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Published Date: 2019-09-10 21:35:33
Subject: PRO/AH/EDR> Eastern equine encephalitis - North America (18): USA human, horse, deer
Archive Number: 20190910.6667626
EASTERN EQUINE ENCEPHALITIS - NORTH AMERICA (18): USA HUMAN, HORSE, DEER
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International Society for Infectious Diseases
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In this update:
[1] 2 new human EEE cases Massachusetts
[2] 8th Horse and human in Massachusetts
[3] Suspected human cases SW Michigan
[4] Deer, horses, humans positive, Michigan
[5] Indiana: 2 horses
[6] 5 more horses and an alpaca in New Jersey

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[1] 2 new human cases Massachusetts
Date: Fri 6 Sep 2019
Source: Boston Globe [edited]
https://www.bostonglobe.com/metro/2019/09/06/two-more-human-cases-eee-confirmed-state-health-officials-people-have-contracted-virus/uFSuUSiSixfN7OXSLtHwbP/story.html?p1=HP_Feed_ContentQuery


Officials confirmed 2 more human cases of eastern equine encephalitis [EEE] Friday [6 Sep 2019], including a 5-year-old Sudbury girl and a Northborough woman in her 60s, and one state scientist said she expects more cases in coming weeks.

According to Sudbury town officials, the child is in critical condition at an area hospital. All outdoor evening town and school activities in Sudbury were cancelled Friday [6 Sep 2019]. Outdoor events for Lincoln-Sudbury Regional High School were also cancelled.

Northborough's health agent confirmed in a statement that the other new case of EEE was a town resident.

The new cases brought the state's tally to 7 and caused risk levels to be raised in a number of Massachusetts communities. In Framingham, Marlborough, Northborough, and Sudbury, the risk levels were raised to critical, while the levels in Berlin, Boylston, Hudson, Maynard, Stow, and Wayland have been raised to high.

Critical risk prompts the state to encourage outdoor gatherings like organized sports events be cancelled or rescheduled to avoid the peak mosquito hours from dusk until dawn. High risk means "conditions likely to lead to infection of a person with EEE occurring in your area."

EEE is a rare but potentially fatal disease that can cause brain inflammation and is transmitted to humans bitten by infected mosquitoes, according to federal authorities. Those who recover from it often live with severe and devastating neurological complications. There is no treatment.

Earlier this year [2019], a Fairhaven woman with EEE died.

Although local mosquito populations are beginning to decrease because of the cooler temperatures, EEE risk in the state will continue until not just the 1st frost, but the 1st "hard frost," said Dr. Catherine Brown, an epidemiologist for the state.

Speaking at a press conference in downtown Boston, Brown said more human cases of EEE in Massachusetts are likely this year [2019], including possible deaths, but she stopped short of calling the current rash of illnesses a public health crisis.

"It is certainly something that we are paying a lot of attention to," she said. She said historically most people who get the disease in Massachusetts become sick before 15 Sep when temperatures typically begin falling.

The state, said Brown, is approaching the "end of the traditional peak transmission period."

Still, the state's public health commissioner, Dr. Monica Bharel, said in a statement confirming the 2 most recent cases that it is "not unusual to see human EEE cases confirmed in September. This is why we continue to urge the public to take seriously the threat that mosquitoes can pose and to take steps to avoid being bitten," she said in the statement.

EEE cycles are "partially triggered when a new variant of the virus" is introduced to the state by migratory birds from the southeastern part of the country, she said. "We think that is probably what happened this year [2019]," she said.

About 1/3rd of infected individuals who develop the disease die, according to federal officials. And, Brown said, survivors can have "very high levels of permanent neurological impairment."

Symptoms can include high fever and headaches, but because the virus invades the central nervous system, patients can also have "rapid progression in changes of level of consciousness and seizures," said Brown.

On Thursday [5 Sep 2019], officials announced that the state's 5th human case of EEE this year had been confirmed in a man in his 70s from southwestern Middlesex County. That case prompted officials to raise risk levels for EEE in Ashland, Hopedale, and Milford to critical and the risk levels in Bellingham, Blackstone, and Millville to high. All told, 36 communities are now at critical risk, 42 at high risk, and 115 at moderate risk for the EEE virus in Massachusetts, according to state officials.

