Posted on 09/01/2002 9:33:43 AM PDT by blam
Experts worry that West Nile risk has been exaggerated
09/01/02
By BILL FINCH
Environment Editor
Alabamians are spraying insecticide, begging for federal dollars, even raising property taxes in hopes of combating an epidemic of West Nile, the mosquito-borne virus that during this year alone has been diagnosed in at least 555 people nationally and resulted in 28 deaths.
But Mobile doctors say they're more worried about how they'll combat another, far more deadly disease that is expected to hit North America in a few short months.
This winter, scientists say, Alabamians will be fighting to survive a new strain of a disease that has killed more than 20 million people in a single year and hundreds of millions in the past century.
Projections by the National Centers for Disease Control indicate that even a mild outbreak of this disease will certainly infect tens of millions of Americans in a matter of weeks, sending more than a hundred thousand people to the hospital and killing some 20,000 in a single year.
Almost everyone who gets the disease will be debilitated for days; those who die will succumb to a slow asphyxiation. And even though a simple spray of bug repellent is considered complete and effective protection against West Nile, doctors believe the only hope of limiting the most devastating effects of this new disease will be a massive, nationwide vaccination program.
What is this horrible disease? It's called the flu, and its gruesome infection and death statistics shed some interesting light on how the public views the health risk from relatively rare diseases such as West Nile virus.
In Alabama, 13 people have been diagnosed with some form of West Nile infection so far this year, according to epidemiologists with the Alabama Department of Public Health. Some of those diagnosed with the infection have bad headaches and fever; others are seriously ill with encephalitic brain infections and will never fully recover. As of Saturday, none had died.
Those statistics have been well reported, on almost a daily basis, on television or in newspapers. But how many reports have alerted the public to the fact that this year, in Mobile alone, more than 130 people have died from flu and its accompanying complication, pneumonia?
Public health experts say that raising public awareness of West Nile virus is useful, since the disease can cause death in a very small segment of the population, and can almost certainly be avoided by taking a few simple precautions.
But increasingly, they say, they're worried that the public and the media are exaggerating the risk of West Nile. And they're worried that could have consequences for controlling more pervasive diseases and causes of death.
Bert Eichold, chief health officer of the Mobile County Health Department, said he wonders whether equal attention will be given to the dangers of flu and the importance of getting flu shots.
"We're spending tens of millions for emergency assistance for West Nile virus, when we run out of flu vaccine every year," Eichold said.
The results of that oversight will be unmistakably apparent in the hundreds of influenza-related deaths next year in Alabama, he said.
It's possible that tens of thousands of Americans and hundreds of Alabamians have already been infected with West Nile.
The simple fact is, there's no way of knowing for sure, because the symptoms of West Nile disease are typically so mild that most never know they've "contracted" it and never go to the doctor for it.
Health experts reporting to the Centers for Disease Control in Atlanta estimate that for every person who develops diagnosed symptoms of West Nile encephalitis, there are at least 150 to 200 people who have mild flu-like symptoms or never even realize they're infected.
Of those who have some symptoms, only a small percentage, generally computed at around 17 percent, develop serious complications. As is the case with the flu complications, most of these people will be over 65 or have some unusual underlying infirmity. For this small group of people -- this year, about one or two people out of every million Americans -- the consequences of full-blown West Nile encephalitis are devastating. Some will die. Those who survive are likely to be permanently disabled.
But an analysis of national health statistics reveals that West Nile is one of the least dangerous diseases the average American will come in contact with over the next year. Even with modern disease suppression efforts, chickenpox and tuberculosis will result in far more grisly infection and death statistics than all mosquito-borne illnesses combined, the CDC's national health statistics make clear. More Americans will be diagnosed with debilitating tick diseases than will be diagnosed with mosquito-borne disease.
"I would say that as a physician in practice in Mobile, Alabama, I would be surprised to see a single mosquito-related illness contracted in Mobile County," said Allen Perkins, vice chairman of the family medicine program at the University of South Alabama. "When I do see it, it's someone traveling outside the United States."
Even among mosquito-borne diseases, West Nile is likely to be rated of minor importance once the current epidemic works its way through the national media, many epidemiologists say.
Those who worry about mosquito diseases wonder why Eastern Equine Encephalitis hasn't made similar headlines. Triple E, as doctors call it, has long been a fact of life in the South, affecting some 10 to 15 people each year.
Unlike West Nile, which has killed less than 1 percent of those with diagnosed infections, equine encephalitis has a death rate of at least 30 percent among diagnosed cases, including several Alabama deaths in the last few years. Fewer than 10 percent of those who are treated for equine encephalitis ever fully recover.
But it may be useful to know that neither Triple E nor West Nile is likely to become the leading cause of death by encephalitis, a name given to a variety of infections that cause debilitating or fatal swelling in the brain. Surprisingly enough, simple cold sores -- the herpes simplex Type 1 virus that affects the vast majority of Americans -- are responsible for between 500 to 1,000 encephalitis cases per year, according to statistics reported by the Centers for Disease Control, the Mayo Clinic and other medical sources.
