West Nile Virus Planning for Northern Virginia,
Maryland, and the District of Columbia

A cooperative effort by local, state, and federal agencies, municipal
and county governments, the military, and the public

West Nile Virus Response Group
Earl Tester - Chairman
May 7, 2000

Introduction

New York City, in the summer of 1999, had the distinction of being the site of the first outbreak of the West Nile arbovirus in the western hemisphere. As a source of outbreaks in Africa, the Middle East and Europe, it had already shown itself capable of inflicting illness upon hundreds, and sometimes thousands of victims. The discovery of the disease in our largest metropolitan area raised the specter of a major illness event for which the United States was unprepared.

Fortunately, the timing of the outbreak and prompt response by federal, state, and city officials led to a cessation in the spread of the virus as the autumn season advanced. However, concern that the virus could winter-over in the New York area, combined with the potential for the organism to survive in the migrating bird population, led health officials to correctly conclude that reappearance of the disease was distinctly possible.

Consequently, the National Centers for Disease Control urged states and local jurisdictions along the Atlantic bird migration route to plan for the possibility of another outbreak of the West Nile virus. Surveillance of the bird and insect populations were then initiated. Jurisdictions began to meet to coordinate activities and identiy local risks of mosquito-borne disease.

In Northern Virginia, the West Nile Virus Response Group was formed in December 1999 to develop just such a response plan. It soon became obvious that other closely-associated communities also needed to be included in the planning. Eventually, Montgomery County, Maryland and the District of Columbia joined the Northern Virginia to create a truly regional approach to West Nile planning. The document before you is the product of the efforts of these many individuals, representing many disciplines. The plan functions to support and expand upon the state plans under development in Maryland and Virginia which must, by their larger audience, be somewhat more general in nature. However, as the state plans supply technical support and coordinate state-wide resources for the effort, both plans are to be included as appendices, as soon as they are available.

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Table of Contents

Forward

Planning Committee - Organizations and Agencies

Committee Members

Executive Summary

Outbreak Risk Category 0 Activities

Outbreak Risk Category 1 Activities

Outbreak Risk Category 2 Activities

Outbreak Risk Category 3 Activities

Outbreak Risk Category 4 Activities

Appendix

Glossary

General West Nile Virus Information

News Bulletin Template #1: Residents Help Eliminate Mosquitos

News Bulletin Template #2: Tips for Eliminating Breeding Sites

News Bulletin Template #3: Health Officials Ask Help in Detecting and Tracking WN Virus

News Bulletin Template #4: Health Officials confirm WNV in Local Bird

News Bulletin Template #5: Health Officials Confirm Local Human case of WNV

News Bulletin Template #6: WN Virus Personal Protection

Physician’s Fact Sheet

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Forward

This plan represents the combined recommendations of representatives from jurisdictions throughout the region and from many diverse disciplines as to how the West Nile virus issue should be approached on a regional basis. It identifies the tasks and tools which should be utilized in mitigating the threat of WN virus, as well as responding to the appearance of the disease itself in the planning area. The plan is intended to assist localities in their own efforts and as a supplement to the central office plans which are being developed or have been developed in the states of Maryland and Virginia, as well as that of the District of Columbia.

The format of this plan is based upon CDC’s Guidelines for Arbovirus Surveillance in the U.S. and uses the risk level approach to planning and response proposed in that document. Should the need arise, the user will find a systematic layout of recommended activities suitable for implementation during the seasonal advancement of the disease in the animal and human populations. Included also are many resources and a timeline chart which identifies off-season planning activities that will facilitate an effective response during the following mosquito breeding season.

The plan is general in nature, recognizing the particular and unique circumstances which exist in each jurisdiction. However, the response tools themselves are derived from sources well-versed in arbovirus monitoring and control. Therefore, in this plan, each district should find information and resources appropriate to its needs with which to formulate it own response activities.

Also, recognizing the importance of keeping local officials apprised of the the West Nile virus and response planning, an executive summary is provided which briefly explains all in suitable detail. It may used as provided or edited to meet local needs.