Also, 9 cases of EEE have been confirmed this year [2019] in animals: 8 horses and one goat.

The MSPCA is expanding its emergency EEE vaccination services for horses whose owners cannot afford the vaccination to Southern New Hampshire, Bristol County, and south-central Massachusetts, the group announced Friday [6 Sep 2019].

The emergency clinic was originally serving only the Merrimack Valley -- where one horse died in Methuen -- but the MSPCA chose to expand it because of the high demand from horse owners in Southern and Western Massachusetts, as well as Southern New Hampshire, said Rob Halpin, a spokesman for the Massachusetts Society for the Prevention of Cruelty to Animals.

Local communities are continuing truck-mounted spraying for mosquitoes, authorities said. The state completed aerial mosquito spraying in parts of Bristol, Plymouth, Middlesex, and Worcester counties in August 2019. Sudbury will have town-wide spraying on Monday and Tuesday [9-10 Sep 2019], weather permitting.

The EEE virus has also been detected on the Outer Cape, with mosquitoes carrying the potentially deadly disease found in Wellfleet, according to town officials.

In a statement dated Wednesday [5 Sep 2019], officials in the popular summer tourist town said the "Massachusetts Department of Public Health (MDPH) announced today that EEE virus has been detected in mosquitoes collected from Wellfleet. The samples were taken on 29 Aug 2019, and we continue to sample the area."

[Byline: Danny McDonald and Travis Andersen]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Transmission of EEE virus to humans requires mosquito species capable serving as a link between infected birds and uninfected mammals such as some species of Aedes, Coquillettidia, and Culex. Although EEE virus transmission can be expected to decline further into September 2019, the areas of transmission will not be totally free of risk of infection until the 1st killing frosts occur, usually in mid-October. Meanwhile, horse owners should take advantage of the equine vaccination opportunities being offered, and people should avoid mosquito bites. - Mod.TY

HealthMap/ProMED-mail map:
Massachusetts, United States: http://healthmap.org/promed/p/224]

******
[2] 8th Horse and human in Massachusetts
Date: Wed 4 Sep 2019
Source: This Week in Worcester [edited]
https://thisweekinworcester.com/douglas-horses-eee-virus/


The Massachusetts Department of Public Health [DPH] announced on Tuesday [3 Sep 2019] that a horse in Douglas has been confirmed as being infected with eastern equine encephalitis [EEE] virus infection.

The new case brings the total number of horse cases of EEE to 8 in Massachusetts this year [2019]. As a result of this finding, the risk level in Douglas has been raised to critical and the risk level in Oxford and Webster has been raised to high.

"Cases of EEE in mammals, including horses, serve as a reminder that there is a continuing risk to humans," said Public Health Commissioner Monica Bharel, MD, MPH. "Even as we head into September [2019], it remains critically important that people take steps to protect themselves and their families from mosquito bites."

In total, there are 29 communities now at critical risk, 39 at high risk, and 123 at moderate risk for the EEE virus in Massachusetts. [A map of the state's current EEE risk levels can be found in the URL above].

There have been 4 confirmed human cases of EEE this year [2019], including a male in Grafton.

The DPH is imploring all Massachusetts residents to use mosquito repellent, and those in high and critical risk communities should consider staying indoors during the dusk to dawn hours to reduce exposure to mosquitoes.

[Byline: Patrick Sargent]

--
Communicated by:
ProMED-mail
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******
[3] Suspected human cases SW Michigan
Date: Wed 4 Sep 2019
Source: WOODTV [edited]
https://www.woodtv.com/news/kzoo-and-bc/suspected-human-cases-of-eee-growing-2-confirmed-in-sw-mi/


Michigan health officials are investigating 5 more potential cases of a dangerous mosquito-borne disease in West Michigan.

Michigan Department of Health and Human Services spokeswoman Lynn Sutfin says the agency has confirmed 2 cases of eastern equine encephalitis in Kalamazoo and Berrien counties. She says MDHHS is investigating another 5 suspected cases: 4 in Kalamazoo County and one in Berrien County.

