KDHE To Expand West Nile Virus Surveillance and Reporting in Kansas

The Kansas Department of Health and Environment (KDHE) is expanding its surveillance and reporting of West Nile Virus (WNV) cases in the state in an effort to provide more complete information on the spread of this infection.

“We want to provide as much information as possible to Kansans regarding West Nile Virus,” said Roderick Bremby, KDHE Secretary. “We believe this additional information will serve to better educate the public about this disease.”

Currently, the KDHE laboratory (DHEL) performs WNV tests on patients where meningitis, encephalitis or acute paralysis symptoms are present. Positive results of these tests are then sent to the Centers of Disease Control and Prevention (CDC) for inclusion in nationally collected information. This testing procedure will not change; however, the following surveillance and reporting procedures will be implemented:

• KDHE will continue to conduct surveillance for meningitis and encephalitis. These are the most severe manifestations of WNV infection. Possible cases will be identified through reports from health care providers and hospitals, and will be confirmed through laboratory tests performed at KDHE. These cases will be reported to the CDC.
• In addition, KDHE will continue to confirm and report to the CDC cases of patients with acute flaccid paralysis, another severe manifestation of WNV infection.
• KDHE will publicly release information on unverified, presumptive WNV positive results from commercial laboratories that were not tested at the KDHE laboratory, either because the patients did not have the severe clinical symptoms of WNV, or because specimens were not submitted to KDHE for testing. Since no follow up is done at KDHE on these results after they are received, very limited information is available on these individuals. In particular, it is unknown what symptoms these persons experienced, why they received a WNV test, and where they live. Therefore, a total count will be provided, with no breakdown by county. It should be noted that the laboratory tests currently available through commercial laboratories are fairly new and lack standardization. Therefore the accuracy of these tests is still unknown, and the presence of false positive and false negative results is possible.For this reason, test results obtained in this way will be classified only as unverified, presumptive WNV infections, and will not be reported to the CDC. KDHE will continue to offer confirmatory tests on positive specimens from patients with meningitis, encephalitis, and acute flaccid paralysis tested at commercial laboratories.
• KDHE will publicly release unverified, presumptive WNV deaths identified through death certificates where the coroner or physician indicates that WNV was the cause of death. These cases will be reported to the CDC only if the cause of death can be verified through tests performed at the KDHE laboratory (in which case the death will be classified as a confirmed case).
• KDHE will publicly release results of the WNV screening program performed in blood donation centers statewide. When available, this information will be provided broken down by county of residence of the donors.

To date, 61 cases of WNV meningitis or encephalitis have been confirmed in Kansas, but as KDHE has pointed out since the beginning of the WNV transmission season, the number of individuals infected with the virus is likely to be much greater, since most infections do not cause any symptoms. The additional information that KDHE is now making available may help better describe the magnitude and spread of this infection, although it needs to be interpreted with caution, because of important limitations that affect its quality.

“We sympathize with anyone who has been impacted by West Nile Virus this year and urge everyone to take precautions against the illness regardless of whether there are reported positive cases in your county,” Bremby added. “Coming in contact with mosquitos infected with West Nile Virus is a risk we face all across the state.”

The following precautions are recommended to minimize contact with mosquitos and exposure to West Nile Virus:

• Use insect repellent containing DEET (according to label directions);
• Limit outdoor activities during dawn/dusk when mosquitos are most active;
• Wear long-sleeved shirts and long pants when outdoors whenever practical;
• Eliminate any stagnant pools of water on your property. (Standing, stagnant water is a common habitat for mosquitos).
• Repair screens or other areas of your home where mosquitos might enter. 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, encephalitis, acute paralysis).

Symptoms of West Nile Virus infection are usually mild and include fever, headache, and body aches, occasionally with a skin rash on the trunk of the body and swollen lymph glands. The symptoms of severe infection (West Nile encephalitis or meningitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis.

While West Nile Virus can cause severe illness, even death, many people who become infected will never know they were infected, because the disease usually produces no symptoms or health complications in humans.

West Nile Virus is primarily a disease of birds that is transmitted by mosquitos on to other birds, horses and humans. Last year Kansas had 22 human WNV cases with no fatalities, and 794 cases involving horses and mules. More than 300 birds were tested. One hundred three of the 105 Kansas counties reported having WNV in either humans, horses, birds, or mosquitos.

Human testing for the disease is generally recommended only for hospitalized patients with severe symptoms. There is no specific treatment for WNV. People more than 50 years old are most susceptible to serious illness as the result of West Nile Virus.

For questions about West Nile Virus in humans, call KDHE at 1-877-427-7317. Physicians, hospitals, and local health departments should report any suspicious cases of encephalitis to KDHE.

A toll-free hotline has been set up for Kansans to report dead birds at 1-866-452-7810. The Dead Bird Hotline number has changed and an updated number will be provided soon. (Individuals who submit birds for WNV testing will not be given the results by KSU or KDHE.)

Additional information on West Nile Virus may be found at http://www.entomology.ksu.edu/DesktopDefault.aspx?tabid=711 .

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