• Florida: (Updated Dec 19, 2002) The first occurrences of WNV in 2002 were in a wild turkey (reported Jan 10), a chicken (Jan 28), and a horse (Feb 7). The wild turkey was found just 10 days after FL had removed 53 counties from the 2001 WNV alert. The first human case was in a Sumter Co resident on Aug 13 2002. As of Dec 19, 29 human cases with 2 fatalities have been confirmed WNV-positive. News reports at the end of Nov 2002 indicate that WNV is again likely to be a year-round issue and surveillance for arboviruses including WNV are continuing. In late Nov, 2 men were confirmed as the first human cases of the year in Palm Beach Co and county health officials report that while moquito numbers are down, WNV-infected mosquitoes are still biting and have infected 2 sentinel chickens in urbanized areas of the county. As of Dec 16 2002, 56 mosquito pools in 8 counties, 434 dead birds in 45 counties, 957 sentinel chickens in 29 counties, 494 horses in 45 counties and 6 other animals from 3 counties were confirmed WNV-positive. In 2001 sentinel chickens tested WNV-positive in 20 counties and provided the first warning of the virus in four.
  In 2001, 12 human cases were confirmed. Florida was the site of the first reported human infection for 2001, announced July 27, in a 73 year-old man from Madison County (onset around July 15); the second, a 64 year-old woman from Madison Co (ann. Aug 4); the third, a 40-year-old man from Jefferson Co (ann. Aug 20); the fourth, a 73-year-old woman from Sarasota Co who is believed to have contracted the virus while visiting Marathon in the Florida Keys in July (ann. Aug 24); the fifth, a 50 year old man from Monroe Co (ann. Sept 19); the sixth, a 73 year old woman from Washington Co (ann. Sept 21); the seventh, a 54 year old woman from Monroe Co. The two cases in Monroe Co add weight to suspicions that the woman from Sarasota Co contracted the virus while in the Florida Keys (Monroe Co); the eighth, a 44-year old male from Duval County in the NE corner of the state, the location of Jacksonville (ann. Oct 3); the ninth, a 36-year-old woman in Leon Co in the northern panhandle, site of Tallahassee, who developed symptoms in mid-Sept and is now recuperating (ann. Oct 10). An additional case is reported from Putnam Co (near Duval). The latest cases as well as several others in Connecticut, Florida, NJ and NY are in people in their thirties, forties or early fifties. At least 49 of 68 Florida counties are on medical alert for WNV. Three of the human cases in Florida appear to have been contracted in or near the Florida Keys, at the southern tip of the state, only a hop, skip and jump away from the Caribbean Islands, where WNV has now been confirmed in the Cayman Islands.
  The first confirmation of WNV in Florida was announced July 6 2001, in a crow found in Jefferson Co. As of Nov 13 2001, WNV has been confirmed in 545 wild birds (up from 217 on Sept 21), 170 sentinel chickens (up from 21 on Sept 21), and 17 mosquito pools (same number reported Sept 21). Most of the WNV activity was in the northern part of the state [More on Weekly surveillance updates].
  The vast majority of equine cases in 2001 were in Florida (43 as of Aug 24 2001; 74 as of Sept 12; 105 as of Oct 1; 139 as of Oct 15; 205 as of Oct 26 in 30 counties; 281 as of Nov 13 in 33 counties; 492 as of Dec 31 in 42 counties), mostly in northern FL (except for recent cases in Broward and Palm Beach {ann. Oct 20} Counties, in southern FL), and additional cases in the same region but across the border in southern Georgia. Out of the 492 horses, 82 died or were euthanatized.
  [Florida Dept of Health West Nile Virus Information: http://www.doh.state.fl.us/disease_ctrl/epi/htopics/arbo/index.htm
  Florida Dept of Agriculture and Consumer Services WNV/EEE Information: http://doacs.state.fl.us/~aes/westnile2001/WestNile.htm]
  
