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Testimony of John R. Lumpkin, M.D.,
Director of the Illinois Department of Public Health
Joint Hearing on West Nile Virus
September 24, 2002
to the Senate Health, Education, Labor, and Pensions Committeeand
theGovernmental Affairs Subcommittee on Oversight of Governmental Management,
Restructuring, and the District of Columbia
First of all, let me thank the Committees for
this opportunity to provide testimony on West Nile Virus and it's very real and
devastating effect in Illinois. As one of the States hardest hit, Illinois has
been working hard, using every available resource, to make an impact on
stopping the spread of West Nile. I am hopeful that my testimony can shed some
light on our activities and the needs of our State, and probably other states
that are impacted by this disease.
I know that there are specific questions of
interest to committee members but, I would like to begin with some background
on our experience in Illinois. As you probably know, Illinois, Louisiana, Ohio,
Michigan, and Mississippi have reported the most cases of WNV during 2002.
- In Illinois cases have been reported in 38 of
the 102 counties (approximately 1/3 of the State). Through 9-20-02 Illinois has
reported 473 cases including 25 deaths (this is a moving target) Although we
have no hard data, numerous survivors have not been discharged to their homes,
but to long-term care facilities or rehab facilities. We understand a major (at
least short term) sequella is inability to ambulate
- The majority of cases have been in the
Chicago metropolitan area. In the Chicago metropolitan area, two areas of
suburban Cook County bordering the City of Chicago (Oak Lawn vicinity and
Skokie vicinity) have been over-represented in the case count.
- IDPH has actually planned for WNV since
summer 2001. Included in the Department's FY02 budget was an initiative related
to West Nile. IDPH provided funding to allow a number of local health
departments to develop their own plans to ensure coordination of efforts with
municipalities, mosquito abatement districts, street departments or other
entities that would be involved in such an endeavor.
- Infections in Illinois were unlikely prior to
2002. The virus was first documented to be present in Illinois in September
2001 when there was evidence in dead crows. Not much time remained in the
mosquito feeding season after discovery of WNV in Illinois in 2001 but the
evidence of it's presence started our preparations in earnest.
- Realizing the potential impact, Governor
George H. Ryan created a Cabinet level work group, headed by IDPH, to
coordinate the state's response among the various agencies involved which
included the Department of Agriculture, Natural Resources, Environmental
Protection and Public Health.
- The Work Group has been meeting consistently
since the early Fall of 2001, and more recently, talking on a daily basis to
coordinate our efforts and information.
- In more general terms, a plan for
surveillance of human mosquito borne infections was established in 1976 and has
been implemented annually since that time.
Current Efforts to Control the Spread of West
Nile Virus in Illinois
- After WNV was first detected in wild birds in
Illinois in May 2002, IDPH put out press releases concerning personal
protection and the removal of standing water and produced 30,000 color posters
and fliers, over half of which have been distributed to local health
departments and others that request them. Bulletins were issued to all local
health departments and municipalities recommending that at minimum, larvicide
be applied to street catch basins twice during the summer to prevent an
outbreak of WNV.
- Prior to the first human case of WNV, Public
Health awarded $264,059 to 20 local health departments to prepare for the
expected WNV outbreak in Illinois. The grants allowed many LHDs to train their
personnel, provide information about WNV to municipalities, and make contacts
with mosquito control agencies.
- An additional 18 grants totaling $462,490
have been made to LHDs to create vector control programs and cleanup
mosquito-producing tire sites.
- Within a week of learning of the first
Illinois resident to contract WNV on 8/8/2002, the Governor instituted daily
meetings of the four-state agency WNV Task Force, created in 2001, to make
funds available to local agencies to combat the advance of WNV in Illinois.
Within 3 weeks, the first emergency grants were executed.
- Since then, emergency WNV mosquito control
grants have been offered to 37 local health departments where human WNV cases
have occurred of which 24 departments have requested and received grants
totaling about $2.6 million providing protection for about 8.1 million people.
- Due to the shortage of licensed mosquito
control personnel in Illinois, the Department of Agriculture, in cooperation
with Public Health, issued an emergency rule to allow health department and
municipal officials to apply certain mosquito larvicides, without a license,
after attending a one-hour seminar. Public Health staff have offered over 20
emergency-rule larviciding seminars to over 500 local officials.
- Public Health has provided extensive
technical assistance and advice to local health departments on mosquito control
and is working closely with CDC and DNR and the UI Vet School to determine the
etiology of WNV, especially concerning the two clusters of cases that have
occurred near Chicago, and possible reservoirs and hosts.
- Public Health has responded to thousands of
phone calls, e-mails and news media contacts to answer questions from the media
and the general public.
What more can federal and state governments do
to prepare for next summer?
