The Buzz on Mosquitoes and West Nile Virus
By Dr. Bob England and Craig Levy

On the other hand, even under the
worst of circumstances, the risk to any
single individual is slight. Only about
1 in 150 infections results in severe
disease, although the risk increases
with age, starting at ~50 years of age.
No matter how hard we try, we
won’t be able to prevent every potential case of WNV. What we CAN do,
however, is to keep close track of
where it has spread, monitor conditions that might allow for local amplification of the virus in birds and in
human-feeding mosquitoes, and use
this information to guide local mosquito control efforts and public education so that we avoid major outbreaks of disease, such as those that
several states suffered last year. So
how do we do that?
Each year, from May through
October, mosquito-, bird- and horsebased surveillance is conducted
statewide for mosquito-borne
encephalitis viruses. These include
SLE, western equine encephalitis
(WEE), and most recently, WNV. This
program has five components:
1. Mosquitoes – Mosquitoes are
trapped and collected by local
environmental health department
staff, brought to ADHS where each
mosquito is sorted by species (one
at a time), then each “pool” of
mosquitoes of a single species
from each trap site is tested at the
Arizona State Health Laboratory

As anticipated, West Nile Virus
(WNV) has arrived in Arizona. On
August 11, WNV activity was detected for the first time in
Arizona in mosquitoes
trapped in Cochise
County. Infections in
horses were detected
in the northeastern part
of the state shortly
thereafter. Between the time this was
written and when you read it, there
have probably been more such findings.
Last year was by far the biggest
year for WNV in the U.S. since it first
arrived in New York in 1999. Human
cases jumped to more than 4,000 in
2002 with 284 deaths, and Arizona
was one of only four states in the continental U.S. without any WNV activity. So now what’s in store for us here?
You might not think of Arizona as
a likely hotbed for mosquito-borne
diseases, but there’s reason for concern. We have plenty of reservoir
birds and plenty of the worst of the
vector mosquito species. There are
many local foci where both of these
come together near human population centers. A disease that is closely
related to WNV, St. Louis encephalitis
(SLE), has been more of a chronic
threat here than in many parts of the
country where you might expect it to
be worse. So buckle up, we may be
in for a ride.

2.

3.

4.

5.

for these arboviruses. So far this
year, more than 800 mosquito
pools have been tested.
Sentinel chickens – 18 flocks of
chickens are maintained in 8 different counties and are periodically tested for seroconversion to any
of the same arboviruses. So far,
more than 900 chicken blood
samples have been tested.
Horses – The University of Arizona
Veterinary Diagnostic Laboratory
tests horses that exhibit symptoms
of neurologic disease for WEE and
WNV. So far, more than 20 horses
have been tested.
Dead birds – Citizens may call in
sightings of recently dead birds,
and many species are collected by
local environmental health staff,
shipped to the UofA Veterinary
Diagnostic Lab, and tested. So far,
more than 300 dead birds have
been tested.
Humans – Clinicians may contact
their local health department to
arrange testing of suspect cases at
the Arizona State Health Lab.
Serologic testing can be performed
on serum or CSF (serum is preferred). Testing is provided for any
hospitalized person with
encephalitis, and any adult hospitalized with aseptic meningitis. We
do not have the ability to test the
many pediatric cases of aseptic
continued on page 8

Visit the ADHS Web site at www.hs.state.az.us
Will it be
another mild
flu season?
Page 2-3
September/October 2003