Finally, this document is intended to facilitate communication and cooperation between the regional jurisdictions whose boundaries touch and, as such, share the risk of rapid spread of the West Nile Virus and other arbovirus diseases.

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Planning Committee - Organizations & Agencies

City of Alexandria, Virginia
Health Department

County of Arlington, Virginia
Department of Human Services, Public Health
Office of the County Manager, Public Information

City of Manassas, Virginia
Public Works
Animal Control
Citizens Respresentative

City of Manassas Park, Virginia
Public Works

City of Norfolk, Virginia

Health Department, Office of Mosquito Control

City of Washington, D. C.

Health Department

Animal Control

Fairfax County, Virginia

Health Department

Park Authority

Fauquier County, Virginia

Fauquier Hospital, Infection Control

Fort Belvoir, U.S. Army

Wildlife Biology

Loudoun County, Virginia

Health Department

Marine Corps Base, Quantico

Div. of Occupational and Environmental Health

Public Works

Cartography and GIS systems 

Marine Corps Base, Quantico (cont.)

Fish, Wildlife & Agronomy Section

Montgomery County, Maryland

Department of Health and Human Services

Office of Epidemiology, Virginia Department of Health

Epidemiology

Potomac Hospital, Woodbridge, Virginia

Infection Control

Prince Willam County, Virginia

Health Department

Public Works

Animal Control

Public Information

Mosquito Control Office

Prince William Hospital, Manassas, Virginia

Infection Control

Prince William Soil & Water Conservation District

Agriculture and Farm Assistance

Virginia Department of Game and Inland Fisheries
Wildlife Biology

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Committee Members

David Winkler, Public Works Branch, Quantico Marine Corps Base

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Executive Summary

Plan Concept

The concept for the structure of this plan is the based upon the combined surveillance of the human, insect, bird and mammal population for indications of the presence of the West Nile virus. As the primary vector, the mosquito becomes the key to the evolution of the response to the disease. In this, the mosquito species identified, as well as their location and population numbers assist in determining the current risk to the community and necessary action plans based upon that preceived risk. In all cases, it is expected that the response to West Nile virus will be a measured one which targets only those areas where there is a confluence of people, mosquitoes, and virus. The planning and response actions are categorized into five major groups of activites: 1) Mosquito Surveillance; 2) Mosquito Control; 3) Bird/Mammal Surveillance; 4) Human surveillance; 5) Public Information.

Mosquito Surveillance

Mosquito surveillance will allow risk assessment and planning, if the virus is found in the region. Initial activities will involve passive measures of trapping, speciating, and determining population densities of local mosquitos. There is a differential risk of disease transmission based upon the presence of identified mosquito carriers and their densities. Therefore, identifying mosquito breeding sites for elimination or treatment, particularly those located near susceptible human populations, will be a continuous and critical effort. Continous adult mosquito monitoring throughout the season will be essential to the prompt response to any evidence of the disease in local animal or human populations.

Mosquito Control

The safest and most useful approach is to prevent mosquito breeding is by eliminating unnecessary pools of water, maintaining swimming pools, bird baths, etc. Jurisdictions which have ordinances prohibiting the breeding and harborage of disease-causing insects should enforce such codes.

Early season control activities are typically limited to breeding site reduction efforts since reducing the adult mosquito population directly reduces the chances of mosquito-borne disease transmission later. Some localities routinely conduct larviciding and some adulticiding as a nuisance reduction measure. The decision to move from this level of control to more aggressive strategies will be determined jurisdiction by jurisdiction. Should there be a significant human disease incidence, a regional approach is then recommended. Limited adult mosquito control to include truck fogging and, ultimately, aerial pesticide application is expected to involve intensive discussion and planning between the local, state and federal juridictions before implementation.

