Public health officials across the states are bracing for another onslaught of West Nile virus, the disease of African origin that infected nearly 10,000 people in 45 states in 2003 and already has caused one death and sickened 57 people this year.
This summer's mosquito season is expected to produce the most severe outbreak of the disease yet and hit particularly hard in the Plains states and on the West Coast.
Carried by birds and transmitted to humans and animals by bites from infected mosquitoes, the disease first appeared in New York City in 1999 and spread swiftly from the East Coast across the country over the next five years.
Warning of the impending West Nile outbreak, a national public health group July 1 criticized states and the federal government for not spending enough money on infectious disease prevention.
Lara Misegades, director of infectious disease policy at the Association of State and Territorial Health Officials, a national organization representing state public health agencies, said: "The states that haven't been affected previously have seen it progress across the United States and certainly have had the advantage of being forewarned. ... I think it's a very different situation than when it emerged in New York and no one was expecting it."
The virus can include mild flu-like symptoms and typically is not life-threatening, however it can cause encephalitis, an inflammation of the brain. Those particularly at risk include people over 50, young children and those with weak immune systems, according to the Atlanta-based U.S. Centers for Disease Control and Prevention.
The disease usually peaks in August and through early fall, but already this year one death and 57 human cases of infection have been reported across eight states Arizona, California, Florida, Michigan, Nebraska, New Mexico, South Dakota and Wyoming, according to CDC data.
In addition, it's been detected in animals and birds in more than half the states: Alabama, Arizona, Arkansas, California, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Virginia and Wisconsin.
Some state lawmakers have joined the fight to curb West Nile virus:
Although most states have rolled out public education campaigns and established mosquito and bird surveillance programs to identify and track the disease, control efforts have been largely under-funded by states and the federal government, according to a July 1 report by the Trust for America's Health, a Washington, D.C.-based organization that aims to make disease prevention a national priority.
"We've been doing budget cuts rather than beefing up when we know an epidemic is about to hit," said Shelley Hearne, executive director of the health trust. She told Stateline.org that in 2003, two-thirds of states made cutbacks in public health funding, which is typically used to battle West Nile and other infectious diseases.
In addition to recommending more state and federal funding for West Nile, the report also calls on governments to target education campaigns to the most vulnerable groups. The report also suggests better information sharing and urges research to find a human vaccine and examine the link between West Nile and birth defects.
"Many states because of the budget crunch in the last couple of years have had cuts in their budget, and many times those cuts get translated into cuts in the public health budget because public health doesn't carry as much weight as it needs to if we want to protect our country," Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University, said in a telephone press conference about the report.
Federal lawmakers last August approved the Mosquito Abatement for Safety and Health Act to help states control mosquitoes to prevent the spread of infectious diseases such as West Nile virus or malaria. However, Congress has not appropriated any funds under the law.
Many states receive some grant money from the CDC for West Nile surveillance efforts, but most states and localities are responsible for funding other efforts such as public information campaigns, pesticide spraying and laboratory testing. Christine Pearson, a spokeswoman for CDC, said the federal agency gave states $23.8 million in total in 2003 to combat West Nile virus. Grant allocations for 2004 were not yet available.
Despite tight budgets and unanswered questions about the nature of the disease, many states say they're doing the best they can and are ready to manage this summer's outbreak.
California, for example, which already has seen 11 human cases of West Nile, is currently working with a $650,000 grant from CDC to fund the state's West Nile prevention efforts, including a hotline to report dead birds and laboratory testing support, said Vicki Kramer, chief of the vector-born disease section of the California Department of Health Services
Nebraska health officials also are preparing for a tough season after being "blind-sided" with more than 2,000 human cases in 2003, said Wayne Kramer, the state medical entomologist. Only Colorado was hit harder last year, citing nearly 3,000 human cases.
"We're a smaller state. And in the rural western parts of the state the economy is not so great, and the towns didn't have resources to do some of the stuff that they would have liked to have done. So we're hitting heavy with the educational campaigns this year," Kramer told Stateline.org.
Kramer added: "The thing with West Nile is that just when people think that they've got it figured out, it does something unexpected, and that's really what we saw last year. We can't get complacent that we think we've got it figured out."