Preparing for WNV: Preparing for WNV: Montana’s ExperienceMontana’s Experience

Jim Murphy, Health Specialist

Montana Department of Public Health & Human Services

(406) 444-0274 jmurphy@state.mt.us

ObjectiveObjective

By the end of this presentation By the end of this presentation participants will be able to:participants will be able to:

List three specific activities that can be List three specific activities that can be implemented at the local level to prepare for the implemented at the local level to prepare for the emergence of WNV. emergence of WNV.

Presentation OverviewPresentation Overview

1.1. Montana’s preparation prior to Montana’s preparation prior to the arrival of WNVthe arrival of WNV

2.2. Impact of WNV in MontanaImpact of WNV in Montana

3.3. Critique of performance & Critique of performance & improving our response improving our response

Montana’s Preparation for WNVMontana’s Preparation for WNV(CDC Epidemiology & Laboratory Capacity (ELC) (CDC Epidemiology & Laboratory Capacity (ELC)

funds in mid-2001)funds in mid-2001)

Developed partnerships with state counterparts in Developed partnerships with state counterparts in Livestock, Agriculture & the University/Extension Livestock, Agriculture & the University/Extension system.system.– Offered funding to support testing efforts of birds, Offered funding to support testing efforts of birds,

horses & mosquitoes.horses & mosquitoes.– Distributed brochures & fact sheets to local partners.Distributed brochures & fact sheets to local partners.– Promoted passive clinical surveillance through Promoted passive clinical surveillance through

mailings to providers.mailings to providers.

2 Human Cases diagnosed in Fall 2002Human cases (2)

Equine (134)

West Nile Virus Infections, by County, Montana 2002

1

1

Year 1 (2002) Results/CritiqueYear 1 (2002) Results/Critique Lab & partners well preparedLab & partners well prepared Low/Moderate level of worry Low/Moderate level of worry

among public & pressamong public & press Horses best sentinel indicator in Horses best sentinel indicator in

sparsely populated statessparsely populated states–Bird & mosquito testing not Bird & mosquito testing not

highly organized? highly organized?

Year 1 (2002) Results/CritiqueYear 1 (2002) Results/Critique

Needs: Needs:

–Better educational resourcesBetter educational resources

–Better bird & mosquito Better bird & mosquito monitoringmonitoring

–Plan for higher volume in Plan for higher volume in coming yearcoming year

West Nile Virus Infections, by County, Montana 2003

228 Cases and 4 deaths in late summer 2003

Counties with >5 cases detailed above

Human cases (228)

Equine (193)

11

11

7

10

14

9

6

9

10

12

23

12

1217

35

Year 2 (2003) Results/CritiqueYear 2 (2003) Results/Critique

What went well?What went well?– Most agencies responded wellMost agencies responded well

– Mosquito monitoring improved but still Mosquito monitoring improved but still of limited useof limited use

– Press & PIO very helpful in promoting Press & PIO very helpful in promoting prevention and getting updates outprevention and getting updates out

Year 2 (2003) Results/CritiqueYear 2 (2003) Results/Critique

Lab & partners not prepared for volumeLab & partners not prepared for volume– Unable to quickly test human & mosquito specimens.Unable to quickly test human & mosquito specimens.

» Providers, mosquito controllers angry with lab delays.Providers, mosquito controllers angry with lab delays.

– Partners unable to keep up with “dead bird” calls.Partners unable to keep up with “dead bird” calls.– Regional medical centers heavily impacted:Regional medical centers heavily impacted:

» 15 to 25 people hospitalized for WNV in 2 to 3 15 to 25 people hospitalized for WNV in 2 to 3 facilities on any given day during peak of seasonfacilities on any given day during peak of season

– Guidance on who & when to test challenging to Guidance on who & when to test challenging to develop.develop.

Year 2 (2003) Results/CritiqueYear 2 (2003) Results/Critique

Information Issues:Information Issues:– Attempts to respond daily to press were noble, but Attempts to respond daily to press were noble, but

unrealistic.unrealistic.– Difficulty determining severity of illness and Difficulty determining severity of illness and

residency issues based on lab reporting.residency issues based on lab reporting.– Lack of consensus on the detail of information to Lack of consensus on the detail of information to

release to public/press. release to public/press. – Data entry into several CDC systems burdensome.Data entry into several CDC systems burdensome.

Improving our Response in Year 3Improving our Response in Year 3

Addressing “Volume” IssuesAddressing “Volume” Issues– Automate Serology tests.Automate Serology tests.– Simplify bird testing.Simplify bird testing.– Provide guidance, forms & expectations to Provide guidance, forms & expectations to

reporting sources ASAP. reporting sources ASAP. – Improve coordination of sample submission.Improve coordination of sample submission.– Support local seminars & distribute WNV Support local seminars & distribute WNV

materials to increase the knowledge level.materials to increase the knowledge level.

Improving our Response in Year 3Improving our Response in Year 3 Addressing “Information” IssuesAddressing “Information” Issues

– Use or designate a PIO to coordinate with Use or designate a PIO to coordinate with press, “pre-draft” releases.press, “pre-draft” releases.

– Review/establish procedures regarding info Review/establish procedures regarding info release ASAP. release ASAP.

– Review/draft reporting forms & the flow of Review/draft reporting forms & the flow of reports.reports.

– Evaluate data tracking/submission to CDC.Evaluate data tracking/submission to CDC.

Lessons Learned:Lessons Learned:

In our experience, most issues In our experience, most issues came down to:came down to:– Clarifying roles Clarifying roles

– Clarifying expectationsClarifying expectations

– Preparing for surge capacityPreparing for surge capacity

– Anticipating the worst…Anticipating the worst…

Questions?