Sandbox ammu WNV green boxes

# Overview
There is currently no specific antiviral pharmacologic therapy indicated for patients with WNV infection, but interferon-alpha-2b or ribavirin have been used. Patients with mild disease may be followed-up as outpatients; whereas patients with severe disease require hospitalization and close monitoring. Current management of infected patients is based on supportive care aimed at symptom relief and prevention of complications.

# Medical therapy
- West nile virus
- 1.1. Prevention
- No WNV vaccines are licensed for use in humans. In the absence of a vaccine, prevention of WNV disease depends on community-level mosquito control programs to reduce vector densities, personal protective measures to decrease exposure to infected mosquitoes, and screening of blood and organ donors.
- Personal protective measures include use of mosquito repellents, wearing long-sleeved shirts and long pants, and limiting outdoor exposure from dusk to dawn. Using air conditioning, installing window and door screens, and reducing peridomestic mosquito breeding sites, can further decrease the risk for WNV exposure.
- Blood and some organ donations in the United States are screened for WNV infection; health care professionals should remain vigilant for the possible transmission of WNV through blood transfusion or organ transplantation. Any suspected WNV infections temporally associated with blood transfusion or organ transplantation should be reported promptly to the appropriate state health department.
- 1.2. Treatment
- There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.

# Overview
Human vaccines are not available for WNV infection. With the absence of a vaccine, prevention of WNV disease depends on community-level mosquito control programs to reduce vector densities, personal protective measures to decrease exposure to infected mosquitoes, and screening of blood and organ donors.

# Primary Prevention

## Vaccination
There is no human vaccine available against WNV.

## Preventing Mosquito Bites
- Insect repellent is recommended when going outdoors.
- Repellents containing DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection.
- To optimize safety and effectiveness, repellents should be used according to the label instructions.
- When weather permits, patients should wear long sleeves, long pants, and socks when outdoors.
- Mosquitoes may bite through thin clothing, so spraying clothes with repellent containing permethrin will give extra protection.
- Do not apply repellents containing permethrin directly to skin.
- Do not spray repellent on the skin under your clothing.
- Take extra care to use repellent and protective clothing from dusk to dawn or consider avoiding outdoor activities during these times.

## Integrated Vector Management (IVM)
- Mosquito abatement programs successfully employ integrated pest management (IPM) principles to reduce mosquito abundance, providing important community services to protect quality of life and public health.
- IVM is based on an understanding of the underlying biology of the arbovirus transmission system, and utilizes regular monitoring of vector mosquito populations and WNV activity levels to determine if, when, and where interventions are needed to keep mosquito numbers below levels which produce risk of human disease, and to respond appropriately to reduce risk when it exceeds acceptable levels.
- Operationally, IVM is anchored by a monitoring program providing data that describe:
- Conditions and habitats that produce vector mosquitoes.
- Abundance of those mosquitoes over the course of a season.
- WNV transmission activity levels expressed as WNV infection rate in mosquito vectors.
- Parameters that influence local mosquito populations and WNV transmission.
- These data inform decisions about implementing mosquito control activities appropriate to the situation, such as:
- Source reduction through habitat modification.
- Larval mosquito control using the appropriate methods for the habitat.
- Adult mosquito control using pesticides applied from trucks or aircraft when established thresholds have been exceeded.
- Community education efforts related to WNV risk levels and intervention activities.
- Monitoring also provides quality control for the program, allowing evaluation of:
- Effectiveness of larval control efforts.
- Effectiveness of adult control efforts.
- Causes of control failures (e.g., undetected larval sources, pesticide resistance, equipment failure).

### Surveillance Programs
- Effective IVM for WNV prevention relies on a sustained, consistent surveillance program that targets vector species.
- The objectives are to identify and map larval production sites by season, monitor adult mosquito abundance, monitor vector infection rates, document the need for control based on established thresholds, and monitor control efficacy.
- Surveillance can be subdivided into three categories based on the objective of the surveillance effort; these are: larval mosquito surveillance, adult mosquito surveillance and WWNV transmission activity.
- However, the surveillance elements are complementary, and in combination provide the information required for IVM decisions.

### Mosquito Control Activities
- Integrated efforts to control mosquitoes are implemented to maintain vector populations below thresholds that would facilitate WNV amplification and increase human risk.
- Efforts to reduce the abundance of WNV-infected biting adult mosquitoes must be quickly implemented to prevent risk levels from increasing to the point of a human disease outbreak.
- Properly implemented, a program monitoring mosquito abundance and WNV activities in the vector mosquito population will provide a warning of when risk levels are increasing.
- Because of delays in onset of disease following infection, and delays related to seeking medical care, diagnosis, and reporting of human disease, WNV surveillance based on human case reports lags behind increases in risk and is not sufficiently sensitive to allow timely implementation of outbreak control measures.
- In outbreak situations, larval control complements adult mosquito control measures by preventing new vector mosquitoes from being produced.
- Source reduction and larvicide treatments may be inadequate to maintain vector populations at levels sufficiently low to limit virus amplification.