Unlike West Nile encephalitis, herpes simplex encephalitis seems to strike healthy middle-aged people as readily as it does the elderly or the immuno-compromised. Without treatment, 70 percent of herpes simplex encephalitis cases result in death. With treatment, the death rate among individuals infected with herpes simplex encephalitis is about 30 percent. So far this year, the death rate for West Nile is hovering at about 0.5 percent of diagnosed West Nile cases.
So why doesn't the public hear more about encephalitis deaths from cold sores?
In part, doctors and epidemiologists say, it's because it's nearly impossible to predict when cold sores are going to cause serious illness. And in part, they say, it's because diseases such as herpes simplex encephalitis and West Nile encephalitis pose about the same risk as being struck by lightning and don't rank when compared to the major preventable causes of death in the United States, such as smoking, bad diet and driving a car.
"There will be more people dying of automobile accidents this weekend than will die from West Nile virus this year," noted Keith Ramsey, the director of infectious disease research at the University of South Alabama.
So why has West Nile received so much attention?
Perkins blames it on the "slow news day" phenomenon.
He pointed out that the weekly West Nile updates from the Centers for Disease Control are identical to the weekly updates during annual flu outbreaks. The difference in public awareness, he said, is that the media has chosen to make the West Nile information a top-of-the-news item.
Perkins and others say it's hard to determine why West Nile seems to catch the public's attention more than other causes of illness and death. Perkins speculates that it's much easier for the media to produce eye-catching visuals when the disease transmitter is a mosquito, rather than a cough. And, he suggested, there's some "primal" reaction to causes of death that involve animals such as sharks, snakes or mosquitoes.
But doctors and epidemiologists contacted by the Register said they're at a loss to explain why there seemed to be less concern when the mosquito-transmitted Triple E killed an Alabama boy last year or when the sister-strain of West Nile, St. Louis encephalitis, swept through Florida a few years ago, resulting in 233 illnesses and 11 deaths.
Others, including Alabama Department of Public Health epidemiologist Brian Whitley, said they wonder if the recent attention has something to do with West Nile's exotic name. And some wondered if it had anything to do with the fact that West Nile was first diagnosed in New York City. That part of the country has little experience with mosquito diseases, they noted, but commands far more media attention than the backwaters of the Southeast, where outbreaks of mosquito-borne diseases are more common.
Regardless, there could be a cost to public health in overstating the dangers of West Nile and other exotic but extremely rare diseases, such as anthrax, the researchers said.
"How many people died of anthrax last year? Five. And how many millions have been shifted into health departments to fight it?" Ramsey asked.
A number of health experts said the real danger in overreaction is that it distracts attention, dollars and time from diseases and causes of death that affect millions of Americans each year.
"There are much more serious health problems in our community and in the state that need attention -- teen pregnancy rates, undiagnosed diabetes and hypertension, children being infected with sexually transmitted disease," said Eichold, Mobile's chief health officer. "We ought to use the best available science and data in applying the limited resources we have."
Eichold said everyone suffers when the public and its government representatives don't set realistic health care priorities.
"We spend more money in America on health care than any other country in the world, but the data does not indicate that it is necessarily spent effectively," said Eichold. "We're spending hundreds of millions preparing for bioterrorism when there are a tremendous number of people who are not being diagnosed for diabetes. How many university medical centers are short on dollars for indigent care every year?"
http://www.thedenverchannel.com/sh/health/stories/health-164334220020831-170825.html
MIAMI -- Health officials are investigating the possibility that a Florida man contracted West Nile virus from an organ transplant or a blood transfusion.
If either is the case, it would be a first, according to the Centers for Disease Control and Prevention.
The CDC's Web site says every case of West Nile virus in the United States has come from contact with a mosquito.
The Miami-area man in question hasn't been identified. Miami-Dade health officials don't believe he was infected by a mosquito. They say the 63-year-old man, who's been in the hospital, is unlikely to have come in contact with mosquitoes in his daily activities..
Officials say the man recently had a heart transplant from a Georgia donor.
I was not at all worried yesterday when I found a dead crow in my yard here in Pennsylvania. It had an arrow through it!
Thanks for the post. I was looking for this article and while looking, I found an article about an English man who got malaria from a mosquito that had flown in on a jet liner, lol. (stranger and stranger)
Hopefully just a cold. However, if the symptoms (assuming it is WNV) get no worse and I do survive (lol), won't I be immune from future infections of WNV?
I'm worried about my Eastern Bluebirds. I've not seen a one in about five weeks. They usually have three broods (very rare I've read) in the birdhouses I have around here. They only had two broods this year. (I've not found any dead Bluebirds though)
If a person is infected with West Nile virus, does that person develop lifelong immunity to future infection by the virus? It is assumed that immunity will be lifelong; however, it may decrease in later years.
Aspirin and chicken soup! :-)
The benefits manager at the company where I retired was named, A. Jay Bird. (I'm not kidding)
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