Avian/Mammal Surveillance

Birds are considered the primary host for West Nile virus. Mammals, particularly horses, can also be infected with the disease and thus provide a mechanism for identifying the presence of the organism in the community. Protocol has been established to collect and test dead indicator birds (crows and blue jays). Flock bird kills and dead mammals will be collected and tested in coooperation with the U.S. Fish and Game (USDA) and the State Department of Agriculture.

Human Surveillance

Human surveillance will be conducted by Virginia, Maryland and the District of Columbia. Increased passive monitoring for encephalitic disease will be the first step, with active surveillance undertaken if human cases are identified or if other indicators of the presence of West Nile virus suggest the need. It is recommended that all three jurisdictions conduct the same level of surveillance.

Public Information

Information dessemination to the public, support communities (health care providers, veterinary communities, etc.) and other governmental entities will be essential for the effective implementation of this plan. Great lengths will be taken to develop bulletins, literature, websites, news briefs and technical briefs which are applicable to each stage of the disease.

Level 0 - Off-season; adult vectors inactive; climate unsuitable; Activites include some breeding site reduction and public education

Level 1 - Adult vectors active, but not abundant; temperatures not satisfactory for virus

Activities (inclusive of level 0) - source reduction; limited larviciding; vector and virus surveillance

Level 2 - Local abundance of adult vectors; Activities (inclusive of level 1) - increased surveillance and larviciding; seroconversion in sentinel hosts; possible adulticiding where indicated

Level 3 - Abundant adult vectors; multiple animal infections identified or confirmed human or equine case; optimal conditions for viral incubation and survival. Activities (inclusive of level 2) - limited adulticiding in high risk areas; expanded public information, active surveillance for human cases

Level 4 - Multiple human cases identified; Activities (inclusive of level 3) - strong adulticiding where indicated; emphasis on personal protection; regular public briefings; maintain surveillance activities

  Coordinated Response Activities

1. Arrange meeting between Local Health Department (LHD), Public Works and other response agencies to confirm and coordinate preseason activities

2. Notify the local and regional response agencies that a positive finding has been identified in a sentinel host

3. Coordinate multi-jurisdictional response activites for affected areas along shared jurisdictional boundaries

 Mosquito Surveillance Activities

1. Establish full-time position for a local mosquito control coordinator

2. Conduct larval surveys - larval dip evaluations

3. Conduct adult mosquitos count surveys

4. Survey and identify water bodies for future monitoring

5. Obtain area maps for use in monitoring activities

6. Determine central depository for mosquito survey results and method of sharing information

7. Determine protocol and testing lab for mosquitoes

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*** It should noted that before embarking on a program of local mosquito control, approved training and certification in the proper use and application of pesticides must be obtained from authorized state and/or federal agencies.

1. Determine local preference for own mosquito control program or contract work

2. Obtain equipment, supplies, permits, and training for local control program

3. Identify, interview, and contract with commercial company for out-resource control program

4. Arrange meeting between Local Health Department and Public Works to confirm and coordinate seasonal mosquito breeding site reduction efforts

5. Establish biological control program - fish breeding (refer to N.J. program)

6. Initiate mosquito breeding site reduction activities (water channeling, ditch maintenance, etc.)

 Avian & Mammal Surveillance Activities

1. Arrange meeting between Local Health department, Deparment of Agriculture, zoo operators, animal control officers, veterinarians, livestock breeders, etc. and other appropriate parties to confirm and coordinate preseason activities

2. Identify local zoos, exotic pet owners, livestock and poultry breeders in jurisdiction

3. Notify local animal rehab people, animal control officers, veternarians, and others of WN virus

4. Local health department and Dept. of agric. should meet with those in #1

5. Determine protocol and testing lab for dead birds and mammals

6. Determine internal procedures for collecting and transporting bird and mammal specimens to the lab in each district

7. Issue letter to Veterinary community regarding WN virus

8. Determine the agency (Heaath Department or other designated agency) which will issue an animal specimen tracking number to citizens delivering carcasses of protected birds and animals for testing

Human Surveillance Activities (see Virginia State Plan & Addendum)

