Experts Regroup on West Nile Virus

ALBANY, N.Y. (AP) - It is spring, and an epidemiologist's thoughts turn to the West Nile virus - the germ that arrived in this country two years ago, imperiling lives and causing alarm along the East Coast.

This year, say public health officials, they are prepared to deal with the mosquito-borne virus. Their plans include less pesticide spraying and more education. More efforts to eradicate larvae, and to deprive mosquitoes of places to breed; less testing of dead birds in some places.

But regardless of what they do, they expect the virus - already detected in New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Maryland and the District of Columbia - to spread southward and westward.

``It will get into places like Florida, Georgia, Texas and Mississippi,'' said John Roehrig, chief of the arbovirus diseases branch of the Centers for Disease Control and Prevention.

The CDC will spend $16 million to track the virus, and will test as far west as California.

The tracking of the disease is much more sophisticated than it was in the first two years of its spread, and authorities say this gives them an advantage as they face the summer of 2001.

``We have good surveillance data now which we didn't have before,'' said Ralph Timperi, director of the Massachusetts State Laboratory Institute. ``With New York and New Jersey as well as Massachusetts, we have gotten better at targeting human risk, and knowing when it is significant.''

In 1999, there were 62 confirmed cases of encephalitis traced to the West Nile virus and seven deaths. Last year, there were 14 confirmed cases and one death.

Most of those infected with the virus suffer from flulike conditions; authorities believe most cases are so mild that those infected never imagine that they have had the disease that led some people to shut themselves inside their homes during the summer.

The disease can be fatal for some older people or those with weakened immune systems. But it appears that contrary to what was originally believed, the very young are not at high risk.

``We are not about to say that West Nile is something that we can ignore or that people should dismiss it,'' said New York State Health Department spokeswoman Kristine Smith.

``It can be a serious health concern. It is something that we have to stay on top of. But it is not something that people have to lose sleep over. It is not something that people should lock their windows and doors and stay inside all summer over.''

New York has put together a master plan to combat West Nile. It includes:

-Determining where mosquitoes are most apt to breed through geographic ``mapping'' of stagnant water and low-lying areas. This should be accompanied by the trapping of mosquitoes as they appear to monitor the presence and activity of the insects.

-Extensive and early applications of larvicide to those areas. There are plans to use Bti, a bacteria that feeds on developing mosquitoes.

-Running a public education campaign to caution people about the need to eliminate areas where mosquitoes might breed - spare tires, clogged gutters, stagnant bird feeders and the like - and how they can use insect repellants and proper clothing to avoid infection.

-Sending only a fraction of the dead crows found locally to the state laboratory for verification that the birds were killed by the virus. While crows remain an excellent indicator of the virus' presence, the 7,000 birds sent to Albany last year for diagnosis overwhelmed the capacity of state laboratories to test them. Better to get limited test results back in a week than to wait for a month, said Dr. Lloyd Novick, health commissioner in Onondaga County.

Other states have similar plans. New Hampshire, expecting a heavy mosquito season after a record amount of snow this winter, plans more education for elderly residents through senior citizens centers and Meals on Wheels programs. New Jersey is targeting tire dumps and other likely breeding grounds for clean up, and is adding staff for testing and reporting outbreaks.

Rhode Island will provide larvicide to all its cities and towns. In Connecticut, officials plan to put out mosquito traps in 91 places around the state. The state also plans to get the word out in dozens of ways, from refrigerator magnets with a mosquito hot line number to grass-roots meetings with health experts and community leaders.

In Maryland, officials say they are undecided about whether to spray pesticides in areas where infected birds are found. That was the practice last year, and some communities feared that the poisons presented more health risks than did the disease.

The same debate is under way elsewhere. In New York, officials have decided to go ahead with wide-scale spraying only in cases where an outbreak of West Nile virus is under way or is likely. Connecticut also recommends less spraying this year.

All of these measures are costly. New Jersey plans to spend $4.5 million, including a $2 million federal grant; Pennsylvania has distributed $3.3 million in grants to county West Nile coordinators to cover the costs of equipment, supplies and training.

New York, the state with the highest number of West Nile cases, also has the costliest plans to combat the disease. It has applied to the CDC for a $10 million grant to use for surveillance and a public education program. The administration of Gov. George Pataki also intends to offer $22 million in matching grants to the state's 62 counties and New York City.

But the money is caught up in the state's yearly battle over its budget. The new budget was supposed to be approved by April 1, but it is late again this year; in 1999, no budget was approved until Aug. 4. Public health officials worry that unless they get an emergency appropriation to deal with West Nile, they will lag in their efforts to control the disease.

``Mosquitoes don't wait until the budget process is over to begin to breed,'' Novick said.

Centers for Disease Control and Prevention: www.cdc.gov/ncidod/dvbid/westnile/resources

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