Arbovirus Epidemiology

2nd Quarter DIDE Training

May 18, 2011

Objectives
Describe the epidemiology of endemic arboviral
infections affecting humans in the United States
Briefly review other arboviral diseases that may
be reported following travel outside the United
States
Discuss mosquito bite prevention

Arboviruses
Arthropod-borne virus
Viruses maintained in nature through biological
transmission between susceptible vertebrate hosts by
blood feeding arthropods (mostly mosquitoes)
Over 130 arboviruses known to cause disease in humans
Three virus families:
Togaviridae
Flaviviridae
Bunyaviridae

Arbovirus Transmission
Transmission intensity coincides with activity of vector
Late spring through early fall (for mosquitoes)
Incubation period: usually 3 to 18 days
Humans are dead-end hosts (i.e., do not become
viremic)
There are exceptions
Blood transfusions
Organ transplants
Perinatal exposure
Certain viruses (e.g., chikungunya virus, dengue,
etc.)
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Human Arboviral Infections

Clinical spectrum varies widely
Most infections are asymptomatic
Can range from mild fever to aseptic meningitis or
encephalitis
Non-neuroinvasive vs. neuroinvasive
Symptomatic infections can result in complications
Hospitalization, long-term neurologic dysfunction,
or even death
Vaccines, specific treatment generally not available for
most arboviruses
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Major Arboviruses Endemic in U.S.

Western equine encephalitis virus (WEE)

Eastern equine encephalitis virus (EEE)
St. Louis encephalitis virus (SLE)
Powassan virus (POW)
West Nile virus (WNV)
California Serogroup viruses
La Crosse encephalitis virus (LAC)

WEE
Family: Togaviridae (genus: Alphavirus)
First isolated in 1930 (horse, California)
No human cases in U.S. for past 10 years
Majority of cases west of Mississippi River
Vector and virus still persist in affected region
Risk groups:
rural residents of the West (particularly
children <1 year)
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WEE Neuroinvasive Disease Cases

Reported by State, 19642009

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EEE
Family: Togaviridae (genus: Alphavirus)
First isolated in 1933 (horse, Virginia)
Average of 6 cases reported per year (range: 0
20)
Atlantic and Gulf coastal areas, Great Lakes
Risk groups
Persons >50 years or <15 years are highest
risk
30% of encephalitic cases result in death
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EEE Neuroinvasive Disease Cases Reported

by Year, 19642009

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EEE Neuroinvasive Disease Cases Reported

by State, 19642009

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SLE
Family: Flaviviridae (genus: Flavivirus)
First isolated in 1933 (human, Missouri)
Average of 102 cases reported per year (range: 2
1,967)
Reported throughout U.S.
Outbreaks: Mississippi Valley and Gulf Coast
High risk
Elderly, low income
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SLE Neuroinvasive Disease Cases

Reported by Year, 19642009

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SLE Neuroinvasive Disease

Cases Reported by State, 19642009

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POW
Family: Flaviviridae (genus: Flavivirus)
First isolated in 1958 (human, Canada)
Transmitted by a tick (primarily Ixodes cookei)
Average of 3 cases reported per year (range: 07)
Most cases in New England, Upper Midwest
High risk
Adults that spend time in tick habitats
1015% result in death
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POW Neuroinvasive Disease

Cases Reported by State, 20012009

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WNV
Family: Flaviviridae (genus: Flavivirus)
First isolated in 1937 (human, Uganda)
Average of 2,500 cases reported per year (range:
219,861)
Emerged in 1999, quickly peaked in 2003
Spread throughout continental U.S.
High risk
Persons >50 yrs of age
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WNV 1999

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WNV 2000

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WNV 2001

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WNV 2002

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WNV 2003

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WNV 2010

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LAC
Family: Bunyaviridae (genus: Bunyavirus, California)
First isolated in 1964 (human, Wisconsin)
Nearly all California serogroup viruses are due to
LAC
Average of 78 cases reported per year (range: 29
167)
Most cases occur in Upper Midwestern, midAtlantic and southeastern states
High risk:
Children <16 years
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California Serogroup Virus Neuroinvasive

Disease Cases Reported by State, 19642009

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Cluster
(20032007)*
#1 (Nicholas,
Fayette,
Raleigh)

Median
Inciden
ce
110 per
100,000
(<15
years)

RR
9.
2

#2 (Wyoming,
40 per
4.
McDowell,
100,000 3
*Haddow AD, Bixler D, Adoi, A. The
Mercer)
(<15
spatial epidemiology and
clinical
features of reported cases
of La Crosse
years)
Virus infection in West Virginia from
2003 to 2007. BMC Infectious Diseases
2011, 11:29

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Other Arboviruses - Dengue

1/3 of the global
population lives in
endemic countries
WHO estimates up
to 100 million
cases/year
20,000 deaths
(mostly children)

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Dengue in the United States

436 travel-associated cases reported in U.S.
in 2010 (most from PR)
Outbreak in Hawaii in 20012002
Local transmission reported in Florida
beginning 2009 (53 cases in 2010)

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Other Arboviruses - CHIK

Chikungunya
Transmission documented in 37 countries
Primarily found in Africa and Asia
1.4 million cases reported in 2006
Travel-associated cases documented in U.S.
109 cases since 1995
Similarities with dengue
Same vectors
Humans can become reservoirs when
infected
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Challenges
Outbreaks
Infrequent
Unpredictable
Geographic distribution knowledge
Surveillance
Prevention/control
Treatment
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Be aware of peak mosquito hours

o
o

For many mosquitoes, peak hours are between dusk

and dawn or evening and early morning.
For the mosquitoes that transmits La Crosse
encephalitis virus peak hours are actually during the
daytime (dawn until dusk).

Use insect repellant that contains DEET, picaridin,

IR3535 or oil of lemon eucalyptus on exposed skin
and clothing when outdoors.
o
o
o

Always follow package directions.

Apply sparingly to children, avoiding hands and face,
and wash them with soap and water when they come
indoors.
Permethrin is a repellant that can be applied to clothing
and provide protection through multiple washes. Do
not apply permethrin-containing repellants directly to
skin.

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Summary
Arboviral infections result from viruses
maintained in nature between arthropods and
vertebrate hosts
LAC continues to be the primary arbovirus of
human concern in WV
Other arboviruses may result from out-of-state
or international travel
Prevention efforts center around removal of
breeding sites and repellant use
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