Do You Think You Have West Nile Virus?

Lots of adults locally have seen a bit sick lately, right? It's not flu season, but the people who are sick are really sick.

At least two women in Studio City have come down with severe flu-like symptoms and terrible fatigue in recent days and both had fevers hitting 104 degrees. No one else in their family got sick. West Nile Virus? Well, in those cases, the doctors didn't test for it.

In most cases, the West Nile Virus does not manifest itself as a symptomatic disease, and in most cases it simply must run its course like any virus. This does also not transmit from human to human, so it's not contagious.

Here is information from the California Department of Public Health's Dr. Carol Glaser, chief of Encephalitis and Special Investigations Section, who talked to Studio City Patch about the specific concerns from readers:

* Should people ask to be tested for that? Is there a need to be tested for West Nile virus? Is the treatment any different than any other virus?

Glaser: Individuals can request that their physicians test them for WNV but ultimately it is up to the physicians to decide if testing is warranted. Although there is no specific treatment for WNV, testing can be beneficial to identify the cause of the illness. In particular, if a patient is severely ill with an unknown illness, a positive WNV test may eliminate the need for unnecessary treatment or other expensive tests. Testing for WNV is readily available through most local health departments or commercial laboratories.

Further, identification of human cases can be valuable to public health since vector control agencies can use this information to target their mosquito control efforts.

* Is this a virus that after infected by a mosquito then can be passed on human-to-human?

Glaser: WNV is typically transmitted by mosquitoes. Infrequently, however, human-to-human transmission can occur via blood transfusions or organ transplants. There is some evidence that WNV may be transmitted via transplacental route or breast milk but this is has only been rarely reported.

* What if your doctor doesn't want to or refuses to test for the West Nile, is there something that could or should be done?

Glaser: Ultimately a physician should make the judgment about the need for testing. CDPH encourages physicians to test for WNV in patients with compatible illness, particularly those with neuroinvasive (e.g. encephalitis or meningitis) illness. Preliminary data collected by the CDPH suggests that, in recent years, many patients with illnesses compatible with WNV were not tested. Physicians who have questions about testing should contact their local public health department.

Also, here is additional information from the Los Angeles County West Vector & Vector-Borne Disease Control District about the virus, the symptoms and what to do if you think you have it:

Q. If I live in an area where birds or mosquitoes with West Nile virus have been reported and a mosquito bites me, am I likely to get sick?
A. No. All residents of areas where virus activity has been identified are at risk of getting the West Nile virus; however persons over 50 years of age have the highest risk of severe disease. Even in areas where the virus is circulating, very few mosquitoes are infected with the virus. Even if the mosquito is infected, less than 1% of people who are bitten and become infected will become severely ill. The chances you will become severely ill from any one mosquito bite are extremely small.

Q. Can you get West Nile encephalitis from another person?
A. No. West Nile encephalitis is NOT transmitted from person-to-person. For example, you cannot get West Nile virus from touching or kissing a person who has the disease, or from a health care worker who has treated someone with the disease.

Q. Can you get West Nile virus directly from birds?
A. There is no evidence that a person can get the virus from handling live or dead infected birds. However, persons should avoid bare-handed contact when handling any dead animals and use gloves or double plastic bags to place the carcass in a garbage can.

Q. What proportion of people with severe illness due to West Nile virus die?
A. Less than 1% of persons infected with West Nile virus will develop severe illness.  Among those with severe illness due to West Nile virus, case-fatality rates range from 3% to 15% and are highest among the elderly.  In 2003, there were 264 total deaths from the West Nile virus in the United States.  In comparison, there are 20,000 to 36,000 deaths annually in the United States resulting from the common influenza virus.

Q. If a person contracts West Nile virus, does that person develop a natural immunity to future infection by the virus?
A. Yes.  At this time, it is believed that immunity will be lifelong.

Symptoms of West Nile Virus

Q. What are the symptoms of the West Nile virus?
A. Approximately 80 percent of people who are infected with WNV will not show any symptoms at all. Up to 20 percent of the people who become infected will display mild symptoms, including fever, headache, and body aches. Symptoms typically last a few days.  And for less than 1%, more severe infection may be marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, paralysis, and, rarely, death.

Control of West Nile Virus

Q. What can be done to control the spread of the West Nile virus?
A. The WNV has spread to 46 states since 1999.  Mosquito reduction and control measures nationwide have been able to slow but not stop the spread of the virus.  It is expected to occupy all of the continental United States by the end of 2004.  Control of West Nile virus and other arboviral diseases is accomplished through integrated vector management programs. The L.A. County West Vector Control District maintains such programs including: surveillance for West Nile Virus activity in mosquito vectors, birds, horses, and sentinel chicken flocks; and the implementation of appropriate mosquito control measures to reduce mosquito populations.  If you have a mosquito complaint, call (310) 915-7370.  A technician will arrange a visit to investigate and locate the mosquito breeding source that is causing your problem.

