# C OMPREHENSIVE 

# M OSQUITO


# S URVEILLANCE AND 

# C ONTROL 

# P LAN



# 2006

The City of New York

DEPARTMENT OF HEALTH AND

MENTAL HYGIENE

Michael R. Bloomberg Mayor Thomas R. Frieden, M

. D

., M

. P

. H

. Commissioner1



## New York City Department of Health and Mental Hygiene

Comprehensive Mosquito Sur veillance and Control Plan


## 2006

TABLE OF CONTENTS

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 6

Public Education and Community Outreach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Host Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Human Surveillance and Provider Edu cation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 13

Mosquito Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Larval Mosquito Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Adult Mosquito Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Surveillance of Potential Adverse Health E ffects from Pesticide Exposure . . . . . . . 25

Research and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 27

Appendix A: Questions and Answers About West N ile virus . . . . . . . . . . . . . . . . . . 29

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 2

New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan

EXECUTIVE SUMMARY

In 1999, New York City experienced an unpreced ented outbreak of encephalitis caused by West Nile (WN) virus, a mosquito-borne virus never before detected in the Western Hemisphere. That year, 59 cases of neur oinvasive disease (e ncephalitis, aseptic meningitis or acute flaccid paralysis) due to WN virus occurred in the New York City metropolitan region. Since 1999, WN virus has r eappeared in New York City each year during the adult mosquito season. A total of 137 human cases of WN neuroinvasive disease, including 17 deaths, have occurred among New York City residents from 1999-

2005. A small number of human cases of WN fever have also be en reported (n=12), although the estimated number of undetected or unreported WN fe ver cases is much higher over the same time period. Over the past six mosquito seasons, WN virus has spread throughout much of the United States , causing large outbreaks of neuroinvasive disease in 2002, 2003, 2004, and last year was responsible for 2,949 human cases of West Nile infection in 43 states, 116 human deat hs along with hundreds of horse and bird

deaths

.

The Department of Health and Mental H ygiene (DOHMH) has analyzed the previous year’s surveillance and control efficacy data in order to better prepare for the upcoming mosquito-breeding season. To ensure a c oordinated approach in managing mosquitoborne disease outbreaks in the City, DOHMH has worked closely with the New York State Departments of Hea lth (NYSDOH) and Environmen tal Conservation (NYSDEC),

the U. S. Centers for Disease Control and Prevention (CDC), and other State and Federal partners, along with many loca l organizations. Several New York City agencies have been crucial to the planning process, includi ng the Mayor’s Offices of Operations and Environmental Coordination, New York City Office of Emergency Management, and the Departments of Environmental Protection, Parks and Recreation, Sanitation, Police, Citywide Administrative Services, Inform ation Technology and Telecommunications and the Housing Authority.

Key to DOHMH’s planning efforts is a primary emphasis on prevention. DOHMH

continues to devote considerable resources to a citywide effort to prevent mosquito breeding, while enhancing existing disease surv eillance, and public and medical provider education activities. The goal of this plan is to prevent disease caused by mosquitoes through aggressive source reduction and la rviciding. Should surv eillance findings indicate that a substantial risk exists for WN virus transmission to humans, adult mosquito control wi ll be considered.

Surveillance data collected in 1999-2005 demonstrate that WN virus can be detected in birds and mosquitoes weeks before there is a significant risk to hu man health. Therefore, the tracking of dead bird re ports, especially cr ows and other corvid s, and the routine surveillance of mosquito populations provide the City the opportunity to specifically target those neighborhoods and communities where virus is reappearing. The goal of early detection is to enhance mosquito control in high-risk areas in an attempt to interruptNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 3

the amplification of the virus before it ha s a significant impact on human health.

Although mosquitoes are most active in New York City from May through October, our strong mosquito prevention, surveillance, a nd control efforts are year-round activities. The current Comprehensive Mosquito Surveillance and Control Plan is designed to minimize the impact of mosquito-borne dis eases through citywide surveillance measures and an integrated approach to mosquito ma nagement with control practices that are commensurate with the risk posed by these diseases. The comprehensive nature of the plan ensures the efficacy of the control measures while minimizing adverse impacts to the environment and human health from these measures. The plan includes the following

components:

Public Education and Community Outreach

Through the media, advertising, presentati ons to community groups and collaboration with community boards and elected officials, the Office of Communications will increase public awareness of mosquito-borne disease ri sk, surveillance, preven tion and control. If

surveillance data indicate an increased human di sease risk that requires the application of pesticides to control adult mosquitoes, accura te and timely information of these mosquito control activities will be provided. Communi cations will provide the public with application schedules, the type of pesticides being used and how to reduce exposure. Additionally, the public will be informed about what to do in the event of pesticide

exposure.

Host Surveillance

Animals will be monitored for infection and il lness, with a focus primarily on dead birds, especially corvids such as cr ows and blue jays and songbird s such as sparrows, robins and grackles. DOHMH’s Office of Vector Surveillance and Control (OVSC) in collaboration with the Office of Veterinary and Public Health Services (VPHS) will monitor disease among domestic animals, partic ularly horses. The public will be asked to report dead birds through New York City’s Citizen Service Center (311) and via

DOHMH’s enhanced WN virus web site (nyc.gov/health). Broad cast alerts will be sent at the beginning of the season to all veterinarian s in New York City. Veterinarians will be requested to report any suspicious animal cases with neurological abnormalities to DOHMH. All animals with neurological sympto ms will be tested for rabies before being

tested for WN virus.

Human Surveillance and Provider Education

A system for detecting mosquito-borne di seases among humans w ill include passive surveillance for suspected cases of viral encep halitis and aseptic meningitis in hospitals

and laboratories. Broadcast alerts will be sent at the beginning of the season and periodically throughout the se ason to all hospitals in New York City. Health care providers play a critical role in the dete ction, prevention and clinical management of mosquito-borne diseases. The Communicable Disease Program will continue its efforts to educate New York City health care providers regarding diseases transmitted by mosquitoes, especially WN virus, and enc ourage reporting of and testing of suspectedNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 4

patients with encephalitis and other diseases possibly caused by arboviral infection. The DOHMH Public Health Laboratory will test blood and cerebrospinal fluid samples submitted by health care providers for WN vi rus and other mosquito-borne viruses upon

request.

Mosquito Surveillance

DOHMH’s Office of Vector Surveillance and C ontrol will monitor mo squitoes citywide by collecting larval an d adult mosquitoes to determin e the distribution, density and species. DOHMH will continue to test adult mo squitoes collected in New York City for

WN virus at its own laboratories. With test ing taking place locally, the time required to

receive results showed si gnificant reduction in 2003, 2004 and 2005. This has allowed for increased public education, more focused mosquito breeding redu ction activities as well as more targeted control of larval a nd mosquitoes in area with increased viral activity.

Larval Mosquito Control

DOHMH will reduce mosquito breeding through the aggressive elim ination of standing water and the applicatio n of larvicide to sites that cannot be emptied or drained. Through a public information campaign, DOHMH will ur ge residents to re duce breeding sites around their homes and commercial properties a nd to report potential mosquito-breeding

sites. DOHMH will collaborate with elected o fficials, other City agencies and large property owners to eliminate standing water in empty lots, tire pile s and other containers. DOHMH will also aggressively enforce the hea lth code that requires elimination of standing water from properties throughout the City. These activities will be augmented with the application of larvicide to poten tial breeding sites wh ere water cannot be eliminated, including catch basins citywide. Wh enever WN virus is detected in an area, DOHMH will increase public education, breeding site reduction and larviciding.

Adult Mosquito Control

A timely and appropriate response to mosquito, bird, mammal and human surveillance findings is key for preventing an outbreak of human disease. DOHMH will implement a phased response to surveillance findings th at will expand education, prevention and

control activities in relation to the threat of an outbreak of human disease. If surveillance indicators suggest that the level of WN viru s activity poses a significant threat to human health, adult mosquitoes will be controlled through the use of adulticides. Mosquito density and distribution, mosquito species, persistence of WN vi rus activity, weather, time of year, and the proximity to human popul ations will be carefully considered in determining the necessity for adult mosquito control. The accuracy, quality and efficacy of the adulticide application will be closely monitored to ensure compliance with Federal and State guidelines. If application of adulticides becomes necessary, DOHMH will provide advance notice to the public and to health care providers.