First Nasal
Vaccine
Approved
for Use
Page 2

Rise In
Norovirus
Outbreaks
Page 4

Aseptic
Meningitis
Outbreak in
Arizona
Page 5

Noteworthy
Information
Page 6

Communicable
Disease
Summary
Page 7
Prevention Bulletin

1

Will It Be Another Mild Flu Season?
By Kathy Fredrickson and Susan Goodykoontz

Mild, short, late – three words
that best describe last year’s
influenza season in Arizona. The
first confirmed case of the season
was reported on Dec. 9, 2003
(influenza B in a Maricopa County
adult); however, influenza activity
did not begin to rise until the first
week of February, peaking near the
end of March and ending in late
May. Influenza activity remained at
relatively low levels throughout the
season compared with other years,
both in Arizona and throughout the
United States. Additionally,
Maricopa County Emergency
Departments reported significantly
fewer instances of diversion during
the season than expected.
Each year, isolates are submitted from providers around the state
to the Arizona State Laboratory for
influenza testing. The results indicate that influenza A(H1N1) was
the predominant influenza strain of
the season with a few reports of
influenza B and influenza A(H3N2)
interspersed throughout the season.
There were 126 influenza virus isolates submitted to the Arizona State
Laboratory, 105 (83%) were
A(H1N1), 10 (8%) were A(H3N2)
and 11 (8.7%) were B. All subtyped
isolates were consistent with vaccine strains.
The 2003-2004 trivalent vaccine will consist of:
• H1N1, A/New Caledonia/20/99
• H3N2, A/Panama/2007/99 (an
A/Moscow/10/99-like virus)
• B/Hong Kong/330/2001-like virus
strain
Vaccine Information Statements
(VIS) for the 2003-2004 influenza
season can be found at
www.cdc.gov/
nip/publications/VIS/vis-flu.pdf.
The Arizona State Laboratory
provides influenza testing free of
charge to providers in the state. If
you have any questions regarding
influenza surveillance or influenza
testing, please contact your local
2

Prevention Bulletin

health department or the state
Infectious Disease Epidemiology
Section at 602.364.3676.

Flu Vaccination

Much of the illness and death
caused by the flu can be prevented
by a yearly flu shot. People in highrisk groups and people who are in
close contact with those at high
risk should get a flu shot every
year. A flu shot can be given to
anyone who wants to avoid the flu
(persons >6 months of age).
The optimal time to receive
influenza vaccine continues to be
October and November. However,
because of vaccine distribution
delays during 2000-2002, the
Advisory Committee on
Immunization Practices (ACIP) recommends that vaccination efforts
in October focus on persons aged
50 years or older and those aged 623 months, persons aged 2-49 with
certain medical conditions that
place them at increased risk for
influenza-related complications,
children less than 9 years receiving
influenza vaccine for the first time,
health-care workers, and household contacts of persons at high
risk. ACIP recommends that vaccination of other groups begin in
November. Persons who provide
important community services
(such as police, fire department
personnel, emergency medical
services) should consider getting a
flu shot so that those services are
not disrupted during a flu outbreak.
continued on page 3

First Nasal Vaccine
Approved for Use
On June 17, 2003 the Food and Drug
Administration (FDA) approved the use of
FluMist, an influenza vaccine that is the first
nasally administered vaccine to be marketed in
the United States. It is also the first live virus
influenza vaccine approved in the U.S.
Unfortunately, it is not approved for use in
many of those same groups for which influenza vaccine is most recommended.
FluMist is approved to prevent influenza
illness due to influenza A and B viruses in
healthy children and adolescents, ages 5-17
years, and healthy adults, ages 18-49.
In clinical trials, FluMist was evaluated in
20,228 individuals, including over 10,000
healthy children 5-17 years old. The efficacy of
the vaccine in preventing influenza was
approximately 87 percent among children
included in the trial. In healthy adults ages 1849 years, FluMist was effective in reducing
severe illnesses with fever, and upper respiratory problems which may be caused by influenza infection.
As with any live virus vaccine, FluMist
should not be given for any reason to people
with immune suppression, including those
with immune deficiency diseases, such as
AIDS or cancer, and people who are being
treated with drugs that cause immunosupression.
The safety of FluMist in people with asthma or other reactive airway diseases has not
been established; FluMist should not be given
to people with a history of these problems. In
a large safety study, children under five years
of age were found to have increased rate of
asthma and wheezing within 42 days of vaccination compared to placebo recipients, and
thus FluMist is not recommended for young
children. For people age 50 years and over, the
safe and effective use of FluMist has also not
been established.
The vaccine should also not be administered to those with therapies including aspirin,
a history of Guillain-Barre syndrome, chronic
diseases, allergies to eggs or those who are
pregnant.
The most common adverse events associated with the vaccine were nasal congestion,
runny nose, sore throat, and cough.
FluMist is produced by MedImmune
Vaccines and will be distributed by Wyeth.
Both companies will market the product. For
more information visit www.fda.gov or
www.cdc.gov/nip.
September/October 2003

