flock was moved to a breeder barn on farm A to replace a flock
slaughtered in November 2002. The flock sampled on the nearby farm was
a breeder flock also in place in September. Both flocks had suspected fowl
pox outbreaks during September. Serum samples were submitted to the U.S.
Department of Agriculture's National Veterinary Services Laboratories for
WNV-neutralizing antibody testing. Of 135 farm A female turkeys, 130 (96
percent) had WNV-neutralizing antibody (measured at 2 dilutions, 1:10 and
1:100, and considered to be positive if a given dilution neutralized >90
percent of virus growth). No WNV-neutralizing antibody was found in 135
female turkeys tested from the nearby farm or 30 male turkeys tested from
- (Reported by: LC Glaser, DVM, MV Wegner, MD, JP Davis,
MD, Div of Public Health, State of Wisconsin Dept of Health and Family
Svcs. ML Bunning, DVM, AA Marfin, MD, GL Campbell, MD, Div of Vector-Borne
Infectious Diseases, National Center for Infectious Diseases; B Bernard,
MD, SW Lenhart, MSPH, Div of Surveillance, Hazard Evaluations, and Field
Studies, National Institute for Occupational Safety and Health; MJ Sotir,
PhD, EIS Officer, CDC.)
- MMWR Editorial Note ------------------- The investigation
described in this report found that workers at farm A had a higher incidence
of febrile illness and prevalence of WNV antibodies than workers at other
breeder and non-breeder farms, workers at a turkey meat processing facility,
or persons who lived on or near the affected farm and who did not work
in the turkey barns. The mode of transmission to these workers is unknown.
Although the majority of human WNV infections are mosquito-borne, transmission
by less typical routes might have occurred, including percutaneous (e.g.,
exposure of broken skin or mucosa to infected turkey feces or serous exudates
from dually-infected pox lesions), fecal-oral, or respiratory (e.g., exposure
to aerosolized infected turkey feces).
- The WNV seroprevalence (96 percent) among female turkeys
on farm A was high. However, experimental evidence suggests that turkeys
develop insufficient levels of WNV viremia to contribute to a bird-mosquito-bird
amplification cycle (ref. 3). Although WNV was detected in the feces of
these turkeys, no oropharyngeal shedding or transmission to cage mates
was observed (ref. 3). Nonvector-borne WNV transmission has been demonstrated
experimentally among rodents and among certain bird species other than
turkeys (refs. 4,5). Once WNV was introduced to female turkeys at farm
A (presumably by mosquitoes), widespread transmission within that flock
might have taken place by fecal-oral, respiratory, or another atypical
(e.g., percutaneous exposure associated with pecking behavior or vaccination)
route. In addition, other unique conditions at farm A, including possible
co-infection with an avian pox virus, might have resulted in higher WNV
viremias or infectious materials with higher WNV titers than laboratory
studies have suggested.
- Despite uncertainty over the mode(s) of transmission,
epidemiologic evidence suggests that this outbreak was related to occupational
exposure. Occupationally acquired WNV infections have been reported previously
among laboratory or field workers who experienced a known percutaneous
injury or aerosol exposure while working with high concentrations of WNV
in cell culture or infected animal tissues (refs. 6, 7, 8, 9). In this
investigation, no such exposure was documented. Because the mode of transmission
in this outbreak is unknown, turkey handlers should 1) take personal protective
measures, including wearing protective clothing and using mosquito repellents
(e.g., those containing DEET on skin and clothing and those containing
permethrin on clothing), as recommended for outdoor workers; 2) wear gloves;
and 3) wash hands frequently. In addition, respiratory protection has been
recommended for reducing other exposures to workers in turkey barns (ref.
10). Respiratory protection should be selected and used in accordance with
the Occupational Safety and Health Administration (OSHA) respiratory protection
standard (Title 29 CFR 1910.134).
- Workers should receive training that reinforces awareness
of potential occupational hazards and risks and stresses the importance
of timely reporting of all injuries and illnesses of suspected occupational
- Health-care workers should inquire about a patient's
outdoor exposure and occupation when a human WNV infection is suspected
or identified and consider WNV as a possible etiology among turkey farm
workers with febrile headache or rash, meningitis, encephalitis, or other
severe neurologic illness, especially when WNV illnesses exist among co-workers
or birds. Suspected occupationally acquired WNV infections should be reported
immediately to local and state health departments.
- The investigation of turkey breeder farm workers in county
A is ongoing. In addition, further studies are needed to determine the
factors involved in this outbreak, to better define the occupational risk
for WNV infections, and to assess appropriate personal protective measures.
On the basis of recommendations from public health staff, the company has
made mosquito repellent containing 30 percent DEET available at farm A
and other turkey breeder farms. Recommendations that were outlined previously
in place at the company farms include protective clothing, frequent hand
washing, and an OSHA-required respiratory protection program. Gloves and
safety glasses also are available to workers.
- (1) Martin DA, Muth DA, Brown T, Johnson AJ, Karabatsos
- JT. Standardization of immunoglobulin M capture enzyme-linked
- immunosorbent assays for routine diagnosis of arboviral
- Clin Microbiol 2000;38:1823--36.
- (2) Beaty BJ, Calisher CH, Shope RE. Arboviruses. In:
- Lennette DA, Lennette ET, eds. Diagnostic Procedures
- Rickettsial, and Chlamydial Infections, 7th ed. Washington,
- American Public Health Association, 1995.
- (3) Swayne DE, Beck JR, Zaki S. Pathogenicity of West
Nile virus for
- turkeys. Avian Diseases 2000;44:932--7.
- (4) Odelola HA, Oduye O. West Nile virus infection of
adult mice by
- oral route. Archives of Virology 1977;54:251--3.
- (5) Komar N, Langevin S, Hinten S, et al. Experimental
- North American birds with the New York 1999 strain of
- virus. Emerg Infect Dis 2003;9:311--22.
- (6)Pike RM. Laboratory-associated infections: summary
and analysis of
- 3,921 cases. Health Laboratory Science 1976;13:105--14.
- (7) Sewell DL. Laboratory-associated infections and biosafety.
- Microbiol Rev 1995;8:389--405.
- (8) Nir YD. Airborne West Nile virus infection. Am J
Trop Med Hyg
- (9) CDC. Laboratory-acquired West Nile virus infection---United
- States, 2002. MMWR 2002;51:1133--5.
- (10) Reynolds SJ, Parker D, Vesley D, Janni K, McJilton
- Occupational exposure to organic dusts and gases in the
- growing industry. Appl Occup Environ Hyg 1994;9:493--502.
- Perhaps the most significant aspects of this investigation
- occupation-related exposure of humans to West Nile virus
- and the likelihood of non-vector transmission of West
- between farmed birds, which also happens with another
- equine encephalitis virus. - Mod.CP/JW
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
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- Zhan le Devlesa tai sastimasa
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