| |
Puerto Rico West Nile Response Plan
|
This report describes the response plan that the Puerto Rico Department of Health (PRDOH), working in collaboration with the Centers for Disease Control and Prevention (CDC) and other state and federal agencies, has implemented to address the potential arrival of West Nile virus (WNV) to Puerto Rico.
In 1999 West Nile virus was first detected in the United States. Since then, the infection has repeated itself annually, spreading through the nation from East to Southwest and being detected in 44 states and the District of Columbia. In 2002, it was responsible for infection in 4,156 humans of which 284 died. It also caused infection in 14,417 horses of which approximately 4,325 (30%) died; birds; and some other species including domestic species. Since 1999, there has also been evidence of WNV in Central America and the Caribbean, mostly in animals. Evidence of local transmission has been documented in Mexico (horses), Cayman Island (one human case), Dominican Republic (antibodies in birds), Jamaica (antibodies in birds) and El Salvador (horses).
Even though most infections are clinically unapparent, 1 out of 5 (20%) persons infected develop West Nile Fever, a sickness very similar to Dengue, and 1 out of 150 develop severe neurological sickness. The severe phase could present meningitis, altered mental state, severe muscular weakness, acute flaccid paralysis, and symptoms similar to those in Polio and Parkinson.
West Nile virus is a flavivirus transmitted primarily by the Culex pipiens mosquito, species commonly found throughout Puerto Rico. Because of the great possibility of WNV’s arrival to the Island, Puerto Rico’s Department of Health has organized a plan to address the issue to protect our citizens.
This plan describes:
- the surveillance systems to identify the virus in birds and mammals,
- the prevention, response, and control systems that will be implemented,
- the surveillance systems to identify the virus in mosquitoes,
- the active and passive surveillance systems for human West Nile virus cases,
- the electronic data collection and sharing among public, state, and federal agencies
- the public campaign for public education
The resources allocated in this effort, including plan, infrastructure, and communication network, will form a cohesive multi-agency approach to respond to other similar disease events. To implement this plan we will require the cooperation and participation of local, state and federal agencies, community organizations, and specially, the general public. Working with connectivity, as a team, we will establish an early detection system that will minimize the risk of West Nile virus infection in humans and animals throughout the Island.
Surveillance
In Puerto Rico, WNV Animal Surveillance consists of laboratory testing of dead birds, birds in captivity, wild birds, sick and healthy horses, and canines. Human Surveillance consists of laboratory testing of patients with meningitis, encephalitis, acute flaccid paralysis, and other Polio, Guillain-Barré and Parkinson-like syndromes.
The main goal of these surveillance systems is to detect areas of local transmission. The data generated by these surveillance systems will be used to release recommendations for the prevention and control of the disease among animals and humans throughout the Island.
Animal Surveillance
Animal surveillance has proved to be an efficient way to identify promptly WNV infection through different regions of the United States. Dead bird surveillance has been the one with best results.
Birds
Dead bird surveillance
In United States, bird mortality and morbidity due WNV has been documented during the past transmission seasons. Researchers have found that human cases are usually preceded by detection of birds dead due to WNV infection. The PRDOH, in collaboration with the CDC, has developed a dead bird surveillance system. Personnel from the PRDOH, CDC, United States Fish and Wildlife Service (USFWS), United States Department of Agriculture (USDA), Puerto Rico Department of Agriculture (PRDA), the Department of Natural and Environmental Resources (DNRA) were encouraged to assist in the recollection and transportation of dead birds trough the island.
This surveillance system consists of the recollection and transportation of dead birds to the Puerto Rico CDC - Dengue Branch Laboratory. As birds arrive to the laboratory, they will be tested for WNV infection. Samples will be collected by collaborating agencies and by the general public as well.
A press conference, lead by the Secretary of the PRDOH, will be held at the beginning of the peak of transmission season (August). In this conference, the general public will be advised to report and transport dead birds to collection sites located through the Island. Instructions for proper handling of the dead birds, location, and phone numbers of collection sites will be given in the press conference and published in national and regional newspapers. Instructions will be available at the PRDOH web page (http://www.salud.gov.pr), will be given when people report by phone, and will be released by press communicates as required.
Samples are transported by the Coordinator or by collaborator agencies. Carcasses will be tested for WNV (deep stick and PCR) by PRDOH personnel in a biosafety level 3 laboratory located at the Puerto Rico CDC-Dengue Branch.
Although all dead bird species will be collected through the Island, the laboratory will only accept fresh carcasses with no signs of decomposition. If the number of samples submitted exceeds the laboratory capabilities, restrictions will be set based on location or specie type. After tests are conducted, results will be posted in the PRDOH web site and the CDC national database for arbovirus known as ARBONET.
Wild bird surveillance
Wild bird surveillance consists of testing blood samples collected from cowbirds (Molothrus bonariensis) captured by DNER as part of Yellow-shouldered Blackbird Recovery Program. Traps are placed in the municipalities of Lajas and Cabo Rojo. Every one or two weeks, traps are visited and captured birds are bled prior to euthanasia (performed by DNER). In addition, there is a collaborative agreement with the Smithsonian Environmental Research Center and the Kansas University; these two institutions will conduct serological studies in wild birds in different areas in the Island. Wild birds will be tested for WNV antibodies (HI).
Zoo
West Nile virus was first confirmed in a dead crow found in the Bronx Zoo in New York. Zoos used to monitor their animal collections very closely. The cause of death is usually investigated. In addition, deaths of wild birds in their facilities are also investigated, as these might have died from communicable diseases.
In Puerto Rico, Island’s zoos agreed to report and summit dead bird samples (collection or wild birds) to the PRDOH for testing. These samples will be transported to CDC-Dengue Branch by the Coordinator or collaborating agencies.
Continua... ver Documento - Puerto Rico West Nile Response Plan
| |
|
|