Surveillance of Potential Adverse Health Effects from Pesticide Exposure

In 2001, DOHMH completed a comprehensive environmental impact study on theNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 5

pesticides used for adult mosquito control. The study concluded that at the relatively low

levels at which adulticides are applied, the occurrence of adverse public health effects to the population from applying pesticides to reduce the adult mosquito population would not be considered significant when compared to the potential risk to the public health from West Nile virus or other mosquito-borne illness. However, health care professionals are informed and reminded throughout the mosquito season about potential health effects of pesticide exposure and the need to report pesticide-related illness to DOHMH and

NYSDOH. DOHMH will monitor the adverse he alth effects asso ciated with the application of pesticides for adult mosquito control.

Research and Evaluation

DOHMH will conduct research to better unders tand where mosquito breeding occurs in New York City and how WN virus and other mosquito-borne viruses are maintained in our environment. Furthermore, DOHMH will c ontinue to evaluate more specific bird, mammal and mosquito surveillance indicators that signal a threat to human health and to assess the efficacy of larval and adult mosquito control.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 6

INTRODUCTION

In late August 1999, the New York City Depa rtment of Health and Mental Hygiene (DOHMH) detected an unusual cl uster of encepha litis cases in northern Queens. This was due to West Nile (WN) virus, a mosquito-bor ne virus that had not been recognized in the Western Hemisphere prior to 1999. In 1999, the outbreak resulted in 44 hospitalized cases among City residents, including 4 fatalities.

Since its introduction to New York City in 1999, West Nile virus has caused successive

outbreaks in the United States each summer a nd fall, and has moved steadily westward. In 2003, West Nile virus caused the larg est outbreak of meningoencephalitis ever recorded in the Western Hemisphere, with 9,862 cases reported overall, including 264 deaths. In New York City, the virus has also persisted and has become endemic, causing

137 neuroinvasive cases and 17 deaths. Fr om 2000-2005, the number of neuroinvasive cases due to West Nile virus among New York City residents has ranged from 2 to 30 (median 15).

In 2005, eleven New York City residents had WN neur oinvasive disease, all possibly or probably acquired within New York City. Th ere were also three cases of WN fever detected in the City in 2005, one of which was likely acquired outside of New York City

.

There were 2,949 human cases and 116 human deaths reported in the United States in 2005, and extensive WN activity de tected on the west coast, in California and Oregon. Please see the CDC homepage at http: //www.cdc.gov/ncidod/dvbid/ westnile/index.htm

for more information.

Since 2003, universal screening of donated blood products has been conducted in New York City by the New York Blood Center, an d six presumptively infected donors have been identified in New York City from 2003- 2005. All implicated blood products were retrieved and removed from the blood supply.

The considerable and rapid spread of th e virus throughout the country from 2002-2005 provides ample evidence that WN virus is permanently established in New York City and

in the United States. With this establishm ent of WN virus thr oughout the City and the region having a routine, year-round Integrat ed Mosquito Management (IMM) program has become a necessity.

There are three probable mechanisms for WN virus overwintering within the City. The principle enzootic vector, Culex pipiens , overwinters in the adult stage; and it is believed that, at least, some infected mosquitoes successfully survive the winter. Alternatively,

infected birds that remain in the area may harbor the viru s throughout the winter months. As spring returns, the virus recrudesces with in the birds and is readily passed to early season mosquitoes. A third mechanism is reintroduction of the virus into the area during the spring or early summer by infected migrat ory birds. Hence, a number of infected mosquitoes and/or birds are present within the City during the early spring months. At this time, the virus resumes its amplification cycle. As mosquitoes feed on birds, the

virus is transmitted back and forth between the vector and the reservoir host populationsNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 7

allowing an increasing number of birds and mosquitoes to become infected. If environmental conditions are optimum for transmission, the virus amplifies to a theoretical point of “spill over”. At this point in the amplification cycle, the virus bridges out of the enzootic, bird-mosquito cycle via br idge vectors. Bridge vectors are mosquito species that readily feed on huma ns and other mammals. It is at this point in the season,

that transmission to humans occurs and when management actions are most critical.

An effective surveillance and control program should be able to detect virus during the amplification cycle prior to bridge vector involvement a llowing for targeted, effective control of the mosquito popul ation that are limited in sc ope. With WN virus, the American crow, Corvus brachyrhynchos , is the most sensitive indicator of viral activity. Typically, infected crows can be found a mont h or more prior to human transmission. As the viral amplificati on continues, infected mosquitoes are usually found several weeks before human transmission. Eventually, proper surveillance will detect viral presence in the bridge vectors and fina lly in humans and other ma mmalian hosts. The goal of DOHMH’s vector surveillance program is to det ect the virus in loca l bird and mosquito populations before sufficient amplification of the virus can occur, so that management practices can be implemented thereby reducin g the number of infected mosquitoes and simultaneously reducing the risk of human transmission.

DOHMH extends its gratitude to the following collaborators with whom it has worked closely to develop a plan that meets the specific needs of New York City: the Federal Centers for Disease Control and Prevention (C DC); the New York State Departments of Health (NYSDOH), Environmental Conser vation (NYSDEC) and Agriculture and Markets; and New York City agencies, including the Mayor’s Offices of Operations, New York City Office of Emergency Management and the Departments of Environmental Protection, Parks and R ecreation, Sanitation, Police, Citywide Administrative Services, Information Technology and Telecommunications and the Housing Authority; along with other partners.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 8

PUBLIC EDUCATION & COMMUNITY OUTREACH

Objective

To increase public awareness of mosquito-borne diseases and surveillance, prevention and control tec hniques and activities.

Background

In 2000, DOHMH launched a public education campaign to increase awareness of WN virus. This campaign highlighted the need for New Yorkers to take personal protective measures against mosquito bites and to el iminate mosquito breeding sites around their

homes. With the theme Mosquito-Proof NYC , a poster campaign in English and protective measures against mosquito bites and to eliminate mosquito-breeding sites Spanish appeared from May to October in Ne w York City’s mass transit system. Similar messages were also aired on television and ra dio. DOHMH developed 22 fact sheets and made information available in 12 languages to community boards, elected officials, schools, community-based organizations, and the general public. In subsequent years, DOHMH staff has made hundreds of presentati ons to various community gatherings.

DOHMH promotes WN virus prev ention strategies and community participation through a number of venues. In 2005, the Office of Community Relations conducted targeted, grassroots educational outreach to senior citizens. Approximately 10,932 cans of DEET was successfully distributed to seniors this year, along with public education materials. Educators conducted 233 presenta tions (38 in Spanish, 12 in Chinese and 5 in Russian) to senior citizens throughout th e City. The Health Media and Marketing Office updated the multi-faceted informational materials for print and radio to promote personal protective measures, dead bird reporting and elimination of standing water. The Press Office made spray notifications and personal precaution announcements through the media. Materials were made widely available in hard c opy and electronic form (through email and the Agency's website), in multiple languages. In formation was also made available through 311 - the City’s non-emergency information line.

In 2006, DOHMH will take standing water and dead bird reports via the New York City’s Citizen Service Center (311) and DOHMH’ s enhanced Web site (nyc.gov/health). Callers can receive comprehensive inform ation about WN virus, including updated information about adulticiding schedules by dialing 311. The Citi zen Service Center provides callers with a liv e operator 24 hours a day, 7 days a week. DOHMH also provides information on WN virus through its we b site (nyc.gov/health/wnv) in the form of fact sheets, press releases, adulticiding schedules, an d maps. This information is regularly faxed to City agencies, elected offi cials, community boards, the Department of Education, hospital, nursing homes, and associa tions of green grocers, day camps, and community organizations. DOHMH will work with the Department for the Aging (DFTA) for distribution of West Nile virus literature and insect repellents to the senior citizens at social gatherings and formal meetings.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 9

Adulticiding information is made available through DOHMH’s web site and 311, regular news broadcasts, scheduled advertising times on local radio, print media, and web sites of news organizations.

Planned Activities

The following key messages will be communicated:

• The public will be informed about the City ’s comprehensive preventive strategies and activities (community education, su rveillance, source re duction, larviciding, etc.) to address the threat of WN virus and to minimize the necessity of pesticide application for adult mosquito control.

• The public will be asked to help eliminate mosquito-breeding sites and to report standing water using the Citizen Se rvice Center (311) and via DOHMH’s enhanced Web site (nyc.gov/health). Th e public will be advised to eliminate standing water sites (tires, buckets, and other water-holding objects) where mosquitoes can breed from their property. They will also be urged to change the water in bird baths once each week; to clean and chlorinate swimming pools or drain and cover if not in use; to prevent water from accumulating in pool covers; and to unclog gutters and down spouts.