Q. Is there a vaccine against West Nile encephalitis?

 A. No, but several companies are working towards developing a vaccine.

Here is some of the best advice from the Centers for Disease Control:

What Is West Nile Virus?

West Nile virus (WNV) is a potentially serious illness. Experts believe WNV is established as a seasonal epidemic in North America that flares up in the summer and continues into the fall. This fact sheet contains important information that can help you recognize and prevent West Nile virus.

What Can I Do to Prevent WNV?

The easiest and best way to avoid WNV is to prevent mosquito bites.

• When you are outdoors, use insect repellent containing an EPA-registered active ingredient. Follow the directions on the package.
• Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.
• Make sure you have good screens on your windows and doors to keep mosquitoes out.
• Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.

What Are the Symptoms of WNV?

• Serious Symptoms in a Few People. About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.

• Milder Symptoms in Some People. Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.

• No Symptoms in Most People. Approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.

How Does West Nile Virus Spread?

• Infected Mosquitoes. Most often, WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite.
• Transfusions, Transplants, and Mother-to-Child. In a very small number of cases, WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby.
• Not through touching. WNV is not spread through casual contact such as touching or kissing a person with the virus.

How Soon Do Infected People Get Sick?

People typically develop symptoms between 3 and 14 days after they are bitten by the infected mosquito.

How Is WNV Infection Treated?

There is no specific treatment for WNV infection. In cases with milder symptoms, people experience symptoms such as fever and aches that pass on their own, although even healthy people have become sick for several weeks. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment including intravenous fluids, help with breathing and nursing care.

What Should I Do if I Think I Have WNV?

Milder WNV illness improves on its own, and people do not necessarily need to seek medical attention for this infection though they may choose to do so. If you develop symptoms of severe WNV illness, such as unusually severe headaches or confusion, seek medical attention immediately. Severe WNV illness usually requires hospitalization. Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WNV.

What Is the Risk of Getting Sick from WNV?

People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites.

Being outside means you're at risk. The more time you're outdoors, the more time you could be bitten by an infected mosquito. Pay attention to avoiding mosquito bites if you spend a lot of time outside, either working or playing.

Risk through medical procedures is very low. All donated blood is checked for WNV before being used. The risk of getting WNV through blood transfusions and organ transplants is very small, and should not prevent people who need surgery from having it. If you have concerns, talk to your doctor.

Pregnancy and nursing do not increase risk of becoming infected with WNV.

The risk that WNV may present to a fetus or an infant infected through breastmilk is still being evaluated. Talk with your care provider if you have concerns.

What Is the CDC Doing About WNV?

CDC is working with state and local health departments, the Food and Drug Administration and other government agencies, as well as private industry, to prepare for and prevent new cases of WNV.

Some things CDC is doing include:

• Coordinating a nation-wide electronic database where states share information about WNV
• Helping states develop and carry out improved mosquito prevention and control programs
• Developing better, faster tests to detect and diagnose WNV
• Creating new education tools and programs for the media, the public, and health professionals
• Opening new testing laboratories for WNV
• Working with partners on the development of vaccines

The County Health Department has these statistics:

West Nile virus (WNV) causes a potentially serious illness related to Japanese Encephalitis (JE) and Saint Louis encephalitis (SLE). The virus survives in nature in birds and is transmitted by mosquitoes that feed on infected birds (click on image). When humans and other mammals, such as horses, are bitten by infected mosquitoes they may also become infected with WNV. Most persons who become infected with the virus will not become ill. However, for the small proportion who do become sick, symptoms can include fever, headache, rash, muscle weakness, and nausea and vomiting. A smaller proportion may develop neurological symptoms such as limb paralysis, tremors, and altered mental status.

Before 1999,when it was detected in New York City, WNV was found in Africa, Asia, Europe, Middle East, and Australia. Since then, the virus has spread throughout the United States as well as other parts of North America. In 2006, 4269 confirmed human WNV cases were reported nationally to the Centers for Disease Control and Prevention (CDC); California (CA) reported 278 cases.

Report Dead Birds/Reporte Pajaros Muertos: 1-877-747-2243 or by the Internet.

Bird Maps: West Nile infected dead birds are indicators of the virus presence. In 2004, viral positive dead birds were recovered from nearly all areas of Los Angeles County. Since then, collection, testing and site posting of viral positive dead birds have been ongoing. For current bird maps and information on how to collect dead birds for disease testing visit Veterinary Public Health. Latest Bird Map

Confirmed West Nile Cases in Los Angeles County*

Year

* Does not include the cities of Long Beach and Pasadena..

Updates are provided daily if case counts change. Total includes asymptomatic blood donor cases.

Local Epidemiology Reports (WNV Case Totals): 2010  2009 2008 2007 2006  2005  2004