GEORGIA UPDATE

2009

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Rosmarie KellyPublic Health EntomologistGeorgia Division of Public Health

2009• drought• SNOW• warm • flood• COLD warm• more weird weather• SWINE FLU• flood• BRRRRR!!!

virus#

cases EEE 46 WNV 3

veterinary cases

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County#

cases VIRUS

Cherokee 1 LAC

White 1 LAC

HUMAN CASES 

Bibb 1 WNV

Clinch PVBD WNV

Muscogee 2 WNV

Tift 1 WNV

Ware PVBD WNV

County# pools

submitted# WNV+

pools%

WNV+

DeKalb 536 5 0.93%

Fulton 326 8 2.45%

Lowndes 1235 8 0.65%

Muscogee 36 3 8.33%

mosquitosurveillance(25 counties)

Human Arboviral Disease Surveillance in

Georgia

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Meghan Weems

Most Common Arboviral Diseases in Georgia

• West Nile Virus• Lacrosse Encephalitis• Eastern Equine Encephalitis• Internationally acquired Dengue

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Reporting Sources

• Georgia Public Health Laboratory• Commercial Labs• Local hospitals• Blood organizations such as

American Red Cross

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How to report

• Via reportable disease card sent in mail

• Via SENDSS, Georgia’s internet based reportable disease surveillance system

• Via fax• Via phone call with district or state

epidemiologists

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Where cases are reported• Cases are reported in SENDSS • Cases are then entered into our Arboviral

database, which is used to populate maps on Oasis.

• Cases are also entered into CDC’s Arbonet, which populates USGS’s national case maps

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What information is collected?

• Basic case demographics

• Hospitalization status• Admitting diagnosis• Testing history and

results• Blood donation/organ

donation history• Underlying medical

conditions and medication use history

clinical#

cases%

uncomplicated fever   0% encephalitis/meningitis

4 67%

other   0% asymptomatic 2 33%

 

Gender#

cases%

male 4 67% female 2 33% unknown   0%

8Data are used to educate physicians about arboviral diseases.

Presumptive Viremic Blood Donor

• Receive presumptive viremic blood donor reports from blood banks

• Data are collected from donor screening tests performed by nucleic acid amplification testing (NAT)

• A PVD is a person associated with a blood donation that meets at least one of the following criteria:– One reactive NAT with a signal-to-cutoff ≥17– Two reactive NATs

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Veterinary Cases

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Georgia Department of AgricultureDr Rhonda Veit

Georgia Dept of Agriculture

• The Animal Health office governs the prevention, control and eradication of certain infectious and communicable diseases of livestock and  other domestic animals.

• Reportable Arboviral Diseases– EEE– WNV

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Who Reports

• Veterinarians, veterinary technicians, lab technicians, wildlife biologists, and animal owners are required to report.

• Depending upon the disease or syndrome, reporting is required whether a clinical diagnosis, laboratory diagnosis, or just a reasonable suspicion of a disease is present.

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What is Done with the Data• Veterinarians at GDA follow-up with owner of the

animal to provide vaccine information• Data are shared with GDPH• Info is reported out to the Health District• Local Environmental Health Specialists provide

education on risk reduction and mosquito control• Cases are then entered into our Arboviral

database, which is used to populate maps on Oasis.

• Cases are also entered into CDC’s Arbonet, which populates USGS’s national case maps

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Detection of veterinary cases indicates that the risk of human disease is increasing.

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Dead Bird Surveillance

16GDPH and UGA/SCWDS

Collecting the Data

• Dead bird surveillance has been a sensitive indicator of local epizootic transmission of WNV in Georgia and in other states and can play a role in predicting human risk of infection.

• This surveillance involves (a) collecting and mapping reports of dead bird sightings from the public and (b) testing some dead birds for arboviruses, especially early in the season, late in the season, and where there are clusters of dead birds.

• Environmental Health Specialists collect dead birds from members of the public.

• Testing of dead birds for arboviruses is still offered free-of-charge at the Southeastern Cooperative Wildlife Disease Study (SCWDS) at the University of Georgia.

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Where Are The Birds?

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Mosquito Surveillance

19GDPH and UGA/SCWDS

Collecting the Data• Mosquito surveillance is done by:

• local mosquito control• local environmental health• University program• Public Works• State entomologist

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• Mosquito surveillance is an important part of mosquito control

• Arboviral encephalitis can be prevented in two major ways:

1. Personal protective measures to reduce contact with mosquitoes2. Public health measures to reduce the population of infected mosquitoes in the environment

Mosquito Surveillance

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USING THE DATA

• Education• Mosquito Control• Data sharing

– other agencies– stakeholders

• Media• Training Programs• Evaluation

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Goal• reducing the risk of arboviral disease

transmission• monitor for new and emerging

arboviral diseases

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The Cost of WNVThe Cost of WNV

• In 2005, an outbreak of West Nile virus (WNV) disease occurred in Sacramento County, California; 163 human cases were reported.

• In response to WNV surveillance indicating increased WNV activity, the Sacramento-Yolo Mosquito and Vector Control District conducted an emergency aerial spray.

• WNV disease in Sacramento County cost ≈$2.28 million for medical treatment and patients’ productivity loss for both West Nile fever and West Nile neuroinvasive disease.

• Vector control cost ≈$701,790, including spray procedures and overtime hours.

• The total economic impact of WNV was $2.98 million.

A cost-benefit analysis indicated that only 15 cases of West Nile neuroinvasive disease would need to be prevented to make the emergency spray cost-effective.

Emergency Mosquito Control

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Surveillance trailer

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Protocols

• Emergency Surveillance– To determine the scope of the public health-related

mosquito problem, both vector species and nuisance problem

– Need to collect mosquito population data to send to GEMA, FEMA, CDC, budget office, GDPH, etc…

• Training– Must be public health related– Requesting Agency to provide a prime mover and a driver– Request comes to GDPH entomologist, not GEMA

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RESPONSE: Surveillance and Control

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ANY QUESTIONS?

Thanks to everyone involved in arboviral surveillance in Georgia.

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