• The Office of Communications will increase public awaren ess about the nature of mosquito-borne diseases and the signs and symptoms of WN virus infections (headache, high fever, muscle pai n, weakness and disorientation).

• The public will be informed about the proper personal protective measures to avoid mosquito bites such as ensuring that screens fit tightly on doors and windows, wearing protective clothing (long pants, long-sleeved shirts, and socks) and appropriate use of insect repellents.

• The public will be informed about the importance of reporting dead birds to DOHMH for surveillance purpos es, although it will also be made clear that the City does not pick up all dead birds that are reported. Information about the species being prioritized for testing, how to properly dispose of birds not being retrieved by the City, and the role that birds (especially crows) have in the transmission cycle of WN virus will be disseminated.

If the application of pesticides to cont rol adult mosquitoes becomes necessary, the public will be informed in a timely manner to reduce direct exposure to pesticides. The public will also be given detailed information about the pesticides being used and the potential risks associated with exposure. The public will be encouraged to contact the Poison Control Hotline (212-POIS ONS/764-7667 or 1-800-222-1222) with any suspected pesticide-related illness or exposure.

• Fact sheets in several languages will be distributed to community-based organizations, community boards, elected o fficials, schools, elde r care facilities, libraries, outdoor activity sites, and many other organizations City-wide.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 10

• The Citizen Service Center (311) will be updated regularly with information pertaining to DOHMH pesticide spraying activ ities. Beginning in April, operators will be available 24 hours a day, 7 days a week for WN virus related inquiries and

reports.

• DOHMH’s web site (nyc.gov/health) will be regularly updated and, beginning in April, the public can use web-based form s for reporting dead birds and standing

water.

• Regular updates will be made to elected officials and community boards, who are essential to the City’s communicatio n activities about WN virus activity. Presentations, available in multiple la nguages, will be offered by DOHMH staff to community boards and a wide variety of organizations. These will include information about mosquito breedi ng site reduction and related DOHMH

activities.

• Press releases regarding all activities will be issued regularly and DOHMH will work closely with media to achieve accuracy of the WN virus coverage.

• In the event adulticiding is necessary:

o Information will be released at least 24 hours in advance through the media, DOHMH web site and Citizen Service Center (311), and to hospital emergency departments, pertinen t City agencies, elected officials, community boards, the Department of Education, nursing homes, associations of green grocers, day camps, and community organizations.

Under certain conditions and with the approval of the NYSDOH, applications in green areas may take place with less than the required 24 hour notice. For these cases, the green area will be closed to the public during and a few hours after the application of adulticide.

o Police Department escorts will accompany the applicator’s trucks to announce that adulticiding is about to take place, and will urge people to go indoors to reduce exposure to pesticides.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 11

HOST SURVEILLANCE

Objective

Utilize data on bird and mammal mortality a ssociated with West Nile virus as a means of early detection of West Nile viru s activity in the City in order to predict the spread of the disease before the onset of human illness.

Background

Many species of birds have tested positive fo r WN virus, however crows and blue jays continue to be the birds most susceptible to the disease. Consequently, these species are most closely monitored by DOHM H and State agencies. Howeve r, their local populations have significantly declined as a result of WN virus epizootics in the last six years. In 2005, only four percent of all dead bi rds reported to DOHMH were crows

. Other potential WN virus reservoir host birds in New York City are grackles, house sparrows,

and American robins. Of the 425 dead birds submitted by DOHMH and other organizations to NYSDEC, NYSDOH and the Wildlife Conservation Society for testing, 41 (9.6%) birds tested positive in 2005. WN virus infection was highest among corvid species, 40% in crows and 12% in blue jays.

OVSC will continue tracking dead birds, as th is type of surveillance has shown promise for predicting the spread of WN virus. Al so, it is the single best surveillance mechanism for detecting on-going transmission in a wide-re gion, not just where sentinel chickens are placed, or where mosquitoes are collected and tested. Certain species of mosquitoes feed primarily on birds, cycling the virus between the two populations. Testing birds for WN virus is, therefore, particularly important for monitoring and subsequent control of mosquito-borne diseases.

There will be no sentinel live bird surv eillance conducted by DOHMH in 2006 as it has limited use as an early warning system for huma n disease. Mammals do not appear to be

as sensitive to WN virus as bi rds; therefore, reports of dead animals will not be solicited by the DOHMH in 2006. In 2001, 2002 and 2005 no mammals tested positive for WN virus in New York City. In 2003, one non-equine mammal and in 2004, one horse and one non-equine mammal tested positive for WN virus in New York City though it has not

been concluded whether WN virus was re sponsible for the animal’s death. DOHMH’s

animal surveillance efforts have been as sisted by a number of partner organizations, including the New York City Department of Parks and Recreation, the New York State Department of Agriculture and Markets, th e Animal Medical Center, the Staten Island Zoo, and the Wildlife Conservation Society. In the future DOHMH will continue to ask veterinarians and other animal specialists to monitor for unusual illness and death among

mammals.

Planned Activities

• Beginning in April, DOHMH will ask the publ ic to report via the Citizen ServiceNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 12

Center (311) and the DOHMH web site (nyc.gov/health) the number, location, and types of dead birds they find. This information will be collected 24 hours a day, 7 days a week. Only a select gr oup of dead birds reported to DOHMH will

be collected and tested for WN virus.

• DOHMH will use WN virus positive bird repo rts as early indicators of WN virus activity. Particular emphasis will be pl aced on the number of infected birds.

• Beginning in April, birds repo rted as and confirmed to be crows, blue jays, and sparrows will be picked up and tested fo r WN virus. Following June 1, 2005 birds (with the exception of pigeons) that have recently expired will be retrieved when

DOHMH is able to confirm the location of the bird with the reporting party and can gain access for pick-up. For those bi rds not retrieved by the City, the public will be advised to discard them safely. Although all birds may not be picked up, the reported dead bird information will be used by the Department to enhance its disease surveillance program.

• An appropriate sample of dead birds, es pecially crows, blue jays, sparrows and robins that have died within the previ ous 24 hours, will be submitted for testing. The NYSDEC’s Wildlife Pathology Unit (WPU) will perform autopsies on all submitted birds and the NYSDOH’s laboratory will conduct testing for WN virus.

• In May, DOHMH will ask local veterinari ans to enhance surveillance for encephalitis and other mosquito-borne di seases in vertebrates by identifying unusual neurological abnormalities in patient s, especially in mammals such as horses, dogs, and cats, and to report suspected infections to DOHMH.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 13

HUMAN SURVEILLANCE AND PROVIDER EDUCATION

Objective

To quickly detect human illness due to mosquito-borne diseases, especially WN

virus.

Background

During 1999-2005, 137 New York City residents were hospitalized with neuroinvasive disease due to West Nile virus. Among thes e cases, 17 died as a result of West Nile infection. The epicenter in 1999 was north ern Queens and in 2000 was Staten Island;

from 2001-2005 there has been no clear epicenter, though most cases have continued to occur in Queens, Bronx, and Brooklyn. Most of the hospitalized cas es have occurred in

older New Yorkers ( median: 69 years; range 1-93).

In 2005, 11 New York City residents had WN neuroinvasive disease. There were also

three cases of WN fever detected in the City in 2005. Among the 14 NYC cases of WN viral disease, 13 individu als possibly or probably became infected locally.

Among these 13 individuals were 2 cases id entified through the investigation of transplant-associated WN virus infection. A liver recipient (along with a lung recipient hospitalized in Pennsylvania) was ultimately di agnosed with WN neuroinvasive disease. The common organ donor, a Bronx resident, was found to have had symptoms compatible with WN fever shortly before hi s death, tested positive for WN virus antibody on serum, and was determined to have been in fected most probably via a mosquito bite. The investigation was summarized in an MMWR Dispatch (http://www.cdc.gov/mmwr/previe w/mmwrhtml/mm5440a5.htm).