Flu Season

continued from page 2

Pregnant Women

Pregnancy can increase the risk for
complications from the flu, and pregnant women are more likely to be
hospitalized from complications of
the flu than non-pregnant women of
the same age. In previous worldwide
outbreaks of the flu (pandemics of
1918-19 and 1957-58), deaths
among pregnant women were associated with the flu. Pregnancy can
change the immune system in the
mother, as well as affect her cardiovascular system (heart and lung function). These changes may place pregnant women at increased risk for
complications from the flu.
Because the flu shot is made
from inactivated viruses (the viruses
are killed), many experts consider flu
shots safe during any stage of pregnancy. However, since miscarriages
(spontaneous abortions) most often
occur in the first trimester of pregnancy, many providers have been reluctant to give a flu shot during the first
trimester so as to avoid a coincidental association with miscarriage.
Women who will be beyond the
first three months of pregnancy during the flu season should get a flu
shot. Pregnant women who have
medical problems that increase their
risk for complications from the flu
should get a flu shot before the flu

season, no matter their stage of pregnancy.
Healthy Children Aged 6-23 Months

Because children aged 6-23
months are at substantially increased
risk for influenza-related hospitalizations, influenza vaccination of all
children in this age group is encouraged when feasible.
The Vaccines for Children (VFC)
program has expanded to cover federal VFC-eligible children during the
2003-2004 flu season.

Where To Call for Flu Shot Clinics

Community Information and
Referral Flu Hotline. Maricopa
County 602.263.8856, and for the
rest of the state, 800.352.3792.
www.cir.org.
Kathy Fredrickson is the Office Chief for the
Arizona Immunization Program and can be
reached at kfredri@hs.state.az.us. Susan
Goodykoontz is an epidemiologist with the
Office of Infectious Diseases and can be reached
at sgoodyk@hs.state.az.us. The Immunization
Office can be reached at 602.364.3630.

September is Antibiotic Resistance Awareness Month
The Centers for Disease Control and Prevention (CDC) is kicking
off a national media campaign on appropriate antibiotic use in
September with “Snort, Sniffle, Sneeze…No Antibiotics Please” as the
slogan. In conjunction with this campaign, Governor Janet Napolitano
has proclaimed September as “Antibiotic Resistance Awareness
Month.”
The good news is penicillin resistant pneumococcus from invasive
sites continues to decline in Arizona. Isolates with intermediate and
high level resistance declined from 28% in 2000 to 20 % in 2002.
Resistance levels of isolates from children showed an even more dramatic decrease from 46% in 2000 to 26% in 2002. Your continued
assistance on this worthwhile project is greatly appreciated. Thank you!
Free brochures, posters, and appropriate use guidelines are
available from the Arizona Department of Health Services,
Infectious Disease Epidemiology Section at 602.364.3676 or
ckioski@hs.state.az.us.
September/October 2003

Prevention Bulletin

3

Rise In Norovirus Outbreaks
Prompt Reminder of Good Hygiene Practices
By Graham Briggs
FIGURE 1

The Arizona Department of Health Services
LIST
(ADHS) has offered laboratory testing for suspected norovirus clusters for approximately one
year. As of July 2003, county health departments County
and ADHS have identified five laboratory conGila
firmed outbreaks of norovirus and a handful of
suspected norovirus clusters (See Fig. 1).
Gila
The high attack rates and explosive nature of
these outbreaks, usually via person-to-person
Yavapai
contact, provides a strong reminder for directors
Maricopa
of health care, childcare and other residential
facilities to reinforce hand hygiene and hand
Yavapai
washing practices and to exclude ill employees
and visitors from the facility.
An example of this occurred over the Fourth of July
weekend at a children’s summer camp. Campers were initially kept together indoors because of a bobcat wandering around camp. One child was reported to have been
vomiting in this enclosed space and was the probable
index case. An outbreak of gastroenteritis among 52% of
102 campers and employees followed. Testing at the
Arizona State Laboratory confirmed presence of norovirus
in stool samples collected. In addition, the bobcat tested
positive for rabies virus at the State Laboratory.
Health care providers are reminded to report to your
county health department any suspicious clusters of gastrointestinal illness. The local health department will facilitate appropriate laboratory test confirmation and implement control measures. Suitable specimens for testing
include stool and emesis from symptomatic cases as well

OF NOROVIRUS OUTBREAKS IN ARIZONA,
JANUARY – JULY, 2003

Month

# ill

Attack rate

Setting

April

23

74%

Assisted Living Facility

April

115

58%

Skilled Nursing Facility

May

26

44%

Retirement Community

May

26

53%

Retirement Community

July

53

52%

Summer Camp

as stool from cases as soon as possible after resolution of
symptoms.
The State Laboratory uses reverse transcriptase-polymerase chain reaction (RT-PCR) to screen for norovirus,
which can detect 100 virus particles/ml. Positive results
are confirmed by DNA sequencing. While the State
Laboratory cannot test single suspected cases of norovirus,
it will test representative samples for all suspicious clusters
of gastroenteritis. Please contact your county health
department or Graham Briggs at 602-364-3676 or
gbriggs@hs.state.az.us , in the Infectious Disease
Epidemiology Section at ADHS if you have questions
concerning norovirus.
Graham Briggs is an epidemiologist with the ADHS Office of Infectious
Diseases and can be reached at the contact information provided above.

