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Surveillance infrastructure lacking for West Nile, other arboviruses
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Since 2005, 22% of US jurisdictions stopped conducting active human surveillance for West Nile virus, according to a report in MMWR. In addition, 13% stopped mosquito surveillance and 70% had reduced mosquito trapping and testing.
When West Nile was first introduced in 1999, the CDC Epidemiology and Laboratory Capacity (ELC) cooperative supported surveillance and prevention efforts in all 50 states and six large cities. In 2005, when the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment, it found all had developed a surveillance and control program. However, ELC funding for West Nile surveillance declined by 61% from 2004 to 2012.
When the United States experienced a severe West Nile season in 2012, the CSTE conducted a follow-up assessment of the ELC-supported West Nile programs.
“Reduction in early detection capacity compromises local and national ability to rapidly detect changes in West Nile virus and other arboviral activity and to initiate prevention measures,” the researchers wrote. “Each jurisdiction is encouraged to review its current surveillance systems in light of the local threat of West Nile virus and emerging arboviruses (eg, dengue and chikungunya) and ensure it is able to rapidly detect and respond to critical changes in arbovirus activity.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Lyle Petersen, MD, MPH
Arboviral diseases are notoriously unpredictable. Nobody could have predicted the emergence of West Nile virus in New York City in 1999, its spread across the United States within four years, or that every summer it would cause neuroinvasive disease outbreaks in the United States that would eclipse in size all that it had caused elsewhere in the world. Fifteen years later, we still cannot predict West Nile outbreaks months ahead of time in large part because factors that influence its natural transmission cycle, such as weather, defy long-term prediction. Nevertheless, the national ArboNET surveillance system — through a combination of human, mosquito, and animal surveillance — can identify impending outbreaks with sufficient lead time to allow health authorities to respond effectively.
The CSTE survey has documented substantial degradation in our national arbovirus surveillance and response capacity. Unfortunately, this comes at a time when the need has never been greater. The massive West Nile virus outbreak in 2012 aptly demonstrated the danger of complacency. Furthermore, viruses not currently in the public lexicon — chikungunya, Zika, dengue, and Heartland — are already here or are knocking at our door. More worrisome, the factors leading to these and other arboviruses, such as human travel and international trade, are accelerating. Rebuilding our national surveillance and response capacity will take time and resources. We simply don’t have the luxury of waiting until the next inevitable crisis to act.
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