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IMPORTANT - West Nile cases in Atlanta
IMPORTANT MESSAGE from Georgia Department of Public Health Entomologist - Just an FYI, We already have a West Nile case in Metro Atlanta some 2 - 3 months earlier than we usually see cases. With the wet winter and warm spring, the mosquito populations have gotten an early start, and both nuisance and vector species are likely to be a real problem. I am getting reports of high Cs melanure (EEE) numbers as well, an we are expecting it to be a bad EEE year.
Mosquitoes love beer drinkers
March 6, 4:28 AM
Birmingham Science News Examiner
Paul Hamaker
Scientists from France, Canada, and Africa have determined that the primary malaria insect carrier in Africa is more likely to bite people who drink beer. The research was reported at PLOS One on March 4, 2010.
A mosquito is the primary malaria carrier in Africa because the mosquito prefers to feed on humans. The mosquitoes are attracted by a variety of body odors including breath.
Fifty adult males aged between 20 and 43 years in good health and not using any medication volunteered for the experiment. One group drank the local beer and one drank water.
The beer drinkers attracted forty-seven to sixty-five percent more mosquitoes than the water drinkers in a statistically controlled experiment. The volunteers were not directly exposed to the possibility of being bitten by the mosquitoes.
The reason the mosquitoes were more highly attracted to beer drinkers is not clear.
Malaria is a potentially deadly disease in Africa.
According to the Center for Disease Control (CDC) the majority of malaria cases in the United States result from travel to countries where malaria is not controlled. Alabama even had 9 cases of malaria reported in 2007.
http://www.cdc.gov/Features/dsMalariaSurveillance/
Avoid drinking beer if you are traveling to a country where malaria is common. You can send the beer to me.
Prevent disease and reduce the number of alcoholic mosquitoes at the same time.
For additional Mosquito Control Information please visit www.Tuxedo MosquitoControl.com
Birmingham Science News Examiner
Paul Hamaker
Scientists from France, Canada, and Africa have determined that the primary malaria insect carrier in Africa is more likely to bite people who drink beer. The research was reported at PLOS One on March 4, 2010.
A mosquito is the primary malaria carrier in Africa because the mosquito prefers to feed on humans. The mosquitoes are attracted by a variety of body odors including breath.
Fifty adult males aged between 20 and 43 years in good health and not using any medication volunteered for the experiment. One group drank the local beer and one drank water.
The beer drinkers attracted forty-seven to sixty-five percent more mosquitoes than the water drinkers in a statistically controlled experiment. The volunteers were not directly exposed to the possibility of being bitten by the mosquitoes.
The reason the mosquitoes were more highly attracted to beer drinkers is not clear.
Malaria is a potentially deadly disease in Africa.
According to the Center for Disease Control (CDC) the majority of malaria cases in the United States result from travel to countries where malaria is not controlled. Alabama even had 9 cases of malaria reported in 2007.
http://www.cdc.gov/Features/dsMalariaSurveillance/
Avoid drinking beer if you are traveling to a country where malaria is common. You can send the beer to me.
Prevent disease and reduce the number of alcoholic mosquitoes at the same time.
For additional Mosquito Control Information please visit www.Tuxedo MosquitoControl.com
Dark clouds are filling the skies around South Georgia
By Jay Polk
DOUGHERTY COUNTY, GA (WALB) – Dark clouds are filling the skies around South Georgia and that can only mean one thing. The rain is coming - again. While the totals for the last couple of months won't be setting any records, they are impressive. In Albany, we've picked up 14.83".
Much higher than the normal total of 9.48"
All of this rain means that there's plenty of standing water. No matter where you're looking, eastside or westside. In town or in the country there's water everywhere. For most people it's only an inconvenience, but Donnell Mathis sees something else.
"I see a potential problem" he said.
It's his crew that makes sure that people in Dougherty County don't get bitten by mosquitoes. All of this rain means that they'll be busy over the next couple of months.
According to Mathis, "we will have problems with mosquitoes at the beginning of our season."
And if you think that the cold weather would have reduced the number of mosquitoes, think again.
"The weather that we've had has NOT been cold enough to kill the mosquito larvae," said Mathis.
To kill the mosquito larvae, the weather has to be below freezing all day long for two weeks. Since that didn't happen, residents will eventually see mosquitoes. When they do, they can call Mosquito Control and their trucks will spring into action.
"We'll come out and do a surveillance. We'll come out and look around the homes and try to figure out what's causing the problem," said Mathis.
But they're not just reactive, they're proactive too.
On a daily basis, Mosquito Control will go around and they'll put these things called dipping cups in the water. What they're looking for is mosquito larvae and when they find it, that's when they'll start treating.
When larvae are found chemicals are applied to take care of the problem.
It's important to keep the mosquitoes to a minimum, because they can carry some nasty diseases.
"West Nile Virus is one of the main factors here in Dougherty County.
Also they carry the Eastern Equine Encephalitis, Dengue, Yellow Fever,"
Mathis said.
And over the next few months, Public Works will try to make sure that you stay safe from the bite of the mosquito. And Mathis says that you can help them by emptying out any outdoor containers around your home that can hold water.
©2010 WALB News. All rights reserved.
For Additional Information on Mosquito Control
www.TuxedoMosquitoControl.com
DOUGHERTY COUNTY, GA (WALB) – Dark clouds are filling the skies around South Georgia and that can only mean one thing. The rain is coming - again. While the totals for the last couple of months won't be setting any records, they are impressive. In Albany, we've picked up 14.83".
Much higher than the normal total of 9.48"
All of this rain means that there's plenty of standing water. No matter where you're looking, eastside or westside. In town or in the country there's water everywhere. For most people it's only an inconvenience, but Donnell Mathis sees something else.
"I see a potential problem" he said.
It's his crew that makes sure that people in Dougherty County don't get bitten by mosquitoes. All of this rain means that they'll be busy over the next couple of months.
