# Presentation: 701026

## Initiating and Maintaining an Integrated Vector Control Program

- Jim Miller, MD, MPH
- New York City Department of Health
- email: jmiller@health.nyc.gov

## Acknowledgements

- NYCDOH
- 	Communicable Disease
- 	Vector Surveillance and Control
- 	Environmental and Occupational 	Disease Epidemiology
- 	PH Laboratory
- 	Public Affairs
- 	Policy and Planning
- NYSDOH
- NYSDEC
- NYSDAgMarkets

- CDC (Fort Collins)
- National Wildlife Health Center
- USDA
- EPA
- USGS
- Other state and local health and public works departments
- American Mosquito Control Association (regional affiliates)

**Notes:**
I’d like to first acknowledge the many persons who are part of our effort in New York City, especially the persons in the 6 offices listed here, as well as our state and federal colleagues, and others engaged in mosquito control activities.

## Pre-WNV Mosquito Control in NYC

- Malaria prevention began in 1901
- Sanitary Code regulates standing water
- Physician education, hospital reporting
- 1935 WPA: 3200 miles of drainage ditches, larvicided 70,000 catch basins
- 1957 helicopter spraying of pesticide to reduce number of biting mosquitoes
- 1999 backyard pesticide application in response to public complaints

## Chief Elected Official Buy-In

- Mayor and Director of Emergency Management actively endorsed adult mosquito control
- Lack of buy-in limits program options

## Budget

- Local
- Significant investment of local tax dollars
- Subject to annual re-appropriation
- State
- Formula grant (percentage reimbursement) supports local health department programs
- Federal
- Grant award from CDC
- 2nd year award less than 1st year

## Personnel

- Single office -versus- De-centralized
- Weekly Steering Committee meetings
- Summer Students
- Contracts for larval and adult control
- Critical Services:
- Mosquito collection and identification
- Laboratory testing (human, mosquito, birds)
- Pesticide applicators

## Communication

- Medical community
- Active surveillance
- Broadcast faxes with current information
- Surrounding communities
- Look for consensus
- Network of colleagues
- Mosquito control programs
- Mosquito control associations (e.g., AMCA)
- Federal resources

## Regulatory Environment

- Emphasis on larval control
- Monitoring pesticide application
- Set-backs from open water
- Pre- and post-spray water testing
- Park Rangers watch for fish kills
- Delay application before heavy rain
- Use of GPS to track pesticide application
- State DEC and EPA staff present
- Environmental Impact Statement

## Public Perception of Risks Associated with Pesticides

- 29% (257/880) more worried about getting sick from WNV than pesticides
- 23% (198/880) more worried about getting sick from pesticides than WNV
- 31% (276/880) equally afraid of WNV and pesticides
- 17% (149/880) not afraid of getting sick from either
- Source: Hinten S, CDC, et al. 2000 Staten Island Serosurvey, unpublished data.

## NYC’s Environmental Impact Statement

- Eye and skin irritation may occur
- Respiratory tract irritation may occur
- Organophosphate (OP) impact on aquatic crustaceans, especially if OP applied before a rainstorm
- Noise associated with pesticide application
- Potential harm to health from spraying less significant than disease risk of not spraying
- Available at: http://cityweb.nycnet/html/doh/html/wnv/feis.html

## Public Confidence

- Outreach
- Poster, flyer, hotline, web, press release
- Participation
- Standing water
- Dead birds
- Notification
- Articulate rationale for control
- 48-hour advance notice
- NYPD escorts/park closure
- Legal Challenge and Protests

## Using Mosquito and Bird Data to Explain Need and Timing of Pesticide Application

- From: Kulasekera V et al. EID 2001; 7(4):724.

**Using Mosquito and Bird Data to Explain Need and Timing of Pesticide Application**

## Using Dead Bird Density Information to Help Direct Larval and Adult Mosquito Surveillance and Control

**Using Dead Bird Density Information to Help Direct Larval and Adult Mosquito Surveillance and Control**

**Notes:**
We’ve learned how important maps are in revealing where the risk of human WNV infection is greatest, and accordingly, where prevention and control efforts are most likely to serve a useful purpose.
This map shows areas with increasing densities of dead birds relative to where human infections subsequently occurred. Producing maps such as this requires trained workers and special software.

## Surveillance for Pesticide-Associated Health Effects

- _Poison Control Center_
- 	Physicians and public asked to self-report symptoms
- _Physician Office Visits_
- 	DOH telephoned offices during 5 days 	following pesticide application
- 	No reports of pts adversely effected
- _Emergency Department Visits_
- 	DOH chart review of all visits x5 days (3 hospitals)
- 		No apparent patients with pesticide exposure
- 	No increase in asthma calls to 911
- _Asthma Care Regression Analysis_
- 	Population-level ecologic study-no apparent increase

## Integrated Database

- Standing water reports
- Dead birds
- Larval mosquito surveillance
- Adult mosquito collection and testing
- Suspect and confirmed human cases
- GIS-based
- Model for other programs

## Beyond WNV

- Other mosquito-borne infections
- Small NYC malaria cluster in 1993
- EEE in Boston mosquitoes in 2000
- SLE, LaCrosse
- New mosquito species
*Aedes albopictus, Oc. japonicus*
- Tick-borne diseases
- LD, RMSF, babesiosis, ehrlichiosis