DoD West Nile Virus Surveillance ProgramEntomological Value, Implications, &

Lessons Learned

Ben Pagac, Army Center for Health Promotion & Preventive Medicine, Fort Meade, MD

Most rapidly-spreading arboviral disease ever documented

1999

2000

2001

2002

2003

2004

2005

2006

WNV Human Disease*Year Rank Cases Fatalities Hotest States1999 7 62 7 NY2000 8 21 2 NY, NJ, CT2001 6 66 9 NY, NJ, FL2002 3 4,156 284 IL, MI, OH2003 1 9,862 264 CO. NE, SD2004 5 2,539 100 CA, AZ, CO2005 4 3,000 119 CA, IL, SD2006 2 4,189 149 ID, CO, CATotal - 23,895 934

*Military-associated: 2006 - 7AD; 2004 - 3 (1 AD, 2 dep/ret)

DoD Installations/facilities

Since North American WNV Onset Key DoD Surveillance Objectives

1. Rapid, open communication2. Blend multi-agency efforts3. Early detection4. Implement PREVENTIVE vector management 5. Implement measured response planning based on surveillance findings6. Reduce the human disease threat

Field, Lab, Data, Response, Collaboration, Readiness

Field….

• Trapping – type, habitat, frequency• Specimen ID – tools, keys, guides• Adjusted duties – based on resources

(mosquito and dead bird collection)• Specimen handling – cold-chain, shipping• Training - on site & regional, with realistic expectations

WOW! …. A gravid Coquilletidia perturbans with symbiotic acarines

attached antepronotally

That’s so… yesterday

Lab….

• Mission expansion – Regional lab expansion• Specimen processing – volume, tracking, cold-chain• ID verification – spot check, reliability feedback (comm. loop)• Testing – RT PCR• Turn-around: Supplies for field• Turn-around: Results (mosquito trap numbers…immediate!)

Average intervals: 2004 (73k fm / 10k pools) 10d post-collection / 6d post-receipt2006 (6.5k fm / 890 pools) 9d post-collection / 5d post-receipt

Data Reporting…CHPPM Labs – Mosquito Data Flow

Immediate Notification of +Pools – PHONCON, FAX, EXSUM To: FE, PVNTMED, State Health Depts, MEDCOM Reps

Weekly Report Via E-Mail – w/ Bird. Human, Veterinary data To: FE, PVNTMED, DOD GEIS, CDC, interested parties

Web Database- since 2005 To: all people – link also provided from e-mail

Monthly Reports & web database To: State Health Depts.

National Database - ARBONET To: CDC

Triennial DoD Meetings-Summary To: Armed Forces Pest Management Board

Special Projects – Threat/GIS Mapping/Modeling To: Academic/Military Institutions

Response…..

Response…..

VecTest Kit

--

Is abbreviated surveillance worth doing?

In 2006 guidance for 13 sensitive DC sites; 2 - 4 gravid traps, 1 night/week

Year Trap Nights

Ave. Trap Nights

Trap Index

# pos. pools

MIR(X1000)

# positive installations

Range; # positive pools per installation

2005 623 50 12.6 15 2.2 4/13 0-8

2006 534* 41 11 27 4.0 8/13 0-6

*14% reduction

TIs and positive pools - tangible basis for triggering systematic intervention

Trend: positive pools tended to show up when installation TIs exceed 10.

Trap indices at army-supported DC area installations during week of first WNv-positive pool detection and two-weeks after response was initiated.

Does intervention have an impact?

Collaboration….

Examples:

• Intra-DOD – Military Services, DEH, MED, VET, CHPPM, GEIS, WRAIR, USAMRIID, AFIP

• Inter-agency/institution – NPS, USGS, CDC, States, COG, Academia

Current Mosquito Trapping Sites ( Each site = 1 to 20 traps)

NPS Nat. ZooArmyNavy Air ForceArling/Alex.DC

N

West Nile Virus: approximate geographic range

Readiness….

Conclusions• Military Med, Vet, and Engineering resources quickly adapted to the establishment

of a comprehensive National surveillance and response program for a threat of unknown magnitude

• Vocational boundaries were sometimes willingly stretched to accomplish mission• Military efforts blended with, bolstered, and sometimes were the sole source of

National epidemiologic information on the WNV threat• Health threat response measures were data driven• Value of data was maximized by broad & rapid distribution• Trap indices can be predictive of viral activity• Field-expedient wicking assays work• Targeted interventions work• 2006 – Lean DoD Surveillance at sensitive Military (DC) sites proved valid &

valuable; to continue in 2007• Principles & experience gained are being applied OCONUS• Elevated diagnostic capabilities with quick turn-around, large sample capacity,

great accuracy, appropriate equipment, and adaptability are poised to address other potential threats

• Enhanced domestic military field vector surveillance experience, capability, and infrastructure are in place to tackle future potential threats (natural or malicious)

ACKNOWLEDGEMENTS:

DOD Global Emerging Infectious Disease System (CDR Clara Witt)Army Proponency Office for Preventive Medicine (LTC David West)Centers for Disease Control & Prevention (Drs. D. Gubler, C. Moore, R. Wirtz, R. Nasci)US Geological Survey Nat. Wildlife Hlth. Ctr. (Drs. R. McLean, L. Glaser, E. Saito, G.

McGlaughlin)NY State Health Department (Dr. Dennis White)State & Municipal Health DepartmentsCollaborating UniversitiesDC Department of Health (Dr. Peggy Keller, Ms. J. Hinson)US National Park Service (Ms. Jil Sweringen)Smithsonian Institution National Zoological Park (Drs. R. Yates, R. Montalli)Walter Reed Army Institute of Research (LTC J. Ryan)Army/Navy/Air Force Preventive Medicine PersonnelArmy/Navy/Air Force Public Works, Pest Management PersonnelArmy Medical Research Institute for Infectious Diseases (MAJ J. Blow, Dr. Michael Turell)Army Veterinary Clinics (MAJ Felicia Langel)Army Veterinary Command Food Analysis and Diagnostic Lab Air Force Institute of Env., Safety, Occ. Health Risk Analysis (Dr. Chad McHugh)Navy Disease Vector Ecology Center (CDR David Claborn)Army CHPPM–N,S,W (E. Stanwix, D. Kuhr, W. Irwin, J. Harrison, M. Miller, S. Spring)Army CHPPM-N,S,W Survey Officers and TechniciansArmed Forces Retirement Home (T. Bechtol, Andy Dietz)