West Nile Virus in Maricopa County
Background, Surveillance and Plan of Action.

Maricopa County
1

ABSTRACT
West Nile Virus (WNV) made a dramatic intercontinental jump to North America in 1999. Exact
reasons for its abrupt appearance in NYC are unknown. WNV is now recognized as the most
widespread disease of its genre and has rapidly spread across the U.S., involving all but 4 states.
During the 2002 season more than 4000 illnesses and 274 deaths were attributed to WNV.
Evidence now exists implicating WNV in lactational, intrauterine and organ recipient transmissions
as well as the viruses potential to infect the U.S. blood supply.
WNV is permanently established as a significant pathogen in the U.S. prompting research
exploring new treatments, diagnostic tests and vaccines. Research is ongoing regarding the
mystery of the virus’s emergence in North America and it’s rapid spread across the continent.
Arizona is one of 4 states without endemic WNV activity, although the virus has been identified in
the border states of New Mexico and Colorado. A single human case in California has also been
reported without the expected concomitant bird or mosquito viral activity. In 2002 Maricopa
County dead bird, sentinel flock, mosquito pool, human and equine surveillance plans have been
enhanced in anticipation of the emergence of WNV in our region. Continuing to draw from the
experiences of other jurisdictions, Maricopa County WNV prevention efforts will focus on early
identification of WNV activity in birds and mosquitoes resulting in utilization of measures to
reduce mosquito breeding habitats, aggressive public education campaigns and graded
enhancement of human and equine surveillance.
Although these efforts cannot entirely prevent WNV illness the goal is to thwart the viral
amplification cycles that result in increased risk to humans and domestic animals. This goal can
only be reached through comprehensive and adequately funded preparation and the wellcoordinated efforts of all stakeholders in both the public and private sectors.

2

TABLE OF CONTENTS

I.

GENERAL BACKGROUND/HISTORY

II.

WNV SURVEILLANCE IN MARICOPA COUNTY

III.

PLAN OF ACTION FOR WNV IN MARICOPA COUNTY, 2003:
SURVEILLANCE/CONTROL

IV.

THE FUTURE

V.

CONCLUSIONS

VI.

APPENDICES
A. SPECIES AFFECTED BY WNV
B. RESULTS OF HUMAN SURVEILLANCE FOR WNV IN MARICOPA COUNTY, 2002
C. COSTS OF ENHANCED SURVEILLANCE FOR WNV IN MARICOPA COUNTY, 2002
D. MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
EPIDEMIOLOGY/SURVEILLANCE PLAN FOR WEST NILE VIRUS 2003

VII.

REFERENCES

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I. GENERAL BACKGROUND/HISTORY
West Nile Virus (WNV) is one of the group of arboviruses (arthropod-borne) known to cause
meningitis and encephalitis in humans, such as Western Equine Encephalitis (WEE) and St. Louis
Encephalitis (SLE) viruses. Other familiar arboviruses cause Yellow fever, Denge fever and
LaCrosse encephalitis.
WNV belongs to the Flaviviridae family, the genus Flavivirus Japanese encephalitis antigenic
complex. This includes the Alfuy, Cacipacore, Japanese encephalitis, Koutango, Kunjin, Murray
Valley encephalitis, St. Louis encephalitis, Rocio, Stratford, Usutu, West Nile, and Yaounde
viruses (2).
First isolated from the blood of a woman with a febrile illness in the province of West Nile,
Uganda in 1937, WNV has been a common cause of both animal and human disease in Africa,
the Middle East, Europe and western Asia. Small outbreaks have occurred in Israel (1999 and
2000), Algeria (1994), Romania (1996 and 1997), the Czech Republic (1997), the Democratic
Republic of the Congo (1998), Russia (1999) and the United States (1999-2002) (1). WNV is now
recognized as the most widespread virus of its genre in the world.

Electron micrograph of WNV in brain tissue of a crow
Illustration 1

(http://www.cdc.gov/ncidod/dvbid/westnile/virus.htm)

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Life Cycle of WNV
The principal vector for WNV and other arboviruses are bird-feeding mosquitoes. Infected
mosquitoes carry viral particles in their salivary glands and infect susceptible bird species during
a blood meal. Although mosquitoes of the genus Culex are the primary vectors in the life cycle,
WNV has been isolated from over 43 other mosquito species (3, 4).
Wild birds are the key reservoir hosts for WNV, which has been isolated from over 160 avian
species both wild and domestic. Although most infected birds are asymptomatic, crows and jays
are more likely to become ill or die, often presenting the first clues to the presence of WNV in
communities. Birds can remain highly viremic for 4-5 days successfully sustaining and amplifying
the life cycle of the virus in endemic areas (3, 4).
Humans, equines and other mammals are considered incidental or “dead end” hosts of WNV;
these species become infected but do not contribute to the viral life cycle. There is however, a
theoretical risk of transmission to another hosts by way of vector mosquito bites, albeit not yet
well documented. WNV has been isolated from a wide variety of domestic, zoo and farm species
(3, 4). For a list of these species, see appendix A.

Incidental Infections

Life Cycle of WNV
Illustration 2

5

WNV Arrival in the U.S.
During the summer of 1999, WNV was identified in North America for the first time in a total of
four U.S. states. The outbreak in New York City resulted in 62 human cases and 7 deaths.
It is still unknown how WNV was introduced to North America. Its appearance in an area of
frequent travel, international trade and bird migration routes suggests the natural or traderelated importation of exotic animals and plants from overseas as a probable answer (4).
Examination of the DNA sequence of the virus isolated from both humans and animals in NYC in
1999 revealed a near 100% match with virus isolated from Israel in 1998 (6, 7).
The mechanism of WNV's spread through the U.S presents another challenge for scientists. The
virus had spread to 12 states and the District of Columbia by the year 2000. By 2001 it had been
isolated in animals or humans in 15 additional states and, by 2003, WNV activity was reported in
a total of 44 states and the District of Columbia. In 2002 the virus appeared in Pacific coast
states before it appeared in Southwestern states (2), (See Table 1 and Map 1).