  
• Georgia: (Updated Dec 19 2002) As of Dec 19 2002, 118 of GA's 159 counties had detected WNV. WNV has been confirmed in 43 humans (7 fatalities):
  1) 51-year-old from Atlanta (fatal; ann Aug 22)
  2) 53-year-old man from Covington (ann Aug 22)
  3) 69-year-old woman from Perry (ann Aug 22)
  4) 77-year-old man from Columbus (fatal; ann Aug 22)
  5) 52-year-old man from Columbus (ann Aug 22)
  6) 46-year-old man from Columbus (ann Aug 22)
  WNV has also been confirmed in 926 birds, 164 horses and 95 mosquito pools. The first WNV-positive bird was found May 15, 2002.
  In 2001, 6 persons from widely dispersed sites (5 counties) within the state were confirmed WNV-positive. DPH advised that mosquitoes may persist throughout the year in the mild climates of southern Georgia, presenting some year-round WNV risk. The first person to die from WNV in 2001 was a 71-year-old Atlanta (Fulton Co) woman who died Aug 11 after 12 days of treatment [More]. On Dec 4 Georgia DPH announced 5 additional cases with illness onset presumed between Sept and Oct: a 68-year-old man from Pierce Co in SE Georgia, a 61-year-old from Macon Co (west central), a 73-year-old from Richmond Co (east central on South Carolina border), a 70-year-old from Wayne Co (SE, adjacent to Pierce Co) and another patient from Wayne Co.
  By end of 2001, 68 horses in 26 counties were confirmed WNV-positive (22 fatalities). The first case was announced Aug 16. According to Fort Dodge Animal Health, over 25,000 doses of WNV vaccine were distributed to Georgia veterinarians during the month of Aug 2001.
  Three flamingos (2 adult, 1 chick) that died at Zoo Atlanta late Aug-early Sept 2001 tested WNV-positive, zoo officials confirmed Nov 28. 2001 The virus was discovered in routine examinations of the dead birds. "Natural causes" were given as the official cause of death because the zoo said that "we can't say conclusively that they died [as a result of WNV infection], only that they tested positive. Little is known about what symptoms flamingos would show once infected, so it's difficult to diagnose" [Note that disease pathology in the flamingos that died at the Bronx Zoo in NYC in 1999 is detailed in Steele et al. 2000. Pathology of Fatal West Nile Virus Infections in Native and Exotic Birds... Veterinary Pathology 37(3): 208-224].
  Georgia's first indication of WNV was an infected crow in Lowndes Co in July 2001. By end of 2001, 326 birds were found WNV-positive in 55 geographically dispersed counties. Testing in Georgia was done by the Southeastern Cooperative Wildlife Disease Study at the University of Georgia in Athens.
  On Sept 29 2001, a Georgia newspaper reported that a dog showing clinical symptoms of WNV was confirmed to be infected, treated by its vet, and recovered sufficiently to go home. Later, it was thought that WNV neither sickened nor even infected the 2-year-old male Labrador retriever. There are still no confirmed clinical canine cases in the US [More]. However, in 1999 CDC found 3 positive sera from healthy dogs in a preliminary screening of 84 dog serum samples from New York City [More] and similar findings had been made decades previously in Africa. (There was a published report of WNV isolated from a dog in Botswana, S. Africa in 1982).
  [Georgia Division of Public Health: http://health.state.ga.us/epi/vbd/mosquito.shtml]
  
  
• Hawaii: (Website Checked Dec 19 2002) No infections/transmission within the state have been detected, but the state health dept reported Nov 27 that a WNV-infected tourist from Minnesota had arrived Sept 29, and had since returned home and recovered. "The State Dept Health is working toward taking necessary precautions to prevent this virus from coming to islands."
  [Hawaii Dept Health WNV page: http://www.state.hi.us/doh/wnv/index.html]
  
  
• Idaho: (Website Checked Dec 19 2002) The first case of WNV was in a horse in Canyon County (which borders Oregon, in southern ID) in mid-October. WNV had previously been detected in a raven in a neighboring county in NE Washington, so was expected in Idaho. The Idaho Dept of Health and Welfare launched a WNV informational website mid-Aug 2002. Mosquito and dead bird surveillance and testing were conducted Summer 2002, with negative results only. A 47-year-old Ada Co, ID man diagnosed with WNV is thought to have contracted the disease while on a trip to the East Coast (ann Sept 6, 2002).
  [ID Dept Health and Welfare News Releases: http://www2.state.id.us/dhw/news/nr.htm]
  
