The record-breaking number of West Nile virus infections and deaths in Texas this summer led to the first aerial spraying for mosquitoes in Dallas since 1966 and increased the number of people seeking information or treatment for pesky mosquito bites at medical facilities.
No other state came close to the 1,711 human cases of West Nile illness in Texas, which included 78 deaths as of the end of October, according to the Centers for Disease Control and Prevention and the Texas Department of State Health Services. The total includes 926 cases of West Nile fever, the milder form of the disease, and 789 cases of West Nile neuroinvasive disease, a severe infection that can include meningitis and encephalitis.
Hardest hit was Dallas County with 375 cases, including 18 deaths. Individuals older than 50 or with weakened immune systems are at most risk. For example, the youngest person to die in Dallas County was 45 years old and the oldest was around 90, said Zachary Thompson, director of the Dallas County Department of Health and Human Services Office of Public Information. Out of 254 counties, 120 reported at least one human case of West Nile illness.
Dealing with “the fear factor” was the most trying part of the outbreak, said Patricia Cook, RN, BSN, a public health nurse for 35 years. “We would see people occasionally in the lobby just worried about their safety and their children playing outside,” said Cook, the immunization supervisor for the Preventive Health Department of Dallas County Health and Human Services. “They asked what were the symptoms of West Nile virus and what was Dallas Countys role in trying to help prevent it.”
When someone called the North Texas Poison Center they had the option to press one number to get information about the West Nile virus or aerial spraying. “In the message we did talk about the impact on fetuses and one of the things we said was that based on the research out there, there was little to no effect on fetuses,” said Melody Gardner, RN, MSN, CCRN, managing director of the North Texas Poison Center.
The center received 1,772 calls regarding West Nile and aerial spraying between August 13 through September 26 with the majority during the first week, she said.
Media attention heightened concern about possible exposure to West Nile virus, said Clint Sanders, RN, BSN, CEN, interim ED manager at Methodist Dallas Medical Center. The publicity “caused many people to call 911 and seek medical treatment for a simple mosquito bite,” said Sanders. “The media seemed to focus more on the deaths and poor outcomes. Most people exposed to West Nile are asymptomatic or have mild symptoms such as low-grade fever, body aches and fatigue for a couple of days. The Centers for Disease Control [and Prevention]shows that only about 1 in 150 cases become severe.”
To calm people arriving at the ED, nurses explained and reviewed the symptoms. If they did not meet the criteria, they were told it was probably just a regular mosquito bite, Sanders said. Nurses explained that the majority of cases can be handled at home by increasing fluids and over-the-counter pain and fever reducers. Mild cases may last only a couple of days and up to two weeks.
Patients with severe cases usually present with meningeal signs, altered mental status or severe headache. The diagnosis of West Nile virus is confirmed by blood work or a lumbar puncture, Sanders said. A majority of the treatment revolves around preventing secondary infections. These patients will be given IV fluids and monitored for fevers, making sure their breathing airway is maintained if they show any altered mental status, he said.
Patients with West Nile neuroinvasive disease receive supportive treatment such as rehabilitation, pain management and infection in the hospital for anywhere from a week or two up to several months, said Susan De Sessa, DrPH, CPH, medical epidemiologist with infection prevention at Parkland Health & Hospital System. “After that they are generally discharged to a rehabilitation facility if the disease was severe enough. Some patients will never return to baseline from the disease and may require permanent skilled nursing around the clock,” she said.
For nurses who find themselves dealing with an outbreak, communication and cooperation between hospital departments and with outside organizations are key. “Keeping the health department well-informed was how we found out quickly that there was an outbreak in Texas,” said De Sessa.
Be prepared to educate, said Cook. “Explain what [West Nile] is and the protective measures. When there is an outbreak like that, the public becomes anxious. Educate them to decrease anxiety.”
Sanders agreed education about taking steps to avoid being bitten by mosquitoes is vital. This can be done through community health outreach and awareness programs and the schools, he said. “The community needs to know to empty anything that can hold stagnant water, which breeds mosquitoes, avoid going out at dawn and dusk when mosquitoes are most active and take precautions by wearing an insect repellent, long sleeves and pants,” Sanders said.