Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

full-text ►

Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 7—July 2015

Research

Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1

On This Page

• Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2
• Table 3
• Table 4

Downloads

• PDF[506 KB - 8 pgs]
• RIS[TXT - 2 KB]

James Hadler , Dhara Patel, Roger S. Nasci, Lyle R. Petersen, James M. Hughes, Kristy Bradley, Paul Etkind, Lilly Kan, and Jeffrey Engel

Author affiliations: Yale University School of Public Health, New Haven, Connecticut, USA (J.L. Hadler); Council of State and Territorial Epidemiologists, Atlanta, Georgia, USA (D. Patel, J. Engel); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (R.S. Nasci, L.R. Petersen); Emory University School of Medicine, Atlanta (J.M. Hughes); Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA (K. Bradley);National Association of County and City Health Officials, Washington, DC, USA (P. Etkind, L. Kan)

Suggested citation for this article

Abstract

Before 1999, the United States had no appropriated funding for arboviral surveillance, and many states conducted no such surveillance. After emergence of West Nile virus (WNV), federal funding was distributed to state and selected local health departments to build WNV surveillance systems. The Council of State and Territorial Epidemiologists conducted assessments of surveillance capacity of resulting systems in 2004 and in 2012; the assessment in 2012 was conducted after a 61% decrease in federal funding. In 2004, nearly all states and assessed local health departments had well-developed animal, mosquito, and human surveillance systems to monitor WNV activity and anticipate outbreaks. In 2012, many health departments had decreased mosquito surveillance and laboratory testing capacity and had no systematic disease-based surveillance for other arboviruses. Arboviral surveillance in many states might no longer be sufficient to rapidly detect and provide information needed to fully respond to WNV outbreaks and other arboviral threats (e.g., dengue, chikungunya).

Before 1999, there was no appropriated funding in the United States for arboviral surveillance, and many states had no arboviral surveillance systems (2). After the emergence of West Nile virus (WNV) in New York, New York, in 1999 (3), Congress appropriated annual funding to support WNV surveillance activities in affected states and large cities; funds were awarded to these areas through epidemiology and laboratory capacity (ELC) cooperative agreements from the Centers for Disease Control and Prevention. CDC collaborated with state, local health, and academic partners to develop WNV detection, monitoring, and prevention guidance (4,5). By 2004, WNV had spread across the continental United States (6), and transmission to humans had been documented by multiple routes, including blood transfusions and organ transplantation (7–10). That year, CDC distributed nearly $24 million to all states and 6 large city/county health departments for WNV surveillance and prevention.

In 2000, CDC established ArboNET, a comprehensive national surveillance data capture platform to monitor WNV patterns. In 2003, CDC expanded ArboNET to include other arboviral diseases. ArboNET relies on a distributed surveillance system, whereby ELC-supported state and local health departments report data weekly on detection of arboviruses in humans, animals, and mosquitoes. CDC posts all data on the Internet with weekly updates (11). In 2004, the Council of State and Territorial Epidemiologists (CSTE) conducted a WNV surveillance capacity assessment and found that WNV surveillance programs were in place and well developed in jurisdictions receiving WNV surveillance funding (12). CSTE attributed the success of capacity development primarily to availability of federal funds and technical guidance from CDC.

Annual funding for WNV and other arbovirus surveillance distributed through the ELC cooperative agreements has steadily decreased since 2006 to 39% of its 2004 zenith, reaching lows of $9.3 million in 2012 and in 2013 (R.S. Nasci, unpub. data). Concomitantly in 2012, the nation experienced the highest incidence of confirmed WNV neuroinvasive disease since 2003 and the highest number of confirmed deaths (286) for any year thus far (13). In addition to the continued challenge of WNV to financially stressed arbovirus surveillance systems, there is the growing threat of other arboviral diseases, such as dengue (14), chikungunya (15–17), and Powassan virus encephalitis (18).

In August 2013, CSTE conducted another assessment of state and selected local health departments (LHDs) to measure their current surveillance and staffing capacity for WNV and other arboviruses and compare findings with those from the 2004 assessment (19). Its objectives were to describe 1) national capacities for surveillance for WNV and other arboviruses in the 50 states and 6 ELC-funded LHDs in 2012 and changes since 2004; 2) surveillance capacities of LHDs with historically high WNV burdens but no direct federal funding and how they compare with those in ELC-supported LHDs; and 3) the outstanding needs to bring US arbovirus surveillance to full capacity.

Dr. Hadler is clinical professor of epidemiology and public health at Yale School of Public Health and consultant to the New York City Department of Health and Mental Hygiene and to CSTE. His main research interests include the epidemiology and prevention of infectious diseases, disease surveillance, and health disparities.

Acknowledgments

We thank the workgroup for developing the assessment tool and providing valuable insights on interpretation of findings. In addition to the authors, workgroup members are Jane Getchell and Kelly Wroblewski (Association of Public Health Laboratories), James Blumenstock and Abraham Kulungara (Association of State and Territorial Health Officials), and Alfred DeMaria, Catherine Brown, Carina Blackmore, and Jennifer Lemmings (CSTE). We also thank Kimberly Miller, Rebecca Rutledge and Jessica Wurster for assistance with data analysis.

This study was supported by Cooperative Agreement no. 1U38HM000414-05 from the Centers for Disease Control and Prevention. K.B. is listed as principal investigator on the ELC cooperative agreement for Oklahoma.