  
• Illinois: (Updated Dec 19 2002) WNV surveillance began for 2002 on May 1, and the first occurrence in 2002 was a dead crow found May 2 in Kane Co (NE IL, W of Chicago). Due to heavy rains and flooding in the spring, increased risk for mosquito-borne diseases was expected this year [More].
  As of Dec 18 2002, WNV had been detected in 100 of 102 IL counties and is presumed to also be in the others (Alexander and Calhoun). As of Dec 19, 778 human cases (52 fatalities) were reported by the IL DOH. The first human case was a 22-year-old Maryland woman who contracted WNV while living and working near Chicago (onset Jul 26, experienced only mild symptoms and recovered without hospitalization). Human cases have ranged in age from 3 mn-97 years (average=56 yr) [More Human Data].
  As of Dec 19 2002, 1,084 horses, 528 mosquito pools and 513 birds tested WNV-positive. The U Illinois School of Veterinary Medicine also found WNV in 3 grey squirrels from Cook Co, a dog from Mclean Co and a wolf from Will Co [More].
  WNV was first confirmed in Illinois Sept 5 2001, in 2 dead crows from the Chicago metropolitan area. In 2001 a total of 138 birds from 7 counties near Chicago and the southern tip of Lake Michigan (Cook, Crawford, DuPage, Kane, Lake, McHenry, and Will) tested positive. In addition, 2 horses, 1 from Cook Co and 1 from Kane Co tested WNV-positive (1 fatality). The Cook Co horse that became ill Sept 30 had no history of recent travel and was the first confirmed equine case of clinical WNV infection detected in Illinois (ann Oct 25 2001). Ten mosquito pools collected in the Cook Co suburbs of Chicago were also identified WNV-positive in 2001.
  [Illinois Dept of Public Health: http://www.idph.state.il.us/envhealth/wnv.htm]
  
  
• Indiana: (Updated Dec 19 2002) In 2002, 87 of Indiana's 92 counties had detected WNV indicating that WNV was widespread throughout the state. The IN DOH reported 104 presumed human cases with 8 fatalities though CDC only reports one fatality. The first human case was a 46-year-old resident of Wabash Co (ann Aug 9). Health officials warn against large numbers of Culex mosquitoes which only bite humans on occasion since a high percentage of them have been testing WNV-positive.
  On Aug 26 2002, the IN DOH stopped testing of birds in counties that had at least one confirmed case of WNV in order to make the most efficient use of laboratory resources. As of Dec 19, 688 horses had tested WNV-positive. The first WNV-positive bird was found June 5, 2002. On May 1, the ISDH reported wet and warm conditions in Indiana, ideal for the growth of mosquito populations and expect a higher risk of transmission of WNV in 2002.
  In 2001, 47 birds in 7 counties were confirmed WNV-positive, the first case of WNV in IN was confirmed Aug 21 2001, in a crow from central IN (Marion Co -- location of Indianapolis) [More]. The first equine case was was a 5-year-old mare from NC IN (illness onset Oct 16; ann fatality Oct 30). The cases from far flung corners of the state indicated that the virus was present throughout the state. As of Sept 7, the Indiana State Department of Health had collected and tested 4643 live birds from 33 counties, 8410 mosquitoes from 13 counties, as well as 13 dead birds from 7 counties.
  [Indiana State Dept of Health News Releases: http://www.IN.gov/isdh/whatsnew/news/newsrelease.htm]
  
  
• Iowa: (Updated Dec 19 2002) In 2002, WNV has been detected in all of IA's 99 counties. As of Dec 19, 51 human cases with 2 fatalities had been confirmed WNV-positive. As of Nov 19, the Iowa DOH reports 113 WNV-positive birds, 1039 WNV-positive horses, 31 WNV-positive chickens, 8 WNV-positive mosquito pools and 1 squirrel. The first WNV-positive bird was found Jul 15, 2002 in Scott Co.
  On Sept 14 2001, a WNV-positive crow was reported in Scott Co (eastern IA) in the town of Walcott (quad cities area), the first case of WNV in Iowa.
  [Iowa Dept of Public Health News Releases: http://www.idph.state.ia.us/news_rel/list.htm]
  