Map 1

(http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm#map1)

6

Year

1999

2000

2001

Cases
Fatalities

62
7

21
2

66
9

2002* (as of
1/20/03)
3989
259

WNV Annual Case Count
Table 1
Several hypotheses have been formulated regarding this rapid transcontinental expansion of
WNV endemic areas in the U.S.: “over-wintering” of infected mosquitoes, that is, the ability to
survive adverse climatic conditions and remain viable until the next season; the persistence of
WNV in chronically infected endemic vertebrate hosts such as birds or frogs; persistence of the
virus in the hibernating female of the Culex species, thus infecting her progeny transovarially;
and the reintroduction of the virus seasonally by chronically infected migratory birds from tropical
or subtropical endemic areas (5).
Clinical Aspects of WNV
Most human WNV infections result in mild or even absent symptoms after an incubation period of
3-15 days. Serosurveys performed in NYC confirmed that approximately 20% of those infected
developed mild disease and less than 1% suffered from severe disease (1,4).
West Nile Fever
Well documented for many years in Europe, West Nile Fever is a case of mild WNV disease in
humans, characterized by a 3-15 day incubation followed by abrupt onset of flu-like symptoms
such as fever, myalgia, arthralgia, pharyngitis, adenopathy, headache, rash, nausea, vomiting
and malaise (5). West Nile fever typically resolves spontaneously after only a few days and does
not appear to cause any long-term health effects.
West Nile Meningitis/Encephalitis
Severe WNV disease, West Nile meningitis or encephalitis, is characterized by fever, severe
cephalgia and mental status changes. Unique to WNV meningitis and encephalitis are the
commonly reported patterns of severe muscle weakness and spastic or flaccid paralysis, which
are unusual in other viral nervous system infections (6). Although rare, the most serious
manifestation of WN virus infection is fatal encephalitis.
Historical Data: NYC Experience
During the WNV outbreak in 1999 in NYC the most common symptoms among hospitalized
patients were fever (90%), weakness (56%), nausea/vomiting (53/51%), headache (47%) and
mental status changes (46%) (1).
Age appeared to be the most important risk factor for severe disease; data revealed that the
attack rate for severe neurologic disease was 10 times higher for those 50-59 years old and 43
times higher for those 80 years old and above when compared to persons aged 0-19. The
median age for hospitalized patients during the outbreak was 71 years (range 5-90) and the
relative risk for death for patients age 75 and over was 8.5 (1, 4) when compared to the younger
age group (0-19).
A one-year follow up of hospitalized patients affected in the 1999 outbreak revealed significant
residual symptomatology: fatigue (67%), memory loss (50%), difficulty ambulating (49%),
muscle weakness (44%), and depression (38%) were reported (4).

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2002 WNV Outbreak in the U.S. – New Findings
The 2002 outbreak in the U.S. is the largest documented WNV epidemic in the world to date.
Several case reports from 2002 have contributed evidence of previously undocumented or poorly
understood modes of viral transmission. The new information has prompted reevaluation of
practices and procedures at the individual as well as the community level.
WNV transmission from organ transplant
In August 2002, 4 organs from a single donor in Georgia were linked to 3 cases of encephalitis
(one fatal) and one case of mild febrile illness in the recipients. Three of the four organ recipients
tested positive for WNV. It is not known how the donor (who was said to have been healthy
before a fatal accident) contracted the disease but health officials are investigating the blood
products he received during trauma resuscitation as a potential source of infection with WNV (8).
WNV transmission from blood transfusion
The Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), with
state and local health officials are investigating 33 cases from 17 states of WNV illness associated
with receiving blood products within 30 days of the onset of symptoms. So far, there is evidence
indicating WNV infection as a result of the transfusion in six of those cases. In each of the six,
either the donor or retention segments from the blood transfusion (tubing and needles used
during the transfusion procedure) tested positive for WNV. Additionally, in each case the donor
was reported as having had an illness clinically compatible with WNV (9). The FDA has revised
blood bank guidelines, adding protections to exclude donors with symptoms compatible with
WNV infection as well as measures to quarantine blood products already in the system from
donors who become ill after donation. The FDA and other agencies are evaluating a direct rapid
screening method for WNV and have proposed allowing the use of such a test under the
“Investigational New Drug” application process during the summer of 2003. The new method will
enable blood banks to rapidly screen for WNV just as they routinely check for diseases such as
HIV, syphilis and hepatitis (10).
WNV transmission from nursing mother to infant
In September 2002, a 40-year-old Michigan woman delivered a healthy infant but required two
transfusions after the delivery. The patient was readmitted 12 days later with symptoms of
meningitis, her CSF was WNV positive; she was treated, recovered and was discharged. The
nursing infant, who is healthy and reportedly had no mosquito exposure, has tested WNV
positive. A sample of the breast milk was also positive for WNV and a viral culture is pending. Of
note, the mother received blood from the same donor who also gave a transfusion of platelets to
a liver transplant patient who subsequently died of WNV encephalitis. The CDC has not issued
any change in breast-feeding recommendations as a result of this case (11).
Intrauterine Transmission
In August 2002, a pregnant New York woman was hospitalized for fever, headache, rash and
weakness in the legs. In October, she tested WNV positive and went on to deliver an infant of
38-weeks gestation suffering severe cerebral abnormalities. The infants’ blood and CSF tested
WNV positive; placental and umbilical tissues also tested WNV positive confirming an apparent
intrauterine infection. The CDC has stressed that these findings do not prove a causal relationship
between the WNV infection and the fetal abnormalities, however they acknowledge that
intrauterine infections associated with Japanese encephalitis and Dengue fever have resulted in
fetal infections and spontaneous abortions have been documented in the literature. Precautions
for pregnant women to avoid mosquito exposures have been emphasized. In addition, a
voluntary registry has been established by the CDC to monitor the birth outcomes of pregnant
women with WNV illness (12).