According to Mathis, "we will have problems with mosquitoes at the beginning of our season."
And if you think that the cold weather would have reduced the number of mosquitoes, think again.
"The weather that we've had has NOT been cold enough to kill the mosquito larvae," said Mathis.
To kill the mosquito larvae, the weather has to be below freezing all day long for two weeks. Since that didn't happen, residents will eventually see mosquitoes. When they do, they can call Mosquito Control and their trucks will spring into action.
"We'll come out and do a surveillance. We'll come out and look around the homes and try to figure out what's causing the problem," said Mathis.
But they're not just reactive, they're proactive too.
On a daily basis, Mosquito Control will go around and they'll put these things called dipping cups in the water. What they're looking for is mosquito larvae and when they find it, that's when they'll start treating.
When larvae are found chemicals are applied to take care of the problem.
It's important to keep the mosquitoes to a minimum, because they can carry some nasty diseases.
"West Nile Virus is one of the main factors here in Dougherty County.
Also they carry the Eastern Equine Encephalitis, Dengue, Yellow Fever,"
Mathis said.
And over the next few months, Public Works will try to make sure that you stay safe from the bite of the mosquito. And Mathis says that you can help them by emptying out any outdoor containers around your home that can hold water.
©2010 WALB News. All rights reserved.
For Additional Information on Mosquito Control
www.TuxedoMosquitoControl.com
most efficient way yet to monitor adult mosquitoes
Emory researchers believe they have come up with the cheapest, most efficient way yet to monitor adult mosquitoes and the deadly diseases they carry, from malaria to dengue fever and West Nile Virus. Emory has filed a provisional patent on the Prokopack mosquito aspirator, but the inventors have provided simple instructions for how to make it in the Journal of Medical Entomology.
“This device has broad potential, not only for getting more accurate counts of mosquito populations, but for better understanding mosquito ecology,” says Gonzalo Vazquez-Prokopec, the invention’s namesake.
Vazquez-Prokopec is a post-doctoral fellow working with Uriel Kitron, chair and professor of environmental studies.
“There is a great need for effective and affordable mosquito sampling methods. Use of the Prokopack can increase the coverage area, and the quality of the data received, especially for blood-fed mosquitoes.
Ultimately, it can help us develop better health intervention strategies.”
In both field and lab tests, the Prokopack outperformed the current gold standard for resting mosquito surveillance – the Centers for Disease Control and Prevention Backpack Aspirator (CDC-BP). In addition to having a longer reach, enabling it to collect more mosquitoes than the CDC-BP, the Prokopack is significantly smaller, lighter, cheaper and easier to build.
Anyone with access to a hardware store, and about $45 to $70, can make the Prokopack, which uses a battery-powered motor to suck up live mosquitoes for analysis. Mosquito-borne diseases rank among the world’s top killers, and Vazquez-Prokopec hopes that more affordable and efficient surveillance methods will help save lives.
“I come from a developing country,” says the Argentine native. “I understand what it feels like to know that there is a health technology available, and to not have the money to access it.”
For decades, public health officials have struggled to conduct mosquito surveillance. One early method, with obvious drawbacks, was to expose a bit of skin and count the bites. Another low-tech method is to spray inside a home with insecticide, and gather the bugs that fall onto on a drop cloth.
Mosquito traps baited with a chemical that mimics human sweat are sometimes used to catch live adult insects. But these traps capture only females who are looking for a meal.
The CDC-BP can quickly vacuum up samples of live specimens, which can be analyzed in a lab to determine the source of blood they recently consumed. The drawbacks to the CDC-BP, however, include its heavy weight
(25 pounds), its bulk and its price – about $450 to $750 in the United States.
Emory researchers used a CDC-BP in their study of West Nile Virus and urban mosquito ecology in Atlanta. They wanted to learn if mosquitoes that harbor the virus were overwintering in nooks near the ceilings of sewer tunnels. But the CDC-BP only reaches six feet, and the tunnels are 15-feet high.
With a bit of ingenuity and a few trips to the hardware store, the research team put together a solution: a plastic container, a wire screen, a plumbing pipe coupler, a battery-powered blower motor and painter extension poles. After some experimentation with these components, the Prokopack was born.
“It’s not like we woke up one day and said, ‘Let’s invent a mosquito aspirator,’” Vazquez-Prokopec explains. “It grew out of our needs during field research.”
Comparative tests with the Prokopack and the CDC-BP were conducted outdoors and in sewer tunnels during the Emory lab’s Atlanta research projects. Additional field tests were done during a dengue fever study in Iquitos, Peru, where public health technicians are trying to control mosquitoes in homes. The Prokopack, which weighs less than two pounds, collected more mosquitoes than the CDC-BP, and reached higher int o ceilings and into foliage.
Collecting more mosquitoes ininsights into their behaviors. Upper foliage, for instance, can yield more mosquitoes resting after feeding on birds. And upper walls and ceilings of homes may harbor more mosquitoes resting after a meal on humans.
Related:
Urban mosquito research creates buzz -
http://esciencecommons.blogspot.com/2009/08/urban-mosquito-research-creates-buzz.html
“This device has broad potential, not only for getting more accurate counts of mosquito populations, but for better understanding mosquito ecology,” says Gonzalo Vazquez-Prokopec, the invention’s namesake.
Vazquez-Prokopec is a post-doctoral fellow working with Uriel Kitron, chair and professor of environmental studies.
“There is a great need for effective and affordable mosquito sampling methods. Use of the Prokopack can increase the coverage area, and the quality of the data received, especially for blood-fed mosquitoes.
Ultimately, it can help us develop better health intervention strategies.”
In both field and lab tests, the Prokopack outperformed the current gold standard for resting mosquito surveillance – the Centers for Disease Control and Prevention Backpack Aspirator (CDC-BP). In addition to having a longer reach, enabling it to collect more mosquitoes than the CDC-BP, the Prokopack is significantly smaller, lighter, cheaper and easier to build.
