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2012 NC Vector-Borne Disease Summary

Marcée Toliver, NC DHHS, DPH

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Summary of 2012 Surveillance Efforts

NC and surrounding states

Vector Borne Disease

Mosquitoes: WNV, LAC, EEE

Ticks: RMSF, Lyme, Ehrlichiosis

Surveillance categories

Passive: Human, Veterinary

Active: Mosquito Pooling, Sentinel Flock

Plans for 2013

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2012 Active Surveillance

Sentinel flocks

3 flocks being maintained by local programs

Pender: 2

New Hanover: 1

Mosquito Pooling:

Three (3) programs submitted pools to

SLPH

Brunswick: 260+ pools

New Hanover: 3 pools

Forsyth: 42 (approx. half pending testing)

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West Nile Virus

WNV

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West Nile Virus (WNV)

Mosquito-borne virus

First introduced to US in 1999

Now established as a seasonal epidemic in the US

80% of those infected may show no symptoms at all.

20% of the those infected have milder symptoms, such as headache, body ache, nausea, rash. Symptoms may last from a few days to several weeks.

Serious illness occurs in approx. 1 of 50 of those infected with severe symptoms. Symptoms of serious illness can include headache, fever, and neurological symptoms that may persist several weeks or be permanent.

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WNV: 2012 National Picture Human cases (as of Oct. 16, 2012)

Human cases reported from 47 states

WNV activity reported from 48 states

Total cases: 4,531 human cases, worst year since 2003

51% (2,293) classified as neuroinvasive (meningitis or encephalitis), 49% classified as non-neuroinvasive

Studies indicate that for every case of neuroinvasive disease, there are 30-70 non-neuroinvasive cases. (CDC)

168 deaths*

*Based on data from Oct. 9, 2012 CDC report

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WNV Nationally

70% of cases from 8 states

Texas: 1/3 of all cases

California

Louisiana

Mississippi

South Dakota

Michigan

Oklahoma

Source: Arboviral Diseases Branch report of provisional data reported to Arbonet, Oct. 16, 2012

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Neuroinvasive vs Non-neuroinvasive CDC Definition:

Neuroinvasive disease cases, refers to severe cases of disease that affect a person’s nervous system. These include encephalitis which is an inflammation of the brain, meningitis which is an inflammation of the membrane around the brain and the spinal cord and acute flaccid paralysis which is an inflammation of the spinal cord that can cause a sudden onset of weakness in the limbs and/or breathing muscles.

Non-neuroinvasive disease cases refers to typically less severe cases that show no evidence of neuroinvasion—primarily West Nile fever. WN fever is considered a notifiable disease, however the number of cases reported (as with all diseases) may be limited by whether persons affected seek care, whether laboratory diagnosis is ordered and the extent to which cases are reported to health authorities by the diagnosing physician.

NC only reports neuroinvasive cases to the CDC

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Human Cases

Regional Distribution

NC: 6 cases (neuroinvasive)

Cabarrus

Forsyth

Mecklenburg

Pitt

Scotland

Wayne

SC: 28

GA: 54

TN: 28 Maps: http:// diseasemaps.usgs.gov

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WNV Geographic Distribution

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Equine: 1 each from Davidson, Union & Surry

Mosquito pool (1) Forsyth Co., Cx. pipiens, trap date 9/21/12

August September

Wayne

Scotland, Cabarrus Mecklenburg, Forsyth

Pitt Forsyth

Additional viremic blood donor cases from Mecklenburg (late July and New Hanover (late August)

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Eastern Equine Encephalitis

EEE

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Eastern Equine Encephalitis (EEE)

Mosquito borne virus

Considered rare in humans in the U.S.

Reservoir host believed to be birds and maintained by Cs. melanura.

Recent evidence suggests reptiles, specifically poisonous snakes, may play a role.

Most infected show no symptoms.

Symptoms occur 3-10 days after bite, include fever, muscle pain, neurological symptoms including swelling of the brain

Of those infected with severe symptoms, there is approx. 33% mortality or significant brain damage in survivors.

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EEE: 2012 National Picture

EEE activity

has occurred

in 22 states

12 human

cases in 5

states

5 fatalities

Source: Arboviral Diseases Branch report of provisional data reported to Arbonet, Oct. 16, 2012

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2012 EEE in NC

Human case:

11 yr. old

Cumberland County, onset early Sept.

Sentinel Flock

New Hanover: 5+

Veterinary: 18 horses

(one per county except as noted)

Bladen (2)

Carteret

Columbus

Cumberland

Durham

Harnett

Onslow

Pitt

Richmond

Robeson(3)

Sampson(5)

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2012 EEE Geographic Distribution

Equine

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July September

Bladen

Robeson (2), Sampson(2),

Durham, Onslow, Robeson

Bladen Sampson(2)

Carteret Pitt

Richmond

Columbus Harnett Sampson Cumberland

August

Human case in Cumberland

All + chickens in New Hanover

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La Crosse Encephalitis

LAC

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La Crosse Encephalitis (LAC)

Mosquito-borne virus

Most people infected will have no symptoms

Symptoms include fever, headache, nausea, vomiting, tiredness.

Severe illness presents neuroinvasive disease including inflammation of the brain, seizures, coma and paralysis

Severe illness occurs most often in children under the age of 16 and can result in long term disability or death.

