"Bird Flu?" Let's Learn from our West Nile Virus Ractions!

What happens internationally will affect us domestically, and our domestic public health policies will impact people globally.

These Microbial, Parasitical, and Viral predators abound, are presenting a profound threat to our health and the success of our traditionally implemented public health intervention programs. The last decade has been inflicted by several striking outbreaks of infectious diseases in Northern America, such as the West Nile Virus (WNV), SARS, and E.coli O157.

Due to globalization, In September, 1999 a new viral encephalitis outbreak appeared in the New York metropolitan area. This outbreak fostered several media campaigns as well as ineffective approaches to control the “state of emergency”. As of November 2006, over 14,000 people in the United States were infected with the WNV (some of these cases were considered severe involving meningitis or encephalitis) causing more than 900 documented deaths.

Background:
The West Nile virus, found both in tropical and temperate regions, is a virus of the family of Flaviviridae. This virus belongs to a large group of arthropod-borne viruses (nicknamed ARBO viruses) which include many viruses that in general cause encephalitis and other known diseases such as the dengue fever and the yellow fever.Epidemics, like wars, test the limits of freedom in our society. The massive pesticide case in New York City is a sobering reminder that the interest of the individual must on occasion be tempered by the best interest of the community as a whole (based on the government’s views).

Using Pesticides to Control Mosquito Populations:
In New York City, in 1999, when the public heard of the fatal WNV epidemic that is being spread by mosquitoes, they turned to the federal, state and local government for a quick solution. Most government officials were caught off guard and were unprepared to handle a “state of emergency”. Government officials did not develop a plan to effectively tackle an outbreak like this; Pesticide spraying provided a quick and easy fix to a very complicated and multifactorial problem. Thinking that they had to do something “quick”, most government officials put their fingers firmly on the pesticide trigger, deciding that it is the best solution. Unfortunately, they did not think about what would be a safer or more effective intervention that will control this epidemic. These officials now could say that they had done “something”, instead of being blamed for a lag in response.

Later on people started questioning whether the government’s response caused more harm than good. In September, 1999 the pesticide spray planes had taken to the air and the spray trucks to the streets and the city’s residents were being sprayed with Malathion, a controversial neurotoxic pesticide. A storm fell over the environmental and public health community as officials wondered whether this intervention (using a neurotoxic pesticide) was effective and reasonable. Environmental activists opposed this intervention. That same month in speaking to the public’s fear, Mayor Rudolph Giuliani rejected the hazards of spraying saying, “There’s no point in not spraying, because there’s no harm in spraying. So even if we’re overdoing it, there’s no risk to anyone in overdoing it.” He added “the more dead mosquitoes…the better” [18]. This statement from the mayor undermines the forty years of research that indicated that this pesticide (Malathion in particular) is carcinogenic, causes genetical mutations, and neurological disorders. After this statement, public health officials knew that their goals should not only include educating the public about the WNV but also countering misleading information about the adverse effects of pesticide exposure and provide alternative solutions.

The pesticide that was chosen to be used in New York City’s mass spraying was an organophosphate. They are classified in the highest toxicity class of pesticides. Their mechanism is to inhibit the cholinesterase enzymes, which inactivates the nerve transmitter acetylcholine.

Transparency is important. In the United States’ democratic society, all legitimate stakeholders in New York City should have been properly informed about the WNV and the benefits and consequences of the option of using pesticides to control mosquitoes. The public should know the risks and benefits of the various alternative options, and have an input into discussions on issues that affect them, particularly those that affect their health and well-being (such as using neurotoxic pesticides). Initially, there was no dialogue with the stakeholders and the government officials made quick decisions. As the information became available to the public over the following years, it became clear that the WNV, although a serious infectious disease, was not as catastrophic as what it was portrayed to be. Cases reported to the CDC showed that most people who get infected with the WNV are asymptomatic. The vast majority of those who displayed symptoms were either elderly or people with a compromised immune or nervous systems. Moreover, the CDC then concluded that 80-90% of those bitten by an infected mosquito will be asymptomatic, about 20% may exhibit flu-like symptoms, and less than 1% will develop the more severe meningoencephalitis form of this disease. Approximately 10% of these severe cases are fatal (more commonly in the elderly). The irony is that the same people who are at high risk for contracting a severe case of WNV are the same people who are at high risk from pesticide poisoning (the elderly and people with compromised immune system).

Conclusion:
Pesticide spraying for the WNV has raised awareness among the public of the potential hazards of pesticides. Individuals across the country have become activists against their use (especially the more toxic forms). This became an opportunity for community members to educate themselves and other on pesticide use not only in mosquito management programs but also in other areas (for example, agriculture). In addition, many decision makers, such as public health and government officials, have rejected mass spraying, unilateral action for the public’s involvement, and the use of toxic pesticides. The use of pesticides was replaced with non-toxic alternatives and practices to control mosquitoes. These public health and government officials should be highly praised for not only protecting the public from the WNV and pesticide exposure, but also for causing a positive cultural change that rejects toxic pesticide use and embraces the safer integrated pest management program [29].