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Introduction and General Information

  • The most important factor in controlling West Nile virus multiplication and spread is an efficient communication and coordination system - both for professionals and for the general public.
  • The overall control of West Nile Virus infection requires a multifaceted, multidisciplinary approach. It is important that this is carefully coordinated, with decision-makers at all levels aware of the current situation and of the control options being used and proposed.
  • The rapid spread of WN virus throughout the State of New York between 1999 and 2000 led to the development of a integrated response plan by the New York State Department of Health which carefully identifies responsibilities, actions required and appropriate public education messages. This document is available in .pdf format (see below).


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Education of Health (Medical and Veterinary) Personnel

In order for WNV infection to be diagnosed correctly in a timely manner it is necessary for health (medical and veterinary) professionals to have an awareness of the disease and for a system to be in place for sample processing. A communication system should also be present to allow information regarding the occurrence of the disease to be communicated to the appropriate authorities and, when required, to increase the vigilance of health care professionals, whether in the medical or veterinary sphere.

For both medical and veterinary personnel the following are required:

  • Awareness of the existence of WNV infection and the species which may be clinically affected.

  • Information regarding the clinical syndromes which may manifest with WNV infection, including the variety of manifestations that may be seen.

  • Awareness of the factors which may encourage transmission of arbovirus diseases, particularly conditions (climatic) allowing/encouraging increases in populations of vector mosquitoes.

  • Information regarding events which should raise suspicion of WNV infection. 

  • Awareness that the disease does occur, or may occur, in the local geographical area. 

  • Common differential diagnoses for the clinical syndromes which may be seen with WNV infection, both those known to occur locally and those which would be considered "exotic" diseases, allowing for the fact that people and animals may travel and that, as with WN virus, the geographical range of a disease may change. 

  • Information on samples which should be taken (acute and convalescent) and on samples which may usefully be stored if immediate testing is not required, to give further information (positive or negative) at a later date.

  • Laboratories to which samples should be sent, sample collection and packaging requirements and accompanying data required.

  • Information on the signs of pesticide poisoning and which organisations suspected pesticide poisoning cases should be reported to. (D72)

Much of this information (excluding local specifics regarding laboratories, and requirements for sample collection, packaging etc.) is available in published peer-reviewed literature in paper format and/or on the Internet. It is important to realise that medical and veterinary personnel do not have large amounts of free time in which to search for and read information on all the possible health topics. Guidance should be provided indicating key reviews and other papers which busy medical and veterinary personnel can access readily and absorb easily.

Further specific information on diagnosis and other topics is provided in: 

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Communication and Data Sharing for Professionals and their Organisations

It has been recognised that data required for estimating the risk of transmission of arboviruses to humans are rarely available within any single agency and that it is therefore extremely important for data collecting agencies to communicate actively with one another and to exchange information. (D68)
  • "Effective surveillance and response requires close coordination and data exchange between many agencies, including federal, state and local public health, vector control, agriculture, and wildlife departments." (J115.13.w2)

The importance of communication and data sharing between individuals and agencies is illustrated by the role played by wildlife pathology in the original diagnosis of WNV infection in human encephalitis cases in New York City in 1999.

Where possible, communication resources which are already in place, readily accessible and considered trustworthy should be utilised. 

  • The Morbidity and Mortality Weekly Report produced by CDC provided essential updates during the 1999 WN virus epidemic in New York.
  • USGS Wildlife Health Alerts and lists of "Species Found Positive for WNV in Surveillance Efforts" from the National Wildlife Health Center have provided important information on the situation regarding WN virus in free-living animals in particular.
  • ProMED-mail is followed by "virtually everyone in the epidemiological world" (J133.916.w1) and provides an up-to-date resource with daily additions of information. Access to previous postings on West Nile virus are readily available from this site.
  • Medical and veterinary journals which are regularly received and at least partially read by substantial proportions of the appropriate medical and veterinary audiences may be useful. Those which are published more frequently (weekly or biweekly) may be more appropriate for rapid communications than those produced monthly or at longer intervals.

Sharing of case-specific information may involve greater considerations and potential problems regarding confidentiality and some restrictions on information distribution, particularly regarding individual human cases, may be required. However time- and area- (e.g. state, county) based summaries may be provided to a wider audience; the Internet is an obvious means of disseminating such summaries. 

It is important to recognise that expertise required for responding to an arbovirus, such as mosquito surveillance and control measures, may vary greatly between geographical areas. In some regions of the USA integrated mosquito management programmes have been in place for decades whereas other areas may not have this experience and may lack the infrastructure required for effective management implementation. (J133.951.w25).

The role of the Internet in communication and data-sharing should not be underestimated; this method of communication is of increasing importance. (J133.916.w1) For example, primer and protocols for RT-PCR detection of WN virus NY1999 were posted on ProMED-mail by the Emerging Diseases Laboratory, University of California, Irving in October 1999, which assisted in rapid implementation of this method for diagnostic purposes in different laboratories.