Sutfin says all of those sickened were hospitalized at some point. However, their current conditions are unclear.

A Kalamazoo County girl is among those who came down with the disease. SDH, 14, remains in the hospital but is off a ventilator, according to a Facebook update by her mother.

Her family is planning to eventually transfer her to Mary Free Bed Rehabilitation Hospital in Grand Rapids to begin the long road to recovery.

EEE is one of the most dangerous diseases mosquitoes can carry. Although human cases are rare, approximately one in 3 people sickened by EEE will die from it.

Symptoms of EEE include fever, chills and body aches. Severe cases can lead to headaches, disorientation, tremors, seizures, paralysis, brain damage, coma and death.

EEE is more deadly among horses, with a fatality rate of 90%, but there is a vaccine for horses and not for humans.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The case in the 14-year-old girl is indeed unfortunate, as is the situation with the other human clinical cases. There is a significant risk of permanent neurological damage following clinical encephalitis. CDC reports that many individuals with clinical encephalitis "are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. Many patients with severe sequelae die within a few years." (https://www.cdc.gov/easternequineencephalitis/tech/symptoms.html). - Mod.TY

HealthMap/ProMED-mail map of Michigan, United States: http://healthmap.org/promed/p/225
Michigan county map: https://www.mapsofworld.com/usa/states/michigan/michigan-county-map.html/.]

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[4] Deer, horses, humans positive, Michigan
Date: Thu 5 Sep 2019
Source: WWMT 3 [edited]
https://wwmt.com/news/local/deer-tests-positive-for-rare-mosquito-borne-disease-in-kalamazoos-winchell-neighborhood


A wildlife biologist and pathologist with the Michigan Department of Natural Resources confirmed Wednesday [4 Sep 2019] that a Kalamazoo deer tested positive for the rare eastern equine encephalitis virus.

Thomas Cooley, who works in the DNR's Wildlife Disease Laboratory, said wildlife health pathologists tested a 5-year-old female deer euthanized last week by the Kalamazoo Police Department.

The deer was spotted by a homeowner along Frederick Avenue in Kalamazoo's Oakland-Winchell neighborhood. Cooley said the deer was spotted for about 30 hours in the homeowner's backyard. During that time, the deer was stumbling, showing little fear of humans and foaming at the mouth, the homeowner reported.

The deer was put down 26 Aug [2019], picked up the following day, and arrived in the Wildlife Disease Lab on 28 Aug [2019]. The lab staff expedited the testing process, which involves looking at the deer's brain. The tests returned positive results for EEE on Wed 4 Sep 2019.

The DNR, on its website, reports that mammals are typically considered dead-end hosts of the virus. Not enough virus is produced in their blood to infect newly biting mosquitoes. There is also no evidence that infected mammals are able to transmit the virus by direct contact, experts report.

EEE [virus] is primarily transmitted through mosquito viral vectors, especially the _Cutiseta melanura_ species, which prefers to feed on birds. In most native birds, the disease shows no apparent symptoms. There are several mosquito species that can bridge the virus between birds and mammals.

Lynn Sutfiin, a spokeswoman with the Michigan Department of Health and Human Services shared the latest additional cases of EEE or suspected cases in West Michigan. They included:

Human cases:
Kalamazoo County: 1
Berrien County: 1
Additional Suspected cases: 4 in Kalamazoo County, 1 in Berrien County

Horses:
Barry County: 2
Kalamazoo County: 3
St. Joseph County: 2

White-tailed deer:
Barry County: 1
Cass County: 1

Sutfin said all of those sickened were hospitalized at some point. A Kalamazoo girl, 14-year-old SDH, was among those fighting the disease. According to an update posted to Facebook by her mother on Wed 4 Sep 2019, she was still in the hospital but making slow improvements.

To avoid infection of mosquito-borne diseases, the MDHHS recommends:
- Apply insect repellents to exposed skin and clothing when outdoors.
- Wear long-sleeved shirts and pants.
- Keep windows and door screens intact
- Empty water from mosquito breeding sites, such as buckets, unused kiddie pools, old tires, or other small stagnant pools where mosquitoes could lay eggs.
- Use nets or fans over outdoor eating areas.

