quadrimaculatus, which transmits malaria and Aedes
aegypti, which vectors both yellow fever and dengue,
are still present in large numbers, and if persons
carrying the disease in their bloodstreams should come
into Florida from other areas, it would be possible for
mosquitoes to bite them and become infected. In this
way, a new cycle of these diseases could begin.
Although secondary infections may result
from scratching mosquito bites, and there are people
who are allergic to the bites, the chief medical concern
in Florida at the present time is the possibility of an
arthropod- borne encephalitis epidemic. Viruses of
Eastern Equine Encephalitis, Western Equine
Encephalitis, St. Louis Encephalitis, California
Encephalitis and Venezuelan Equine Encephalitis have
been found in mosquitoes in the State.
Eastern Equine Encephalitis Eastern
Equine Encephalitis (EEE) is an enzootic disease that
was first recognized in Massachusetts, in 1831 when 75
horses died of an encephalitic illness. The casual agent,
Eastern Equine Encephalitis virus (EEEV), is an
alphavirus that was first isolated from infected horse
brains in the 1930s and currently occurs in focal
locations of the eastern United States including Florida.
EEE is capable of infecting a wide range of animals
including mammals, birds, reptiles and amphibians. The
virus is maintained in natural cycles involving birds and
Culiseta melanura in freshwater swampy areas with a
peak of activity between May and August. In this usual
cycle of transmission, the virus does not escape from
the swampy areas because the mosquito species,
Culiseta melanura, prefers to feed upon birds and does
not usually bite humans or other animals. However,
transmission of EEEV to mammals occurs via bridge
vectors because they bring the virus from avian
populations to mammalian populations. These bridge
vectors include Coquillettidia perturbans, Aedes
atlanticus, Culex nigripalpus, Cx. quinquefasciatus and
Aedes solicitants. These species feed on both birds and
mammals and can transmit the virus and cause disease
in people, horses, dogs and some birds such as
pheasants, quail, ostriches and emus.
Most persons infected with EEEV have no
apparent illness. However, symptoms of severe cases of
EEE include sudden onset of headache, high fever, chills,
and vomiting. The illness may then progress to
disorientation, seizures, or coma. EEE is one of the most
severe mosquito-transmitted diseases in the United
States with approximately 33% mortality and
significant brain damage in most survivors.
Despite there having been only 81 human
cases documented in Florida in the past fifty years
(1957-2008), the State averages over 70 reported
equine cases each year. In years when conditions favor
the spread of EEE, the number of reported cases can
exceed 200, with over 90% of the affected horses dying.
The distribution of EEE cases have predominantly been
in areas north of Lake Okeechobee, including panhandle
areas (Walton, Holmes, Jackson, Leon, Jefferson,
Madison and Escambia Counties); the lower St. Johns
River areas (Duval, Volusia, Flagler, Putnam and Clay
Counties); and the green swamp region area (Lake,
Orange, Pasco, Polk, Osceola, Pinellas, Hillsborough and
Manatee Counties).
A vaccine is available for horses, but not for
humans. Preventive measures should include effective
mosquito control and avoidance of mosquito bites by
using insect repellent, wearing protective clothing, and
staying indoors while mosquitoes are most active.
St. Louis Encephalitis St. Louis
Encephalitis (SLE) was first recognized in the vicinity of
St. Louis, Missouri and the neighboring St. Louis County
in 1933 when an encephalitis epidemic broke out. Over
1,000 cases were reported to the local health
departments and the newly constituted National
Institute of Health. St. Louis encephalitis virus (SLEV), a
flavivirus, is one mosquito-transmitted viral disease
that is of great medical importance in North America.
During summer, SLEV is maintained in a mosquito-bird
cycle, with periodic amplification by birds and Culex
mosquitoes.
Normally less than 1% of SLEV infections in
humans are clinically apparent and the vast majority of
infections remain undiagnosed. The occurrence and
severity of SLE in humans is strongly dependent on age.
The case fatality rate in Florida SLE epidemics has
ranged from 4-30 percent. Deaths were almost
exclusively among people age 50 and older. It is not
uncommon for those surviving severe cases of SLE to
suffer long-term residual neurological damage, which
include paralysis, memory loss, or deterioration of fine
motor skills.
Major SLE outbreaks occurred in Florida in
1959, 1961, 1962, 1977 and 1990. The epicenter of the
outbreaks in 1961 and 1962 was the Tampa area. In
1961, there were 25 cases with 7 deaths and in the
following year, there were 222 cases with 43 deaths.
One very interesting discovery made at the time was
that the SLE virus was vectored by Culex nigripalpus, a
species which had not been previously implicated in
disease transmission. In other parts of the United States,
SLE is transmitted by Culex quinquefasciatus and Culex
tarsalis. In addition to the illnesses and deaths caused
this epidemic also greatly reduced tourism business.
The reductions were estimated to be as high as $40
million, which added an enormous economic loss to the
human loss and suffering.
West Nile Encephalitis In 1999, a new
form of encephalitis was discovered in the New York
City area. Known as West Nile Encephalitis (WNE), it is
believed to have been brought in from the Middle East
by unknown means and, previous to its introduction,
had never been identified from the Western
Hemisphere. West Nile Virus (WNV) is a flavivirus that
was first isolated in 1937 from a woman in the West
Nile province of Uganda in Central Africa. WNV was first
found in the United States in 1999 during an outbreak
of the disease involving humans, birds and horses in
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