Health departments need to be able to rapidly communicate with local physi- cians to provide testing recommenda- tions and updates during outbreak situ- ations.” She said the county medical society forwarded health advisories to 6,000 area physicians, and its commit- tees allowed physicians “to voice their observations and concerns to public health agencies.”
State and local response In July, DSHS attributed the West Nile virus outbreak to the warm winter and summer rains, particularly in North Texas. At the time, the department said about 80 percent of the state’s West Nile cases were in Dallas, Collin, Tarrant, and Denton counties. West Nile virus can permanently damage its victims, leaving long-term health complications in its wake. Don Read, MD, knows this all too well. He survived West Nile virus after a lengthy battle with it in 2005. Dr. Read missed seven months of work, was in the inten- sive care unit for four-and-a-half weeks, and endured two months of inpatient rehabilitation, three months of outpa- tient rehab, and home care for a month. (See “West Nile Virus: It Could Happen to You,” page 38.)
Because the virus can be so devastat-
ing, Dr. Chung and the health depart- ment realized the importance of physi- cian education. She issued three health advisories. They alerted physicians to the need for testing patients with symp- toms compatible with West Nile virus infection, updated them on the extent of the cases, and reiterated testing and prevention measures. “We wanted the physicians in the com- munity to be aware of the presence of the virus in our county, and we advised them of preventive measures for patients, such as using repellent products when going outside. Once we recognized this was going to be an unusual season, we put out the second advisory that edu- cated physicians on virus symptoms and testing,” she said.
Philip Huang, MD, health authority
for the Austin/Travis County Health and Human Services Department, says his agency acted early in the summer when
George Smith, DO, of West, right, and other members of the Disaster Medical Assistance Team (DMAT) helped treat San Antonio shelter patients during Hurricane Katrina in 2005.
November 2012 TEXAS MEDICINE 37
samples of mosquito specimens first test- ed positive for West Nile virus. “Every summer, we send out a press
release notifying the public of the four Ds: Dress with long sleeves and pants, use repellent products with DEET, drain standing water, and avoid going out- side at dusk and dawn,” said Dr. Huang, chair of the Travis County Medical So- ciety (TCMS) Public Health Committee. The department relied on TCMS to
spread the word to physicians. “In addition to sharing patient educa- tion points with physicians, we informed them about testing for and reporting the disease and kept them up to speed on the situation. TCMS was a valuable part- ner in communicating with area doctors,” Dr. Huang said.
By late September, West Nile virus had claimed three lives in Travis Coun- ty, and the area had reported 103 total cases, 45 of which were neuroinvasive. According to CDC, neuroinvasive types of the virus include West Nile encephali- tis, West Nile meningitis, and West Nile meningoencephalitis. To battle the infected mosquito popu-
lation, the city implemented an inte- grated mosquito management plan that included public education, measures to eliminate adult nesting and larvae
breeding sources, and ground pesticide spraying. Dr. Huang says the City of Aus- tin won’t implement aerial spraying un- less local government officials declare a public health emergency. The effect of West Nile virus prompt- ed DSHS to conduct a free webinar on the virus in August. DSHS Commissioner David Lakey, MD, and department staff members Robert Kaspar, MD; Paul Mc- Gaha, DO; and Tom Sidwa, DVM, dis- cussed the virus and its epidemiology, prevention, diagnosis, and treatment. DSHS has posted West Nile virus statis- tics on its website,
www.dshs.state.tx.us/ idcu/disease/arboviral/westnile. Dr. Chung hopes surveillance data collected by local health agencies will be the basis for guidance in future out- breaks. Local health department officials interviewed those who tested positive for the virus and forwarded the informa- tion to DSHS and CDC. “What we’re able to learn about this
outbreak will assist public health pro- fessionals throughout the state and na- tion with effective prevention messag- ing in the future. For instance, we need to know why some people don’t wear mosquito repellent, even when they know West Nile virus has been detected in their areas. Understanding that will
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