The Michigan Department of Health and Human Services says as of Monday [2 Sep 2019], it's confirmed 6 cases of EEE in horses in Barry, Kalamazoo and St. Joseph counties. None of the sickened horses were vaccinated against EEE, and all of them have died, according to the MDHHS.

The state says 2 deer in Barry and Cass counties have also been diagnosed with EEE.

[Byline: Will Haenni]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[It remains baffling why people neglect or refuse to vaccinate their horses when vaccination has proven to provide protection for your horse, when used appropriately. The vaccine is a combination of 2 vaccines given approximately 3 weeks apart. Owners in areas where the EEE burden is high, such as the Gulf Coast states and those on the Eastern seaboard of the US, should be vaccinating with a booster shot about every 3 months, as EEE immunity wanes very quickly. There are other equine diseases we would love to have a vaccine to prevent and there is no vaccine. However, there is a vaccine, an effective vaccine. Please take appropriate care of your animals and vaccinate the animal! You can augment the efforts of the vaccine by using horse safe or horse approved mosquito and fly repellent.

EEE is known to affect other animals, such as alpacas, deer, and especially horses. You cannot catch EEE from your horse or alpaca or deer or even from another human being. The virus is transmitted by mosquitoes. Eliminating mosquito breeding locations, such as water in old tires, or in the catch pan of potted plants, or any other places can help decrease the mosquito population. - Mod.TG]

******
[5] Indiana: 2 horses
Date: Mon 2 Sep 2019
Source: News18 [edited]
https://www.news18.com/news/india/eastern-equine-encephalitis-two-indiana-horses-diagnosed-with-rare-mosquito-borne-disease-2293849.html


The office of the Indiana state veterinarian reported on 29 Aug 2019 that 2 Elkhart County horses were confirmed with eastern equine encephalitis (EEE). A mosquito-borne disease like malaria, dengue, chikungunya and zika, the EEE virus is a rare cause of brain infections (encephalitis) where approximately 30% of people with EEE die and many survivors have ongoing neurologic problems, says CDC.

According to a report in The Horse, the 1st horse, a 6-year-old gelding showed clinical signs of collapsing and contracting cast, lockjaw and seizures. Veterinarians euthanised the unvaccinated gelding, and on 23 Aug [2019], it was confirmed that the horse had contracted EEE.

The 2nd horse, a 3-year-old grade mare showed mild neurological signs, including seizures and thrashing. The mare, which too was unvaccinated had to be euthanised, was confirmed positive on 27 Aug [2019].

Notably, eastern equine encephalomyelitis is caused by the eastern equine encephalitis virus, for which wild birds are a natural reservoir. Mosquitoes that feed on EEE-infected birds can transmit the virus to horses, humans or other birds.

Eastern equine encephalitis virus (EEEV) is a member of the genus _Alphavirus_, family Togaviridae.

Notably, the incubation period for EEE virus disease [in humans] according to CDC ranges from 4 to 10 days and can result in one of 2 types of illnesses, systemic or encephalitic.

Systemic infection has an abrupt onset and is characterized by chills, fever, malaise, arthralgia, and myalgia. While in infants, the encephalitic form is characterised by abrupt onset of the disease, in older children and adults, encephalitis is manifested after a few days of systemic illness. Signs and symptoms showcased by encephalitic patients include fever, headache, irritability, restlessness, anorexia, vomiting, diarrhea, cyanosis, convulsions and coma.

Notably, there is still no human vaccine against EEEV infection or specific antiviral treatment for clinical EEE infection is available. Patients should be evaluated by a doctor, undertake proper tests and get supportive treatment.

To prevent being infected with EEE virus, a few things that one should remember is to avoid mosquito bites by using mosquito-repellent, look for EPA-labeled products containing DEET, or oil of lemon eucalyptus, mosquito-proof homes and protect horses by using licensed EEE vaccines. Horses should be vaccinated at least annually.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[HealthMap/ProMED map available at:
Indiana, United States: http://healthmap.org/promed/p/217]

******
[6] 5 more horses and an alpaca in New Jersey
Date: Fri 6 Sep 2019
Source: NJ.com [edited]
https://www.nj.com/healthfit/2019/09/5-more-horses-in-nj-die-after-contracting-severe-mosquito-borne-virus.html


In New Jersey, 5 more horses have been euthanized after contracting the severe mosquito-borne illness eastern equine encephalitis, officials said in a statement.