Anyone with access to a hardware store, and about $45 to $70, can make the Prokopack, which uses a battery-powered motor to suck up live mosquitoes for analysis. Mosquito-borne diseases rank among the world’s top killers, and Vazquez-Prokopec hopes that more affordable and efficient surveillance methods will help save lives.
“I come from a developing country,” says the Argentine native. “I understand what it feels like to know that there is a health technology available, and to not have the money to access it.”
For decades, public health officials have struggled to conduct mosquito surveillance. One early method, with obvious drawbacks, was to expose a bit of skin and count the bites. Another low-tech method is to spray inside a home with insecticide, and gather the bugs that fall onto on a drop cloth.
Mosquito traps baited with a chemical that mimics human sweat are sometimes used to catch live adult insects. But these traps capture only females who are looking for a meal.
The CDC-BP can quickly vacuum up samples of live specimens, which can be analyzed in a lab to determine the source of blood they recently consumed. The drawbacks to the CDC-BP, however, include its heavy weight
(25 pounds), its bulk and its price – about $450 to $750 in the United States.
Emory researchers used a CDC-BP in their study of West Nile Virus and urban mosquito ecology in Atlanta. They wanted to learn if mosquitoes that harbor the virus were overwintering in nooks near the ceilings of sewer tunnels. But the CDC-BP only reaches six feet, and the tunnels are 15-feet high.
With a bit of ingenuity and a few trips to the hardware store, the research team put together a solution: a plastic container, a wire screen, a plumbing pipe coupler, a battery-powered blower motor and painter extension poles. After some experimentation with these components, the Prokopack was born.
“It’s not like we woke up one day and said, ‘Let’s invent a mosquito aspirator,’” Vazquez-Prokopec explains. “It grew out of our needs during field research.”
Comparative tests with the Prokopack and the CDC-BP were conducted outdoors and in sewer tunnels during the Emory lab’s Atlanta research projects. Additional field tests were done during a dengue fever study in Iquitos, Peru, where public health technicians are trying to control mosquitoes in homes. The Prokopack, which weighs less than two pounds, collected more mosquitoes than the CDC-BP, and reached higher int o ceilings and into foliage.
Collecting more mosquitoes ininsights into their behaviors. Upper foliage, for instance, can yield more mosquitoes resting after feeding on birds. And upper walls and ceilings of homes may harbor more mosquitoes resting after a meal on humans.
Related:
Urban mosquito research creates buzz -
http://esciencecommons.blogspot.com/2009/08/urban-mosquito-research-creates-buzz.html
Chikungunya fever: an old disease re-emerges
The new era of globalization and environmental change has witnessed the arrival of many new and re-emerging diseases which create new challenges for policy makers and researchers working on infectious diseases. Massive urbanization has facilitated the spread of contagious diseases in human populations due to faster travel over greater distances and worldwide trade. Although more affluent countries are better-equipped to manage the spread and treatment of infectious diseases, it has become increasingly clear that they still face major challenges when dealing with diseases whose boundaries have been expanding due to warmer and wetter weather. A good example of such an abrupt increase in the incidence of disease are infections caused by arboviruses, whose expansion to new geographic areas has been facilitated by the establishment of new vectors. The Chikungunya outbreaks in late 2005 represent a fine example of how a virus originally from Africa and mosquitoes originally from Asia can meet in the Indian Ocean and contribute to re-emergence of a disease, and then spread to other parts of the world.
West Nile: A life changed by one mosquito bite
Rhode Island News
01:00 AM EDT on Sunday, September 20, 2009 FELICE J. FREYER Journal Medical Writer
Jana Hesser participates in the Save the Bay Swim from Newport to Jamestown in August. Less than a year earlier she was paralyzed by an unusually severe case of West Nile virus and spent two months in the hospital.
The Providence Journal / John Freidah
Before she got the fever, before her speech slowed and her mind fogged, before her legs weakened and the EMTs carried her from her second-floor condo, Jana Hesser was bitten by a mosquito.
She doesn’t remember the bite. But later she thought she could pinpoint when it happened –– an August evening in 2008 when she’d gone for a walk with her sister in the Swan Point Cemetery, in Providence. A colleague in the state Health Department told her that mosquitoes trapped in late August at that very cemetery had tested positive for West Nile virus.
Jana Hesser’s case was reported in the newspaper, in the bland, anonymous way of such reports: “Rhode Island’s first human case of West Nile virus this year was confirmed last week, in a person with a weakened immune system.”
But if you had met her then, “weakened” would not be the word you would use to describe this athletic woman in her mid-60s, an avid walker and swimmer, a Ph.D. with a demanding job supervising the Health Department’s health and behavioral surveys. True, her immune system had recently taken a beating: She suffered from lymphoma, a cancer of the body’s infection-fighting lymph system. In July 2008 she had completed a successful round of chemotherapy.
By August, though, the worst was over. She’d recovered from the chemo and her cancer was in remission. Her doctor says Hesser was “in very robust health” at that time, the day she and her younger sister decided to take a walk in the woodsy cemetery off Blackstone Boulevard.
If Swan Point is indeed where the fateful mosquito bite occurred, the sisters’ evening stroll was the start of a remarkable medical journey.
WEST NILE VIRUS first arrived in North America in 1999, somehow making its way to New York City from the Middle East. The disease passed between mosquitoes and birds. Mosquitoes bit birds and infected them; other mosquitoes bit the infected birds, and some of those mosquitoes also bit people, injecting the virus into the bloodstream. In 2000, West Nile was found in eight northeastern states. By 2002, it had reached the West Coast.
As West Nile made its way across the continent, it turned out to be a fairly benign infection, never causing widespread illness. Four out of five infected people don’t even get sick. Among the 20 percent who do feel ill, the vast majority suffer from West Nile fever, a syndrome of fever, headache, muscle pain, rash, fatigue and sometimes nausea that fades away in a few days to a few weeks.