ADHS On The Move
The Bureau of Epidemiology and Disease Control Services will be moving
its offices Sept. 8 to the new main health department building located at 150 N.
18th Avenue, Phoenix, AZ 85007. New phone and fax numbers for the offices
are listed below.
Office
Bureau Chief
Environmental Health
HIV
Immunizations
Infectious Diseases/TB/STDs (Main Line)
Communicable Disease Reporting
Emergency Response/Bioterrorism
4

Prevention Bulletin

Phone
602.364.3860
602.364.3118
602.364.3610
602.364.3630
602.364.4562
602.364.3676
602.364.3289

Fax
602.364.3266
602.364.3164
602.364.3268
602.364.3285
602.364.3198
602.364.3199
602.364.3264
September/October 2003

Aseptic Meningitis Outbreak in Arizona
Arizona has experienced a dramatic
increase in the number
of aseptic meningitis
(AM) cases in 2003. As
of July 31, 465 cases
of AM have been
reported to the Arizona
Department of Health
Services. By the time
you read this, it will
probably top 500. This
represents more than a
fourfold increase from last year when 104 cases were
reported for the same time period.
AM cases have been reported in eight counties, but 89
percent of cases were reported in Maricopa County. Most
of the AM cases were in younger age groups (median
age = 13 years, range 0 week to 86 years). The overall
reported AM rate statewide for the first half of the year was
8.6 cases per 100,000 population in 2003, compared to
1.9 cases per 100,000 for the same time period in 2002.
The highest case rate in 2003 was reported in Maricopa
County with 12.7 cases per 100,000 (compared to 2.7

cases per 100,000 in 2002). Most of the cases have been
sporadic, but several cases were clustered within families.
Cases of AM typically peak in August each year in
Arizona.
Enteroviruses are the leading cause of AM across the
country. AM cases are more common during the summer
and fall. The dramatic increase in AM cases seen this year
is largely due to an increase in circulation of Echovirus
type 30. This year, the Arizona State Health Laboratory has
reported 57 enterovirus isolates (mostly from CSF specimens), and 42 of these (74%) were Echovirus 30.
Increases in the circulation of Echovirus 30 appear to be
somewhat cyclic. The last increase in Echovirus 30 in
Arizona was seen in 1998-1999. Arizona is not the only
state experiencing an increase in AM due to Echovirus 30
as several other western states have reported similar
increases.
Transmission of enteroviruses is usually through the
fecal-oral route. Prevention of transmission is achieved
mainly through personal hygiene, especially handwashing.
Craig Levy is the manager of the Vector-Borne and Zoonotic Disease
section at the Department. He can be reached at 602.364.4562 or
clevy@hs.state.az.us.

Community Health Profiles
The Arizona Department of Health Services,
Division of Public Health collaborated and
developed Community Health Profiles for
87 incorporated towns and cities in Arizona.
The purpose of the Community Health
Profiles is to aggregate various data from different agencies, especially those programs
within the Arizona Department of Health
Services to provide a user-friendly community health profile for communities in
Arizona.
The Community Health Profile is in the
initial phase of a long-term project to
improve the accessibility of health-related
data to communities and is a product of an
Arizona Department of Health Services workgroup. The
Profiles can be used by a variety of individuals, groups, and
organizations to address a number of health issues. One of the goals of the project was to provide the data in groupings (using headings such as demographics,
birth measures, prevention measures, etc.) to highlight data that would facilitate
health program planning, implementation, and improvement in communities.
The profiles can be accessed through the Arizona Department of Health
Services web page at www.hs.state.az.us. For more information about this effort
please contact Patricia Tarango at 602.542.1219 or to receive this document in
an alternative format contact Rodney Cluff at 602.542.2998.
September/October 2003