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Laboratory Acquired Infections
Two laboratory-acquired cases of WNV have been documented this year. Although this is not a
new experience in WNV research there is concern that as far more laboratories will be
participating in procedures involving WNV infected tissues such exposures will increase. In one
case a laboratory employee lacerated his thumb with a scalpel performing a necropsy on a dead
bird subsequently found to be WNV infected. Four days later he began to exhibit typical
symptoms from which he recovered without hospitalization. In the other case a research
laboratory employee suffered a needle stick while harvesting WNV infected mouse brains. Three
days later he began to have symptoms. Of interests in this case the patient had a history of
Dengue fever and had received both yellow fever and Japanese encephalitis vaccines. Despite
the presence of these presumptively protective Flavivirus antibodies he still contracted WNV
illness although the episode was considered mild and the patient recovered completely (13).
The Subcommittee on Arbovirus Laboratory Safety of the American Committee on ArthropodBorne Viruses recommends biosafety level 3 (BSL) containment for handling WNV specimens.
BSL-2 facilities, by modifying procedures, can also achieve acceptable safety standards in order
to continue to provide essential clinical services. CDC officials have recommended continued
training and prompt reporting. A baseline serum and medical follow-up will be required for all
potential laboratory exposures. (13)
II. WNV SURVEILLANCE IN MARICOPA COUNTY
In anticipation of the westward spread of the West Nile Virus in 2002 surveillance efforts to
detect the illness in Maricopa County have been increased during the peak mosquito season of
May through November.
In endemic areas veterinary surveillance, particularly in avian species, has proven to be a reliable
early indicator for WNV activity both temporally and geographically (14). As a result the Arizona
Department of Health Services’ Vector-borne and Zoonotic Disease Program, the Arizona
Veterinary Diagnostic Laboratory and Maricopa County public health officials have collaborated to
enhance dead bird, sentinel chicken flock, mosquito pool and equine testing for WNV.
Mosquito Pools
The Arizona State Health Laboratory (ASHL) has tested over 750 mosquito pools in 2002 from
locations throughout the state. While no WNV positives occurred 31 samples tested positive for
WEE or SLE.
Sentinel Chicken Flocks
Four chicken flocks have been established and strategically spread across the county. Although
the virus does not affect chickens their serum will indicate antibodies if bitten by WNV infected
mosquitoes in the area. Over 1500 chicken blood samples from across the state were tested
during the surveillance season at the ASHL. None tested positive for WNV although the chicken
flocks did confirm the presence of WEE and SLE in the county.
Dead Bird Submissions
Dead birds from a variety of genres have been collected from areas across the state. At the
beginning of the season information was given to the community regarding the proper
submission of dead birds and their importance in WNV surveillance. The University of Arizona’s
Veterinary Diagnostic Laboratory performed approximately 200 dead bird necropsies, none were
WNV positive.

9

Equine
Local veterinarians have been alerted to consider WNV in horses presenting with CNS
abnormalities such as ataxia, weakness of the limbs, recumbency and muscle fasciculation.
Approximately 50 equine serum samples have been tested state wide; one horse residing in
Maricopa County at the time of diagnosis tested WNV positive, however investigation revealed
the virus was contracted in another state. Two other WNV-positive horses were identified in
Arizona counties (Cochise and Pima); these cases were also determined to have out of state
transmission.
Human Surveillance
The epidemiology division has employed a set of criteria to enhance surveillance and assure
appropriate testing of cases of viral neurologic disease for WNV during the peak mosquito
season. The criteria were designed to closely reflect the WNV experience of endemic areas of the
U.S. in terms of demographics and symptomatology. Cases meeting the following criteria were
investigated and tested for WNV:
ü ALL encephalitis cases
ü Adults (>35) with aseptic meningitis
ANY age aseptic meningitis with one or more of the following:
ü Altered mentation
ü Seizure
ü Profound muscle weakness
ü Flaccid paralysis
ü Spastic paralysis
Details of the results of human surveillance in Maricopa County can be found in Appendix B. Two
Maricopa County meningitis/encephalitis patients tested positive for WNV at the ASHL; the results
were confirmed by CDC laboratories. Two other human cases of WNV illness were reported in
Arizona (Pima). In all four cases the investigation revealed the virus was contracted out of state.
Appendix C denotes the approximate costs of enhanced surveillance in 2002.

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III. PLAN OF ACTION FOR WNV IN MARICOPA COUNTY, 2003:
SURVEILLANCE/CONTROL
Human Surveillance Plan
Resources
Maricopa County epidemiology has prepared a proposal for reestablishing enhanced surveillance
for WNV in spring of 2003. (See Appendix D: Epidemiology/Surveillance Plan for West Nile Virus
2003, 12/12/02). Additional resources requested for the 2003 season include a nurse investigator
and 2 administrative assistants. Responsibilities will include community outreach, active
surveillance at Maricopa County hospitals, operating hotline numbers, collection of laboratory
samples, home and hospital interviews/visits and phlebotomies. A formal process will be followed
to track the costs incurred to include salaries, travel and equipment.
Risk Assessment and Staged Response
The Level of Risk definitions and expected responses can be found in Table 2. Two stages of
enhanced human surveillance will be guided by the Level of Risk indicated from results of
enhanced mosquito and bird surveillance.

RISK
LEVEL
I

DEFINITION

RESPONSE

II

Mosquito Season–no arbovirus
detected
Virus Detected- mosquitoes &/or birds

Business as usual: continue
surveillance & education.
•Activate active case surveillance in
affected areas
•Step-up prevention education
•Step-up surveillance - affected &
adjacent areas

III
IV

Equine Cases-but still local/focal WNV
Human Cases and/or Widespread WNV

•Intensify prevention education efforts
•Expand active human case
surveillance
•Increase MD outreach, add sentinel
hospitals

Risk Assessment and Staged Epidemiologic Response
(Reproduced from Risk Assessment and Staged Response from Arizona Department of Health
Services’ Vector-borne and Zoonotic Disease Program)
Table 2
Two Stages of Enhanced Human Surveillance
-“Enhanced Passive Surveillance” will begin at the start of the mosquito season (Risk Level I
conditions) and will involve promoting prompt reporting of viral encephalitis and select cases of
meningitis by healthcare institutions and providers. Routine contact with hospital ICP’s and
laboratories will continue. Public education regarding mosquito reduction and avoidance will
begin.
-“Active Surveillance” will begin with the announcement of Risk Level II conditions. Active
surveillance will involve regular formal contact with healthcare institutions and providers, weekly
e-mail and fax updates, broadcast fax emergency announcements, and on-site interviews and
sample procurement as needed. Suspect case investigation criteria will be expanded. Public
education messages will be enhanced to include WNV specific information, prevention messages
and to publicized hotline numbers. Hotline phones will be engaged to answer public inquiries and

11

provide provider consultations. All efforts will be staged with careful consideration of risk
assessment and available resources.
The testing/investigation criteria will be amended as follows to reflect recent experiences in
endemic areas:
ü All cases of viral encephalitis
ü Hospitalized cases of aseptic/viral meningitis and:
o >Age 30
o Altered mentation
o Profound muscle weakness
o Neuropathic symptoms;
§ Flaccid paralysis
§ Spastic paralysis
§ Guillain-Barre Syndrome
§ Seizure
The age criteria will be heavily dependent upon testing resources (lab capacity, availability of
reagents) and risk level assessment and will be reevaluated regularly. Cases with travel/mosquito
bite history, organ or blood transfusion recipients with compatible symptoms will be evaluated on
an individual basis.