1. Arrange meeting between Local Health Department, hospital infectious control officials, HMO representatives, local health care community representatives, etc. and other appropriate parties to confirm and coordinate preseason activities

2. Insure dissemination of West Nile virus information to health care community

3. Institute passive surveillance and reporting (see glossary)

4. Identify local contacts in the health care community and prepare notification list

5. Identify spokesman in LHD to answer questions from the health care community

6. Compile and distribute region wide list of contacts and phone numbers

Public Information Activities

1. Arrange meeting between Local Health Department and local public information officials and other appropriate parties to confirm and coordinate preseason activities

2. Prepare and distribute mosquito breeding prevention brochures, newsletters, etc. for mass distribution (schools, senior centers, libraries, hcf, multi-lingual)

3. Issue press release for level 0-1, plus press release background briefing

(TEMPLATE #1 or similar)

4. Arrange for Cable television spot on WN virus information

5. Conduct presentation to local Board of County Supervisors or to City Council

6. Identify LHD spokesman for questions from public

Coordinated Response Activities

1. Coordinate multi-jurisdictional response activites for affected areas along shared   jurisdictional boundaries

Mosquito Surveillance Activities

1. Survey area and identify potenital mosquito breeding sites for reduction activities

2. Determine who is going to do larviciding

3. Obtain supplies, permits and training for in-house program, equipment

4. Contract with commercial mosquito control company for out-source program

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Risk Level 1 Activities

*** It should noted that before embarking on a program of local mosquito control, approved training and certification in the proper use and application of pesticides must be obtained from authorized state and/or federal agencies.

1. Conduct larviciding, as deemed necessary

2. Conduct general mosquito breeding site reduction activities using mosquito traps

 3. Initiate restricted treatment of protected areas (i.e. culverts, stormwater drainpipes) where winter-over mosquito adults are identified

Avian & Mammal Surveillance Activities

1. Collect birds for laboratory evaluation as protocol dictates

2. Determine need for sentinel flocks and mosquito traps; locate potential sites

3. Obtain funding to support sentinel flocks and aestablish a maintenance program

4. Place sentinel flocks

5. Arrange for cable television spot for dead crow testing

Human Surveillance Activities

1. Notify and educate Health Care community to report encephalitis/meningitis to LHD

for evaluation for further testing for WN virus

2. Set up LHD database and communication systems with surrounding localities and institute weekly data compilation throughout the season

3. Email fact sheets to Health Care community

4. Advertise health alerts on Local Health Department website

Public Information Activities

1. Continue to distribute mosquito breeding prevention brochures

2. Update website

3. Continue cable television information spots

4. Issue press release for level 1-2 (TEMPLATE #1 and #2 or similar)

Coordinated Response Activities

1. Notify the local and regional response agencies that a positive finding has been identified in a sentinel host

2. Coordinate multi-jurisdictional response activites for affected areas along shared jurisdictional boundaries

Mosquito Surveillance Activities

1. Increase vector and virus surveillance

2. Continue larval and adult surveying and testing

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Risk Level 2 Activities

*** It should noted that before embarking on a program of local mosquito control, approved training and certification in the proper use and application of pesticides must be obtained from authorized state and/or federal agencies.

1. Increase larviciding in selected areas, as needed

2. Initiate selective adulticiding, as necessary and feasible

3. Larvicide extensively in area of a seroconverted sentinel flock or positive trap

4. Conduct pretreatment and post-treatment suveillance

 Avian & Mammal Surveillance Activities

1. Collect birds for laboratory evaluation as protocol dictates

2. Increase mammal surveillance

3. Notify the Veterinary community and others associated with avain and mammal operations that a positive finding has been identified in a sentinel host

Human Surveillance Activities

1. Notify Health Care community (see Contacts & References) that a case has been identified in a sentinel host

2. Notify area labs of identification of sentinel host infection. All arboviral testing should be done on a STAT basis

3. Distribute physician’s fact sheet to physicians, including patient care information and signs and symptoms of encephalitis