By Craig Levy

Reader Survey Results
Thank you to all who responded to the Prevention Bulletin
Reader Survey printed in the
May/June issue. In general, responses were positive, indicating a high
level of readership and sense that
the content and article length were
appropriate. A variety of suggestions
for article ideas and ways to
improve the Bulletin’s layout have
been noted, and we appreciate
your ideas. Just over half of respondents indicated they wanted to continue receiving a printed copy of
Prevention Bulletin instead of an
on-line version. We think there is
merit to both sides, and will ask
again for your format preference in
a future issue of Prevention Bulletin.
Please continue sending your
suggestions and comments to us at
ccasill@hs.state.az.us. We want to
continue to make Prevention
Bulletin your newsletter of choice
when it comes to Arizona’s epidemiology and disease control
information.
Prevention Bulletin

5

Noteworthy...
Input Invited On Revised
Draft Communicable
Disease Rules
The Bureau of Epidemiology
and Disease Control Services
(BEDCS) has completed a revised
draft of rule changes for the communicable disease rules in 9 A.A.C.
6, Articles 1, 2, 3, 5, and 6. In
March 2003, BEDCS solicited input
from interested persons on a draft of
communicable disease rule
changes. In response to comments
received and internal review of the
draft rules, BEDCS has made numerous changes to the draft rules. Thus,
BEDCS is again soliciting input so
that major issues can be identified
and, if possible, resolved before the
formal rulemaking process begins.
The revised draft rules are available for review on the ADHS website by going to
www.hs.state.az.us/diro/
admin_rules/draft4.htm and selecting one of the links for “Revised
Draft—Communicable Diseases and
Infestations.” If you do not have
access to the ADHS website and
would like a copy of the draft rules,
please call 602.364.0781 to request
a copy. Comments should be submitted by October 24, 2003, to:
Sarah Harpring
1740 W. Adams, Suite 202
Phoenix, AZ 85007
E-mail: sharpri@hs.state.az.us
Fax: 602.364.1150

New TB Treatment
Guidelines
New guidelines for treatment of
tuberculosis were jointly put forth
by the Centers for Disease Control,
the American Thoracic Society, and
the Infectious Disease Society of
America in June of this year. The
standard six-month “short course”
with initial four-drug treatment is
still the mainstay, but there are several new features including:
Extended treatment for patients
with cavitary disease who are still
culture-positive at two months of
6

Prevention Bulletin

treatment. Once weekly treatment
with rifapentine during the continuation phase in selected patients.
Practical treatment recommendations for special situations such as
HIV infection, extrapulmonary
tuberculosis, interrupted therapy,
and hepatic and renal disease.
The full text of the new guidelines is available for free at
www.cdc.gov/mmwr/PDF/rr/rr5211.
pdf. If you do not have access to the
Internet, you may call the Arizona
Department of Health Services’ TB
Elimination Section at
602.364.4562 for a free copy.

Inhale Life –
“It’s a Girl Thing”
It’s a girl thing, and it’s a powerful message being delivered by two
of Arizona’s most high-profile girls –
Phoenix Mercury players Adrian
Williams and Lisa Harrison.
The Arizona Department of
Health Services (ADHS) has teamed
up with the Phoenix Mercury to
spread the message that it’s dangerous for young girls to try smoking.
“We need to reach young girls
because just as many girls as boys
are beginning to smoke in Arizona.
That is a disturbing new trend,” says
Arizona Department of Health
Services Director Catherine Eden.
Eden points to a recently
released study from the National
Center on Addiction and Substance
Abuse that shows smoking among
teenage girls is
on the rise.
Research indicates that girls
can sink into
addiction within 21 days of
regular tobacco
use and find it
more difficult to
quit than boys,
who frequently
do not become
addicted until
they have been
using tobacco for six months.

Punctuated by the tag line,
“Inhale Life – It’s a girl thing,”
Phoenix Mercury players Lisa
Harrison and 2003 WNBA All-Star
Adrian Williams convey the message that smoking is a dangerous
experiment because it is so quickly
addictive. The campaign, which targets girls ages 7 to 18, stresses that
making healthy choices can lead to
success in school, career and life.
The ADHS/Mercury partnership
will encompass TV and radio advertising, print ads, mall kiosks and a
variety of other event appearances
and promotional tactics through the
end of the Mercury’s 2005 WNBA
season.
More information about the
“Inhale Life – It’s a girl thing” campaign can be found at
www.phoenixmercury.com.

