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--></style><title>WNV Update Aug 20, 2002 & Comments re: CDC
Press Conf</title></head><body>
<div><font face="Georgia" size="+1" color="#505800"><b>1) Latest
News</b></font></div>
<div><font face="Georgia" size="+1" color="#505800"><b>2) CDC Press
Conference (Aug 15) Reporting </b></font></div>
<div><font color="#000000"><br></font></div>
<div><font face="Georgia" size="+1" color="#505800"><b>1) Latest
News</b></font></div>
<blockquote>(for details, maps, background and current information see
the Cornell Environmental Risk Analysis Program's West Nile Virus
webpages <http://www.cfe.cornell.edu/ERAP/WNV>)</blockquote>
<div><br></div>
<div><font face="Georgia" size="+1"
color="#505800"><b>Where:</b></font> West Nile Virus is approaching
the 105th meridian on its trek west, as of Aug 16 detected as
far west as Goshen Co, Wyoming (on the Nebraska border) and in the
Western Great Plains of Colorado. Thus far in 2002, West Nile Virus
has been detected in birds, mosquitoes, humans, horses and/or other
mammals in at least 39 states (in all states east of the Mississippi)
and Washington DC in the US; as well as in Manitoba, Ontario, and
Quebec provinces in Canada; and in people and mosquitoes in Israel. It
has been most recently reported for the first time from Colorado and
Wyoming (ann Aug 16), South Carolina (ann Aug 13), and from Vermont,
for the first time since 2000 (ann Aug 6). Its range has expanded in
each of the 4 years since the initial North American outbreak in 1999,
and has expanded considerably in 2002--already detected in 11 states
where it had not previously been seen (Colorado, Kansas, Minnesota,
Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Texas,
West Virginia, and Wyoming).</div>
<div><br></div>
<div><font face="Georgia" size="+1"
color="#505800"><b>People:</b></font> As of Aug 16, CDC reports 251
human cases of WNV, primarily in the Gulf Coast States (since then
additional cases have been reported in Texas and Tennessee, bringing
total to at least 254). Eight fatalities are reported in Louisiana, 2
in Mississippi and 1 in Illinois. This is more than a doubling in the
number of human cases reported in ERAP's last WNV update on Aug 7 (112
cases, 5 fatalities).</div>
<div><br></div>
<div>A tally of human cases includes 11 states and Washington DC:
Alabama (3), Florida (1), Illinois (9), Indiana (1), Louisiana (147, 8
fatalities), Maryland (1, another contracted disease in Illinois),
Mississippi (55, 2 fatalities), Missouri (5, 1 of whom is resident of
Massachusetts), New York (1), Ohio (2), Tennessee (2), Texas (26), and
Washington, DC (1).</div>
<div><br></div>
<div>Note that these numbers are changing rapidly, state sources are
often a step ahead of reports of confirmed cases released by CDC,
and--because several of the human cases were contracted while
traveling in another state--tallies of human cases by state of
residence are not entirely consistent with those tallied by the
location of the illness. For example, a visitor to Washington State
contracted WNV while in Louisiana, a 22-year-old Maryland resident
contracted WNV while working in Illinois, a 38-year-old Massachusetts
woman became ill in Missouri, a Florida resident likely contracted the
disease in Louisiana, a Texas resident is suspected of having WNV in
Arkansas, and several residents of Alabama and Florida have been
hospitalized in the other state.</div>
<div><br></div>
<div><font face="Georgia" size="+1"
color="#505800"><b>Horses:</b></font><font color="#000000"> As of
August 8, 2002, there are at least 130 cases reported from 15 states:
Alabama (4), Arkansas (2, preliminary), Florida (24), Georgia (2,
unconfirmed), Illinois (3), Kansas (1), Kentucky (3), Louisiana (17),
Minnesota (9), Mississippi (15), Nebraska (12), North Dakota (11),
South Dakota (7), Tennessee (1), and Texas (20). </font>
The number of cases today, nearly two weeks later than this Aug 8
tally, are likely to be significantly higher and the Aug 8 tally
showed a large increase from the numbers reported in the most recent
USDA APHIS tally (July 25):<font color="#000000"> 47 horses from 7
states: Florida (14), Kentucky (1), Louisiana (17), Mississippi (1),
North Dakota (2), Tennessee (1), and Texas (11). North Dakota and
Texas reports are of the first equine cases ever detected in these
states.</font></div>
<div><br></div>
<div>Numbers of equine cases are likely to increase through the Fall.