The table below summarizes morbidity and morta lity due to West Nile virus in New York City from 1999-2005:

1999 2000 2001 2002 2003 2004 2005

Cases 46 14 9 30 31 5 14
Syndrome

Neuroinvasive 44 14 7 29 30 2 11

WN Fever 2 2 1 1 3 3

71 62 51 73 66 34 61
(5-95) (36-87) (44-75) (22-91) (8-93) (1-66) (27-84)

# Deaths 4103702 Median age (yrs) 80 87 0 75 72 0 61 Case fatality rate 9% 7% 0 10% 23% 0 18% Median age* (yrs) (Range)

* Median age calculated fo r neuroinvasive cases only

Serosurveys performed in Queens (1999) an d Staten Island (2000 ) indicated thatNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 14

approximately 140 subclinical WN virus infe ctions, including 30 ca ses of WN fever, probably occurred for every one hospitalized case. Therefore, an estimated 15,070 asymptomatic infections and 4,110 cases of WN fever have occurred among New York City residents from 1999-2005. The vast majo rity of asymptomatic infections and WN fever cases go undetected and unreported in Ne w York City, since ma ny individuals with febrile illness may not seek me dical attention and may not be tested for WN virus even if they do see a provider. Commercial testing is now available for WN virus, but many New York City providers sti ll rely upon free testing for WN virus at the Public Health Laboratory.

As part of an active surveillance and provi der education program, DOHMH’s Bureau of Communicable Disease offers slide presentati ons to health care providers. Broadcast alerts are issued by e-mail and facsimile to all NYC hospitals, encouraging prompt reporting of suspected cases of encephalitis, as eptic meningitis and acute flaccid paralysis from July through October. Providers and laboratory personnel are also instructed on how to submit specimens for WN virus testi ng to the DOHMH Public Health Laboratory through these same outreach methods. The Bu reau of Communicable Disease maintains a database for all suspected cases of WN viru s, and in past years has actively arranged for the timely collection and transportation of appropriate diagnostic specimens to the DOHMH Public Health Laboratory.

In prior years, DOHMH actively facilitated the transportation of specimens to the DOHMH Public Health Laboratory for rapid WN virus testing for all cases meeting certain criteria. Beginning this year, providers will be encouraged to continue WN testing for appropriate pati ents through commercial labora tories, or to arrange for shipment of specimens to the DOHMH Public Health Laboratory themselves. Under special circumstances specimen transportation and testing will be by DOHMH (e.g. high suspicion for WN virus, possible transfusion or transplantation relate d cases, or unusual clustering of cases suggestive of an out break of WN virus or another cause of encephalitis).

Serologic testing for WN virus is performe d at the DOHMH Public Health Laboratory (PHL). The laborato ry performs tests for antibodies to WN. If physicians request antibody testing dengue, Eastern equine encephalitis and/or St. Louis encephalitis (SLE) viruses, specimens will be referred to the NYSDOH Wadsworth Laboratory for testing. Serologic specimens which test positive for WN virus at PHL are sent for confirmation by plaque reduction neutralization testing to the NYSDOH if appropria te. Cerebrospinal fluid specimens from hospitaliz ed patients with encephalitis are also forwarded to the NYSDOH for testing by polymerase chain reac tion for a panel of viruses that cause human encephalitis.

Planned Activities

• Beginning in late June, DOHMH will remi nd providers to report all suspected

cases of WN virus neuroinvasive disease (encephalitis, aseptic meningitis or acute flaccid paralysis), and to test all hosp italized patients, either at commercial laboratories or at the PHL, for WN virus.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 15

• From July through October, regular broad cast updates will be sent to all City hospitals and infectious di sease specialists regarding the importance of reporting suspected West Nile viru s cases. DOHMH will provide the criteria for reporting and submission of appropriate laboratory specimens for WN virus testing. To maintain physician awareness throughout the mosquito season, these alerts will be sent at least monthly with update d information on WN virus activity.

• DOHMH will encourage providers to test appropriate suspect cases through commercial laboratories. However, th e DOHMH Public Health Laboratory will continue to conduct diagnostic testing fo r WN virus and forward specimens for testing for other mosquito-borne viral causes of encephalitis to NYSDOH, as

needed.

• DOHMH will work closely with NYSDOH and CDC to ensure that surveillance

information is standardized and remains confidential.

• DOHMH will conduct health care provider education to increase knowledge about the proper detection, prevention a nd clinical management of mosquitoborne diseases and other types of encepha litis and meningitis. Presentations will be made at local hospitals and to specialty societies as requested. Also, DOHMH will provide educational opportu nities on mosquito-borne diseases through its Continuing Medical Educati on and Continuing Nursing Education

programs.

• The Bureau of Communicable Disease will work with other agencies to ensure that any case of West Nile infection in a person who has received or donated blood products or organs is ra pidly investigated and reporte d so that other affected blood products or organs can be promptly identified and withdrawn before they

are used.

The Bureau of Communicable Disease will work to educate pregnant women, and obstetricians and gynecologists in New York City about the possible impact of WN

infection on the fetus and the need to te st pregnant women who develop illnesses

consistent with WN fever or neuroinvasive disease, to encourage pregnant women with evidence of WN viral infection to particip ate in the CDC WN and pregnancy registry. The Bureau will collaborate with CDC and the treating obstetricians and pediatricians to closely monitor any potentially affected fetu s or neonate and to perform comprehensive diagnostic testing for WN viru s infection or possibly asso ciated adverse effects.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 16

MOSQUITO SURVEILLANCE

Objective

To monitor the seasonality, population dynamics and abundance of mosquito populations and detect th e presence of arboviruses

Background

Mosquitoes were collected weekly from mo squito traps over 72 permanent locations throughout New York City in 2005. A total of 143,258 adult mosquitoes were identified to species, of which 92,2 62 belonging to twenty-two species were tested for the presence

of West Nile virus infecti on. Three mosquito species, Culex pipiens

, Cx. restuans , and

Cx. salinarius were infected with WN virus. Of the 4,860 mosquito pools tested, 122 tested positive for WN virus: 38 in the Bronx; 6 in Brooklyn; 22 in Staten Island; and 56 in Queens

. Cx. pipiens was identified as the primary en zootic vector of WN virus from 1999-2005 based upon the number of positive pools. In fall and winter 2006, hibernating

Culex females were collected from indoor resting sites and we re kept at 24-25 o C with 14:10 (L:D) photoperiod for 20-30 da ys and later tested for the presence of WN virus.

No WN virus was detected in these overwintering mosquitoes.

The risk of mosquito-borne di sease depends on both the number of mosquitoes capable of transmitting the virus and the prevalence of the virus among these mosquitoes. Proper surveillance data on larval and adult mosqu itoes is important for guiding appropriate prevention and control activit ies. Larval surveillance can provide information on expected adult mosquito density and can indicate areas where efforts to eliminate mosquitoes at their source (breeding sites) should be targeted. Adult mosquito surveillance and viral testing provide early predictive information about the potential for

a disease outbreak.

Planned Activities

• DOHMH will continue to work closely with other City agenci es to collect and map information on potential mo squito-breeding habitats.

• DOHMH will determine which areas shou ld be regularly inspected for the presence of larvae. These sites will be s ubjected to routine inspection to determine the presence of mosquito larvae.

• Larval habitat information will be collected and updated throughout the season.

• In the urban areas, mosquito trapping will be conducted from sewer and adjacent buildings by using light traps in re sponse to resident complaints.

• From June to October, DOHMH will trap adult mosquitoes at more than 50 permanent sites throughout the 5 boroughs. The trapping season may beNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 17

lengthened or shortened de pending on the weather.

• Mosquitoes will be collected using DOHM H miniature light and gravid traps on a weekly basis. Each trap collection w ill be sorted by species of mosquitoes collected. Information on the location, coll ection data, trap t ype and the total number of female mosquitoes will be recorded.

• Extra trapping will be conducted to colle ct day biting mosquitoes using omni directional Fay Prince traps and mosquito magnets.

• Adult mosquito trapping will be expanded in areas where WN virus is detected in mosquitoes, birds, other animals, and human s. This will help determine extent of viral activity and delineate spray zones.

• In the event that pesticides are applie d for adult mosquito control, DOHMH will set traps more frequently to evaluate the efficacy of the control measures.

