State public health officials are prepping for another bout with West Nile virus, the mosquito-born illness that infected 4,156 humans and killed 284 in 46 states last year. Cash-strapped states believe additional federal funds and intense public information campaigns could help curb the disease that's spread swiftly across the country since it first appeared in New York in 1999.
The illness has spread every year since, and last year brought the worst epidemic to date, records maintained by the federal Centers for Disease Control and Prevention (CDC) show.
"West Nile virus has managed to surprise us each year. We'd like to come to some comfort level in determining how many human cases there could be," said Dr. Kristy Bradley, Oklahoma's assistant state epidemiologist.
But the truth is, Bradley and other health experts said, nobody knows what 2003 will bring.
Originally from Africa, the disease is carried by birds and transmitted to humans and animals by bites from infected mosquitoes. The virus is typically characterized by mild, flu-like symptoms and is not usually life threatening, but can cause encephalitis, an inflammation of the brain, according to the CDC's Web site. Persons over 50 are at the greatest risk for developing encephalitis. Last year, Illinois led the country with West Nile deaths and infections; 64 of 884 infected Illinoisans died. It was followed by Michigan with 51 deaths and 614 infections. Only four states -- Utah, Arizona, Nevada and Oregon had no West Nile virus cases.
This year, public health officials have already reported a smattering of suspected cases, including two in Louisiana. CDC did not respond to phone calls seeking a total count of new suspected cases.
"I don't think the public health community can rest on its laurels ... we just haven't had that luxury," said Helen Fox Fields, senior director of infectious disease policy at The Association of State and Territorial Health Officials (ASHTO).
Fields said there's an "extra watchfulness" within the public health community right now because of West Nile, but also due to SARS (Severe Acute Respiratory Syndrome), smallpox and other potential bio-terror threats.
In 2002, states received between $30 million and $40 million from the CDC to combat West Nile, a U.S. House of Representatives aide said, and for fiscal 2003, states will receive an estimated $34 million.
But some state officials said the federal money has been insufficient. Bradley said Oklahoma received $200,000 last year and its resources were quickly depleated. Though the number of humans infected in 2002 was relatively small, the Sooner State was among the top in the country for infection in horses, with more than 1,000 equine cases. Oklahoma expects to receive the same amount of funding for 2003. "We need more (funding), we really do," Bradley said, citing the need to pay for surveillance, additional staff, training and public awareness campaigns.
Her plea may be answered if Congress passes one of two pending bills that would allocate additional West Nile dollars to states. The measures differ slightly, but both would give states an additional $100 million, in large part for mosquito control and abatement programs.
H.R. 342 passed the House March 13. The Senate version is expected to move through committee later this week, said Christine Iverson, a press official at the Senate Health, Education, Labor and Pensions (HELP) Committee.
In the absence of increased federal help, state health officials are relying on the news media to help spread the word. In Louisiana, for example, health officials are "taking every possible opportunity to talk to the news media about West Nile virus to educate the public about what precautions they can take," said Bob Johannessen, spokesman for the Louisiana Department of Health and Hospitals.
"The thing that has really tied our hands is resources. We're trying to be pretty aggressive through the media because it doesn't cost us anything," said Jana Kettering, spokeswoman for the Utah Department of Health.
Health officials in several states said they're placing a greater emphasis on public education and prevention this year, rather than focusing so heavily on bird surveillance.
"Initially we were focused on the surveillance, but we also want to get a real public education message out there," said Linda Glaser, the West Nile virus surveillance coordinator for the Wisconsin Department of Public Health. In Utah, where there has not been a reported case of West Nile, health officials are bracing for a potential outbreak, Kettering said.
Since April 15, Utah has issued CDC public service announcements to television and radio stations across the state. Health officials hosted a statewide conference with physicians and plan to hang "Fight the Bite" educational posters at parks, campgrounds, public pools and other outdoor areas. Additional posters will be distributed to the medical community.
Other state preparations include:
"Now it's West Nile virus, but there could always be another mosquito-related virus down the line. We need to be ready," Oklahoma's Bradley said.