  
• Israel: (Updated Oct 22 2002) The Israeli Health Ministry ann Oct 16 that there have been 26 human cases of WNV in 2002 (2 fatalities) in Kiryat Gat, Migdal Ha'emek, Kfar Sava, Hadera, Rishon Letzion, Kiryat Tivon, Or Yehuda, a moshav near Eilat, and 3 towns in the Negev. A 48-year-old man and a 40-year-old woman from the Eilat region were the first human WNV cases in 2002 (mild clinical symptoms appeared late July, ann Aug 16). WNV-positive mosquitoes were detected May 13, 2002, during a routine inspection in the Negev Desert, and in July WNV-positive mosquitoes were reported from the southern part of the Arava and north of the Dead Sea. In 2000 and 2001 infected mosquitos were first detected in August [More]. It is thought that the infected mosquitoes were detected earlier in 2002 due to the heavier rains than usual during the past winter and into the spring (600 mm in the Negev this year, as compared to an average 350 mm). In early Aug 2002 Aedes caspius, a diurnal species of mosquito (i.e., active in daytime), was identified as a WNV vector and detected in the Southern Arava and on the Carmel Coast. Previously only nocturnal Culex mosquitoes (Culex pipiens and Culex perexiguus) had been identified as WNV vectors in Israel (see Nir et al. 1972 and Samina et al. 1986 for details on historical information about WNV vector species in Israel).
  Israel is on the migratory route of many bird species between Europe and Africa. The first descriptions of WNV date to the 1940s, with repeated outbreaks during the 1950s and sporadic episodes since. [For more information search the WNV Bibliography of Scientific Literature, keyword Middle East and see "West Nile Fever in Israel 1999-2000: from geese to humans" Bin et al. Annals of the New York Academy of Sciences 951 :127-142 (2001).]
  The Israeli Environment Ministry and its Jordanian counterpart signed an agreement to combat spread of WNV by joint efforts to locate and destroy mosquito-hatching grounds. In 2002 10.5 million NIS (appx $2.15 million US) was allocated for WNV prevention and control [More].
  In 2001, Ha'aretz reported there were 36 people infected (3 fatalities) (Oct 17, 2002, cited in ProMED Oct 20), but elsewhere as many as 44 confirmed cases were reported, with first reports of human illness in 2001 in early Aug. In 2000 452 human cases were reported, primarily from the central and northern parts of the country, peaking in Sept and declining in Oct (29 fatalities, all but one older than 68).
  [Jerusalem Post: http://www.jpost.com; Ha'aretz: http://www.haaretzdaily.com]
  
  
• Kansas: (Updated Jan 31 2003) In 2002, WNV was confirmed in 103 of KS's 106 counties in humans, birds, mosquitoes, horses and a mule. There were 22 human cases (0 fatalities) reported in KS, the first cases were confirmed on Oct 11.
  1) 52-year-old from Wyandotte Co (onset 12 Aug; ann Oct 10)
  2) 58-year-old from Rice Co (onset 15 Aug; ann Oct 10)
  3) 29-year-old from Rice Co (onset 16 Aug; ann Oct 10)
  4) 72-year-old from Rice Co (onset 28 Aug; ann Oct 10)
  5) 28-year-old from Shawnee Co (onset 30 Aug; ann Oct 10)
  6) 75-year-old from Johnson Co (onset 16 Sept; ann Oct 11)
  In 2002, a total of 793 WNV-positive equine cases in 100 counties, 21 WNV-positive mosquito pools in 6 counties, and 170 WNV-positive birds from 36 counties were detected. Dr. Sanjay Kapil (chief virologist at the KSU Veterinary DiagnosticLaboratory) ann Aug 8, one horse from Winfield (Cowley Co; S. KS) tested WNV-positive. This was the first time WNV was detected in Kansas.
  WNV surveillance began in Sept 2001 in conjuction with Kansas State University, with 600 mosquito pools, 100 sentinel chickens, and 45 birds tested. All 2001 results were WNV-negative.
  [KDHE News Releases: http://www.kdhe.state.ks.us/news/]
  