But West Nile also showed that it could get nasty. In about 1 in 150 cases, the virus invades the nervous system, inflaming the brain or the membranes that surround it. The result is meningitis or encephalitis, or both, bringing high fever, headache, neck stiffness, stupor, disorientation, coma and tremors. Usually such patients are old or have weakened immune systems.
Then, in 2002, reports emerged of West Nile taking an especially scary form. Six people in Mississippi and Louisiana lost the use of one or more limbs, a paralysis that looked exactly like polio. These patients were not all old and sickly. Five of the six were under 60; three, like Jana Hesser, were in good health before the wrong mosquito found them.
Hesser’s first symptoms came in mid-September, 2008, near the end of her visit to the Dana-Farber Cancer Institute, in Boston. She had gone there to have stem cells collected from her blood in preparation for a stem-cell transplant. Although her cancer was in remission, a stem-cell transplant could reduce t he likelihood that it would come back. It took three days to On the third day, Hesser started running a fever. She was with her older sister, Martha Maletta, visiting from Shrewsbury, Mass., and Martha’s husband, Lon. They brought her to Miriam Hospital, where doctors prescribed antibiotics for what they thought was almost surely a bacterial infection. They sent her home with instructions to call, if the fever didn’t break.
Hesser’s fever persisted over the next several days, followed by more troubling symptoms. When she spoke, she had trouble finding the words.
Her legs grew weak, to the point that she couldn’t get out of bed. An ambulance was summoned. Hesser remembers staring at the Miriam Hospital ceiling panels as she rolled in on a stretcher. The rest of the next week is a blank.
As Hesser was being admitted, her oncologist, Dr. Anthony E. Mega, received a phone call from Dana-Farber. In stem-cell transplants, the patient’s cells are routinely tested for every conceivable infectious agent, because the transplant procedure opens the door for any lurking infections to attack. So Hesser’s cells had been thoroughly tested. And the tests had found something.
“You’re not going to believe this,” Mega recalls the Dana-Farber doctor saying. Hesser had West Nile virus. Mega was stunned: “It wasn’t even close to being on my list of what was happening.”
Hesser had received two transfusions as part of the stem-cell collection process. West Nile can be transmitted through blood donations. But all the donors were traced and found to be free of West Nile. However unlikely it seemed, Hesser’s illness could only have originated with an unlucky mosquito bite.
In the hospital, Hesser got weaker and slow to respond. “We were watching her deteriorate before our eyes,” says Andrea Schindler, a nurse practitioner in Miriam’s cancer unit who had grown attached to Hesser. “It was scary. It was very scary.”
Fearing Hesser might lose the ability to breathe, Mega transferred her to the intensive care unit so she could be quickly put on a ventilator.
A tube was inserted through her nose to feed her.
Her two sisters worked out a plan to be with her all the time. Martha and Lon Maletta, who are retired and live less than an hour away, came on weekdays. The younger sister, Marilyn Saulle, and her husband, Roger, who work during the week and live three hours away in Yonkers, N.Y., visited on weekends.
Saulle arrived on the weekend that Hesser was in the ICU. She was shocked to see her sister attached to tubes and monitors, immobilized, trembling incessantly, and barely able to respond. “It’s like she was in there,” Saulle recalls, “but she was way in there.”
Hesser’s son, Jordan Pavlides, came by every day and stayed for a couple of hours. He remained resolutely upbeat. Pavlides, now 25, knew his mother as healthy and strong; it was unimaginable to him that she wouldn’t recover. But there were days in the intensive care unit that gave him pause. He remembers her following him with her eyes, unable to speak. The best she could do was slightly raise her eyebrows.
MEANWHILE, the medical team worked to make sense of what was happening to her. No one had ever seen a case like this. Schindler, the nurse practitioner, went online to learn more, and ended up talking by phone with one of the leading experts in nervous-system infections, Dr. James J. Sejvar of the U.S. Centers for Disease Control and Prevention. Sejvar suggested treating Hesser with immunoglobulin, a substance that fires up the immune system.
Hesser did get the immunoglobulin, but it was hard to tell if it made any difference. As with most viruses, there was no other treatment.
Schindler and Mega feared she would die, as have many others with such severe illness. They also worried she would survive, but never be the same person again.
Still, Hesser continued to breathe on her own, and she was transferred out of the ICU. Slowly, she began to come back. Her memory tunes in again around this time. She remembers crowstudents hovering over her with amazement and concern. She remembers a doctor asking her a question and the excruciatingly long time it took her to organize the nerves and muscles involved in saying “yes.”
Hesser’s sisters made use of CaringBridge.com, a social networking Web site for cancer patients. They posted updates on her condition, and friends from throughout the country replied with words of encouragement.
Over the next few days Hesser gradually emerged, sitting up, finding more words. On Oct. 10, Hesser was transferred to the rehabilitation unit at Memorial Hospital of Rhode Island, in Pawtucket. Although she’d undergone physical therapy at the Miriam, she could not walk and had a persistent tremor in her hands. No one knew whether she would ever walk again. The physical therapists helped Hesser onto her feet, and with a walker she took one slow step after another. Then, a few days after arriving at Memorial, Hesser’s legs gave out. She collapsed: weakness had progressed to paralysis.
Dr. Erica Szabados, a neurologist, conducted a battery of tests and found Hesser had suffered nerve loss in her thighs and hips –– in a pattern that was “consistent with West Nile virus.” But it was a very unusual manifestation of the illness. Hesser had progressed from West Nile fever, to meningitis and encephalitis, and then ––weeks later –– to paralysis. Usually, when West Nile attacks the nervous system, the symptoms appear within the first few days. Szabados plans to report Hesser’s case in a medical journal.