It should be noted that in 2001 the final tally of<font
color="#000000"> 738 cases in 20 states, was nearly double the 347
cases reported by Oct 31, with dramatic increase during Fall 2001,
from 137 cases reported by Oct 1 and 191 cases in 15 states reported
by Oct 15. </font></div>
<div><br></div>
<div>News releases from health departments throughout the US show
State veterinarians advising horse owners to vaccinate their horses
with 2 doses of the vaccine conditionally approved by USDA APHIS last
summer. The vaccine has also been used recently on captive birds
in the collections of the US National Zoo. Although the initial permit
period has ended, ERAP has recently learned that the conditional
license has been extended with a full licensure hearing expected soon
and that the vaccine can still be ordered from Fort Dodge. The
extension was apparently requested by the company because they had not
compiled all their supporting data.</div>
<div><font face="Geneva" size="-1" color="#999999"><br></font></div>
<div><font face="Geneva" size="-1" color="#999999"><br></font></div>
<div><font face="Geneva" size="-1" color="#999999"><br></font></div>
<div><font face="Geneva" size="-1" color="#999999"><br></font></div>
<div><font face="Georgia" size="+1" color="#505800"><b>2) CDC Press
Conference (Aug 15) Reporting</b></font></div>
<div><font face="Georgia" size="+1"
color="#505800"><b><br></b></font></div>
<div><font face="Georgia" size="+1" color="#505800"><b>A lesson to be
learned </b></font></div>
<div>Late last week the news media were replete with stories about
what's to come with human cases of West Nile Virus, generally
headlining with titles like "West Nile death toll may jump"
(Aug 16 Atlanta Journal-Constitution) or more hyper-pointedly
"West Nile Likely to Make 1000 Very Sick and Kill
100".</div>
<div><br></div>
<div>After reading several press stories (e.g., see full text from
Atlanta-Constitution, below), I assumed that the CDC had called a
press conference in order to make this declaration. Since I was
curious how the CDC had arrived at these numbers* we ferreted
out the full text transcript of the press conference at
<http://www.cdc.gov/od/oc/media/transcripts/t020815.htm>.
>>From the transcript we learned that WNV was the last of 3 topics
covered, that spokesperson Dr Lyle Petersen's main messages were about
what CDC is doing to learn about and prevent WNV, and that CDC has set
up a new telephone hotline that received 3,500 calls its first week
(1-888-246-2675 for English, 1-888-246-2857 for Spanish and
1-886-874-2646 for hearing impaired).</div>
<div><br></div>
<blockquote>[* I.e., I wondered on what basis (or
"model") the "prediction" was made that 1000
people would become seriously ill and that 100 would die. E.g.,
What assumptions were used to integrate information about the disease
cycle in so many disparate ecosystems, taking into consideration that
WNV (a) showed up so much earlier than in previous years, (b)
has been detected this year in a widely expanded range, where it may
have been (c) carried by different or newly-detected species of birds
and mosquitoes and perhaps by truck, train or boat.]</blockquote>
<div><br></div>
<div>After making his opening statement Dr. Petersen fielded
several questions covering a fairly standard set of topics. At
one point he was asked about the number of human cases and replied
"We're still on the up slope of the epidemic curve, and if you
look at the previous years, the peak of disease activity in humans has
occurred around the last week of August and the first week of
September... So in other words we expect more cases to
occur."</div>
<div><br></div>
<div>He was later pressed on this topic by Seth Borenstein, a reporter
with Knight-Ridder. We have copied this section of the transcript
below to show (a) that the numbers (100 dead, 1000 very sick)
came out of the mouth of the reporter, not Dr. Petersen, (b) were
based on a back-of the envelope calculation extrapolating from the
ratio of cases reported at this time a year ago with the final numbers
for 2001 and therefore that (c) potentially pertinent ecological and
epidemiological factors that might affect outcomes in 2002 were not
considered in Borenstein's projections. While some of Dr.