4. Notify CDC & regional contacts

Public Information Activities

1. Arrange special briefings for senior centers, civic associations

2. Arrange the same interviews to local media

3. Continue distribution of education materials

4. Issue press release for Level 2 (TEMPLATE #3 or similar)

1. Notify the local and regional response agencies that multiple positive enzootic findings have been identified

2. Coordinate multi-jurisdictional response activites for affected areas along shared jurisdictional boundaries

Mosquito Surveillance Activities

1. Dedicate staff to full-time surveillance duties

2. Increase mosquito surveying, particularly in high-risk areas and in the area where the positives were identified

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Risk Level 3 Activities

*** It should noted that before embarking on a program of local mosquito control, approved training and certification in the proper use and application of pesticides must be obtained from authorized state and/or federal agencies.

1. Institute adulticiding in high-risk areas

2. Re-survey and larvicide, as needed, in the areas of positive findings

3. Re-survey and intensify mosquito breeding site reduction in positive areas

4. Conduct pretreatment and post-treatment surveillance

Avian & Mammal Surveillance Activities 

1. Increase surveillance in high-risk areas and paricularly in areas of positive findings

2. Update public awareness fact sheets for public information officials

3. Test animals that have exhibited neurological symptoms

4. Have animals which have been submitted for rabies test also be tested for WN virus

1. Institute active surveillance of sentinel acute care hospitals

2. Institute active surveillance at other hospitals, laboratories, primary care practices, infectious disease doctors, neourology practices, and military medical facilities

3. Start Epidemiological investigation(s) on human case(s)

4. Update CDC and regional contacts

5. Expand public information program (use of repellents; personal protection, avoidance of high vector contact areas)

 Public Information Activities

1. Issue press release for levels 3 (TEMPLATE #4 or similar)

2. Continue expert interviews

3. Arrange Cable television infospots on symptoms

4. Activate hot line for public/hcp for information

Coordinated Response Activities

1. Notify the local and regional response agencies of multiple human cases

2. Coordinate multi-jurisdictional response activites for affected areas along shared jurisdictional boundaries

Mosquito Surveillance Activities

1. Dedicate additional staff to full-time surveillance operations

2. Conduct prespray and postspray surveillance

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Risk Level 4 Activities

*** It should noted that before embarking on a program of local mosquito control, approved training and certification in the proper use and application of pesticides must be obtained from authorized state and/or federal agencies.

1. Concentrate available resources on strong adulticiding efforts over areas at risk

2. Dedicate additional staff to full-time control operations

Avian & Mammal Surveillance Activities

1. Increase surveillance in high-risk areas

2. Update and distribute fact sheets for animal care community

Human Surveillance Activities

1. Maintain active surveillance and investigation of human cases

2. Update CDC and regional contacts

3. Train and increase staffing

4. Update and distribute fact sheets for health care community

Public Information Activities

1. Issue press release for Level 4 (TEMPLATE #5 or similar)

2. Hold daily public information briefings on status of epidemic; continue emphasis on personal protection measures

3. Conducr media interviews on daily basis

4. Continue cable infospots even after first frost in preparation for following year

5. EVALUATE RESPONSE FOR FOLLOWING YEAR

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Glossary

WNVRG – West Niles Virus Response Group

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General West Nile Virus Information

• Centers for Disease Control and Prevention www.cdc.gov/ncidod/dvbid/arbor/arboinfo.htm
• VDH Office of Epidemiology www.vdh.state.va.us/epi/newhome.htm
• American Mosquito Control Association www.mosquito.org

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NEWS BULLETIN TEMPLATE #1 (LEVEL 0 AND/OR 1)