Most patients with West Nile paralysis suffer lasting effects; only a third return to their previous level of functioning. But Hesser was determined to walk again. “There was a part of me,” she said later, “that expected to get well because I always have.”
On Oct. 28, she was able to stand up, clutching the walker. On Oct. 30, she took three steps. Eventually she made it 40 feet.
On Nov. 19, Hesser went home, in a wheelchair, carried up the stairs just as she had been carried down two months earlier. With her sisters taking turns staying with her, she continued to work with physical therapists, and continued to build strength. The big challenge was getting down the stairs. She practiced a step at a time, her son in front of her in case she fell, a therapist behind her holding a safety belt.
On Christmas Eve, Hesser finally left her apartment on her own two feet.
Her son held onto her belt as she descended. Using a walker, she went to a party.
From there, Hesser charged forward. January: returned to work for two hours a day, using a walker; resumed swimming. March: back to work full-time, using two canes. April: attended organizational meeting for 100-mile bike ride, with one cane. June: first bike ride, 24 miles.
August: Save the Bay swim.
Yes, you read that right. Hesser participated in the annual swim across Narragansett Bay this year, her fifth time. She covered the 1.7 miles in one hour and 10 minutes, one of her best times ever. Next Sunday, Sept.
26 –– exactly one year after lying motionless in the Miriam ICU –– she will ride 100 miles in the Seacoast Century, raising money for the Leukemia and Lymphoma Society.
Today, Hesser has returned to her previous life, with a few twists. She can walk without support, but –– despite her ability to bike and swim –– she can’t walk as fast as she’d like. She can perform her job competently, but her short-term memory sometimes fails on the less-important matters.
HER LYMPHOMA remains in complete remission. In fact, Hesser believes that the West Nile infection may have wiped it out. A Dana-Farber doctor told her that an overwhelming infection can sometimes put the immune system in hyperdrive, killing a cancer. Mega, her oncologist, calls that “a relatively far-fetched theory.” He continues to monitor Hesser for relapse. If the lymphoma does return, he’s confident she’ll respond w ell to treatment. For now, though, the bone marrow transeems too risky, as long as she’s still in remission.
Now 65, Hesser plans to retire in December, hoping to travel and visit friends around the country. Asked what she took away from the experience, Hesser names several things: her deepened appreciation for her sisters and son, without whom she doesn’t think she would have survived; her newfound admiration for the competence and compassion of medical professionals, especially nurses; a sense of “nothing bothers me anymore.”
But the biggest revelation concerns all the friends who wrote and visited. She really didn’t know so many people cared. “At some level you know you have friends, but sometimes you feel like you don’t,” Hesser says. “I will never feel alone again.” This is the part that brings her to tears. “I mean, hundreds of people.”
Everyone involved with Hesser’s extraordinary illness and recovery took something away from it. Mega calls it an example of teamwork in medicine and a testament to the human spirit. Her sisters talk about how Hesser’s willpower, and physical strength from a lifetime of healthy living, got her through it.
And nearly everyone mentions mosquitoes. How they use repellent now. How they see the annoying little insects in a new light. Just last week, a batch of mosquitoes in Pawtucket tested positive for West Nile virus. No human cases have been reported this year, but mosquitoes will remain active until the first hard frost.
“People think, ‘oh it’s a bug bite–– whatever,’ ” says Szabados, the Memorial Hospital neurologist. “But it can have consequences.”
ffreyer@projo.com
For additional Mosquito Info go to: www.tuxedomosquitocontrol.com
01:00 AM EDT on Sunday, September 20, 2009 FELICE J. FREYER Journal Medical Writer
Jana Hesser participates in the Save the Bay Swim from Newport to Jamestown in August. Less than a year earlier she was paralyzed by an unusually severe case of West Nile virus and spent two months in the hospital.
The Providence Journal / John Freidah
Before she got the fever, before her speech slowed and her mind fogged, before her legs weakened and the EMTs carried her from her second-floor condo, Jana Hesser was bitten by a mosquito.
She doesn’t remember the bite. But later she thought she could pinpoint when it happened –– an August evening in 2008 when she’d gone for a walk with her sister in the Swan Point Cemetery, in Providence. A colleague in the state Health Department told her that mosquitoes trapped in late August at that very cemetery had tested positive for West Nile virus.
Jana Hesser’s case was reported in the newspaper, in the bland, anonymous way of such reports: “Rhode Island’s first human case of West Nile virus this year was confirmed last week, in a person with a weakened immune system.”
But if you had met her then, “weakened” would not be the word you would use to describe this athletic woman in her mid-60s, an avid walker and swimmer, a Ph.D. with a demanding job supervising the Health Department’s health and behavioral surveys. True, her immune system had recently taken a beating: She suffered from lymphoma, a cancer of the body’s infection-fighting lymph system. In July 2008 she had completed a successful round of chemotherapy.
By August, though, the worst was over. She’d recovered from the chemo and her cancer was in remission. Her doctor says Hesser was “in very robust health” at that time, the day she and her younger sister decided to take a walk in the woodsy cemetery off Blackstone Boulevard.
If Swan Point is indeed where the fateful mosquito bite occurred, the sisters’ evening stroll was the start of a remarkable medical journey.
WEST NILE VIRUS first arrived in North America in 1999, somehow making its way to New York City from the Middle East. The disease passed between mosquitoes and birds. Mosquitoes bit birds and infected them; other mosquitoes bit the infected birds, and some of those mosquitoes also bit people, injecting the virus into the bloodstream. In 2000, West Nile was found in eight northeastern states. By 2002, it had reached the West Coast.
As West Nile made its way across the continent, it turned out to be a fairly benign infection, never causing widespread illness. Four out of five infected people don’t even get sick. Among the 20 percent who do feel ill, the vast majority suffer from West Nile fever, a syndrome of fever, headache, muscle pain, rash, fatigue and sometimes nausea that fades away in a few days to a few weeks.