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IV. THE FUTURE
Vaccine
Human vaccines for WNV are being developed. Drug maker Acambis and National Institutes of
Health (NIH) researchers are working with an experimental vaccine for WNV using both an
experimental dengue virus and the existing Yellow Fever vaccines as the foundation for the new
drug by substituting WNV specific surface proteins for the existing viral particles. Both vaccines
have been extensively tested on animals with promising results. The Acambis drug is moving
forward with Phase I Trials and an investigational new drug (IND) application will be filed with
the Food and Drug Administration. Clinical trials will likely begin in 2003 (15)
Disease Ecology
Researchers in the U.S. along with our neighbors in Canada and Mexico are investigating the
mysterious emergence of WNV in North America and the patterns of the virus’s persistence in the
continent by trying to gain a more detailed understanding of the avian and mosquito species
involved in the life cycle and how they are affected by climactic and geographical issues (15).
Treatment and Diagnosis
NIH funded institutions have screened over 300 antiviral and immunotheraputic drugs for
treatment of WNV. Of these, 12 have shown in vitro activity against the virus warranting animal
testing.
Several small biotechnology companies are attempting to develop new, commercially available
diagnostic assays for WNV. A new rapid diagnostic test will likely become available in late 2003
(15).

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V. CONCLUSIONS
The year 2002 marked the largest WNV outbreak to date in the world as the virus rapidly spread
across the U.S. The epidemic has cost hundreds of lives and millions of dollars, impacting those
directly affected as well as the community at large. The magnitude of the spread of the WNV was
unexpected and as a result health officials in many jurisdictions have struggled to limit its human
impact.
Maricopa County has been spared the burden of widespread WNV-illness thus far, however the
area is home to a viable mosquito population, many species of migratory birds and a large
human populace with a propensity for outdoor activities making arrival of the virus inevitable and
advanced preparations invaluable.
Maricopa County has the luxury of applying the lessons learned from WNV endemic regions in the
past four years and must plan accordingly. If we are to interrupt the amplification cycle of WNV
before significant human impact it will be important to invest heavily in preventive measures
such as early public awareness messages regarding mosquito control and dead-bird submissions,
rapid and accurate bird necropsies and concomitant mosquito pool and sentinel flock testing.
Once local viral activity has been confirmed preplanned strategies for larvacidal applications,
equine vaccinations and reemphasizing measures for mosquito avoidance should be immediately
implemented for the appropriate geographical region.
Prior to the identification of WNV activity in Maricopa County enhanced human surveillance must
already be in progress with sufficient resources to generate comprehensive case investigations
and assure assessment and testing of all potential WNV cases in the jurisdiction.
As with most significant public health issues the cooperation of many local, state, and federal
agencies will be required as well as that of the medical community, and the lay public.

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APPENDIX A
SPECIES AFFECTED BY WEST NILE VIRUS
(Reproduced from the National Wildlife Health Center:
http://www.nwhc.usgs.gov/research/west_nile/wnvaffected.html)

Birds
Order Anseriformes
Family Anatidae
Wood Duck-Aix sponsa
Eurasian Wigeonc-Anas penelope
Mallard-Anas platyrhynchos
Bronze-winged Duck (Spectacled Duck)c-Anas specularis
Domestic Gooseac-Anser chinensis
Canvasback-Aythya valisineria
Canada Goose-Branta Canadensis
Barnacle Gooseac-Branta leucopsis
Emperor Goosec-Chen canagica
Greater Magellan Goose (Andean Goose)ac-Chloephagapicta leucoptera
Abyssinian Blue-winged Gooseac-Cyanochen cyanopterus
Tundra Swanc-Cygnus columbianus
Trumpeter Swanac-Cygnus Cygnus buccinator
Mute Swan-Cygnus olor
Rosybilled Duckac-Netta peposaca

Order Apodiformes
Family Apodidae
Chimney Swift-Chaetura pelagica
Family Trochilidae
Ruby-throated Hummingbird-Archilochus colubris

Family Ciconiidae
Saddle-billed Storkac-Ephippiorhynchos senegalensis

Marabou Storkac-Leptopilos crumeniferus
Lesser Adjutant Storkac-Leptoptilos javanicus
Family Laridae
Inca Ternac-Larosterna inca
Family Phoenicopteridae
Chilean Flamingoc-Phoenicopterus chilensis
Family Threskiornithidae
Scarlet Ibisc-Eudocimus ruber
Waldrappac-Geronticus eremita
Order Columbiformes
Family Columbidae
White-crowned Pigeon-Columba leucocephala
Rock Dove (Feral Pigeon)-Columba livia
Mauritius Pink Pigeonac-Columba mayeri
Common Ground-Dove-Columbina passerina
Eurasian Collared-Dove-Streptopelia decaocto
White-winged Dove-Zenaida asiatica
Mourning Dove-Zenaida macroura
Luzon Pigeon (Bleeding Heart Pigeon)ac-Gallicolumba luzonica

Order Caprimulgiformes
Family Caprimulgidae
Common Nighthawk-Chordeiles minor

Order Coraciiformes
Family Alcedinidae
Belted Kingfisher-Ceryle alcyon

Order Casuariiformes
Family Dromaiidae
Emuc-Dromaius novaehollandiae

Order Cuculiformes
Family Cuculidae
Yellow-billed Cuckoo-Coccyzus americanus

Order Charadriiformes
Family Charadriidae
Ruddy Turnstone-Arenaria interpres
Killdeer-Charadrius vociferus

Order Falconiformes
Family Accipitridae
Cooper's Hawk-Accipiter cooperii
Northern Goshawk-Accipiter gentilis
Sharp-shinned Hawk-Accipiter striatus
Golden Eagle-Aquila chrysaetos
Red-tailed Hawk-Buteo jamaicensis
Rough-legged Hawkc-Buteo lagopus
Red-shouldered Hawk-Buteo lineatus
Broad-winged Hawk-Buteo platypterus
Swainson's Hawk-Buteo swainsoni
Swallow-tailed Kite-Elanoides forficatus
Bald Eagle-Haliaeetus leucocephalus
Mississippi Kite-Ictinia mississippiensis
Osprey-Pandion haliaetus
Harris' Hawkc-Parabuteo unicinctus