• The DEP will continue to use mosquito ma gnet traps to survey and control adult mosquitoes at wastewater treatment plants. Additionally , DOHMH will place mosquito magnet traps to survey and cont rol adult mosquitoes in the Rockaways

Peninsula.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 18

LARVAL MOSQUITO CONTROL

Objective

To reduce the abundance of adult mosqu itoes through the use of Integrated Mosquito Management (IMM) practices

Background

Culex pipiens , a primary vector of WN virus and one of the most common mosquitoes found in urban areas, breed quickly and us e standing or slow-moving water containing decaying organic materials to lay their eggs. Prime breeding sites include discarded tires left outdoors, poorly maintained bird baths, clogged rain gutters, unused swimming and plastic wading pools, pots and pans with standi ng water, and puddles that last for a week or more. Eliminating breeding sites is the si mplest and most effective way to reduce the number of mosquitoes. Every residen tial and commercial property owner should regularly inspect their property and buildings to determine if conditions are conducive to mosquito breeding and endeavor to eliminate those conditions. Mosquito breeding can be prevented by either eliminating the standing wa ter (source reduction), or if that is not possible, treating the water wi th larvicide to pr event mosquitoes from developing.

DOHMH’s public education campaign emphasi zes the need for New Yorkers to eliminate mosquito-breeding sites around th eir homes. From April to October 2005, DOHMH received 3,811 complaints of standing water through the City 's Citizen Service Center Information Line ( 311), on DOHMH’s web site, and fr om elected officials and community groups. The NYC DOHMH investig ated each of the complaints. Every report led to a letter being sent to the prope rty owner regarding the need to eliminate mosquito-breeding sites and 3,449 sites were visited and checked for the presence of mosquito breeding. In order to respond to egregious conditions, the Board of Health adopted a resolution that made standing wate r a public health nuisance and allowed for

the issuance of Notice of Violations to unresponsive property owners. In 2005, 813

Notice of Violations were issued to unresponsive landlords.

DOHMH will conduct extensive larviciding in accordance with perm its issued by NYS Department of Environmental Conservation (D EC) in catch basins (street corner storm drains), sewage treatment plants, and areas of permanent standing water. DOHMH works with the New York City Department of E nvironmental Protection (DEP), the New York City Housing Authority, and the New York C ity Department of Parks and Recreation to treat catch basins and other potential breedi ng sites for mosquitoes, and has expanded the use of mosquito larvae-eating fish at DEP wastewater treat ment plants. Approximately 140,000 catch basins across the City will be inspected and/or treated at least twice each season by hand application of larvicides. In areas that are inaccessible by ground vehicles, larvicide may be applied aerially.

The larvicides most commonly used in New York City are VectoLex ( Bacillus sphaericus ),VectoBac [ Bacillus thuringiensis var. israelensis (Bti)] and/or AltosidNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 19

(methoprene). B. sphaericus and Bti are naturally occurring soil bacteria that produce toxins which cause disease in mosquito larv ae. These products are considered ideal for mosquito management because of their specif icity to mosquitoes and because of their lack of toxicity to humans and the natural enemies of mosquito larvae. These bacteria form asexual reproductive cells, called spores, which enable them to survive in adverse conditions. They also produce unique crysta lline bodies. When eaten, the crystalline

bodies dissolve in the intestine of the larvae and paralyze th e cells in the gut, interfering with normal digestion and triggering the larvae to stop feeding. The spores can then invade other tissues, multiplying in the la rva’s blood, until the insect dies. Death typically occurs within a few hours of ingestion.

Planned Activities

• Under the direction of the Mayor’s Office of Operations WN virus Task Force, OVSC and other City agencies have identif ied areas of standing water associated with surface grading problems, road construction, clogged sewers and catch basins, obstructed waterways, etc. that are serving as mosquito-breeding habitat. These conditions will be remediated as they are identified.

• The WN virus Task Force will work to inform large-property owners and managers of the need to eliminate mosquito-breeding sites on their property or to properly treat them with larvicides.

• DOHMH will work with the New York City Department of Sanitation to prioritize and enhance the enforcement of lot cleaning and to ensure an aggressive tire disposal program. Abandoned lots ar e particularly conducive to mosquito breeding, and in areas where WN virus has already been detected these lots will be targeted for remediation.

• DOHMH will work with the New York City Department of Buildings to develop and implement a protocol for requiring all City’s demolition and excavation contractors to larvicide when their activities result in significant sources of mosquito breeding.

• The public will be asked to help eliminate mosquito-breeding sites and to report standing water using the City 's toll-free Citizen Service Center Line (311) and the DOHMH Web site (nyc.gov/health).

• OVSC will monitor reported br eeding sites; send letters to property owners asking them to address the problem; conduct on-s ite inspections of the more egregious conditions; make referrals to appropria te agencies for abatement; and, if necessary, issue notices of violation.

• DOHMH will again use VectoLex ( Bacillus sphaericus ), VectoBac/AquaBac ( Bacillus thuringiensis var. israelensis , Bti) and/or Altosid (methoprene) to control mosquito larvae. DOHMH will co ntinue to explore other DEC-approved products that may increase the effect iveness of the larviciding program.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 20

• Beginning in May, larvicides will be a pplied at wastewater treatment plants, parks, and other surface waters, if larval breeding is determined to exist. Applications will be made by hand, bac kpack or aerially via helicopter and continue to be applied as needed th roughout the mosquito-breeding season.

• Beginning in June, larvicides will be a pplied to sewers and to more than 140,000 catch basins citywide. Applications will continue, based upon larval surveillance findings, as needed throughout th e mosquito-breeding season.

• With the identification of an infected bird or mosquitoes in the area, OVSC staff will intensify larval control. Target ed neighborhoods will have expanded public outreach regarding breeding site elimin ation and personal protection; also community-specific media materi als will be distributed.

• DOHMH will work with the Parks Department and other partners to ensure that green areas (e. g., parks, cemeteries, and golf courses) receive intensified mosquito prevention activity, especially in areas where infected dead birds or mosquitoes are found.

• The DEP will continue to use larvae-eating fish at wastewater treatment plants.

• During inspections, DOHMH will provide “M osquito Dunks” to property owners with clear written instructions on how to use the larvicide product.

• DOHMH will provide occupational safety a nd health training to all employees involved in mosquito surv eillance and control oper ations. Additionally, DOHMH will require that all employees from cont racted vendors be provided with similar training as well as appropriate personal protective equipment.

• For residents conserving rainwater, OVS C will recommend c overing the barrels or other water holding containers with a ti ght-fitting lid or very fine mesh screen. Also, bacterial larvicides containing Bti can safely be placed in the barrels to control any mosquito larvae that may be developing.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 21

ADULT MOSQUITO CONTROL

Objective

To reduce the abundance of WN virus infect ed adult mosquitoes in targeted areas through the judicious use of pesticides

Background

Comprehensive vector, bird and human surve illance data collected during the last five

seasons have allowed DOHMH to develop more sensitive surveillance criteria for determining the level of WN virus activity in birds and mosquitoes that indicate a significant risk for a human disease. DOHM H will monitor this su rveillance data on a citywide basis to identify areas at risk for human transmission.

The adulticides used during the last six seasons in New York City is Sumithrin. This product is a first-generation s ynthetic pyrethroid that has been used for more than 30 years. Sumithrin, similar to other pyrethroids, provide s a rapid knockdown of adult mosquitoes. It exhibits very low mammalian to xicity, degrades very rapidly in sunlight, provides little or no residual activity, and doe s not bio-accumulates in the environment. This product is applied at very small quantit ies per acre and is therefore referred to as ultra low volume (ULV) application. ULV- delivery techniques minimize environmental impacts while effectively managing adult mosquito populations. In addition, DOHMH adulticiding operations are m onitored by city, state and fe deral officials to ensure compliance with all USEPA and NYSDEC requirements.

The presence of mosquito-borne viral pathogen s in or near New York City will result in one or more responses or interventions by DOHMH. These interventions can range from routine continuing existing surv eillance to, in worst-case s cenarios, large-scale aerial application of adulticides. DOHM H will utilize its surveillance data to assess the risk of

an outbreak of human disease and the need to apply pesticides in a limited and targeted area to control adult mosquitoes by consideri ng habitat; time of year; weather conditions; the intensity of viral activity; the distribution, densit y, species, age and infection rate of the vector population; and the density and proximity of human populations. The response of DOHMH will depend upon, but not be limite d to: the intensity and persistence of pathogen activity, proximity of pathogen activ ity to human populations within the City, time of year, mosquito population density, and weather conditions . Because these conditions can vary greatly and cannot be pred icted, a consultation process will be used to determine which, if any, responses are ap propriate, on a case-by-case basis. The responses initiated by the DOHMH can be grouped into 3 broad categories or levels of

risk.

Planned Activities

Level 1 – No Pathogen Detection

DOHMH Responses: Surveillance and Control programs continue as outlined in theNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 22

City’s Mosquito Surveillance and Control Pl an. Periodic reports or communications are made to the WN virus Steering Committee providing current status of the various surveillance programs. Periodic press rel eases are issued provi ding the public with

current surveillance results.

