eastern equine encephalitis - ippsr · "eastern equine encephalitis virus in the united...
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Eastern Equine Encephalitis
Nike Shoyinka MD MPHMedical Director
Ingham County Health Department
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EEE - History ● 1831 - Encephalomyelitis virus affects horses in Massachusetts
● 1933 - Virus isolated from horse
● 1937 - Virus identified in ring necked pheasant
● 1938 - Virus isolated in human brain
● 1942 -1943 - Michigan epidemic
● 1947 - Louisiana and Texas
○ 14000 cases 83% fatality rate
● 1951 - Isolated from the Culiseta melanura
● 1959 - Largest recorded EEV outbreak NJ, 32 lab confirmed human cases
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EEE - Virus
● Arbovirus - Arthropod - borne
● Mosquito borne alpha virus
● Most virulent variant is found in
North America
● Causes one of the most severe
encephalitides in North America
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Clinical Features● Incubation period - 4-10 days
● Asymptomatic
● Systemic disease
○ Headache
○ Fever
○ Myalgia /arthralgia
○ Flu-like symptoms
*Infection confers life long immunity
● Neuroinvasive disease
○ Fever
○ Headaches
○ Altered mental status
○ Seizures
○ Permanent neurological
sequlae - 50%
○ Mortality - 30%
*4-5% of infections result in invasive
disease
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EEE - Vector ● Main vector - Culiseta Melanura
● Bridge Vector
○ Coquillettidia sp
○ Aedes spp
○ Ochlerotatus spp
○ Culex spp
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EEE Transmission
nemassmosquito.org
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EEE cases reported by month of illness onset
Lindsey, Nicole P., J. Erin Staples, and Marc Fischer. "Eastern equine encephalitis virus in the United States, 2003–2016." The American journal of tropical
medicine and hygiene 98.5 (2018): 1472-1477.
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EEE Transmission
Outbreaks are hard to predict
Transmission heavily dependent on
- Temperature
- Precipitation
- Human activity
- Vector and Host spread
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EEE - Epidemiology
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EEE - Epidemiology
| Fig. 1 Reported cases of human eastern equine encephalitis (EEE) virus disease by state of residence to ArboNET, 2008–2017. Of note, the map shows the state of residence for each case, which is not necessarily where the infection was acquired. The cases from Montana and Missouri were thought to be travel-associated and not locally acquired. (This image is provided courtesy of ArboNET, Arboviral Diseases Branch, U.S. Centers for Disease Control and Prevention.)|
State Cases
Massachusetts 12
Michigan 10
Connecticut 4
NewJersey 3
Rhode Island 3
Indiana 1
North Carolina 1
Tennessee 1
https://www.cdc.gov/easternequineencephalitis/tech/epi.html
2019 - 35 cases2009-2018 - 72 cases
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EEE - Michigan
Human
Animal
www.michigan.gov/eee
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EEE- Public Health Response
● Source reduction
● Surveillance
● Control
● Communication
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EEE - Public Health Response -Communication
● Timely collection/dissemination of
information about disease distribution
● Effective communication and support about
disease reduction and prevention
Healthcare providers
● Reporting
● Increased clinical suspicion
● Testing
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Surveillance
● Passive Surveillance -
● Targeted surveillance
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Courtesy of Emerging and Zoonotic Infectious Disease Section, MDHHS
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Michigan Mosquito Surveillance
● Commercial city and township
mosquito control programs
● Federally funded local health
department surveillance for
WNV in high incidence
jurisdictions
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EEE - Public Health Response - ControlEliminate breeding grounds
● Remove old plastics tires
● Empty bird baths
● Clear gutters
● Fill or drain puddles, swampy areas (wikipedia)
Protection
● Mosquito repellant
● Avoid dusk to dawn outings
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EEE - PH response - Control
● Aerial spraying - Low Flying Aircraft
● Pyrethrin 5% EPA approved organic
● 0.87 ounce per acre/1 tablespoon per football field
● Adulticide
● Weather dependent
● No health effects to general public
● Opt out
● No reported cases after aerial spraying
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Acknowledgements1. Kimberly Signs, DVM, Emerging and Zoonotic Infectious Disease
Section, Bureau of Epidemiology and Population Health, MDHHS
2. William Nettleton MD Medical Director, Kalamazoo and Calhoun County
Health Department
3. Meghan Weinberg MPH PhD, Region 1 Epidemiologist Surveillance and
Infectious Disease Epidemiology Section MDHHS
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Thank You