But West Nile also showed that it could get nasty. In about 1 in 150 cases, the virus invades the nervous system, inflaming the brain or the membranes that surround it. The result is meningitis or encephalitis, or both, bringing high fever, headache, neck stiffness, stupor, disorientation, coma and tremors. Usually such patients are old or have weakened immune systems.
Then, in 2002, reports emerged of West Nile taking an especially scary form. Six people in Mississippi and Louisiana lost the use of one or more limbs, a paralysis that looked exactly like polio. These patients were not all old and sickly. Five of the six were under 60; three, like Jana Hesser, were in good health before the wrong mosquito found them.
Hesser’s first symptoms came in mid-September, 2008, near the end of her visit to the Dana-Farber Cancer Institute, in Boston. She had gone there to have stem cells collected from her blood in preparation for a stem-cell transplant. Although her cancer was in remission, a stem-cell transplant could reduce t he likelihood that it would come back. It took three days to On the third day, Hesser started running a fever. She was with her older sister, Martha Maletta, visiting from Shrewsbury, Mass., and Martha’s husband, Lon. They brought her to Miriam Hospital, where doctors prescribed antibiotics for what they thought was almost surely a bacterial infection. They sent her home with instructions to call, if the fever didn’t break.
Hesser’s fever persisted over the next several days, followed by more troubling symptoms. When she spoke, she had trouble finding the words.
Her legs grew weak, to the point that she couldn’t get out of bed. An ambulance was summoned. Hesser remembers staring at the Miriam Hospital ceiling panels as she rolled in on a stretcher. The rest of the next week is a blank.
As Hesser was being admitted, her oncologist, Dr. Anthony E. Mega, received a phone call from Dana-Farber. In stem-cell transplants, the patient’s cells are routinely tested for every conceivable infectious agent, because the transplant procedure opens the door for any lurking infections to attack. So Hesser’s cells had been thoroughly tested. And the tests had found something.
“You’re not going to believe this,” Mega recalls the Dana-Farber doctor saying. Hesser had West Nile virus. Mega was stunned: “It wasn’t even close to being on my list of what was happening.”
Hesser had received two transfusions as part of the stem-cell collection process. West Nile can be transmitted through blood donations. But all the donors were traced and found to be free of West Nile. However unlikely it seemed, Hesser’s illness could only have originated with an unlucky mosquito bite.
In the hospital, Hesser got weaker and slow to respond. “We were watching her deteriorate before our eyes,” says Andrea Schindler, a nurse practitioner in Miriam’s cancer unit who had grown attached to Hesser. “It was scary. It was very scary.”
Fearing Hesser might lose the ability to breathe, Mega transferred her to the intensive care unit so she could be quickly put on a ventilator.
A tube was inserted through her nose to feed her.
Her two sisters worked out a plan to be with her all the time. Martha and Lon Maletta, who are retired and live less than an hour away, came on weekdays. The younger sister, Marilyn Saulle, and her husband, Roger, who work during the week and live three hours away in Yonkers, N.Y., visited on weekends.
Saulle arrived on the weekend that Hesser was in the ICU. She was shocked to see her sister attached to tubes and monitors, immobilized, trembling incessantly, and barely able to respond. “It’s like she was in there,” Saulle recalls, “but she was way in there.”
Hesser’s son, Jordan Pavlides, came by every day and stayed for a couple of hours. He remained resolutely upbeat. Pavlides, now 25, knew his mother as healthy and strong; it was unimaginable to him that she wouldn’t recover. But there were days in the intensive care unit that gave him pause. He remembers her following him with her eyes, unable to speak. The best she could do was slightly raise her eyebrows.
MEANWHILE, the medical team worked to make sense of what was happening to her. No one had ever seen a case like this. Schindler, the nurse practitioner, went online to learn more, and ended up talking by phone with one of the leading experts in nervous-system infections, Dr. James J. Sejvar of the U.S. Centers for Disease Control and Prevention. Sejvar suggested treating Hesser with immunoglobulin, a substance that fires up the immune system.
Hesser did get the immunoglobulin, but it was hard to tell if it made any difference. As with most viruses, there was no other treatment.
Schindler and Mega feared she would die, as have many others with such severe illness. They also worried she would survive, but never be the same person again.
Still, Hesser continued to breathe on her own, and she was transferred out of the ICU. Slowly, she began to come back. Her memory tunes in again around this time. She remembers crowstudents hovering over her with amazement and concern. She remembers a doctor asking her a question and the excruciatingly long time it took her to organize the nerves and muscles involved in saying “yes.”
Hesser’s sisters made use of CaringBridge.com, a social networking Web site for cancer patients. They posted updates on her condition, and friends from throughout the country replied with words of encouragement.
Over the next few days Hesser gradually emerged, sitting up, finding more words. On Oct. 10, Hesser was transferred to the rehabilitation unit at Memorial Hospital of Rhode Island, in Pawtucket. Although she’d undergone physical therapy at the Miriam, she could not walk and had a persistent tremor in her hands. No one knew whether she would ever walk again. The physical therapists helped Hesser onto her feet, and with a walker she took one slow step after another. Then, a few days after arriving at Memorial, Hesser’s legs gave out. She collapsed: weakness had progressed to paralysis.
Dr. Erica Szabados, a neurologist, conducted a battery of tests and found Hesser had suffered nerve loss in her thighs and hips –– in a pattern that was “consistent with West Nile virus.” But it was a very unusual manifestation of the illness. Hesser had progressed from West Nile fever, to meningitis and encephalitis, and then ––weeks later –– to paralysis. Usually, when West Nile attacks the nervous system, the symptoms appear within the first few days. Szabados plans to report Hesser’s case in a medical journal.
Most patients with West Nile paralysis suffer lasting effects; only a third return to their previous level of functioning. But Hesser was determined to walk again. “There was a part of me,” she said later, “that expected to get well because I always have.”
