In June WEST NILE was identified nationwide. Today it’s POWASSAN VIRUS. – ARE WE PREPARED FOR A SURGE OF EMERGING MOSQUITO AND TICK BORNE VIRUSES?

Last Fall I was tested for Lyme disease after the summer in a tic infested area only to find that I had West Nile sometime in the past.

Last month I read that the West Nile virus was found in New York City. “The New York City Health Department says it had detected the first of the season’s mosquitoes with West Nile virus. The agency says the infected mosquitoes were found in Staten Island. No human cases were reported in the agency’s announcement Monday…..Mosquito season in New York typically spans from April to September.” (A)

So I Googled and found that West Nile virus has been reported nationwide. “Mississippi. California. Washington (state). Colorado. Texas. Florida. The elderly are most at risk of the illness. Healthy people generally feel mild flu-like symptoms, or none at all, when bitten by an infected mosquito. Researchers estimate only one in 100 West Nile infections causes symptoms, according to AP.” “ (B)

Todays’ headline is about Powassan virus in upstate NY – ever heard of it?
“Following the death last month of a Gansevoort man who contracted Powassan virus from a tick, a second Saratoga County resident has been hospitalized with the rare disease and a third is suspected of being infected, according to the state Health Department….
The cluster of Powassan virus cases is highly unusual, but not unheard of…. Before this year, there had been just 24 cases of the virus statewide since 2000, resulting in five deaths, including another Saratoga County resident in 2013. But there was one other cluster of three cases in Westchester County once, in 2007….” (C)

Which, of course, brings me to ZIKA and other emerging viruses.
“Zika hasn’t been in the news as much these days, but that doesn’t mean that the virus has gone away.
“People are just going to have to accept that as part of the new reality,” ….And as summer heats up and mosquito season begins again, the risk for Zika and other mosquito-borne diseases like dengue, chikungunya, and West Nile will rise also. It’s still unclear just how high the Zika risk will be this summer. Some researchers have predicted that the number of cases could explode, while others point to past success controlling the virus in the US at least as an indication that risk is not high.” (D)

The mosquitoes that carry Zika virus, dengue, chikungunya and yellow fever are more common across the United States than previously believed, federal experts reported Tuesday.
Updated maps for 2016 show the Aedes aegypti mosquito in 38 counties where it wasn’t found before — a 21 percent increase, the Centers for Disease Control and Prevention reported. (E)

“Aedes aegypti are present in more than half the states, from California to Florida and as far-flung as San Francisco, Kansas City and New Haven; entomologists have found that they regularly survive through the winter in sheltered spots in Washington, D.C. Unlike the salt-marsh mosquitoes that whine through beach towns at twilight or the night-biting Culex that carry West Nile between birds and humans, aegypti prefer proximity to people; we are their favorite meal. To get to us, they fly into houses and conceal themselves in closets and under beds and furniture. They have evolved to breed in the tiny pools of water we carelessly create around us: in an abandoned tire, the saucer under a houseplant, even an upturned bottle cap.” (F)

And Lyme! “An unusually large abundance of acorns in the northeast two years ago fueled a population boom of white-footed mice last year. And those tiny mice are breakfast, lunch and dinner to ticks, dozens of which can attach themselves to a single rodent, feed on its blood and acquire the bacteria that cause Lyme disease. Now some scientists are predicting a surge in the number of Lyme-carrying ticks beginning this month and lasting into early summer. (G)

ARE WE READY FOR A SURGE OF AN EMERGING VIRUS?
We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs). (H)
1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.
2. REVRCs should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and emerging viruses “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
REVRC protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as West Nile, Chikungunya, MERS, and Dengue.

(A) NYC health officials detect mosquitoes carrying West Nile virus, https://www.statnews.com/2017/06/20/west-nile-virus-new-york-city/
(B) West Nile Found in Florida, http://abcnews.go.com/Health/story?id=117346&page=1
(C) 2nd case of tick-borne Powassan virus in Saratoga County, 3rd suspected by Claire Hughes, http://www.timesunion.com/allnews/article/2nd-case-of-tick-borne-Powassan-virus-in-Saratoga-11296321.php
(D) Zika and other mosquito-borne diseases could hit hard this summer, by Kevin Loria, http://www.businessinsider.com/zika-mosquito-borne-disease-summer-risks-2017-6
(E) Zika Mosquitoes Are in More Places Than You Thought, CDC Says, by Maggie Fox, http://www.nbcnews.com/storyline/zika-virus-outbreak/zika-mosquitoes-are-more-places-you-thought-cdc-says-n774791
(F) Why the Menace of Mosquitoes Will Only Get Worse, by Matyn McKenna, https://www.nytimes.com/2017/04/20/magazine/why-the-menace-of-mosquitoes-will-only-get-worse.html
(G) Why 2017 may be a very bad year for Lyme disease, by Scott Fallon, https://www.usatoday.com/story/news/nation-now/2017/04/06/2017-may-very-bad-year-lyme-disease/100120496/
(H) https://doctordidyouwashyourhands.com/2017/05/ebola-is-back-in-africa-is-zika-next-are-we-prepared/