Family Laridae
Herring Gull-Larus argentatus
Laughing Gull-Larus atricilla
Ring-billed Gull-Larus delawarensis
Great Black-backed Gull-Larus marinus
Black Skimmer-Rhynchops niger
Grey Gullac-Larus modestus
Order Ciconiformes
Family Ardeidae
Yellow-crowned Night-heronc-Nyctanassa violacea
Black-crowned Night-heronc-Nycticorax nycticorax
Great Blue Heron-Ardea herodias
Green Heron-Butorides virescens
Least Bittern-Ixobrychus exilis
Family Cathartidae
Turkey Vulture-Cathartes aura
Black Vulture-Coragyps atratus
King Vultureac-Sarcoramphus papa

Family Falconidae
Merlin-Falco columbarius
Prairie Falcon-Falco mexicanus
American Kestrel-Falco sparverius
Order Galliformes
Family Numididae
Crested Guineafowlac-Guttera pucherani

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Family Odontophoridae
Northern Bobwhite-Colinus virginianus
Family Phasianidae
Chukarac-Alectoris chukar
Ruffed Grouse-Bonasa umbellus
Domestic Chicken (Red Junglefowl)c-Gallus gallus
Green Junglefowlac-Gallus varius
Impeyan (Himalayan) Pheasant (Monal)c-Lophophorus impeyanus
Bulwer's Wattled Pheasantac-Lophura bulweri
Turkey (domestic and wild)-Meleagris gallopavo
Ring-necked Pheasant-Phasianus colchicus
Mount Peacock-Pheasantac-Polypectron inopinatum
Crested Partridgeac-Rollulus roulroul
Blyth's Tragopanc-Tragopan blythii
Argus Pheasant (unspecified)ac-various
Order Gaviformes
Family Caprimulgidae
Common Loon-Gavia immer
Order Gruiformes
Family Accipitridae
Black-necked Craneac-Grus nigricollis
Family Gruidae
Demoiselle Craneac-Anthropoides virgo
West African Crowned Cranea-Balearica pavonina pavonina
Wattled Craneac-Bugeranus carunculatus
Whooping Craneac-Grus americana
Mississippi Sandhill Cranec-Grus canadensis pulla
Red-crowned Craneac-Grus japonensis
Siberian Craneac-Grus leucogeranus
Hooded Craneac-Grus monacha
White-naped Craneac-Grus vipio
Family Rallidae
Virginia Rail-Rallus limicola
Order Musophagiformes
Family Musophagidae
Lady Ross' Turaco (Plantain-Eater)ac-Musophaga rossae
Order Passeriformes
Family Bombycillidae
Cedar Waxwing-Bombycilla cedrorum
Family Cardinalidae
Northern Cardinal-Cardinalis cardinalis
Blue Grossbeaka-Guiraca caerulea
Dickcissel-Spiza americana
Family Corvidae
Western Scrub-Jay-Aphelocoma californica
American Crow-Corvus brachyrhynchos
Common Raven-Corvus corax
Fish Crow-Corvus ossifragus
Blue Jay-Cyanocitta cristata
Steller's Jay-Cyanocitta stelleri
Black-billed Magpiec-Pica hudsonia
Family Emberizidae
Song Sparrow-Melospiza melodia
Savannah Sparrow-Passerculus sandwichensis
Fox Sparrow-Passerella iliaca
Eastern Towhee-Pipilo erythrophthalmus
Field Sparrow-Spizella pusilla
Family Estrildidae
Zebra Finchc-Taeniophygia guttata
Family Fringillidae
American Goldfinch-Carduelis tristis
House Finch-Carpodacus mexicanus
Purple Finch-Carpodacus purpureus
Evening Grosbeak-Coccothraustes vespertinus
European Goldfinchc-Carduelis carduelis

Family Hirundinidae
Barn Swallow-Hirundo rustica
Purple Martin-Progne subis
Family Icteridae
Red-Winged Blackbird-Agelaius phoeniceus
Rusty Blackbird-Euphagus carolinus
Brewer's Blackbird-Euphagus cyanocephalus
Baltimore Oriole-Icterus galbula
Brown-headed Cowbird-Molothrus ater
Boat-tailed Grackle-Quiscalus major
Great-tailed Grackle-Quiscalus mexicanus
Common Grackle-Quiscalus quiscula
Family Laniidae
Loggerhead Shrike-Lanius ludovicianus
Family Mimidae
Gray Catbird-Dumetella carolinensis
Northern Mockingbird-Mimus polyglottos
Brown Thrasher-Toxostoma rufum
Family Paridae
Tufted Titmouse-Baeolophus bicolor
Varied Titc-Parus varius
Black-capped Chickadee-Poecile atricapilla
Carolina Chickadee-Poecile carolinensis
Family Parulidae
Black-throated Blue Warbler-Dendroica caerulescens
Yellow-rumped Warbler-Dendroica coronata
Yellow Warbler-Dendroica petechia
Blackpoll Warbler-Dendroica striata
Common Yellowthroat-Geothlypis trichas
Kentucky Warbler-Oporornis formosus
Northern Parula-Parula americana
Ovenbird-Seiurus aurocapillus
Northern Waterthrush-Seiurus noveboracensis
Nashville Warbler-Vermivora ruficapilla
Canada Warbler-Wilsonia canadensis
Hooded Warbler-Wilsonia citrina
Family Passeridae
House Sparrow-Passer domesticus
Family Sylviidae
White-crested Laughingthrushac-Garrulax leucolophus
Family Sittadae
White-breasted Nuthatch-Sitta carolinensis
Family Sturnidae
European Starling-Sturnus vulgaris
Family Troglodytidae
Carolina Wren-Thryothaurus ludovicianus
Winter Wren-Troglodytes troglodytes
Family Turdidae
Veery-Catharus fuscescens
Hermit Thrush-Catharus guttatus
Gray-cheeked Thrush-Catharus minimus
Swainson's Thrusha-Catharus ustulatus
Wood Thrush-Hylocichla mustelina
Eastern Bluebird-Sialia sialis
American Robin-Turdus migratorius
Family Tyrannidae
Traill's Flycatcher-Empidonax traillii/alnorum
Eastern Phoebe-Sayornis phoebe
Scissor-tailed Flycatcher-Tyrannus forficatus
Eastern Kingbird-Tyrannus tyrannus
Family Vireonidae
Black-whiskered Vireo-Vireo altiloquus
Warbling Vireo-Vireo gilvus