On Oct. 28, she was able to stand up, clutching the walker. On Oct. 30, she took three steps. Eventually she made it 40 feet.
On Nov. 19, Hesser went home, in a wheelchair, carried up the stairs just as she had been carried down two months earlier. With her sisters taking turns staying with her, she continued to work with physical therapists, and continued to build strength. The big challenge was getting down the stairs. She practiced a step at a time, her son in front of her in case she fell, a therapist behind her holding a safety belt.
On Christmas Eve, Hesser finally left her apartment on her own two feet.
Her son held onto her belt as she descended. Using a walker, she went to a party.
From there, Hesser charged forward. January: returned to work for two hours a day, using a walker; resumed swimming. March: back to work full-time, using two canes. April: attended organizational meeting for 100-mile bike ride, with one cane. June: first bike ride, 24 miles.
August: Save the Bay swim.
Yes, you read that right. Hesser participated in the annual swim across Narragansett Bay this year, her fifth time. She covered the 1.7 miles in one hour and 10 minutes, one of her best times ever. Next Sunday, Sept.
26 –– exactly one year after lying motionless in the Miriam ICU –– she will ride 100 miles in the Seacoast Century, raising money for the Leukemia and Lymphoma Society.
Today, Hesser has returned to her previous life, with a few twists. She can walk without support, but –– despite her ability to bike and swim –– she can’t walk as fast as she’d like. She can perform her job competently, but her short-term memory sometimes fails on the less-important matters.
HER LYMPHOMA remains in complete remission. In fact, Hesser believes that the West Nile infection may have wiped it out. A Dana-Farber doctor told her that an overwhelming infection can sometimes put the immune system in hyperdrive, killing a cancer. Mega, her oncologist, calls that “a relatively far-fetched theory.” He continues to monitor Hesser for relapse. If the lymphoma does return, he’s confident she’ll respond w ell to treatment. For now, though, the bone marrow transeems too risky, as long as she’s still in remission.
Now 65, Hesser plans to retire in December, hoping to travel and visit friends around the country. Asked what she took away from the experience, Hesser names several things: her deepened appreciation for her sisters and son, without whom she doesn’t think she would have survived; her newfound admiration for the competence and compassion of medical professionals, especially nurses; a sense of “nothing bothers me anymore.”
But the biggest revelation concerns all the friends who wrote and visited. She really didn’t know so many people cared. “At some level you know you have friends, but sometimes you feel like you don’t,” Hesser says. “I will never feel alone again.” This is the part that brings her to tears. “I mean, hundreds of people.”
Everyone involved with Hesser’s extraordinary illness and recovery took something away from it. Mega calls it an example of teamwork in medicine and a testament to the human spirit. Her sisters talk about how Hesser’s willpower, and physical strength from a lifetime of healthy living, got her through it.
And nearly everyone mentions mosquitoes. How they use repellent now. How they see the annoying little insects in a new light. Just last week, a batch of mosquitoes in Pawtucket tested positive for West Nile virus. No human cases have been reported this year, but mosquitoes will remain active until the first hard frost.
“People think, ‘oh it’s a bug bite–– whatever,’ ” says Szabados, the Memorial Hospital neurologist. “But it can have consequences.”
ffreyer@projo.com
For additional Mosquito Info go to: www.tuxedomosquitocontrol.com
Mosquito control -- licensed to kill (part one)
Adulticide
On a sultry summer evening, under the spreading light of a streetlamp, two children play a game of hopscotch. So absorbed in their activity are they, completely unmindful of their surroundings, that they do not see or hear the stranger approaching.
Slowly but purposefully, the silent killer creeps along, getting ever closer. Something alerts them, the truck engine, perhaps, and the girls look up from their game.
The driver of the mosquito control truck has shut off his spray. He smiles and gives the girls a wave, waiting until he is safely past them before switching back on the fine mist that wafts up into the night air, in search of mosquitoes seeking to feed on the children.
This “silent killer” is adulticiding, which sounds a bit strange and mysterious to the layman. If homicide is the act of killing a man, or homid, why not simply call mosquito spraying “mosquitociding?
Killing mosquitoes generally falls into two categories: killing adult mosquitoes, or adulticiding, and killing them in the larval stage, or larviciding.
Adulticiding can be as simple as swatting a mosquito that has landed on your arm, or as awe-inspiring as a DC-3 roaring down Fort Meyers Beach at 200 feet above the ground with a thick white cloud of pesticide billowing out behind.
Until recently, one of the most popular ways of getting pesticide into contact with airborne mosquitoes was through the use of a thermal fog.
Pesticide – most popularly DDT just after World War II, and in later years Malathion – is mixed with diesel oil, heated and released as a cloud of tiny white particles resembling smoke. Many older Floridians have fond memories of riding their bikes behind the DDT truck. They wanted to be coated with pesticide so they could stay out late and play without being bothered by mosquitoes. An appalling practice by today's sensibilities, it doesn't seem to have harmed them in the long run.
The latest adulticide technology involves applying an Ultra Low Volume
(ULV) spray of undiluted pesticide. This does away with the diesel oil “carrier,” which makes it a good deal more efficient, environmentally friendly, and doesn't cause traffic accidents due to reduced visibility.
Tiny droplets, in the size range of 10 – 15 microns (a typical human hair is 100 microns in diameter), are released up into the air, where they spread out to be carried on the evening breeze. Droplets this small tend to remain airborne until they come into contact with a blood-seeking mosquito. The size is no accident; the equipment is calibrated so that the droplets contain just enough pesticide to kill a mosquito, yet too little to harm larger, non-target insects. Since there is much less wasted pesticide, the amount required is significantly smaller. The machines are quieter and the pesticide plume nearly invisible, resulting in numerous calls to mosquito control organizations from citizens who “haven't seen or heard the truck go by in a long
time....”*
Adulticiding at the organizational level is accomplished most commonly by truck-mounted spray systems, but also by airplane, helicopter, all-terrain vehicle, and even occasionally airboat. Mosquito control inspectors who respond to domestic service requests are equipped with hand-held sprayers, which they may use for small area space spraying, or to create a barrier around homes surrounded by extensive foliage.
