KDHE Statement Regarding West Nile Virus Testing and Reporting in Kansas

The Kansas Department of Health and Environment (KDHE) has become aware of increasing concerns about West Nile Virus testing and reporting in Kansas. This is a complex issue for many reasons including the differences in testing procedures between labs, and the broad reporting guidelines issued by the Centers for Disease Control and Prevention (CDC).

There are many ways to collect data on West Nile Virus as well as to report the data. KDHE chose to inform the public early in the year that this would be a difficult year for West Nile Virus in Kansans because we expected to see a large increase in the number of cases of West Nile Virus based on trends in other states. As predicted, we have seen a large increase in the cases to date, and a much faster spread of the disease. In addition, the presence of the virus has been demonstrated in animals in virtually all parts of the state.

Nevertheless, there seems to be some lack of clarity among the public, as well as physicians, about West Nile Virus reporting and testing. We have made many efforts to urge Kansans to take precautions regardless of whether or not there is a confirmed case in their community, because we know the virus is likely in all parts of the state, or could be on any given day, as mosquitos and birds migrate to new areas.

“If Kansans are waiting to take precautions against West Nile Virus until they hear of a confirmed case in their area or county, then we have a significant communication problem,” said Roderick Bremby, KDHE Secretary. “We will work to increase our communication of the way we test, confirm, and report cases as well as increase our effort to get the message out to all Kansans to avoid mosquitos.”

“We recognize there are more cases of West Nile Virus in Kansas than those confirmed by the state laboratory,” Bremby added. “We sympathize with anyone who has or will be affected by the disease and understand it may bring discomfort and difficulty depending on the severity. We encourage everyone to remember that if their case does not fit the criteria to be tested at the state level, this does not mean they have not encountered West Nile Virus. We are testing those cases with signs of encephalitis or meningitis, based on CDC criteria, because there is a need to provide physicians with this testing information.”

KDHE has been collecting information and processing laboratory specimens from individuals with signs of meningitis or encephalitis. These are usually very sick individuals who may benefit from receiving a definite diagnosis of West Nile Virus, since this information can guide the attending physicians to make important decisions about treatment. West Nile Virus infection can cause a variety of symptoms. Most people who are infected never become sick, and of those who are sick, only a few develop a severe disease that involves the central nervous system (i.e., meningitis or encephalitis).

Last year KDHE sent specimens to CDC for any Kansan who experienced symptoms of West Nile Virus meningitis or West Nile Virus encephalitis, and we reported those cases to the public, recognizing there were other cases that we could not confirm for a number of reasons including such mild symptoms that the cases were not reported to us, or the need for additional testing had passed because the person was now healthy.

This year we are reporting human cases the same way as we did last year. The only difference from 2002 to 2003 is KDHE is conducting the testing on human specimens at our state lab and at the same time, more testing is underway throughout the state in private laboratories. Tests available through commercial laboratories, while helpful for the clinical management of individual patients, are not as accurate and standardized as those available at state public health laboratories and at the CDC. For this reason, KDHE does not add private lab results to our state confirmed case list unless the tests are done on patients with meningitis or encephalitis and can be confirmed in the state laboratory.

Our first commitment is to protecting Kansans and we have urged Kansans to take precautions against West Nile Virus this year and last year. Starting in June 2003 we began issuing news releases on a regular basis urging Kansans to take precautions against West Nile Virus, reminding them the disease was in 103 of 105 Kansas counties in 2002, and predicting that 2003 would be a more difficult year in terms of a sharp increase in the number of cases. Since June, we have issued 18 news releases. KDHE’s Public Information Office with the assistance of the Bureau of Epidemiology has conducted almost daily interviews on the illness since the presence of West Nile Virus was announced in June in mosquitos.

The agency launched a public information campaign that involved sending public service announcements to media, issuing fact sheets, promoting a website developed specifically to inform the public of the West Nile Virus issue, and providing West Nile Virus prevention materials at the Kansas State Fair in Hutchinson. In addition, KDHE conducted news conferences after the state lab confirmed the first West Nile Virus meningitis human case this year and following the first West Nile Virus encephalitis death.

Our consistent message will continue to urge Kansans in all parts of the state to take precautions to avoid West Nile Virus by:

• Using an insect repellant with DEET.
• Wearing protective clothing.
• Avoiding, when possible, outdoor activities at dawn or dusk when mosquitos are most active.
• Getting rid of standing stagnant water.
• Repairing screens or areas of your home where mosquitos could enter.

In summary, KDHE only counts and reports cases of severe West Nile Virus disease (i.e., meningitis or encephalitis). These cases are confirmed through the state laboratory or the CDC. For each confirmed severe case, it is likely that there are many other people infected who experience mild symptoms. Proper alerts and personal precautions should not depend on the number of confirmed cases of severe disease reported by KDHE, but on the knowledge that the West Nile Virus is widely circulating in Kansas, both among animals and among humans. All Kansans should consider themselves at risk of acquiring the infection, and they should take precautions to avoid mosquito bites.

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