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A9 - Emerging Vector-Borne Diseases in the United States: What Is Next, and Are We Prepared? - Lyle R. Petersen, Roger S. Nasci, Charles B. Beard, and Robert F. Massung
Pages 258-284

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From page 258...
... 1983a. Fulminant Rocky Mountain spotted fever.
From page 259...
... . Other endemic pathogens, such as Lyme disease, have markedly increased in incidence and geographic distribution (Bacon et al., 2008)
From page 260...
... Mosquito-Borne Arboviruses -- Humans as Incidental Hosts Mosquito-borne arboviruses have attained substantial public health importance in recent years in the United States. Among the arboviruses using humans as incidental hosts, West Nile virus produces by far the highest human infection incidence, greatest morbidity, and highest number of deaths (Petersen and Fischer, 2012)
From page 261...
... . Although West Nile virus outbreaks are largely unpredictable, intensive surveillance in urban settings can indicate impending outbreaks with sufficient lead-time to implement safe and highly effective emergency adult mosquito control measures (Carney et al., 2008, 2011; Healy et al., 2015; Ruktanonchai et al., 2014)
From page 262...
... . Since 2003, universal blood screening by nucleic acid amplification testing has nearly eliminated transfusion transmission from West Nile virus (Busch et al., 2005; Stramer et al., 2005)
From page 263...
... . While Aedes albopictus is a competent mosquito vector whose distribution extends throughout much of the eastern United States, recent dengue outbreaks in the contiguous states have only occurred in the southern states in areas with significant Aedes aegypti populations, suggesting a limited potential for Aedes albopictus to cause outbreaks (Bouri et al., 2012)
From page 264...
... . While it is not clear if a true increase or enhanced recognition account for the increasing reported Powassan virus disease incidence, other diseases associated with Ixodes scapularis ticks, such as Lyme disease, human anaplasmosis, and babesiosis, have greatly increased in incidence in recent years (see below)
From page 265...
... SOURCE: Centers for Disease Control and Prevention. FIGURE A9-5  Reported cases of Lyme disease, 1996–2013.
From page 266...
... Adult Ixodes scapularis ticks feed and mate on white tailed deer, whose greatly increased numbers in recent decades have likely contributed to expanding Ixodes scapularis tick populations (Spielman et al., 1985)
From page 267...
... . Rocky Mountain spotted fever (Rickettsia rickettsii)
From page 268...
... Several tick species vector Rocky Mountain spotted fever, which account for its wide geographic distribution. Tick control is impractical in most areas as cases are widely dispersed geographically and temporally.
From page 269...
... For example, the epidemiology of West Nile virus could not have been ascertained at the time of its introduction and only became apparent after more than a decade of observation. Similarly, while it was expected that chikungunya would produce large outbreaks in the Americas, it remains unknown whether the virus will become permanently established in the Western Hemisphere and how long outbreaks will persist and to what extent they will affect the United States.
From page 270...
... It is unknown whether the shifting geographic distributions of the La Crosse encephalitis and eastern equine encephalitis viruses will continue, or if the epidemiology of Powassan virus will change as a result of its apparently new association with Ixodes scapularis. For tropical areas of the United States, such as Puerto Rico and the U.S.
From page 271...
... Considerable investments by the U.S. government for vector-borne disease surveillance and research following the introduction of West Nile virus in 1999 led to substantial short-term improvements in surveillance; our understanding of the epidemiology, ecology, microbiology, and pathogenesis of vector-borne disease; and diagnosis and recognition of endemic and novel agents.
From page 272...
... • Enhance collaboration with academic research and training programs, and provide additional research funding to support field-based entomology and ecology activities and address critical research needs. Prevention: Vector control • Develop strategies to improve implementation of vector and other control measures, particularly in urban areas that have experienced West Nile virus outbreaks.
From page 273...
... • Develop a next-generation Lyme disease vaccine. • Evaluate the cost-benefit of a West Nile virus vaccine.
From page 274...
... Two national surveillance systems monitor vector-borne diseases in the contiguous United States. The ArboNET surveillance system, developed in 2000 to track the spread of West Nile virus across the United States, is the only surveillance system in the world that tracks human arboviral disease cases as well as environmental indicators of arbovirus transmission activity, such as arbovirus infection in mosquito vectors, avian amplifier hosts, veterinary cases, and vectors in real time.
From page 275...
... While ehrlichiosis and anaplasmosis have lower mortality than Rocky Mountain spotted fever, diagnosis of early disease often relies on serologic methods that have limited use in the acute care setting. Next generation nucleic acid sequencing undoubtedly will continue to be developed as a tool to identify new vector-borne pathogens, particularly when combined with a concerted effort to establish surveillance and research protocols to identify patients with illnesses of unknown etiology following potential vector exposure.
From page 276...
... For example, as previously mentioned, surveillance indicators reflecting infection rates in mosquito vectors can predict West Nile outbreaks with sufficient lead time to mobilize safe and effective control measures in urban areas, yet inadequate surveillance effort, public concerns about pesticides, lack of local control capacity, or inability to mobilize funds quickly often delay or prohibit implementation of control measures when and where they would be most effective. Greater understanding of these barriers may promote development of measures to mitigate them, particularly in large metropolitan areas where West Nile virus prevention and control efforts would have the biggest impact.
From page 277...
... For Aedes aegypti, lethal ovitraps, insect growth regulator auto-dissemination devices, and release of Wolbachiainfected or genetically-modified mosquitoes that produce non-viable offspring are among approaches currently under development. Extended release tick control collars are a promising approach for Rocky Mountain spotted fever in locations where dogs are the primary reservoir.
From page 278...
... , phase-3 trials have not been attempted because of uncertain market potential for a West Nile virus vaccine and the considerable logistical difficulties in conducting a phase-3 efficacy trial for a sporadic and geographically dispersed disease that largely occurs in rural and suburban settings. Defining the public health cost-benefit for a West Nile vaccine will help determine future market potential and a clear and cost-efficient pathway to licensure must be identified.
From page 279...
... Doxycycline is the preferred treatment for Rocky Mountain spotted fever, other rickettsiosis, and Lyme disease; however, concerns about dental staining stemming from the experience with early tetracycline formulations still lead to warnings against its use in children. Evidence suggests that modern doxycycline formulations do not cause dental staining.
From page 280...
... Ramping up effective control programs, such as those for West Nile virus, and developing and identifying new scalable methodologies proven effective on reducing human illness from diseases spread by Aedes aegypti mosquitoes and Ixodes scapularis ticks are needed. The development of innovative, cost-effective paradigms for bringing new public health pesticides, vaccines, and therapeutics to market is a prerequisite for spurring their development and bringing them to market.
From page 281...
... 2014. National capacity for surveillance, prevention, and control of West Nile virus and other arbovirus infections -- United States, 2004 and 2012.
From page 282...
... 2009. Increasing incidence of Rocky Mountain spotted fever among the American Indian population in the United States.
From page 283...
... 2006. Rocky Mountain spotted fever in Arizona: Documentation of heavy environmental infestations of Rhipicephalus sanguineus at an endemic site.
From page 284...
... 2008. Persistent West Nile virus transmission and the apparent displacement St.


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