The adulticides themselves have also changed over the years. A common family of pesticides in use today involves formulations of synthesized pyrethrum, a natural insect-killing substance derived from chrysanthemums (ironically one of the first pesticides, dating back to around 400 B.C.)
Killing all the mosquitoes isn't possible, however. These flying menaces have been around since the dinosaurs roamed the earth; they have tremendous staying power. Part of the ir strength is their ability to adapt and develop resistance organizations have to rotate their pesticides every few years to prevent this. One tried and true pesticide, often used in aerial applications, is naled. This organophosphate not only disrupts the mosquito's nervous system, it is also caustic in nature, burning the mosquito in addition to poisoning it. A deadly killer of mosquitoes, it's unfortunately also good at eating up application equipment. Every pesticide has its drawbacks.
Thus mosquito adulticiding is a balancing act, taking into account a multitude of variables: Protecting the health and welfare of the human population; good environmental stewardship; avoiding pesticide resistance; and budget and manpower constraints. By and large, spray trucks no longer run on regular routes and schedules. Managers compile data gathered from mosquito traps, service requests, disease surveillance programs and actual observations by mosquito control inspectors to make decisions on what to spray, where to spray, when to spray, and what to spray it from.
Mosquitoes are adaptable; but so are the men and women dedicated to keeping them at bay.
Additional information on Mosquito Control Go To: href="http://www.TuxedoMosquitoControl.Com">www.TuxedoMosquitoControl.com
On a sultry summer evening, under the spreading light of a streetlamp, two children play a game of hopscotch. So absorbed in their activity are they, completely unmindful of their surroundings, that they do not see or hear the stranger approaching.
Slowly but purposefully, the silent killer creeps along, getting ever closer. Something alerts them, the truck engine, perhaps, and the girls look up from their game.
The driver of the mosquito control truck has shut off his spray. He smiles and gives the girls a wave, waiting until he is safely past them before switching back on the fine mist that wafts up into the night air, in search of mosquitoes seeking to feed on the children.
This “silent killer” is adulticiding, which sounds a bit strange and mysterious to the layman. If homicide is the act of killing a man, or homid, why not simply call mosquito spraying “mosquitociding?
Killing mosquitoes generally falls into two categories: killing adult mosquitoes, or adulticiding, and killing them in the larval stage, or larviciding.
Adulticiding can be as simple as swatting a mosquito that has landed on your arm, or as awe-inspiring as a DC-3 roaring down Fort Meyers Beach at 200 feet above the ground with a thick white cloud of pesticide billowing out behind.
Until recently, one of the most popular ways of getting pesticide into contact with airborne mosquitoes was through the use of a thermal fog.
Pesticide – most popularly DDT just after World War II, and in later years Malathion – is mixed with diesel oil, heated and released as a cloud of tiny white particles resembling smoke. Many older Floridians have fond memories of riding their bikes behind the DDT truck. They wanted to be coated with pesticide so they could stay out late and play without being bothered by mosquitoes. An appalling practice by today's sensibilities, it doesn't seem to have harmed them in the long run.
The latest adulticide technology involves applying an Ultra Low Volume
(ULV) spray of undiluted pesticide. This does away with the diesel oil “carrier,” which makes it a good deal more efficient, environmentally friendly, and doesn't cause traffic accidents due to reduced visibility.
Tiny droplets, in the size range of 10 – 15 microns (a typical human hair is 100 microns in diameter), are released up into the air, where they spread out to be carried on the evening breeze. Droplets this small tend to remain airborne until they come into contact with a blood-seeking mosquito. The size is no accident; the equipment is calibrated so that the droplets contain just enough pesticide to kill a mosquito, yet too little to harm larger, non-target insects. Since there is much less wasted pesticide, the amount required is significantly smaller. The machines are quieter and the pesticide plume nearly invisible, resulting in numerous calls to mosquito control organizations from citizens who “haven't seen or heard the truck go by in a long
time....”*
Adulticiding at the organizational level is accomplished most commonly by truck-mounted spray systems, but also by airplane, helicopter, all-terrain vehicle, and even occasionally airboat. Mosquito control inspectors who respond to domestic service requests are equipped with hand-held sprayers, which they may use for small area space spraying, or to create a barrier around homes surrounded by extensive foliage.
The adulticides themselves have also changed over the years. A common family of pesticides in use today involves formulations of synthesized pyrethrum, a natural insect-killing substance derived from chrysanthemums (ironically one of the first pesticides, dating back to around 400 B.C.)
Killing all the mosquitoes isn't possible, however. These flying menaces have been around since the dinosaurs roamed the earth; they have tremendous staying power. Part of the ir strength is their ability to adapt and develop resistance organizations have to rotate their pesticides every few years to prevent this. One tried and true pesticide, often used in aerial applications, is naled. This organophosphate not only disrupts the mosquito's nervous system, it is also caustic in nature, burning the mosquito in addition to poisoning it. A deadly killer of mosquitoes, it's unfortunately also good at eating up application equipment. Every pesticide has its drawbacks.
Thus mosquito adulticiding is a balancing act, taking into account a multitude of variables: Protecting the health and welfare of the human population; good environmental stewardship; avoiding pesticide resistance; and budget and manpower constraints. By and large, spray trucks no longer run on regular routes and schedules. Managers compile data gathered from mosquito traps, service requests, disease surveillance programs and actual observations by mosquito control inspectors to make decisions on what to spray, where to spray, when to spray, and what to spray it from.
Mosquitoes are adaptable; but so are the men and women dedicated to keeping them at bay.
Additional information on Mosquito Control Go To: href="http://www.TuxedoMosquitoControl.Com">www.TuxedoMosquitoControl.com
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