Level 2 – Initial or Single Pathogen Detection Initial or a single detection of mosquito-borne viral pathogens in mosquito populations or avian populations in or near New York City will result in a move to Level 2 responses.

DOHMH Responses: OVSC recommendations will be communicated to the WN virus Steering Committee and the DOHMH Commi ssioner. Upon approval by the Commissioner, a press release will be drafted, notifying the public of the recent findings. Surveillance programs will continue w ith the following added activities:

• CDC Light Traps will be added to the area of concern if additional surveillance data are required.

• Larval surveillance and enhanced adult trapping will be conducted in affected

areas if needed.

• Laboratory testing of mosquito pools will be given priority in bridge vector mosquito species (i.e. Aedes spp., Ochlerotatus spp., Cx. salinarius ).

• Data from these additional traps and surv eillance measures will aid in determining the extent of pathogen transmission a nd mosquito populations and be used to guide control measures, if applicable.

Level 3 – Continued or Multiple Pathogen Detections Persistent detection of mosquito-borne pa thogens or detection in bridge vector mosquitoes or in non-avian vert ebrate populations in or near New York City will result in a move to Level 3 responses.

DOHMH Responses: OVSC recommendations will be communicated to the WN virus Steering Committee and the DOHMH Co mmissioner. Upon approval by the Commissioner, a press release will be drafted, notifying the public of the recent findings. Surveillance programs will continue as not ed above. Control measures will be implemented.

• CDC Light Traps will be added to the area of concern if additional surveillance data are required.

• Larval surveillance and enhanced adult trapping will be conducted in affected

areas if needed.

• Laboratory testing of mosquito pools will be increased in bridge vector mosquito species (i. e. Aedes spp., Ochlerotatus spp., Cx. salinarius ).

• Control measures to be considered:New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 23

o Application of larvicides (including aerial applic ations) to areas breeding large numbers of mosquitoes

o Ground application of adulticides to immediate areas of concern

o Aerial application of ad ulticides to broader area s, based upon surveillance

data

o Recommend the restriction and/or cancellation of outdoor evening

activities

o Recommend the closing of recreational areas

• Monitor the efficacy of the adulticiding activities.

• DOHMH will comply with Local Law 37 of 2005, which sets forth requirements on pesticide use by New York City.

• DOHMH will consider EPA and NYSDEC registered products for mosquito control that contain the following active ingredients: sumithrin, resmethrin, permethrin, dibrom, or naled. The City will continually review of the available information on the health impact of pest icides. Any products used will be applied in compliance with City, State, a nd Federal laws and regulations.

• The public will be notified of adulticide schedules in advance, which will allow sufficient time to take any necessary precautions to reduce pesticide exposure. (See Public Education and Community Outreach)

• Hospitals will be notified regarding the a dulticiding schedule. Information on the pesticide to be used will be provided to the public, physici ans and other health care providers.

• For quality assurance purposes, a private contractor, independent of the pesticide applicator, will provide guidance and assi st with the technical elements of pesticide application so that operations are conducted according to plan and pursuant to applicable regulations.

• Adult mosquito control will be scheduled when mosquitoes are most active and

when weather conditions are conduci ve to successful application.

• Information will be released 24 hours in advance of scheduled spray event through the media, the DOHMH web site a nd West Nile virus Information Line and pertinent City and community organizations.

• DOHMH will monitor and assess contro l activities for any potential

environmental and health effects thr ough several measures, including pre- and post-spray environmental sampling and addr essing pesticide e xposure complaints received by DOHMH.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 24

• Depending on surveillance findings and othe r criteria, DOHMH or its Contractor may apply targeted adulticides in respons e to community concerns about nuisance mosquitoes on the Rockaway Peninsula.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 25

SURVEILLANCE OF POTENTIAL A DVERSE HEALTH EFFECTS FROM

PESTICIDE EXPOSURE

Objective

To perform passive and syndromic surveilla nce to monitor for possible exposure to pesticides used to control adult mosquitoes and the potential health sequelae due to such

exposure.

Background

Since exposure to pesticides has the potential to cause adverse reactio ns, particularly among those with pesticide sensitivity or underlying health conditions, beginning in 2000, DOHMH took additional care to provide a dvance notification whenever adulticide applications occurred. Prior to conducting adul t mosquito control activities, information on pesticides was sent to all hospital emergency departments, which included product information on pesticides, Material Safety Data Sheets, and other information relevant to identifying possible exposures to pesticides. Each year since 2000, calls to the New York City Poison Control Center (NYC PCC) we re monitored during pesticide spraying and relevant exposures were forwarded to the New York State Pesticide Poisoning Registry (NYS PPR) for review and possible inclusion in the registry. In 2001, active surveillance for pesticide-related health complaints was pe rformed. In this rega rd, chart review was conducted in emergency departments and phy sicians were randomly surveyed in the affected areas by telephone to determine if any individuals had sought care for symptoms related to possible exposure to adulticides. No cases of individuals reporting to emergency departments or seeking care from their physicians for health complaints related to adulticide expos ure were found through these ac tivities. Additional research

was conducted to determine whet her pesticide applications a ssociated with West Nile Virus mosquito control were associated w ith negative health outcomes. As a recent publication reported, no such associations were found. 1

Beginning in 2002 syndromic surveillance was a dopted as a surveillance tool to identify any possible respiratory symptom related cl uster in areas in which a spray action

occurred. If such a cluster is identifie d, DOHMH conducts further review of emergency department data to investigate the possible et iology of that cluster. In addition, Poison Control Center pesticide-related calls are monitored for number and severity that are geographically and temporally a ssociated with spray events.

Planned Activities

Prior to conducting adult mosquito control activities, information on pesticides and their possible adverse health effects will be se nt to all hospital em ergency departments, including product information on pesticides, Material Safety Data Sheets, and other information relevant to identifying possible e xposure to pesticides. Calls received by the

1 Karpati AM, Perrin MC, Matte T, Leighton J, et al . Pesticide Spraying for West Nile Virus Control and Emergency Department Asthma Visits in Ne w York City, 2000. Environ. Health Perspect. 2004 Aug; 112(11): 1183-7.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 26

New York City Poison Control Center (NYC PCC) will continue to be monitored during pesticide spraying for geographic and spatial as sociations with spray events. These data

will continue to be forwarded to the NYS Pesticide Poisoning Registry for possible follow-up and inclusion in the Registry. Syndro mic surveillance will also continue to be utilized to identify possible asthma clusters in the zip codes in which spraying occurs.

Statistical and field in vestigation methods for evaluating spatial and tempor al clustering

are described in recent publications. 2 In the event that a possible respiratory symptom cluster is identified, emergency department chart review will be considered to investigate the possible etiology of that cluster at near by hospitals.

2 See for example: Heffernan, R., F. Mostashari, D. Das, et al . New York City Syndromic Surveillance Systems MMWR September 24, 2004 / 53(Suppl);23-27; and Steiner-Sichel, L., J. Greenko, R. Heffernan, M. Layt on, and D. Weiss. Field Investi gations of Emergency Department Syndromic Surveillance Signals. New York Ci ty MMWR September 24, 2004 / 53 (Suppl.);184-

189.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 27

RESEARCH AND EVALUATION

Objective

To better understand the transmission a nd pathogenicity of mosquito-borne diseases and to assess the effectiveness of DOHMH surveillance, prevention and

control methods

Background

One of the most important roles for public health professionals is to assess the potential impact of a disease on a popula tion and to devise safe and effective methods for reducing the risk of disease transmission. DOHMH, in collaboration with CDC and NYSDOH, has studied closely the risk factors for infection of and morbidity and mortality from WN virus. However, many questions remain about how the virus circulates in nature.

Furthermore, some of the control methods used for managing mosquito populations, especially the application of pesticides fo r adult mosquitoes, are not without potential impact. However, alternative control measures lack sufficient efficacy or environmental impact data to allow their wholesale inte gration into the City’s IMM Plan. The environmental impact statement and other research endeavors are important tools used to assess potential adverse health effects associated with pe sticide exposure. Additional

research is needed in this area as well as in assessing improved techniques for larval and adult mosquito control in New York City.

Planned Activities

• DOHMH will continue to work closely with Federal, State, and Local partners to conduct research that will identify the most effective predictors of human illness from WN virus in New York City, in cluding the analysis of overwintering mosquito populations and the use of pr edictive dead bird cluster models.