Department Awarded
Grants for Chronic
Disease Prevention
The Arizona Department of
Health Services has recently
received two grants that will positively impact the state’s chronic disease prevention efforts. The first
grants focuses on Nutrition, Physical
Activity and Obesity. The initial
phase of the project is the development and implementation of a
statewide nutrition and physical
activity plan. The grant award is for
$321,254. The program will be
housed in the Office of Nutrition
and Chronic Disease Prevention
Services.
The Department also received
notification that it was awarded the
Comprehensive Cancer Control
Grant, funded for $148,834. The
activities of the grant include the
development of a statewide Cancer
Control Plan utilizing broad professional and community input. This
was truly a partner driven application, and we believe that played a
significant role in its success.

September/October 2003

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - July, 2003)1, 2
Jan - July
2003

Jan - July
2002

5 Year Median
Jan - July

6 (3)
1
0
61 (37)
0 (0)

4 (2)
0
1
41 (27)
0 (0)

4 (2)
0
2
41 (27)
0 (0)

526
19
5
380
287

400
16
10
320
185

330
18
8
357
229

175
193
642
6
2,024

192
132
684
3
3,063

254
113
684
9
1,102

438
136
19
13

566
205
14
22

566
130
18
22

8,501
2,270
120 (16)

8,544
2,052
112 (8)

7,429
2,337
106 (15)

0 (0)
605

7 (0)
600

7 (1)
536

0
0
43

1
0
93

2
0
54

1,437
87
317
242
157 (139)

1,752
107
289
217
138 (127)

1,118
121
289
285
167 (106)

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B
Hepatitis B: non-acute3
Hepatitis C
Hepatitis C: non-acute3
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
1
2
3
4

Data are provisional and reflect case reports during this period except Lead Poisoning which is by date of diagnosis.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Based on animals submitted for rabies testing.

September/October 2003

Prevention Bulletin

7

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy
Please include your mailing label with all requests
for changes. Fax changes to 602.364.3265

PRSRT STD
US Postage
PAID
Phoenix, AZ
Permit No. 957

Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
602.364.1201
Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Editorial Board
Bob England, M.D., M.P.H., State Epidemiologist
Victorio Vaz, D.V.M., Ph.D.
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Karen Lewis, M.D.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Graham Briggs, Bob England,
Kathy Fredrickson, Susan Goodykoontz, Craig Levy
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.364.1201 or 1.800.367.8939 (State TDD/TTY Relay).

West Nile Hits Arizona continued from page 1
younger persons. For clinical guidance on WNV, please
meningitis (see related article on page 5.) or the many
visit the CDC web site at www.cdc.gov/ncidod/dvbid/
outpatients you may see with headache and fever. We
westnile/clinical_guidance.htm or the ADHS web site at
also do request samples for follow-up testing of any
www.hs.state.az.us/phs/oids/vector/ann_int_med.pdf .
individual who has tested positive for WNV through a
Encephalitis and meningitis are reportable conditions
private lab. (It is important to note that private testing
in Arizona. In August, ADHS issued an emergency order
is generally much less specific and there have been a
specifically making WNV disease reportable. Please help
number of false positives. The only way to confirm
infection is with paired acute and convalescent serolo- us by reporting promptly. To report a suspect case or
arrange for testing, please contact your local health
gy or with other confirmatory testing by the CDC.) So
department.
far, we have tested more than 50 human serum and
CSF specimens. An adult male from Graham County
was the first reported human case
for Arizona on August 25th.
CHART 1
However, it is likely the man con- POSITIVE ARBOVIRUS FINDINGS AS OF AUG. 25, 2003:
tracted the disease while visiting
COUNTY
WEST NILE
ST. LOUIS
WESTERN EQUINE
Colorado or Wyoming.
Apache
2 horses
1 chicken
1 chicken
Human cases usually occur in
late summer, so you should consider
WNV in your differential of
encephalitis and meningitis cases
that occur now. However, we are in
the throes of an increase in enteroviral aseptic meningitis cases, and this
is the most likely cause of typical
aseptic meningitis, especially in
8

Prevention Bulletin

1 mosquito pool
Cochise
Maricopa

3 mosquito pools
2 mosquito pools
2 chickens

Pinal
Yuma

3 mosquito pools

Navajo
Graham

1 horse
2 mosquito pools

3 mosquito pools
1 chicken

10 mosquito pools
4 chickens
2 mosquito pools
2 mosquito pools

September/October 2003