References

1. Hadler JL, Patel D, Bradley K, Hughes JM, Blackmore C, Etkind P, National capacity for surveillance, prevention, and control of West Nile Virus and other arbovirus infections—United States, 2004 and 2012. MMWR Morb Mortal Wkly Rep. 2014;63:281–4 .PubMed
2. Centers for Disease Control and Prevention. Arboviral infections of the central nervous system—United States, 1996–1997. MMWR Morb Mortal Wkly Rep. 1998;47:517–22 .PubMed
3. Centers for Disease Control and Prevention. Outbreak of West Nile-like viral encephalitis—New York. MMWR Morb Mortal Wkly Rep.1999;48:845–9 .PubMed
4. Centers for Disease Control and Prevention. Guidelines for surveillance, prevention, and control of West Nile virus infection—United States.MMWR Morb Mortal Wkly Rep. 2000;49:25–8 .PubMed
5. Centers for Disease Control and Prevention. Epidemic/epizootic West Nile virus in the United States: guidelines for surveillance, prevention, and control. 3rd revision, 2003 [cited 2014 Apr 25]. http://www.michigan.gov/documents/wnv-guidelines-aug-2003_87983_7.pdf.
6. Petersen LR, Hayes EB. Westward ho?—The spread of West Nile virus. N Engl J Med. 2004;351:2257–9.
7. Pealer LN, Marfin AA, Petersen LR, Lanciotti RS, Page PL, Stramer SL, Transmission of West Nile virus through blood transfusion in the United States in 2002. N Engl J Med. 2003;349:1236–45.
8. Iwamoto M, Jernigan DB, Guasch A, Trepka MJ, Blackmore CG, Hellinger WC, ; The West Nile Virus in Transplant Recipients Investigation Team. Transmission of West Nile virus from an organ donor to four transplant recipients. N Engl J Med. 2003;348:2196–203.
9. Centers for Disease Control and Prevention. Intrauterine West Nile virus infection—New York, 2002. MMWR Morb Mortal Wkly Rep.2002;51:1135–6 .PubMed
10. Centers for Disease Control and Prevention. Possible West Nile virus transmission to an infant through breast-feeding—Michigan, 2002. MMWR Morb Mortal Wkly Rep. 2002;51:877–8 .PubMed
11. Centers for Disease Control and Prevention. West Nile virus: statistics and maps [cited 2014 Aug 24]. http://www.cdc.gov/westnile/statsMaps/
12. Centers for Disease Control and Prevention. Assessing capacity for the surveillance, prevention, and control of West Nile virus—United States, 1999 and 2004. MMWR Morb Mortal Wkly Rep. 2006;55:150–3 .PubMed
13. Centers for Disease Control and Prevention. West Nile virus and other arboviral diseases—United States, 2012. MMWR Morb Mortal Wkly Rep.2013;62:513–7 .PubMed
14. Centers for Disease Control and Prevention. Locally acquired dengue—Key West, Florida, 2009–2010. MMWR Morb Mortal Wkly Rep.2010;59:577–81 .PubMed
15. Ruiz-Moreno D, Vargas IS, Olson KE, Harrington LC. Modeling dynamic introduction of chikungunya virus in the United States. PLoS Negl Trop Dis.2012;6:e1918.
16. World Health Organization. Global alert and response. Chikungunya in the French part of the Caribbean isle of Saint Martin. 2013 Dec 10 [cited 2014 Aug 24]. http://www.who.int/csr/don/2013_12_10a/en/index.html
17. Centers for Disease Control and Prevention. Chikungunya in the Americas. Spread of the virus in the Americas. 2014 Apr 7 [cited 2014 Aug 24].http://www.cdc.gov/chikungunya/geo/americas.html
18. Ebel GD. Update on Powassan virus: emergence of a North American tick-borne flavivirus. Annu Rev Entomol. 2010;55:95–110 and.
19. Council of State and Territorial Epidemiologists. Assessment of capacity in 2012 for the surveillance, prevention and control of West Nile virus and other mosquito-borne virus infections in state and large city/county health departments and how it compares to 2004. February 2014 [cited 2014 Aug 24]. http://www.cste2.org/docs/VBR.pdf
20. Centers for Disease Control and Prevention. West Nile virus in the United States: guidelines for surveillance, prevention, and control. 4th revision. June 14, 2013 [cited 2014 Aug 24]. http://www.cdc.gov/westnile/resources/pdfs/wnvGuidelines.pdf
21. Centers for Disease Control and Prevention. Epi Info. 2013 Apr [cited 2014 Aug 24]. https://wwwn.cdc.gov/epiinfo/user-guide/survey/introduction.html
22. United States Geological Survey. Dengue fever (imported, locally acquired)—human, 2013. 2014 Jan [cited 2014 Aug 24].http://diseasemaps.usgs.gov/del_us_human.html

Figures

• Figure 1. Total and at least 50% time staff performing West Nile virus surveillance in state health departments, United States, 2004 and 2012.
• Figure 2. Comparison of surveillance indices in states reporting need for additional staff with those not reporting a need by type of staff needed, United States, 2012. A) Epidemiologists; B) Laboratory...

Tables

• Table 1. States conducting selected West Nile virus surveillance activities, United States, 2004 and 2012
• Table 2. States with laboratory capacity to support WNV and other arboviral surveillance activities, United States, 2004 and 2012
• Table 3. Local health departments conducting selected WNV surveillance activities, by whether they received federal WNV surveillance funding (ELC) support, United States, 2012
• Table 4. FTE positions for arbovirus surveillance in 2012 and additional FTEs needed by functional job category, 50 states and 21 local health departments, United States

Suggested citation for this article: Hadler JL, Patel D, Nasci RS, Petersen LR, Hughes JM, Bradley K, et al. Assessment of arbovirus surveillance 13 years after introduction of West Nile virus, United States. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.140858

DOI: 10.3201/eid2107.140858

1A shorter version of this report has been published previously (1).