• DOHMH will continue to refine the New York City-specific phased response for risk categories of mosquito-borne disease outbreaks based on the ongoing analyses of bird, mosquito, mammalian and human surveillance data.

• DOHMH will evaluate the most cost-eff ective methods of surveillance and

control.

• DOHMH will research and eval uate the potential public health and environmental impact of the application of pestic ides for adult mosquito control.

• In collaboration with CDC and NYSDO H, OVSC will publish new and relevant information about mosquito-borne disease transmission in New York City in peerreviewed public health and medical journals.

• DOHMH will conduct research to determine the blood feeding preference of theNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 28

mosquito vectors of WN virus in NYC using molecular techniques. This information will help determine what animals are the primary hosts and focus

surveillance and control activities accordingly.

• DOHMH will research and evaluate the development of resistance in mosquitoes due to the application of pesticides (m icrobial larvicides and adulticides).

• DOHMH will conduct an analysis to predict th e risk of West Nile virus infections

and the outcome of interventions in Ne w York City using Probabilistic modeling techniques, Spatial Statistics and Geogr aphic Information System (GIS).

• DOHMH will test hibernating mosquitoes for WN virus infection to determine their role in the overwintering of WN virus from one season to the next.

• The host seeking activity patterns of mosquitoes will be determined by using collection bottle rotator traps in various habitats such as marsh, urban areas and parks.

• Larval surveillance will be conducted before and after th e control activities in the catch basins (storm drain) and natural br eeding sites for determining larval control efficacy of the pesticides.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 29

APPENDIX A: QUESTIONS AND ANSWERS ABOUT WEST NILE VIRUS

Q: What is West Nile virus?

A: West Nile virus is a mosquito-borne viru s that can infect humans, birds, horses, and other mammals. In humans, infection with the virus usually causes no symptoms at all or a mild, flu-like illness. However in some cases, particularly among the elderly, it can also cause more severe neurological diseases such as encephalitis or aseptic meningitis. West Nile virus initially appeared in North America in New York City in 1999. Since then, the virus has spread acr oss the continental United States.

Q: How is West Nile virus spread?

A: West Nile virus is spread predominantly to humans by the bite of an infected mosquito. In 2002 other methods of human tr ansmission were discovered. It has now recently been shown that West Nile virus can be transmitted to humans who receive infected organs through transplantation, or who receive transfusions of infected blood or blood products. In 2003, two cases of blood transfusion-associated WN virus infection were documented, one in Texas and one in Nebraska. Also, in 2002 there was one case of transmission from a pregna nt woman to her fetus and one case of probable mother-to-child transmission th rough breast-milk. West Nile virus is NOT spread by person-to-person c ontact such as touching, kiss ing, or caring for someone

who is infected.

Q: Who is most at risk for getting West Nile ence phalitis after being bitten by a WN

virus infected mosquito?

A: People older than 50 years of age have the high est risk of severe disease, such as encephalitis. It is unknown if immunocompr omised persons are at increased risk for

WN virus disease

.

Q: Where did the West Nile virus come from?

A: Outbreaks of the West Nile virus have o ccurred before in Africa, Egypt, Israel, Asia, Romania, Russia and France. Prior to 1999, the West Nile virus had never been

discovered in the Americas. The virus was mo st likely introduced by an infected bird or mosquito that was imported from a country where the virus is common.

Q: Can you get West Nile virus directly from birds?

A: Currently, there have been no reported cases of West Nile virus be ing spread directly from live or dead birds to the general public . However, dead birds can carry a variety

of other diseases and should never be handled with bare hands. Use gloves to carefully place dead birds in double-plasti c bags and then place dead birds in the

outdoor trash.

Q: Besides mosquitoes, can you get West N ile virus directly from other insects or

ticks?

A: Infected mosquitoes are the primary source of West Nile virus and caused the recentNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 30

outbreaks in NYC. Although seve ral types of ticks in Afri ca and Europe have been found infected with WN virus, there is no information to suggest that ticks or other insects in this country are able to transmit West Nile virus.

Q: What are the symptoms of West Nile virus?

A: Most people who are infected with West Nile virus either have no symptoms or experience mild illness such as fever, headache and body aches before fully recovering. Some may also develop a mild rash or swollen lymph glands. In some individuals, particularly th e elderly, West Nile virus ca n cause serious disease that affects brain and spinal tissue. Severe il lness may include ence phalitis (inflammation of the brain), meningitis (inf lammation of the membrane around the brain), and acute flaccid paralysis (a polio-like syndrome in which muscles become very weak or paralyzed). Symptoms may include: headach e, high fever, stiff neck, confusion, coma, tremors, convulsions, and muscle weakne ss or paralysis. At its most serious West Nile virus can cause permanent neurological damage and death.

Q: If a pregnant woman gets infected with West Nile virus, can it affect her fetus?

A: In 2002 there was one case of transmission of West Nile virus from mother to fetus during pregnancy. The newborn was infected with West Nile virus at birth and had severe medical problems, including a bnormalities of the brain; however, it is unknown whether these problems are due to We st Nile virus or some other cause. Pregnant women should take precautions to reduce their risk for West Nile virus infection by avoiding mosquitoes, wearing protective clothing and using insect repellents containing DEET. (Please see the DOHMH fact sheet on Insect Repellent Use & Safety for more information on DEET). When West Nile virus transmission is occurring in an area, pregnant women w ho have illness with fever should see their health care provider.

Q: How is West Nile encephalitis treated?

A: There is no specific therapy. In more severe cases, intensive supportive therapy is indicated, i. e. , hospitali zation, intravenous (IV) flui ds and nutrition, airway management, ventilatory support (ventilator ) if needed, preven tion of secondary infections (pneumonia, urinary tr act, etc. ) and good nursing care.

Q: Is there a vaccine against West Nile virus?

A: No, but several companies are wo rking towards developing a vaccine.

Q: How long does it take to get sick if bitten by an infected mosquito?

A: Most people who are infected with West Nile virus have no symptoms or experience only mild illness. If illness does occur, symp toms appear within 3 to15 days of being bitten by an infected mosquito.

Q: What should I do if I thin k I have West Nile encephalitis?

A: You should seek medical care as soon as possible if you develop signs of encephalitis such as/including: fever, muscle weakness, and confusion,

Q: What can I do to reduce my risk of becoming infected with West Nile virus?

A: From June through October, when mosqu itoes are most active, take the followingNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 31

precautions:

• Wear protective clothing such as lo ng pants and long-sleeved shirts.

• Avoid shaded, bushy areas where mosquitoes like to rest.

• Limit outdoor evening activity, especially at dusk and dawn when mosquitoes

are most active.

• Use insect repellent containing between 13-25% DEET to minimize the risk of being bitten by a mosquito. Formulations containing more than 25% DEET are unnecessary and may enhance skin reactions on some people. Extra precaution should be used when applying repellents to children and infants. As with all products, the user shou ld follow the manufacturer’s usage

recommendations.

Q: What can I do around my home to help reduce exposure to mosquitoes?

A: Mosquitoes lay their eggs in standing or slow moving water. Also weeds, tall grass, and bushes provide an outdoor resting place for mosquitoes. Mosquitoes breeding or resting on your property can then enter homes through unscreened windows or doors,

or broken screens.

• Repair or replace all screens in your home that have tears or holes.

• Eliminate any standing water th at collects on your property.

o Remove all discarded tires from your property.

o Dispose of tin cans, plastic cont ainers, ceramic pots, or similar water-holding containers.

o Make sure roof gutters drain proper ly. Clean clogged gutters in the spring and fall.

o Clean and chlorinate swimming pools , outdoor saunas and hot tubs. If not in use, keep empty and covered.

o Drain water from pool covers.

o Change the water in bird baths once a week.

o Turn over plastic wading pools and wheelbarrows when not in use.

• Remind or help neighbors to eliminat e breeding sites on th eir properties.

Q: What is the City doing to address the possible return of West Nile virus?

A: DOHMH, along with other City, State and Federal agencies, has developed a comprehensive plan to reduce the risk of illn ess due to West Nile virus. The main goal of this plan is to decrease the number of adult mosquitoes by eliminating their breeding sites wherever possible, and applyi ng larvicides (to kill the immature larval form of the mosquito) to areas with stagnant water that cannot be drained completely. The City also will regularly test mosquito es and birds for West Nile virus throughout the spring and summer. If West Nile virus is found at levels that indicate a threat to human health, local applicati ons of pesticides may be undertaken to prevent people

from becoming infected.

