Infectious Diseases in Clinical Practice:
Special Articles: Review of Literature: General Infectious Diseases
Section Editor(s): Bartlett, John G. MD
LESSONS FROM THE WEST NILE VIRAL ENCEPHALITIS OUTBREAK IN NEW YORK CITY, 1999: IMPLICATIONS FOR BIOTERRORISM PREPAREDNESS [Fine A, Layton M. Clin Infect Dis 2001;32:277]:
The authors review the events that took place in the 1999 outbreak of West Nile virus (WNV) in New York City. The first event was August 23, 1999, when Dr. Deborah Asnis notified Dr. Marcelle Layton of the New York City Department of Health about two patients with fever, altered mental status, muscle weakness, and CSF suggesting viral encephalitis. Active case findings then yielded six additional cases by the end of 1 week, all in a 16-square-mile radius of Northern Queens. The initial tests suggested a flavivirus most consistent with St. Louis encephalitis, but the final conclusion was WNV. The conclusion of the reviewers is that this entire event might have gone undetected if it were not for this initial report by Dr. Asnis. However, once reported, the subsequent events were relatively dramatic. There was only one public health laboratory in the country able to diagnose WNV; this was Fort Collins, which received more than 2000 specimens during a 3-month period. In an effort to control mosquitoes, the Health Department distributed more than 400,000 cans of DEET. The massive public health campaign included a hotline that was manned by 25 to 75 staff at all times for 2 months and received more than 150,000 calls.
This is an invited article in the CID section on bioterrorism. The relevance to this topic is great because it nicely demonstrates some of the nonmedical issues that are often overlooked in planning for bioterrorism. Thus, much of the effort deals with medical decisions, capacity building, triage, etc. The experience with WNV is a good illustration of the public response to this type of environmental health threat. It also illustrates the important role of the alert physician in identifying an important infectious agent that was not the product of bioterrorism, but could have been.
This section of IDCP features summaries of publications relevant to the practice of general infectious diseases. In most cases, a comment is provided from the editor concerning interpretation, impact or further relevant information on the topic reviewed. This represents a modification of selected entries in the “What’s News” section of the Johns Hopkins website for ID (reprinted from http://www.hopkins.id.edu with permission).
© 2001 Lippincott Williams & Wilkins, Inc.