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LAC: 2012 National Picture

Reported from 11 states (as of Oct. 16th)

65 cases of which 5 were non-neuroinvasive

One fatality (Tennessee)

NC leads the nation with 21 cases.

Source: Arboviral Diseases Branch report of provisional data reported to Arbonet, Oct. 16, 2012

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LAC in NC No other

surveillance mechanism for LAC

21 cases reported

Buncombe: 12

Haywood: 1

Macon: 2

Swain: 1

Transylvania: 3

Outliers:

Onslow (1)

Washington (1)

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Wk 22 Wk 23 Wk 24 Wk 25 Wk 26 Wk 27 Wk 28 Wk 29 Wk 30 Wk 31 Wk 32 Wk 33 Wk 34 Wk 35 Wk 36 Wk 37 Wk 38 Wk 39

LAC 2012 Seasonal Distribution Bunc Hay Mac Ons Swa Tran Wash

June July August September

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All Human Arboviral Cases Seasonal Distribution

June August September July

11 1 1 1 1

2

4

1 1

2

3

1 11

4

1

22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

2012 Human Arboviral Cases(as reported to ArboNet)

Eastern Equine Encephalitis La Crosse West Nile

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Ticks

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Ticks Tick-borne illness a growing concern across NC

Primarily for:

RMSF

Lyme

Ehrlichia

As well as:

Anaplasmosis

Babesiosis

STARI

Rickettsia parkeri rickettsiosis

Tularemia

Tick paralysis

364D Rickettsiosis (newly identified in California)

Heartland virus (newly identified phlebovirus in Missouri)

Investigated as a source of several Bartonella bacterial species

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CAVEAT

All Human Case Data is PRELIMINARY.

Human case data is very ‘fluid’.

Most cases are still under investigation, at local health

departments as well as at DPH

Case counts will not be final until spring of next year

State reports “Confirmed” and “Probable” to CDC

Suspect: cases are investigated, but not reported unless

they meet criteria.

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Rocky Mountain Spotted Fever

RMSF

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Rocky Mountain Spotted Fever (RMSF)

Tick-borne bacterial illness.

Transmission by American dog tick or brown dog

tick.

Symptoms include fever, headache, abdominal

pain, vomiting, and muscle pain. A rash may or

may not develop.

Can be severe or even fatal if not treated in the first

few days of symptoms.

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RMSF

Preliminary data (as

of Oct. 16, 2012):

442 cases in 77 counties

Compare to 2011: 341 in

76 counties

American dog tick female – just getting started laying eggs.

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RMSF: Geographic Distribution

Preliminary data from NC NEDSS as of Oct 16, 2012

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Lyme Disease

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Lyme Disease

Tick-transmitted illness

Transmission is by the black legged tick

Symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans (bulls-eye rash).

If left untreated, infection can spread to joints, the heart, and the nervous system.

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Lyme Disease in NC

ENDEMIC (dfn.):

2 confirmed cases

within a county

Wake, Haywood,

Guilford

Pending (one case has

been confirmed)

Cleveland, Gates,

Perquimans, Pitt, Wilkes, Wilson

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Lyme Disease Geographic Distribution

Preliminary data from NC NEDSS as of Oct 16, 2012

Preliminary data (as of Oct. 16, 2012): 74 cases in 44 counties (confirmed and probable) 2011: 91 in 46 counties

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Ehrlichiosis

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Ehrlichiosis

Tick-borne illness

At least 3 species of bacteria in the US: Ehrlichia

chaffeensis, Ehrlichia ewingii, and a third Ehrlichia

species provisionally called Ehrlichia muris-like

(EML).

Primary vector: lone star tick (for E. chaffeensis

and E. ewingii)

Symptoms include: fever, headache, fatigue, and

muscle aches, usually occurring within 1-2 weeks

after a bite.

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Ehrlichiosis in NC

Preliminary data (as of Oct.

16, 2012):

107 cases in 34 counties

2011: 110 in 44 counties

Engorged larval lone star tick – on a penny

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Ehrlichiosis: Geographic Distribution

Preliminary data from NC NEDSS as of Oct 16, 2012

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2013 Vector Borne Goals

Funding provided by CDC under two concurrent grant vehicles

Enhanced LAC surveillance in collaboration with Mission Hospital, Dr. Bryan Bird (WCU) and John Wallace (UNC)

Address some of the deficiencies that resulted from the abolishment of PHPM

Continue with reporting and data analysis

Conclude projects that were unfinished

Renew relationships with local programs to assist them in meeting their goals while enhancing surveillance state-wide

Start new projects!

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• DPH Communicable Diseases Section: • Arboviruses:

http://epi.publichealth.nc.gov/cd/diseases/arbo.html • Tick-Borne:

http://epi.publichealth.nc.gov/cd/diseases/ticks.html • ARBONET: Disease maps and case county by county

http://diseasemaps.usgs.gov/

•CDC Division of Vector-Borne Diseases: http://www.cdc.gov/ncezid/dvbd/

•TIC-NC: slide shows on various tick species http://tic-nc.org

•NCMVCA: Customizable educational brochures

http://www.ncmvca.org

Suggested Resources

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Questions?

Comments?

Suggestions?

Contact information: marcee.toliver@dhhs.nc.gov marceetoliver@gmail.com

Acknowledgements • Jodi Reber, DPH

• Dr. Carl Williams, DPH

• Jenn Lehman, CDC