ARLINGTON RESIDENTS ENCOURAGED TO HELP ELIMINATE MOSQUITO BREEDING PLACES

Arlington health officials are asking residents to be more conscious this year of the need to eliminate mosquito breeding places around their homes. "We are more concerned about mosquitoes this year than in the past for two reasons," said Dr. Susan Allan, chief of Arlington’s Public Health Division. "First, we know we will have to contend with the Asian Tiger Mosquito again this year. Second, we are also concerned about any sign that the West Nile Virus, which can be transmitted by mosquitoes to humans, may be moving farther south." The Asian Tiger Mosquito is a smaller, more aggressive variety of mosquito than the normal breed usually found in Arlington and northern Virginia. It breeds readily in small, shallow pools of standing water, and can become a problem should preventive measures not be taken. "We would encourage residents to be on the lookout for small pools of water in discarded tires, tarps covering firewood, etc., that could be breeding grounds for mosquitoes," said Allan. "Taking away those easy targets will help limit the reproduction of this mosquito and help prevent the mosquito population from impacting our summer quality of life." Although there is no conclusive scientific evidence linking the Asian Tiger Mosquito with transmitting the West Nile virus to humans, the mosquito more common to the northeast United States, Culex pipiens, is known to have transmitted the virus to humans after ingesting the virus from infected birds. "Last summer and fall, the West Nile virus was responsible for 61 cases of encephalitis in New York City and surrounding counties, including seven deaths," noted Allan. "The virus had never before been identified in the western hemisphere. That is precisely why we want to monitor the situation closely this year."Most birds simply carry the virus; crows and blue jays, however, belong to a genus that is particularly vulnerable to the virus. A crow carcass found near Baltimore last year was confirmed to have been a carrier.--MORE—2-2-2-2MOSQUITOES"Should a citizen find a dead crow or blue jay that appears to have died as the result of natural causes, we would ask that the citizen call the Animal Welfare League at 703-931-9241," said Ann Beam, an administrative assistant to the Arlington Animal Welfare League. "It would also be helpful if the citizen could cover the carcass with a box, trash can, plastic or paper weighed down by rocks, although just calling the League is sufficient." The West Nile virus causes encephalitis, which is an inflammation of the brain. Mild symptoms associated with the virus include fever, head and body aches, often with swollen lymph glands. More severe infection is maked by headache, high fever and neck stiffness, which can progress to stupor, disorientation, coma, tremors, occasional convulsions, paralysis and in relatively rare instances, death. Treatment involves intensive supportive therapy for more severe cases. Elderly people are more susceptible to the virus than younger age groups. There is no vaccine to prevent contraction of the disease. Dogs and cats can be infected with the virus the same way as humans; however, there is only one verified case of a dog in 1982 in Botswana being infected with the virus and no verified cases of cats being infected. Animals cannot transmit the disease to other animals or humans.

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Appendix D

NEWS BULLETIN TEMPLATE #2 (LEVEL 1 AND/OR 2)

TIPS FOR ELIMINATING MOSQUITO BREEDING SITES AROUND THE HOME

Dispose of cans, bottles and plastic containers properly. Store items to be recycled in covered trashcans or sealed bags.Dispose of discarded tires properly. Drill drainage holes in tires used for playground equipment.Clean roof gutters and down-spout screens regularly. Eliminate standing water on flat roofs.Turn over plastic wading pools, wheelbarrows and canoes when not in use.Do not leave trashcan lids upside down. Do not allow water to collect in the bottom of trashcans.Flush birdbaths and the bottoms of potted plant holder trays twice weekly.Adjust tarps over grills, firewood piles, boats and swimming pools to eliminate standing water.Regrade drainage areas and clean out debris in ditches to eliminate standing water in low spots.Clean and chlorinate swimming pools. Aerate garden ponds.Fix leaky water faucets and eliminate condensation puddles around airconditioners.Store pet food and water bowls indoors when not in use.