Petersen's attempts to explain why these numbers could at best be a
"ballpark estimate" made it into the fine print, the
headlines and lead text that I saw focused on the easy-to-remember
numbers, now attributed to CDC.</div>
<div><br></div>
<div><br></div>
<div><font face="Georgia" size="+1" color="#505800"><b>Excerpt from
CDC Telebriefing Transcript, Aug 15, 2002</b></font></div>
<div><font face="Georgia" size="+1"
color="#505800"><b><br></b></font></div>
<blockquote>
<blockquote>
<blockquote>AT&T OPERATOR: And next we go to Seth Borenstein with
Knight-Ridder. Please go ahead.</blockquote>
</blockquote>
</blockquote>
<div><br></div>
<div
> <span
></span
>
QUESTION: Yes, thank you for the follow-ups. Dr. Petersen, you said 10
to 15 percent of the<br>
<span
></span
>
cases of overall years of offset had symptom onset before August 1. My
calculation, looking at<br>
<span
></span
>
your website, that's 123 cases you had by the end of July. Am I wrong
to interpret that you're<br>
<span
></span
>
going to be at, near or above 1,000 cases by the end of West Nile
season, and does that</div>
<div
> <span
></span
>
mean--and do you expect a 10 percent fatality rate, which seems to be
about what's been<br>
<span
></span
>
happening?<br>
<br>
<span
></span
>
DR. PETERSEN: Okay. The easy part of your question is what is the
fatality rate likely to be.</div>
<div
> <span
></span
>
Every year we've found that the fatality rate has been among--this is
among people with<br>
<span
></span
>
encephalitis and meningitis. The fatality rate has ranged from 11 to
14 percent. And that's been<br>
<span
></span
>
very consistent.<br>
<br>
<span
></span
>
Now, it may potentially be somewhat lower this year because the age
distribution of the cases, for<br>
<span
></span
>
whatever reason, is lower, and age is related to mortality. But I
would expect the mortality to<br>
<span
></span
>
be--among the more severe cases, to be somewhere around 10 percent
this year as opposed to<br>
<span
></span
>
previous years. Maybe a little less, but somewhere it's going to range
in that range when all is<br>
<span
></span
>
said and done.<br>
<br>
<span
></span
>
QUESTION: So are we expecting--do you expect near 1,000 cases
though?<br>
<br>
<span
></span
>
DR. PETERSEN: If--<br>
<br>
<span
></span
>
QUESTION: You've had 123 [inaudible] in July.<br>
<br>
<span
></span
>
DR. PETERSEN: If the epidemic curve this year is similar to that in
previous years, that would<br>
<span
></span
>
be a ballpark estimate. Now, we don't know, since we've never had a
big epidemic in the southern<br>
<span
></span
>
United States, where the peak of the epidemic curve will actually be.
I mean if the epidemic curve<br>
<span
></span
>
is lower, I mean earlier in the year, you may find less cases. If it's
similar to previous years, yeah,<br>
<span
></span
>
you can make an estimate of potentially 1,000 cases, but it's, it's
again very imprecise and I can't<br>
<span
></span
>
predict the future.<br>
<br>
<span
></span
>
What I think it is safe to assume is, is that we can expect more cases
and potentially a lot more<br>
<span
></span
>
cases.<br>
<br>
<span
></span
>
The other factor that we don't know is what is the effect of mosquito
control? I suspect that the<br>
<span
></span
>
mosquito control efforts that are going on in Louisiana and elsewhere
are going to have a major<br>
<span
></span
>
effect on blunting this epidemic. So if in fact those efforts are
highly successful, we may see a lot<br>
<span
></span
>
less than 1,000 cases. But the bottom line is we'll see more cases and
potentially a lot more in the</div>
<div
> <span
></span
>
upcoming weeks.</div>
<div><font face="Georgia" size="+1"
color="#505800"><b><br></b></font></div>
<div><font face="Georgia" size="+1"
color="#505800"><b><br></b></font></div>
<div><font face="Georgia" size="+1" color="#505800"><b>Aug 16 Atlanta
Journal-Constitution</b></font></div>
<div><font face="Times New Roman" size="+1" color="#000000"><br>
</font><font face="Arial" size="+2" color="#000000"><b>West Nile death
toll may jump, CDC says</b></font><font face="Times New Roman"
size="+1" color="#000000"><br>
<br>
</font><font face="Geneva" size="-1" color="#000000">By</font><font
face="Geneva" size="-1" color="#0000FF"><u> M.A.J.