However, we believe that Increased attention in
the form of federal funds are needed at both the state and federal level for
more full-time Public Health staff to:
- Administer a grant program to assist local
health departments in assuring that arbovirus surveillance and control programs
are provided where these services are not offered by mosquito abatement
districts or other agencies.
- Work with mosquito abatement districts and
other municipal mosquito control programs to assure the implementation of
comprehensive and effective mosquito control programs next spring that
emphasize source reduction and larviciding.
- Provide mosquito control training for local
health departments and municipalities that leads to licensing by the Department
of Agriculture; and training in mosquito and bird collection techniques to
assist Public Health in arbovirus surveillance work.
- Provide resources to state public health,
animal disease, and research laboratories to provide the analytical,
entomological, and epidemiological tools needed to fight WNV, as well as
funding for materials and personnel to rapidly perform confirmatory testing
- Additional surveillance staff are also needed
that can be mobilized to facilitate rapid processing of human surveillance
data, rapid analysis of data and rapid dissemination of data.
- Begin early public information campaigns.
- We also believe that USEPA should consider
the creation of a special Pesticide Applicator license for municipal officials.
Current licensing focuses on agricultural pesticide applications. The license
should only require enough training so that municipal officials could apply
low-risk mosquito larvicides.
Have State resources to fight West Nile virus
come at the expense of other programs?
- Local Health Protection Grants, intended to
support local health department programs in water supply, sewage disposal, food
sanitation and infectious diseases were used to support the emergency WNV
mosquito control grants provided by the WNV Task Force to LHDs.
- Public Health staff that operate other
programs dealing with general administration, lead, mold and moisture,
environmental toxicology, and structural pest control have been diverted to WNV
- Federal money to support bioterrorism
preparedness, epidemiology and laboratory capacity, has made us better prepared
to deal with this outbreak. Specifically, we believe this has been demonstrated
with enhanced rapid communication to LHDs, hospital ICPs, hospital laboratories
and infectious disease physicians and the funding used in disseminating
information about responsibility to report human infectious disease cases
responsibilities and methods of reporting.
Where have West Nile Virus infections been
most prevalent in 2002, and why have infections become significantly more
common this year, as compared to years past? Can we expect the number and
severity of human cases to worsen in years to come?
- The virus has expanded its range across the
Midwest into areas that include large population centers, such as Chicago,
suburban Cook County and the nearby suburban counties. Although the virus first
appeared in Illinois during August 2001, it was near the end of the mosquito
transmission season. Apparently, in 2001 virus amplification in wild birds did
not reach a level where humans were at significant risk.
- In contrast, WNV-positive dead birds appeared
in May 2002, at the beginning of the summer, which permitted summer-long virus
amplification in the wild bird population. Furthermore, the hot summer of 2002
was conductive to breeding and flight activity of the house mosquito, the
primary vector of WNV. As a result, there was a high level of virus
amplification in birds and mosquitoes. Consequently, more people were exposed
to the virus in 2002.
Is West Nile Virus similar to any other
mosquito-borne illnesses found in the United States? If so, what lessons has
the Department learned from responding to previous outbreaks?
- WNV has many similarities to St. Louis
encephalitis, which caused an outbreak in Illinois during 1975. Since then,
cases of SLE have been rare in Illinois, although they have been more common in
- However, WNV appears to be better adapted to
the temperatures in northern states; it has even been detected in southern
- Because there have been few cases of
mosquito-borne disease in recent years, many local mosquito abatement programs
have been reduced or eliminated, which results in less effective emergency
control programs. Similarly, there are few environmental staff with experience
in mosquito surveillance and abatement at the state level to assist local
officials during emergencies.
- State and local mosquito abatement resources
need to be rebuilt.
- A lesson learned from the SLE outbreak of
1975 was to establish a system for surveillance of human illnesses before cases
occur. In Illinois we have such a system in place.
- Another lesson learned was to establish an
"early warning system" that became functional in 1976 to detect
evidence of arbovirus infections in wild birds. IDPH also has this type of
system in place. The Department has traditionally collected some 5000 live
birds annually for testing. The bird blood is tested for SLE, EEE and now, WNV.
Additionally, we test mosquito pools as a supplement to live bird testing.
- Provide scientifically sound information to
organizations that provide mosquito control services on appropriate mosquito
Our ability to identify and track disease is
key to being able to take appropriate measures. In addition to that very real
part of the equation - both government and individuals can do a lot to curb the
spread of the disease by specific activities. Comprehensive mosquito abatement
programs are important to addressing the problem. But what remains the single
most effective precautions are those that can and should be taken by
- Stay indoors at times when mosquitoes are
- when outdoors - wear protective clothing
- use mosquito repellent containing 25-35%
- Check residential screens to ensure insects
are kept out of living areas
- and, eliminate stagnant water where
mosquitoes might breed.