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Appendix E

NEWS BULLETIN TEMPLATE #3 (LEVEL 1 AND/OR 2)

ARLINGTON HEALTH OFFICIALS ASK FOR HELP IN DETECTING AND TRACKING WEST NILE VIRUS

Arlington health officials are calling on citizens to help them monitor a potential return of the West Nile virus to the region. Last year a dead crow found in Baltimore was confirmed to be carrying the virus. "We urge Arlingtonians to be on the lookout for dead birds, especially crows and bluejays, that appear to have died as the result of natural or unknown causes," said Dr. Susan Allan, chief of Arlington’s Public Health Division. "Crows and blue jays are especially susceptible to the virus, and we can detect the virus in the remains, which will enable us to detect and track the virus should it move into northern Virginia.""The virus cannot be contracted from handling bird carcasses," Allan said. "Still, bare-handed contact with any animal carcass should be avoided. Should a citizen find a dead crow or blue jay that appears to have died as the result of natural causes, we would ask that the citizen call the Animal Welfare League at 703-931-9241. The League also advises us that it would be helpful if the citizen could cover the carcass with a box, trash can, plastic or paper weighed down by rocks, although just calling the League will aid us in our monitoring endeavor." The West Nile virus is transmitted to humans by mosquitoes that have ingested the virus from infected birds. Most birds simply carry the virus; crows and blue jays, however, belong to a genus that is particularly vulnerable to the virus. The West Nile virus causes encephalitis, which is an inflammation of the brain. Mild symptoms associated with the virus include fever, head and body aches, often with swollen lymph glands. More severe infection is maked by headache, high fever and neck stiffness, which can progress to stupor, disorientation, coma, tremors, occasional convulsions, paralysis and in relatively rare instances, death. Treatment involves intensive supportive therapy for more severe cases. Elderly people are more susceptible to the virus than younger age groups. There is no vaccine to prevent contraction of the disease. "Last summer and fall, the West Nile virus was responsible for 61 cases of encephalitis in New York City and surrounding counties, including seven deaths," noted Allan. "The virus had never before been identified in the western hemisphere. That is precisely why we want to monitor the situation closely this year."--MORE--2-2-2-2WEST NILE VIRUS Dogs and cats can be infected with the virus the same way as humans; however, there is only one verified case of a dog in 1982 in Botswana being infected with the virus and no verified cases of cats being infected. Animals cannot transmit the disease to other animals or humans.

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Appendix F

NEWS BULLETIN TEMPLATE #4 (LEVEL 2 AND/OR 3)

HEALTH OFFICIALS CONFIRM WEST NILE VIRUS IN BIRD CARCASS FOUND IN ARLINGTON

Arlington health officials have confirmed that a bird carcass found in the County has tested positive for the West Nile virus. "We have received confirmation from the Virginia state laboratory in Norfolk that a crow/blue jay carcass found in Arlington has tested positive for the virus," said Dr. Susan Allan, chief of Arlington’s Public Health Division. "This is cause for concern and calls for increased vigilance on the part of health officials and citizens." The crow/blue jay was found {by a citizen/County employee} at {location}. The County has sent ### birds to Norfolk for testing. This bird is the first of ## to test positive. Results are still pending on ## others. The West Nile virus is transmitted to humans by mosquitoes that have ingested the virus from infected birds. Most birds simply carry the virus; crows and blue jays, however, belong to a genus that is particularly vulnerable to the virus. The West Nile virus causes encephalitis, which is an inflammation of the brain. Mild symptoms associated with the virus include fever, head and body aches, often with swollen lymph glands. More severe infection is maked by headache, high fever and neck stiffness, which can progress to stupor, disorientation, coma, tremors, occasional convulsions, paralysis and in relatively rare instances, death. Treatment involves intensive supportive therapy for more severe cases. Elderly people are more susceptible to the virus than younger age groups. There is no vaccine to prevent contraction of the disease. "Citizens, especially the elderly, are encouraged to stay indoors at dawn, dusk and the early evening when mosquitoes are most active. Wearing long-sleeved shirts and long pants when going outdoors will also help to reduce risk," said Allan. "Applying insect repellant sparingly to exposed skin or spraying thin clothing in accordance with the manufacturer’s Directions for Use are also suitable precautions." Allan notes that an effective repellant will contain 20-30 percent DEET (N,N-diethyl-meta-tolumide).--MORE—2-2-2-2WEST NILE VIRUS"DEET in higher concentrations can cause side effects, especially in children, Allan said. "Also avoid putting repellant on the hands of younger children, as they may irritate the eyes and mouth. Do not put insect repellant on children less than three years old." Arlington citizens who find dead crows and blue jays that have obviously not been the victims of collisions with an automobile or attacks from other birds or animals are asked to call the Arlington Animal Welfare League at (703) 931-9241, ext. 200/201, for pick up. Citizens are encouraged only to report the location of a dead bird carcass; there is no need for them to handle the carcass. "The virus cannot be contracted from handling bird carcasses," Allan said. "Still, bare-handed contact with any animal carcass should be avoided. The Animal Welfare League is equipped and trained in the recovery of animal carcasses."