  
• Kentucky: (Updated Jan 31 2003) As of Jan 14 2003, WNV has been detected in 109 of KY's 120 counties. The Kentecky Dept of Public Health confirmed 56 human cases with 19 probable cases in KY:
  1) 84-year-old man from Union Co (western, on Ohio River and Il border) who had multiple health problems (hospitalized since early Aug; died Aug 19; ann Aug 20)
  2) resident of Jefferson Co
  3) resident of Jefferson Co
  As of Jan 14 2003, the WNV-positive totals for 2002 are 690 birds, 513 horses and 55 mosquito pools. Kentucky has been actively conducting surveillance for WNV since early 2000. Dead bird surveillance is ongoing throughout the state. Mosquito testing is being conducted in eight health districts -- Fayette and Jefferson counties, Northern Kentucky, Gateway, Barren River, Kentucky River, Green River & Purchase districts.
  In 2001, all cases of WNV were found in the northcentral part of the state. As of Nov 15 2001, 8 horses in 8 counties (6 fatalities) were identified WNV-positive, of 111 horses tested. A ninth horse was diagnosed in Kentucky, but was exposed in Florida. The 3-year-old horse from Bourbon Co (northern KY) confirmed WNV-positive on Sept 19 (disease onset on or before Aug 23; ann Aug 31) which had not recently travelled, was the first time WNV had been detected in the state.
  As of Nov 15, 44 birds were found WNV-positive, of 514 birds tested. The first WNV-positive birds for Kentucky were confirmed Sept 19: 1 crow and 2 sparrows from Jefferson Co, 1 grackle from Woodford Co.
  Six of 381 mosquito pools tested WNV-positive in 2001.
  [Kentucky Department for Public Health: http://chs.state.ky.us/publichealth/west_nile_virus.htm]
  
  
• Louisiana: (Updated Jan 31 2003) In 2002, 329 human cases with 24 fatalities were confirmed. As of Sept 23, the number of human cases had reached 261 (11 fatalities) and health officials were worried about the direction of the outbreak in Rapides since it is one of the two heavily populated areas without an established mosquito control program. Human cases of WNV have been detected almost 3 months earlier in LA in 2002 than in 2001. Fatalities include:
  1: 83-yr-old woman from Baton Rouge (died Jul 29)
  2: 53-yr-old man from Folsom (St. Tammany Parish) (died Jul 29)
  3: 75-yr-old man from Baton Rouge (died Jul 4)
  4: 72-yr-old man from Iowa (Calcasieu Parish) (died Jul 29)
  5: 76-yr-old woman from St. Tammany Parish (died Jul 4)
  6. 94-year-old female from Tangipahoa (ann Aug 9)
  7. 76-year-old female from St. Tammany (ann Aug 9)
  8. 78-year-old man (ann Aug 16)
  Human cases of WNV are from 30 parishes including Jefferson, Orleans, St. Bernard, Ascension, E Baton Rouge, E Feliciana, Iberville, Point Coupe, W Baton Rouge, St James, St John, Terrebonne, Evangeline, Lafayette, St Landry, St Martin, Allen, Calcasieu, Bossier, Red River, Ouachita, Tensas, Union, Livingston, St Helena, St Tammany, Tangipahoa and Washington Parishes. At least 51 cases are in people under the age of 30.
  CDC director Dr. Julie Gerberding announced that health officials in Louisiana will soon receive additional funding of $3.4 million for public health efforts related to the outbreak.
  