The deaths come after the virus claimed the lives of 3 other horses and an alpaca in New Jersey in recent months, all of which were euthanized after testing positive for the disease.

So far this year [2019], 10 animals -- including 9 horses and one alpaca -- have contracted the virus in the state, according to the New Jersey Department of Agriculture.

The 5 horses euthanized include an 18-year-old gelding horse in Morris County, a 4-month-old gelding in Salem County, a 4-year-old gelding and a gelding of unknown age in Ocean County, and a 1-year-old filly in Atlantic County, the statement said.

The horses were not vaccinated for the virus, officials said.

"As more cases of eastern equine encephalitis are reported, we strongly encourage horse owners to check their records to verify that their animals are protected from this disease, or to know if vaccination is needed," New Jersey Department of Agriculture Secretary Douglas Fisher said in a statement. "Animals that have been vaccinated are much less likely to contract deadly diseases such as eastern equine encephalitis. It is the most effective strategy, and equine vaccines are available commercially."

The virus -- which is known to affect both horses and camelids like alpacas -- can cause inflammation of the brain tissue and has a greater chance of killing horses than West Nile virus, officials said. The virus, also known as "sleeping sickness," is rare and also affects the animal's nervous system.

Officials are urging horse and alpaca owners to contact their veterinarians to ensure their animals are up to date on their vaccinations.

Officials said horses and alpacas are not likely to spread EEE to humans because the animals are considered "dead-end" hosts for the virus. However, people can still contract EEE [virus] from mosquitoes. Symptoms include fever, chills, body and joint aches.

For more information about EEE, visit the state Department of Agriculture website at <NJ.gov/agriculture>.

EEE and West Nile virus, officials say, must be reported to the state veterinarian at 609-671-6400 within 48 hours of diagnosis.

The New Jersey Animal Health Diagnostic Laboratory is available to help with testing for both EEE and West Nile virus and can be reached at 609-406-6999 or via email at <Jerseyvetlab@ag.state.nj.us>.

[Byline: Spencer Kent]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[HealthMap/ProMED-mail map of New Jersey, United States: http://healthmap.org/promed/p/232.
New Jersey county map: https://www.mapsofworld.com/usa/states/new-jersey/newjersey-county-map.html/. - Mod.TY

See Also

Eastern equine encephalitis - North America (17): USA (IN,ME,NY) horse 20190901.6652598
Eastern equine encephalitis - North America (16): USA (RI) human 20190901.6651775
Eastern equine encephalitis - North America (15): USA (OH, MA) horse
Eastern equine encephalitis - North America (14): USA (NJ) human 20190829.6648576
Eastern equine encephalitis - North America (13): USA (NJ,WI,MA) horse, alpaca 20190828.6644628
Eastern equine encephalitis - North America (12): USA (MI) susp human, horse 20190827.6642800
Eastern equine encephalitis - North America (11): USA (MA) human, fatal 20190826.6640548
Eastern equine encephalitis - North America (10): USA (MA) human 20190825.6639420
Eastern equine encephalitis - North America (09): Canada (ON), USA (LA,NY) horse 20190821.6633946
Eastern equine encephalitis - North America (08): USA (MA) 20190818.6627860
Eastern equine encephalitis - North America (07): USA, horse 20190817.6627654
Eastern equine encephalitis - North America (06): USA (NJ) 20190817.6626825
Eastern equine encephalitis - North America (05): USA (MA) 20190814.6621422
Eastern equine encephalitis - North America (04): USA (NC,WI,FL) horse 20190807.6610761
Eastern equine encephalitis - North America (03): USA (SC,MS,NJ) horse 20190727.6591645
Eastern equine encephalitis - North America (02): USA (LA) horse 20190331.6396591
Eastern equine encephalitis - North America: USA (GA) horse 20190320.6377189
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