16

Order Pelecaniformes
Family Pelecanidae
American White Pelican-Pelecanus erythrorhynchos
Brown Pelicanac-Pelicanus occidentalis
Family Phalacrocoracidae
Double-crested Cormorant-Phalacrocorax auritus
Guanay Cormorantc-Phalacrocorax bougainvillei
Order Piciformes
Family Picidae
Red-headed Woodpecker-Melanerpes erythrocephalus
Downy Woodpecker-Picoides pubescens
Yellow-bellied Sapsucker-Sphyrapicus varius
Order Podicipediformes
Family Podicipedidae
Pied-billed Grebe-Podilymbus podiceps
Order Psittaciformes
Family Cacatuidae
Cockatoo (unspecified)c-Cacatua spp.
Cockatielc-Nymphicus hollandicus
Family Psittacidae
Red-crowned Parrotc-Amazona viridigenalis
Macaw (unspecified)c-Ara spp.
Budgerigarc-Melopsittacus undulatus
Lorikeet spp.c-Tricheglossus spp.
Order Spheniscformes
Family Spheniscidae
Black-footed (Jackass) Penguinc-Spheniscus demersus
Magellan Penguinac-Spheniscus humboldti
Order Strigiformes
Family Strigidae
Northern Saw-whet Owl-Aegolius acadicus
Short-eared Owl-Asio flammeus
Verreaux's Eagle Owl (Milky Eagle Owl)ac-Bubo lacteus
Great Horned Owl-Bubo virginianus
Snowy Owlc-Nyctea scandiaca
Eastern Screech Owl-Otus asio
Tawny Owlc-Strix aluco
Barred Owl-Strix varia
Family Tytonidae
Barn Owl-Tyto alba
Order Struthioniformes
Family Struthionidae
Ostrichac-Struthio camelis

Family Suidae
Babirusaac-Babyrousa babyrousa
Order Carnivora
Family Canidae
Domestic Dogc-Canis familiaris
Timber Wolfc-Canis lupus
Family Felidae
Domestic Cat (feral)-Felis catus
Family Mustelidae
Striped Skunk-Mephitis mephitis
Family Phocidae
Harbor Sealc-Phoca vitulina
Family Procyonidae
Red Pandaac-Ailurus fulgens fulgens
Family Ursidae
Black Beara-Ursus americanus
Order Chiroptera
Family Vespertilionidae
Big Brown Bat-Eptesicus fuscus
Little Brown Bat-Myotis lucifugus
Order Lagomorpha
Family Leporidae
Domestic Rabbitc-Oryctolagus cuniculus
Order Perissodactyla
Family Equidae
Domestic Horsec-Equus equus przewalski caballus
Donkeyc-Equus asinus
MulecFamily Rhinocerotidae
Great Indian Rhinocerosac-Rhinoceros unicornis
Order Primata
Family Cercopithcidae
Barbary Macaquec-Macaca sylvanus
Family Lemuridae
Ring-tailed Lemurac-Lemur catta
Order Proboscidea
Family Elephantidae
Indian (Asian) Elephantac-Elephas maximus indicus

Mammals
Order Artiodactyla
Family Bovidae
Domestic Cattlec-Bos taurus
Mountain Goatc-Oreamnos americanus
Domestic (Suffolk) Sheepc-Ovis aries

Order Rodentia
Family Sciuridae
Gray Squirrel-Sciurus carolinensis
Fox Squirrel-Sciurus niger
Eastern Chipmunk-Tamias striatus
Reptiles

Family Camelidae
Llamac-Lama glama
Alpaca (Suri)c-Lama pacos
Family Cervidae
White-tailed Deera-Odocoileus virgninianus
Reindeerc-Rangifer tarnadus

Order Crocodylia
Family Alligatoridae
American Alligatorc-Alligator mississippiensis
Order Squamata
Family Varanidae
Crocodile Monitorac-Varanus salvadorii

17

APPENDIX B
RESULTS OF HUMAN SURVEILLANCE FOR WNV IN MARICOPA COUNTY, 2002
Maricopa County has experienced a slow but steady increase in the rate of viral
meningitis/encephalitis cases reported in the past 4 years as shown in Chart 1.
Of the 200 cases reported during the mosquito season 2002 21 are not considered in the data as
they were ruled out (8), duplicate (4), or out of jurisdiction (9).
Maricopa County Viral Meningitis/Encephalitis Rates 1998-2002:
#Cases/100,000 Population (DES projection)

7

6

5

4
6.44
3
5.14
4.09
2

3.46
3.19

1

0

1998

1999

2000

2001

2002

Chart 1
Chart 2 represents the remaining 179 cases by the month report was received. Date of symptom
onset (which would more clearly illustrate the seasonal peak of disease) was not used in this
report due to the fact that onset data were missing in more than one third of the reports. The
average lag time between symptom onset to date received in cases with available data was 14.2
days (range 1-38 days).
V ira l M e ning itis/E n c e p h a litis C a s e s b y M o n t h
A rbovirus Sea son 2002 (May-N o v )
40
35
30
39

25
20

32
26

15

23

10

21

21

17

5
0
M ay

June

July

August

Sepem ber

October

Novem ber

M onth
(by date reported)

Chart 2
Of the 179 cases of viral CNS disease reported during the period of enhanced surveillance 50 met
age criteria for WNV investigation. The Charts 3 -5 illustrate the general demographics of this
group including age, sex race and location.

18

Viral Meningitis Cases Meeting Age Criteria by Age
Group (2002)

Viral Meningitis Cases Meeting Age Criteria by Age
Group/Sex (2002)
FEMALE

MALE
13%

19%

17%

19%

62%

70%

35-45 y/o

45-64 y/o

65+

35-45 y/o

45-64 y/o

65+

Chart 3

Viral Meningitis Cases Meeting Age Criteria by Race
(2002)
2% 2%0%

6%

12%

78%

Caucasian
Native American

Hispanic
Other

African American
Unknown

Asian

Chart 4

Map 2

19

Results of Enhanced Human Surveillance
In addition to the 50 cases meeting age criteria 7 more investigations were initiated for cases
reported as aseptic meningitis exhibiting paresthesias (3), numbness (2) or altered mentation
(2).
In August, as the national case count grew beyond all expectations and media coverage of the
WNV epidemic intensified many private physicians began requesting WNV testing of the ASHL. As
a result county epidemiologists were required to triage all request for testing using the
established criteria prior to the specimen delivery to the lab. As some requests were for nonhospitalized patients with strictly upper respiratory symptoms, headache alone or history of travel
to a WNV endemic area without symptoms, any request not meeting criteria was referred to a
commercial laboratory for testing. More than 50 such consultations resulted in 21 samples to the
ASHL, 15 to commercial labs.
Table 2 shows the degree of symptomatology of the 57 cases investigated in Maricopa County for
2002. These data reveal significant differences in symptom breakdown from cases of WNV
disease in NYC (see Historical Data: NYC Experience).
Symptom

