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Too early to tell if West Nile virus will be as bad this year

The failure of the Mississippi Department of Health (MDH) to provide timely and accurate information about the number of West Nile virus (WNV) cases in Mississippi could have reduced the impetus to deal with the problem, said Sen. Alan Nunnelee, chairman of the Senate Public Health & Welfare Committee, who held 2006 hearings into problems at the MDH.

“There was significant underreporting of West Nile Virus,” Nunnelee said. “How that affects the health of most Mississippians is that we know West Nile is a mosquito-borne virus. We live in the Deep South, and mosquitoes are bad in the summertime. When the statistics are significantly underreported, it impacts local governments in the amount of resources they would dedicate to mosquito eradication. It also alerts physicians when patient presents themselves with symptoms that might be consistent with West Nile Virus. It goes way up the radar screen. That is just one aspect.”

The MDH has corrected the problems with WNV reporting, says Carol Jones, a spokesperson for MDH.

“We are getting out the information as quickly as we get it,” Jones said.

In both 2006 and now again in 2007, Mississippi was the first state in the union to report a WNV case. So far in 2007, there have been five reported cases of WNV and one death in Mississippi, according Dr. Lovetta Brown, interim state epidemiologist for MDH. There has been one case in each of five counties: Madison, Scott, Lawrence, Warren and Walthall counties.

“We just have to be really careful because West Nile is here,” Brown said. “It is too early to tell if it is as bad as last year. We have launched campaigns in areas where we have had cases and have also distributed funding to many of the rural counties that were impacted by Katrina so these communities can do more mosquito abating procedures. Those programs, if done properly, are very instrumental in decreasing the cases of West Nile, and that is why we provided funding to the counties that were impacted by Katrina.”

Running the numbers

WNV claimed 14 lives in Mississippi in 2006. There were 184 cases reported in 2006 with the largest number, 30, in Forrest County. That gave the region including Forrest County the highest WNV rate in the state at approximately 21 cases per 100,000 population. There were also 20 cases in Hinds County, 18 in Rankin County and 12 in Harrison County.

The cases reported in 2006 were the highest since 2002 when 193 cases were reported statewide. There were 83 cases and two deaths reported in 2003, and 52 cases and four deaths reported in 2004. There were 70 cases of WNV and six deaths in 2005.

Dr. Ralph Kahler, infectious disease specialist at the Hattiesburg Clinic, said it appears that mosquito-spraying programs in the area have helped prevent the spread of WNV. In 2006 after local authorities learned of the high number of WNV cases, prevention efforts were ramped up. Kahler said the hearings in Jackson did serve to increase awareness of the problem and the response by the local governments.

Knowledge of the presence of the disease also led to increased awareness by health professionals. But Kahler doesn’t think that there were more cases reported in Hattiesburg than other areas simply because of increased awareness.

“Certainly after the first few cases, everyone had a higher index of suspicion,” Kahler said. “But I really do think we had more serious cases last year than in years past. That is the first time it has happened. We don’t know if it is some kind of post-Katrina hurricane aftermath or exactly what. But when we finally did recognize the magnitude of the problem, the spraying programs for mosquitoes got in high gear and it kind of trailed off after that. In years past the Jackson area has been a bit of the leader, but last year we had a profound jump in our cases. The flurry of cases seemed to come in late June and early July. Probably half of our cases came the first month.”

Reporting of WNV is complicated by the fact that 80% of the people who have West Nile never know that they have it because it doesn’t develop into a serious illness. Kahler said approximately 20% of victims have a flu-like illness with fever, aches, rash, some eye pain and sometimes headaches. Approximately 1% will have neurological manifestations of meningitis or encephalitis, and a small percentage of those will have permanent neurological deficit in the form of paralysis or death.

“Death is mostly in the older or more immuno-compromised groups,” Kahler said. “Most of the deaths I have personally seen have been in people over 65. As far as a convalescent period, it may take people months to get back to normal where they aren’t having aches, weakness and difficulty concentrating.”

Residents and business owners need to do their part to help combat the problem. Kahler recommends going around yards and removing anything holding standing water that can serve as breeding areas for mosquitoes. Empty children’s wading pools when not in use, and replace the water weekly in pet dishes and bird baths. If outside and fairly sedentary, he recommends protective clothing and/or a mosquito repellent.

Lisa Taylor, district environmentalist for the MDH region that includes Forrest County, said so far this year they have not had any positive human cases reported in the Forrest County area. It also hasn’t been found in the mosquito population.

“We are trapping mosquitoes regularly to monitor and detect WNV hot spots,” Taylor said. “We work with the public, educating them. We have pamphlets and brochures and attend neighborhood meetings educating the public on what they can do in their neighborhood. One of the most important things is coordinating with county and city efforts regarding spraying and larvicide efforts. Environmentalists are out in the field daily in heavily populated areas checking on wastewater, and are constantly on the watch for areas that might be breeding mosquitoes. If we find such an area, we tell property owners what they can do to prevent mosquitoes from breeding.”

Malfunctioning wastewater systems need to be repaired, and standing water removed. More information on precautions can be found at http://www.healthyms.com/. “Anything as small as a bottle cap that sits undistributed can be conducive to breeding mosquitoes,” Taylor said. “A general walkthrough and cleanup of your area can be very helpful.”

Taylor said the Department of Health has had excellent cooperation with the city and county with mosquito-spraying programs.

“We work with the supervisors and city officials on a regular basis,” she said. “We work with those officials throughout the year.”

West Nile virus is transferred from birds to humans and horses. Birds are very susceptible to WNV, especially blue jays and crows. Dead birds in an area are a good early warning that infected mosquitoes are present. The health department recommends reporting dead birds of all kinds as one of the best ways to help with the surveillance of WNV. Mississippi residents can report a dead bird by calling 1-877-WST-NILE (1-877-978-6453).

Contact MBJ contributing writer Becky Gillette at bgillette@bellsouth.net.

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