  The Office of Pulic Health has ceased testing of dead birds in parishes that have shown WNV to be endemic [More]. As of Sept 22, 306 horses and as of Aug 16, 167 dead birds had tested WNV-positive. The first occurance of WNV in 2002 was confirmed Feb 7 2002, in a horse from Cameron Parish (SW Louisiana along the Gulf Coast) that was diagnosed in January 2002; this case illustrates that WNV has a year-round season and that the winter was not cold enough to prevent its spread. As of June 24, 2002, 3 mosquito pools tested WNV-positive. Two pools were Culex quinquefasciatus one found in Baton Rouge (E. Baton Rouge Parish) and the other in Covington (St. Tammany Parish, SE LA). Culex quinquefasciatus are the same species of mosquitos that were involved with the St. Louis Encephalitis outbreak in N. LA in 2001. The third pool were Culex salinarius found in Slidell (St. Tammany Parish, SE LA). Culex salinarius are the most abundant pest mosquito in LA.
  There have been 81 WNV-positive birds so far in 2002 all from S. LA including Ascension Parish (14), East Baton Rouge Parish (19), East Feliciana Parish (1), Iberville Parish (3), Jefferson Parish (11), Jefferson Davis Parish (1), Livingston Parish (3), Madison Parish, St. Tammany Parish (10), Tangipohoa Parish (12), Washington Parish (1) and West Baton Rouge Parish (6). The detection of WNV in Washington Parish, is the first time WNV has been detected there.
  The Office of Public Health ann that testing of birds will be suspended in Ascension Parish (East bank of the Mississippi River only), East Baton Rouge Parish, East Feliciana Parish, Jefferson Parish, Ouachita Parish, St. Tammany Parish, Tangipahoa Parish, and West Baton Rouge Parish (Port Allen only). Health officials know that WNV is present and well-established in all of these areas.
  
  In 2001, the first (and only 2001) human case in LA was a middle-age "drifter" from Kenner, just west of New Orleans (infected mid-Sept; hospitalized Sept 29; ann Oct 22). This case was not thought to be an indicator of high levels of WNV in the state with general risk to the human population, but rather to reflect a somewhat atypical situation of a person who spent much time out-of-doors and "on the streets" near the area where WNV activity had already been confirmed in birds. "It is not extraordinary that a person who is outside a lot and not taking [anti-mosquito] precautions has come down with the disease," said Dr. Raoult Ratard, state epidemiologist. "But I don't think we are going to have an outbreak. It's very late in the season." CDC cautioned that WNV can be transmitted year-round in mild southern climates.
  In 2001, according to USDA APHIS there were 9 equine cases (10 according to Louisiana OPH) in 4 southern parishes with 3 fatalities. The first case was announced Sept 4 (a 7-year-old Quarter-horse mare unable to move Aug 21, euthanatized Aug 23).
  In 2001, 6 birds (all from Jefferson Parish, just outside New Orleans) were confirmed WNV-positive (first one, a blue jay found July 23, ann Aug 15). An AP news story reported that officials with Mosquito Control Inc., which contracts with Jefferson Parish to spray insecticide, said that the company surveyed the East Jefferson area where the birds were found for obvious mosquito breeding grounds, but none were found. However, inspectors said mosquitoes may have been able to breed in standing water that pooled under buildings where the ground had subsided. The company had already stepped up efforts to track populations of the mosquito species that were known to carry the virus. It was also using trucks to spray the highest concentration of insecticide allowed by the EPA within a 3-mile radius of where the dead birds were found. "The entire parish is getting sprayed with a higher concentration, but the area where the birds were found will get the highest," Machado said.
  The cluster of suspected WNV cases in Ouachita Parish in the north-central part of the state was confirmed in early Sept 2001 to be St. Louis Encephalitis (SLE)--making this what appears to be the largest outbreak on record of SLE in Louisiana, with 63 confirmed human flavivirus cases, including 2 deaths as of Sept 23 2001. Five weeks into the epidemic, the epidemic curve appeared to be winding down, with new cases found at a rate of about 1/day. Presumed vector was Culex quinquefasciatus, the Southern House Mosquito, which breeds and behaves much like Culex pipiens, the Northern House Mosquito.
  [LA WNV info: www.fightthebitelouisiana.com; Louisiana Dept of Health and Hospitals: http://www.dhh.state.la.us/
  Office of Public Health: http://www.oph.dhh.state.la.us/infectiousdisease/westnile/index.html]

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