% With
symptom

Headache

54

Gi

34

Fever

32

Photophobia

18

Weakness

16

Altered mentation

16

Neck pain/stiffness

14

Arthralgia/Myalgia

8

Seizure

6

Other

16

Symptomatology of Viral Meningitis/Encephalitis Cases investigated 2002
Table 3
Of the 57 viral meningitis/encephalitis case investigations carried out this summer in Maricopa
County 2 patients tested positive for WNV IgM. In the first case a woman with a travel/mosquito
bite history in Ohio approximately 10 days prior to the onset of headache, fever, nausea,
vomiting and stiff neck was admitted to a local hospital in August. The second patient gave
history of having spent the summer in Indiana; 4 days after returning to her winter home in
Arizona she began to experience headache, neck pain and extreme fatigue. The WNV serology,
which was initially done at a commercial lab, was confirmed by the ASHL.

20

APPENDIX C
COSTS OF ENHANCED SURVEILLANCE FOR WNV IN MARICOPA COUNTY, 2002
At the start of the enhanced surveillance period no measures were taken to account for the
expenses of the effort as its magnitude was unexpected and underestimated. Listed below are
the cost per epidemiologist involved during the surveillance period by hourly pay rate factoring in
indirect and personnel costs (indirect: $ 0.157, personnel: $1.161).
ACTIVITY

TOTAL COST ($)

MC lab draws
Epi person/hours:
Planning
Triage/ Consults
Investigating
Correspondence/Mailings
Reports
Aggregate
Epidemiologist
Epidemiologist
Epidemiologist
Total

662.02
1560.01
17,713.35
19,935.38
T able 4

21

APPENDIX D
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
EPIDEMIOLOGY/SURVEILLANCE PLAN FOR WEST NILE VIRUS 2003
Prepared by Mare Schumacher
Updated 12/17/02
Background and Current Enhanced Surveillance Efforts
In the U.S. as of December 11, 2002, there have been 3829 cases of human West Nile Virus
(WNV) illness, resulting in 225 deaths. WNV activity has been documented in 42 states including
the Arizona border states of Colorado, California (human case) and New Mexico (veterinary
samples). In Arizona, 4 human (Pima-2, Maricopa-2) and 3 equine (Pima-1, Cochise-1, Maricopa1) WNV positive cases have been identified. All of these cases had exposures outside of Arizona.
Predictions are for Maricopa County to see it's first cases of endemic WNV during the
spring/summer of 2003.
Increased efforts to detect WNV illness in Maricopa County were instituted last summer. Human
surveillance for WNV in Maricopa County was expanded during the mosquito season (May thru
October). In addition to routine testing for all encephalitis cases, samples for selected cases of
aseptic meningitis were submitted to the State laboratory by MCDPH and other county health
departments. This practice will continue into 2003.
Last year, surveillance of animals susceptible to WNV was also enhanced. The MCDPH, the
Arizona Department of Health Services’ Vector-borne and Zoonotic Disease Program, the Arizona
Veterinary Diagnostic Laboratory, and Maricopa County Vector Control collaborated to enhance
dead bird, sentinel chicken flock, mosquito pool and equine testing for WNV.
Enhanced Surveillance Efforts for 2003
Because WNV illness is transmitted by mosquitoes, enhanced surveillance will need to begin
again in April of 2003 and surveillance can be expected to continue into December 2003. During
this period, the MCDPH surveillance team (epidemiology staff and community health nursing
surveillance staff) will need to conduct investigations of all suspect WNV cases. Due to the media
interest in WNV, the team expects a greater number of suspect cases in 2003, in addition to the
expected actual cases. Surveillance and investigations will include the following activities:
Arbovirus testing for:
• All viral encephalitis cases (routine)
• Selected viral meningitis cases:
§ >35 y/o
§ altered mentation
§ seizure
§ profound muscle weakness
§ flaccid paralysis
§ spastic paralysis
Testing will be performed at the AZ State Health Laboratory at the request of MCDPH.
Telephone triage:
•

Contact hospitalized cases (ICP’s providers)

22

•
•

Interview outpatient cases and get information on specimens (providers, labs)
Communicate with community members with questions

Site visits:
•
•
•

Review medical records for hospitalized cases
Interview hospitalized/convalescing patients
Collect convalescent specimens and/or lab results
Data management:

•
•
•
•
•

Collect case information
Complete data entry
Analyze data
Clean and maintain database
Produce reports

Community outreach:
•
•
•
•

Distribute initial fact sheet to providers/Infection Control Practitioners (see Attachment A)
Provide pamphlets
Provide regular updates to reinforce protocols and disseminate new info (see Attachment
B)
In addition to MCDPH efforts, public service announcements are currently being
negotiated by ADHS with Cox Communication

Resources Needed for Epidemiology for Summer 2003 West Nile Virus Enhanced Surveillance
and Outbreak Response
When the disease arrives in Arizona, the surveillance team will need to investigate every suspect
case of WNV and field questions and concerns from the public. With even as few as one suspect
case per day, the surveillance investigation workload will increase significantly as each case
requires a full interview of the patient, communication with labs, hospitals and the patient’s
medical provider, in addition to follow-up interviews, site visits and blood draws.
In order to meet the demand that the introduction of WNV into Arizona will produce, the
Epidemiology and Community Health Nursing staff request $99,057.37 in additional funds.
Requested funds would cover 1 surveillance nurse and 1 administrative assistant to help the
existing staff handle the increased number and types of activities needed. All positions would be
hired on a full-time basis for 35 weeks of the year (to cover the mosquito season). The
administrative Assistant would be hired from a temporary service at the rate of $14.30 per hour.
Hiring a partial-year surveillance nurse may be more difficult. The MCDPH typically hires
temporary nursing help from a nurse pool at $30-35 per hour. However, the WNV surveillance
nurse will need to have analytical and research skills in addition to basic nursing skills. The
estimated cost per hour for a temporary surveillance nurse is $52.00 per hour (including an
additional $6/hour for research skills). Job descriptions for each of the positions are provided
below.

