E D I T O R I A L

Bugging the system: West Nile virus Nancy J. arard

RN

reventing the devastating effects of microorganisms on patients and health care work- ers is a major goal of perioper- ative nurses. The increasing

incidence and migration around the world of viruses, such as the West Nile virus (WNV), require continuing updates and potential modifications to perioperative care. These microorgan- isms are spreading faster than science can keep up with them, bugging not only the human system, but the health care delivery system as well.

The impact of these virulent agents was made clear to my family recently. A family member suddenly became ill with unusual symptoms that mimicked several neurological disorders. Pain, weakness, severe headaches, increasing numbness, and weakness in her legs and arms, along with mental changes, led to a scary hospitalization. After a week of diagnostic testing, the results came back. She had WNV and, conse- quently, earned a number as a Texas victim of WNV Luckily, despite the severity of neurological symptom, she recovered completely within three months. Her health care provider com- municates with her frequently, sharing the newest Centers for Disease Control and Prevention (CDC) updates about the disease. As my family members and I gained

knowledge about WNV, it became clear that the disease could have ramifica- tions in the OR. For example, my fami- ly member’s neurologist told her that she could never donate blood again because the virus can be contracted via a blood transfusion. She also could never donate an organ. Another piece of information was that she should never get a flu shot. Unfortunately, this was after she had gotten the flu shot, so she did have a minor relapse.

WHAT IS WNV? Most people tie the appearance of

WNV in the United States to New York in 1999. A number of dead birds were found in New York City that year, and a relationship was estab- lished between the birds and an increased incidence of encephalitis and meningitis in humans.’ The causative culprit was identified as a fla- vivirus. Other flaviviruses are yellow fever, Japanese encephalitis, dengue, and Saint Louis encepha- litis. The cvcle of trans- mission f& WNV is infection of a bird, which is bitten by a mosquito that then bites human and other hosts, such as horses, to transmit the VirUS.2

West Nile virus has spread rapidly across the nation in just four years. Statistics from the CDC through December 2003 show a total of 8,734 diagnosed cases in 2003, and 208 of the infected Datients died? Cases

I n four years, West Nile Virus

has spread across the nation. In

2003, there were 8,734 cases and 208 deaths from

the disease. have shown up in almost every state, but a few states have the majority of WNV cases, including Colorado (2,477 cases with 45 deaths), Nebraska (1,760 cases with 21 deaths), and South Dakota (1,013 cases with 21 deaths). Although Texas has had only 586 diagnosed cases, it has the largest ratio of deaths at 32.3 General recommendations for prevention from the CDC are to minimize potential exposure to mosquitoes, use repellent containing N,N-diethyl-3-methylbenza- mide (ie, DEET), and report any inci- dence of dead birds. Links to individual state and local

government WNV web sites can be

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found at http://m.cdc.gov /ncidod/dvbid/zuestnile/city - sfates.htm. The World Reference Center for Arbo- viruses, which is located at the University of Texas medical branch at Galveston and is maintained by the National Institution for Allergies and Infectious Diseases, is researching better diagnostic procedures, information about the virus and how it is trans- mitted, and new vaccines and antiviral medicines?

SYMPTOMS symptoms of WNV are

described as none, mild, or serious. The majority of peo- ple infected with the virus have a mild case and exhibit no symptoms at all; thus, researchers cannot determine exactly how many people are infected. Some patients devel- op a mild case of WNV and have symptoms similar to those of flu (ie, fever; head- ache; nausea and vomiting; body aches; swollen lymph glands; skin rash on chest, stomach, and back that lasts several days). Serious cases of WNV occur in about one in 150 people who contract the virus. These people can have encephalitis, meningitis, high fever, severe headache, stupor, disorientation, muscle weak- ness, vision disturbances, numbness in limbs, paralysis that can be permanent, or they may die. Diagnosis can be complicated because WNV mimics neurological disor- ders, such as multiple sclero- sis or Guillian Barre.4 For my family member, these serious

symptoms proved confusing to medical staff members. This was the first case seen at that hospital, and diagnosis was delayed because WNV was not suspected.

IMPLICATIONS FOR PERIOPERATIVE NURSES

There are implications con- cerning WNV for perioperative nurses. Perioperative nurses need to be knowledgeable about the disease. Asking about a positive diagnosis of WNV in preoperative data collection can alert health care professionals to potential problems in patients who have had WNV. These patients may be more susceptible to postoperative viral infections. People older than 50 years of age are at the highest risk for developing sig- nificant symptoms and may develop encephalomyelitis.

Reports to the CDC's ArboNet surveillance system and by private blood collec- tion agencies identified about 1,OOO viremic donors (eg, donors who were infected with WNV without any signs of illness at the time they donated blood) from January to September 2003.5 Routine blood and body secretion pre- cautions among health care workers seems to be suffiaent to provide protection at this time; however, there are docu- mented inadences of the virus being transmitted in breast milk, via blood transfusions and via organ transplanta- tion.I5 Two cases of WNV caused by blood transfusions have been reported in 2003, one in Texas and one in

Nebraska. Perioperative nurs- es should be alert to the possi- bility of WNV in patients receiving blood and report suspected transfusion-associat- ed problems to their managers or state health authorities.

Perioperative nurses are experts in debugging sys- tem. West Nile Virus is caused by just one more bug perioperative nurses need to be aware of and carry in their extensive arsenal of knowl- edge. Awareness will benefit both professional and person- al lives. *o

NANCY J. GIRARD RN, PHD, FAAN

EDITOR

NOTES 1. P Sampathkumar, "West Nile virus: Epidemiology, clinical presentation, dia osis, and re- vention," my0 &ic ProceeJns 78 (Se tember 2003) 1137-1143. 2. "&D research on West Nile virus," National Institute of AUer and Infectious Diseases, h t t p : / L . niaid.nih.govlfact sheets/westnile.htm (accessed 30 Dec 2003). 3. "West Nile virus, 2003 human cases as of December 10,2003," Centers for Disease Control and Prevention, http:/b.cdc.gov /ncidod/dvbid/wes tnile/surv&control CaseCount03.htm (accessed 30 Dec 2003). 4. "West Nile virus: What you need to know. CDC factsheet," Centers for Disease Control and Prevention, h t t p : / b . c d c OZI /ncidod/dvbid/wes tnile/wnvJct Sheethtm (accessed 30 Dec 2003). 5. "Blood transfusion, organ donation and blood donation screening information," Centers for Disease Control and Prevention, http://zuzuzacdc.gov /ncidod/dvbid/wes tnile/qa/transfu sion.htm (accessed 30 Dec 2003).

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