McKENNA</u></font><font face="Geneva" size="-1" color="#000000"><br>
Atlanta Journal-Constitution Staff Writer</font><font
face="Times New Roman" size="+1" color="#000000"><br>
</font><font face="Arial" size="-3" color="#000000">The West Nile
virus epidemic could cause 1,000 serious illnesses and 100 deaths
before the mosquito season ends this fall, the Centers for Disease
Control and Prevention said Thursday.<br>
<br>
<br>
<br>
<br>
And significant numbers of people made seriously ill by the virus
could face long-term health consequences, the CDC said.<br>
<br>
The grim forecast came as the Atlanta-based agency released the latest
tally for the mosquito-borne infection: nine deaths and 156
lab-confirmed cases of human illness in eight states. In addition, the
virus has been found in horses, birds or mosquitoes in 37 states and
the District of Columbia.<br>
<br>
New cases were reported Thursday in Maryland, Missouri and Ohio. Also,
state health officials announced the discovery of the West Nile virus
in Colorado. None of the state findings released Thursday have been
confirmed by the CDC.<br>
<br>
Dr. Lyle Petersen of the CDC's insect-borne diseases branch in Fort
Collins, Colo., said the latest projections are based on research
conducted since West Nile arrived in the United States in August
1999.<br>
<br>
In each of the past three summers, only 10 percent to 15 percent of
West Nile cases had occurred by Aug. 1, Petersen noted.<br>
<br>
"The vast majority" of the 156 cases confirmed this year by
the CDC "actually had symptoms before Aug. 1," he said.
"We are still on the upslope of the epidemic curve. We expect
more cases to occur."</font></div>
<div><font face="Arial" size="-3" color="#000000"><br>
Many factors could affect the outcome, from less rain to more
aggressive mosquito control, Petersen said.<br>
<br>
Research over the past three summers found a death rate among serious
cases of West Nile disease of 11 percent to 14 percent.</font></div>
<div><font face="Arial" size="-3" color="#000000"><br>
Patients made very ill by West Nile virus -- they represent 1/200th of
those infected with the virus -- may face a rough course.<br>
<br>
A study done in New York City one year after the first U.S. West Nile
outbreak found that "more than half of the [survivors] had very
persistent and potentially severe" neurological problems such as
memory failures and difficulty walking, Petersen said.<br>
<br>
Much remains unknown about the rapidly spreading virus, including
which mosquito species are spreading the disease along the Gulf Coast,
why victims have tended to be younger this year, and how quickly West
Nile will move across the rest of the country.<br>
<br>
"These are very complicated biological systems that are very hard
to predict," Petersen said.<br>
<br>
One complicating factor, the CDC scientist said, is the lack of
consistent mosquito control.<br>
<br>
"Over the last several decades, mosquito-borne diseases were not
thought to be much of a problem any more, and a lot of these
mosquito-abatement programs have basically dried up or disappeared,"
Petersen said.</font><br>
<font face="Arial" size="-3" color="#000000"></font></div>
<div><font face="Arial" size="-3" color="#000000">"This is a
classic case of an ignored problem that has now
resurfaced."</font></div>
<div><br></div>
<div><br></div>
<x-sigsep><pre>--
</pre></x-sigsep>
<div>Lois Levitan, PhD Program
Leader<br>
Environmental Risk Analysis Program<br>
Center for the Environment<br>
213 Rice Hall, Cornell University<br>
Ithaca, New York USA 14853-5601<br>
<br>
Phone: (607) 255-4765 Fax: (607)
255-0238<br>
Email:<x-tab>
</x-tab>LCL3@cornell.edu<br>
<br>
Program Email: envrisk@cornell.edu<br>
Web:http://www.cfe.cornell.edu/ERAP<br>
<br>
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WESTNILEVIRUS-L is an email discussion group for communication<br>
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risk reduction and public education issues. It is moderated
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To subscribe (or unsubscribe), send an email request to
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Received on Tue Aug 20 12:56:41 2002
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