23

Surveillance Nurse
The WNV surveillance nurse would be responsible for all parts of a WNV investigation, including:
• Completing diagnostic telephone interviews of all suspect cases to determine if probable
cases
• Conducting medical and personal interviews of probable cases
• Securing blood samples (through a blood draw) for probable cases
• Telephone triage with medical providers and hospitals to get lab results
• Following up with suspect and probable cases for changes in conditions, new lab tests,
etc.
MCDPH expects to pay more for a qualified surveillance nurse than for a pool nurse. A qualified
surveillance nurse has not only medical knowledge, but research skills as well.
Administrative Assistant/Data Entry Clerk
Administrative assistants will provide administrative support to the surveillance nurse and the
epidemiologists. This will include:
•
•
•
•

Data entry of completed lab results, questionnaires, and other forms
Setting up appointments and communication with patients
Typing, copying communication items for hospitals
Picking-up or delivering of interviews, lab results or other items from hospitals, patients’
homes, or labs

Total Costs
As shown in the table below, the total cost for one administrative assistant, one surveillance
nurse, computer/software, travel, and pamphlets is $99,057.37.
Table 1. Cost for Enhanced WNV Surveillance
Cost per hour/unit

Number of
hours/units

Total Cost

Surveillance nurse
$52.00
1400
$72,800.00
Administrative assistant
$14.30
1400
$20,020.00
Computer
$2,197.00
2
$4,394.00
Software (Access)
$400.00
2
$800.00
Travel
.345 per mile
1575 miles
$543.37
Pamphlets
.50 per pamphlet
1000 pamphlets
$500.00
Total Request
$99,057.37
Note: Computers will be needed for administrative assistants to enter data. The surveillance
nurse will use the division’s laptop, when needed.

24

REFERENCES
1. Nash, D., Mostashari, F., Fine, A., Miller, J., O’Leary, D., and Murray, K. (2001). The Outbreak
Of West Nile Virus Infection In The New York City Area In 1999. New England Journal of
Medicine (NEJM), 344, 1808-1814.
2. Centers for Disease Control and Prevention (CDC). Division of Vector-Borne Infectious
Diseases. West Nile Virus. Virology: Classification of West Nile Virus. Available at:
http://www.cdc.gov/ncidod/dvbid/westnile/virus.htm.
3. CDC. Division of Vector-Borne Infectious Diseases. West Nile Virus. Vertebrate Ecology:
Transmission Cycle. Available at:
http://www.cdc.gov/ncidod/dvbid/westnile/birds&mammals.htm.
4. Petersen, L., Marfin, A. (2002). West Nile Virus: A primer for the clinician. Annals of Internal
Medicine, 137, 173-179.
5. Hubalek, Z., Halouzka, J. (1999). West Nile Fever--a Reemerging Mosquito-Borne Viral Disease
in Europe. Emerging Infectious Diseases, 5, 643-648.
6. Tyler, K. (2001). West Nile Virus Encephalitis in America. NEJM, 344, 1859-1859, editorial.
7. Xi-Yu, J., Briese, T., Jordan I., Rambaut, A., Chi, H., Mackenzie, J., Hall, R., Scherret, J. and
Lipkin, W. (1999). Genetic Analysis of the West Nile New York 1999 Encephalitis Virus. The
Lancet, 354, 1971-1972.
8. West Nile Virus Activity—United States, September 26—October 2, 2002, and Investigations of
West Nile Virus Infections in Recipients of Blood Transfusions and Organ transplantation.
Morbidity and Mortality Weekly Report (MMWR). 2002; 51: 884-895.
9. Public Health Dispatch: Investigations of West Nile Virus Infections in Recipients of Blood
Transfusions. MMWR. 2002 51: 973-974.
10. Recommendations for the Assessment of Donor Suitability and Blood and Blood Product
Safety in Cases of Known or Suspected West Nile Virus Infection. Food and Drug
Administration/Centers for Biologics Evaluation and Research. October 2002.
http://www.fda.gov/cber/safety/wnvdontest.htm
11. Possible West Nile virus transmission to an infant through breast-feeding--Michigan, 2002.
MMWR 2002;51:877--878.
12. Intrauterine West Nile Virus Infection -- New York, 2002. MMWR. 2002; 51:1135-1136.
13. Laboratory-Acquired West Nile Virus Infections -- United States, 2002. MMWR. 2002;
51:1133-1135.
14. Eidson, M., Kramer, L., Stone, W., Hagiwara Y., Schmit, K., (2001). Dead Bird Surveillance as
an Early Warning System for West Nile Virus. Emerging Infectious Diseases. 7, 631-635.
15. National Institute of Allergy and Infectious Diseases (NIAID) Research on West Nile and
Related Viruses. Available at: http://www.niaid.nih.gov/factsheets/westnile.htm.

25

Maricopa County Department of Public Health
Division of Epidemiology/BDPR
Contact Numbers (all 602 area code)
Vjollca Berisha
Garrett Booth
John Carlson
Alisa Diggs-Gooding
Andrew Edmonds
Joesette Frausto
Jeanette Gibbon
Ron Klein
Ashraf Lasee
Chris Mahon
Yanita Moore
Liva Nohre
Lawrence Sands
Sarah Santana
Mare Schumacher
Heather Wanatowicz
Gary West

Senior Epidemiologist
Epidemiologist
Senior Epidemiologist
Epidemiologist
Data Analyst
Administrative Assistant
Epidemiologist
Disease Surveillance Sup
Epidemiologist
Program Admin, CHN
Data Entry Clerk
Senior Epidemiologist
Director, BDPR
Director, Epidemiology
Deputy Director, Epi
Administrative Supervisor
Statistical Programmer

506-6802
506-1027
506-6829
506-6811
506-3252
506-6439
506-6801
506-6722
506-3062
506-6771
506-6805
506-6826
506-6821
506-6952
506-3078
506-6825
506-6830

To report communicable diseases, unusual health occurrences, and public health
emergencies (all 602 area codes unless otherwise noted)

Bite reports
Communicable diseases
Death certificates,
funeral homes,
human remains
HIV (reports)
Public health emergencies
Rabies
STDs (other than HIV)
TB

Business hours
M-F 7-5
506-7387
506-6868 or 506-6767
506-6805

506-6426 or 506-6871
339-8749
506-7387
506-6364 or 506-6147
372-6661

After hours
506-2752
480-303-1100
450-9982 or
420-2839
Not available
480-303-1100
506-3334
Not available
480-303-1100

26