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Appendix G

NEWS BULLETIN TEMPLATE #5 (risk level 4)

HEALTH OFFICIALS CONFIRM CASE OF WEST NILE ENCEPHALITIS IN ARLINGTON

Arlington health officials confirmed today a case of West Nile encephalitis in the County. "This is our first confirmed case of West Nile encephalitis. It underscores the need for citizens to be aware of the potential dangers of this virus and to take appropriate actions to protect themselves," said Dr. Susan Allan, chief of Arlington’s Public Health Division. The individual is being treated {at an area hospital/Arlington Hospital}. "{General comment on patient’s condition}, noted Allan. The West Nile virus is transmitted to humans by mosquitoes that have ingested the virus from infected birds. Most birds simply carry the virus; crows and blue jays, however, belong to a genus that is particularly vulnerable to the virus. The West Nile virus causes encephalitis, which is an inflammation of the brain. Mild symptoms associated with the virus include fever, head and body aches, often with swollen lymph glands. More severe infection is maked by headache, high fever and neck stiffness, which can progress to stupor, disorientation, coma, tremors, occasional convulsions, paralysis and in relatively rare instances, death. Treatment involves intensive supportive therapy for more severe cases. Elderly people are more susceptible to the virus than younger age groups. There is no vaccine to prevent contraction of the disease. "Citizens, especially the elderly, are encouraged to stay indoors at dawn, dusk and the early evening when mosquitoes are most active. Wearing long-sleeved shirts and long pants when going outdoors will also help to reduce risk," said Allan. "Applying insect repellant sparingly to exposed skin or spraying thin clothing in accordance with the manufacturer’s Directions for Use are also suitable precautions." Allan notes that an effective repellant will contain 20-30 percent DEET (N,N-diethyl-meta-tolumide)."DEET in higher concentrations can cause side effects, especially in children, Allan said. "Also avoid putting repellant on the hands of younger children, as they may irritate the eyes and mouth. Do not put insect repellant on children less than three years old."# # #_ NEWS from the Arlington County Government__Office of the County Manager 2100 Clarendon Boulevard, Suite 314, Arlington, Virginia 22201 Telephone: 703/228-3969 Fax: 703/228-3295

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Appendix H

NEWS BULLETIN TEMPLATE #6 (risk level 4)

HEALTH OFFICIALS ASK CITIZENS TO PROTECT THEMSELVES FROM WEST NILE ENCEPHALITIS

The West Nile virus is transmitted to humans by mosquitoes that have ingested the virus from infected birds. Many bird species carry the virus, but crows and blue jays, are particularly vulnerable. Additional information is available in a brochure entitled " Controlling Mosquitoes Around The Home" which is available at most government building, including libraries and schools. # # #_ NEWS from the Prince William Health Department. Telephone: 703/792-6300 Fax: 703/792-7368

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Appendix I

Physician’s Fact Sheet

Surveillance Criteria for Human Encephalitis and Meningitis

3. Health care providers will be informed that appropriate specimens for testing include:

7. Health Department will be contacting physicians and patients to gather information using "Encephalitis / Initial Case Report Form" (attachment B).

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