Q: Is the City planning to apply pesticides as was done previously?

A: If West Nile virus is detected in the co mmunity, the City’s initia l response will be to intensify its efforts to reduce mosquito-bre eding sites and increase its levels of larviciding in those areas in which WN virus has been found. Reducing the adult mosquito population with pesticides (adul ticides) approved by the US Environmental Protection Agency (EPA) will be done if n ecessary to prevent human illness. TheNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 32

decision to spray, either on the ground or by air, will be based on surveillance

information and the documentation of West Nile virus activity at a level that indicates a threat to human health. Adulticiding will be concentrated in areas most at risk for

disease occurrence.

Q: What health risks are posed to people a nd pets from pesticides for adult mosquitoes?

A: In the amounts used, risks to people and pets are relatively low. However, some people may be more sensitive to such pesticides and may want to reduce their chance of exposure by following the suggestions be low. Anyone experiencing persistent or significant adverse reactions to pesticides should seek me dical care or call the NYC Poison Control Center at (212) POISONS or (212) 764-7667.

Q. Will the public be notified in advance about spraying activities?

A: Residents can learn about adulticiding schedules in a dvance through public service announcements, the media, the City's website (nyc.gov/health), and a telephone information line (1-877-WNV-4NYC).

Q: If the City sprays pesticides for adult mosquitoes, what can I do during spraying to reduce the risk of exposure to pesticides?

A: If spraying becomes necessary, the NYC D OHMH recommends that all individuals take the following precautions to avoid direct exposure to pesticides and reduce the

reactions:

o Some individuals are sensitive to pesticides. Persons with asthma or other respiratory conditions are especially enc ouraged to stay in side during spraying since there is a possibility that sp raying could worsen these conditions

o Air conditioners may remain on. But if you wish to reduce the possibility of exposure to pesticides, set the air conditio ner vent to the closed position, or

choose the recirculate function

o If you wish to minimize your exposure to pesticides, you may want to bring children's toys, outdoor equipment and clothes from outdoor areas inside during spraying.

o If outdoor equipment and toys are exposed to pesticides, they may be washed with soap and water to redu ce the possibility of exposure

o Wash skin and clothing exposed to pesticides with soap and water.

Anyone experiencing adverse reac tions to pesticides should seek medical care or call

the NYC Poison Control Center at (212) POISONS or (212) 764-7667.

Q: If I live in an area where birds or mo squitoes with West Nile virus have been reported, and a mosquito bites me, am I likely to get sick?

A: No. Evidence indicates that the chance of human infection and illness resulting from West Nile virus is quite low. In addition, the greatest risk is to those over age 50, particularly the elderly. These members of the population should take the greatestNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 33

care to prevent exposure to mosquito bites.

Q. I've gotten a mosquito bite. Sho uld I be tested for West Nile virus?

A: No. Illnesses related to mosquito bi tes are still uncommon. However, you should see a doctor immediately if you develop symptoms such as high fever, confusion, muscle weakness, severe headaches, and stiff neck or if your eyes become sensitive to light. Patients with mild symptoms should rec over completely and do not require any specific medication or laboratory testing.

Q: Should I report dead birds to the Health Department?

A: Yes. DOHMH encourages New York City residents to report all dead bird sightings within NYC, especially crows and blue jays. This will assist us in our efforts to

monitor possible WN virus activity. However, wh ile every report is important to our monitoring efforts, we will be collecting only a sample of the dead birds and not every dead bird reported. If you do not receive a phone call from DOHMH to arrange pick up of the dead bird within two busine ss days of making the report, please dispose of the dead bird. While there is currently no evidence that West Nile virus can be spread directly from birds to people, dead birds can carry other diseases and, therefore, should never be handled with bare hands. Use gloves to carefully place dead birds in double-plastic bags and then place dead birds in the outdoor trash.

For more information about West Nile virus, call the New York Ci ty Citizen Service Center, 24 hours a day, seven days a week , by dialing 311. TTY/TDD is available by dialing (212) 504-4115 ; or check the DOHMH We bsite at nyc.gov/health

.New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 34

GLOSSARY

adulticide a type of pesticide used to kill adult mosquitoes

Aedes sollicitans See Ochlerotatus sollicitans

Altosid brand name of methoprene, a type of larvicide

arbovirus shortened term for ar thropod- bo rne virus, a virus that is carried by arthropods

arthropod a group of an animal that does not have a backbone and have jointed walking appendages, such as insects, spiders

and lobsters

Bacillus sphaericus a bacterium; type of biological pesticide used to control mosquito larvae in water (mosquito larvae die after ingesting this bacteria)

Bacillus thuringiensis a bacterium; type of biologica l pesticide used to control

var. israelensis (Bti) mosquito larvae in water (mosquito larvae die after ingesting this bacterium); bacteria found in Mosquito

Dunks®

bridge vector an arthropod (in this case, a specific species of mosquito)

that serves as a main transmission of virus between the reservoir (birds) and humans.

catch basins grates seen at street corner s and in other properties for

water runoff

Culex pipiens a species of mosquito, the primary vector for West Nile virus, commonly found in urban areas; breeds in fresh, but stagnant water, such as backyard containers and storm

drains

DEET DEET (chemical name, N,N-diethyl-meta-toluamide) is the active ingredient in many insect repellent products

Eastern equine mosquito-borne viral disease that causes inflammation of Encephalitis (EEE) the brain; similar to West Nile

encephalitis inflammation of the brain, which can be caused by

numerous viruses and bacteria , including West Nile virusNew York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 35

Environmental Impact A document that describes the impact on the environment Statement (EIS) from a proposed action (in th is case, the application of pesticides to control adult mosquitoes).

gravid traps mosquito traps designed to attract pregnant female mosquitoes

Interactive Voice System an automated telephone system by which information can be accessed by choosing from a set of options

larvae immature mosquitoes that live in water; stage which hatches from the egg, prior to adult stage

larvicide a type of pesticide used to control immature or larval mosquitoes

light traps mosquito traps outfitted with a light to attract mosquitoes

malathion an organophosphate pesticid e used to control adult mosquitoes; active ingredient in the product Fyfanon®

meningitis inflammation of the lining of th e brain and spinal cord that can be caused by a virus or bacteria

methoprene a type of insect growth regul ator used to control larval mosquitoes; it prevents mosquito larvae from emerging and developing into adult mosquitoes

mosquito breeding site a location where mosquitoes la y eggs, usually in stagnant water with organic material

mosquito pools a group of mosquitoes of the same species, collected in given area and combined at th e laboratory for testing for the presence of West N ile and related viruses

naled an organophosphate pesticid e used to control adult mosquitoes

neurology the study of the nervous system and its disorders

Ochlerotatus sollicitans species of mosquito that breeds in salt marshes

outbreak an unexpected increase in fr equency or distribution of a

disease

permethrin a synthetic pyrethroid pesticide used to control adult mosquitoes; active ingredient in the product Biomist®New York City Department of Health and Mental Hygiene 2006 Comprehensive Mosquito Su rveillance and Control Plan 36

pesticide substance used to kill pests su ch as insects, mice and rats; an insecticide is a form of pesticide

piperonyl butoxide An additive to pyrethroid pesticides that improves the effectiveness of the active ingredient

resmethrin a synthetic pyrethroid pesticide used to control adult mosquitoes; active ingredient in the product Scourge ®

salt marsh areas of vegetation in bodies of salt water that may support the breeding of certain type s of mosquitoes such as

Ochlerotatus sollicitans ; example of salt marshes is Jamaica Bay.

sentinel an early warning system, in this case, for the presence of virus (e. g. , sentinel chickens)

serologic of, or relating to, serum

source reduction the removal or reduction of larval mosquito habitats

St. Louis encephalitis (SLE) mosquito-borne viral disease that causes inflammation of the brain; very similar to West Nile virus

sumithrin a synthetic pyrethroid pesticide used to control adult mosquitoes; active ingredient in the product Anvil 10+10 ®

VectoBac brand name for the larvicide Bacillus thuringiensis var

. israelensis ( Bti )

VectoLex brand name for the larvicide Bacillus sphaericus

vector an organism (an insect in mo st cases) capable of carrying and transmitting a disease-causing agent from one host to

another

viral of, or relating to, a virus

viral encephalitis inflammation of the brain cause d by a virus, such as West

Nile virus