  • The Internet provides a widely-accessible means of providing the medical community with information such as case definition and reporting obligations as well as forms required for sample submission. (P32.1.w25)

The CDC Epidemic/Epizootic West Nile Virus in the United States: Revised Guidelines for Surveillance, Prevention and Control (D67) includes the following guidance regarding data sharing and requirements for maximum information to be gained from ecological data: [Text copied directly]


The public and animal health response to outbreaks of WN virus involves all levels of government including the federal governments of the U.S., neighboring countries and the Pan American Health Organization. In addition, multiple government agencies at each level are often involved. Rapid, efficient, secure and coordinated systems to share human and ecologic data between these multiple agencies to support long-term surveillance activities and to support activities that are part of the rapid outbreak response are needed. 

During an epidemic involving multiple jurisidictions, CDC and appropriate, authorized users will use Epi-X, a CDC-based system for secured electronic communication or similar integrated communication systems for rapid dissemination of information on public health events of public health significance. User groups should be constructed in a logical and efficient manner. For example, some public health officials need to receive veterinary and wildlife data routinely, whereas others do not; the converse is also true. 

Geographic information system (GIS) data should be used to track epidemics spatially.

A. Human Epidemiological, Clinical and Laboratory Data Collection

CDC will provide generic templates for electronic databases that can be rapidly customized and stored centrally to allow efficient and secure interjurisdictional sharing of human clinical and laboratory data during epidemics. Issues include:

1. Efficiency and Integrity

Centralized electronic databases should be designed to balance the need to maintain data integrity with the desire to minimize duplicate data entry. On a regular and frequent basis, such centralized databases should be backed up automatically with at least one recent backup copy maintained off site.

2. Confidentiality and Security

Patient confidentiality statutes vary from state to state. Data can be shared between jurisdictions if recipients agree to adhere to the confidentiality statutes of the state providing the data. Electronic databases should be appropriately secured by passwords, to limit access and minimize opportunities for breaches in confidentiality or security.

3. Standardization of Data Collection Instruments

Ideally, during an epidemic involving multiple jurisdictions, data collection (by both electronic and written means) should be done in a standardized fashion across all jurisdictions. While a more integrated and National Electronic Disease Surveillance System (NEDSS)-compliant ( data collection instrument is developed and disseminated, CDC will provide a list of the characteristics of data variables (i.e., types, names, lengths, and order) that are contained in centralized electronic databases.

4. Centralization

During an epidemic, centralized electronic databases for sharing epidemiological, clinical and laboratory information should be maintained at CDC. These databases should be accessible to authorized users via the Internet after all personal identifying information has been removed.

B. National Reporting of Human Cases of WN Encephalitis

WN encephalitis is not on the list of nationally notifiable diseases maintained by the Council of State and Territorial Epidemiologists (CSTE) in consultation with CDC. However, this does not preclude states from reporting such cases to CDC, and CDC has designated 10056 as a specific disease code ("EVENT" code) for use in reporting WN encephalitis cases via the National Electronic Telecommunications System for Surveillance (NETSS). For national reporting purposes, states should use the national surveillance case definition of arboviral encephalitis for classifying cases as either confirmed or probable. WN meningoencephalitis should be added to the nationally notifiable diseases list.

C. Ecologic Data

Many of the issues that apply to the interjurisdictional sharing of human data apply to the sharing of ecologic data as well, although key differences exist. For example, in terms of the latter, patient confidentiality is generally not an issue, except for owned animals, while standardization of data collection is a far more challenging issue because of the relatively large number of species often being studied. Specific needs include:

1. Accurate Taxonomic Identification of Specimens

Fully understanding the epidemiology and developing effective prevention and control strategies for WN virus will require accurate identification of all animal species involved in the virus transmission and maintenance cycles. This is especially true for birds and mosquitoes.

2. Unique Identification (UI) Numbering System for Specimens

A standardized UI numbering system should be developed (or adopted from an existing system) for wide-scale use by each state or independent jurisdiction. The numbering system should readily distinguish between each major animal group (i.e., humans, birds, and mosquitoes), county or township of collection, the year of collection, and a specimen-specific number. 

3. Durable Tagging System for Field-Collected Specimens 

It is critical that field specimens--whether blood, tissues, or whole animals--be properly labeled so that specimen identification will not be lost during shipment to testing facilities.

4. Standardized Data Collection and Specimen Submission Instruments

Standardized data collection forms should be developed and used for birds, mosquitoes, and other animals. Some instruments already exist (e.g., at the USGS’s National Wildlife Health Center and at CDC) and these could be a starting point for development of additional instruments for general or specific usage. A difficulty may be the wide taxonomic range (e.g., from mosquitoes to large mammals) and large number of species often studied.


Major ways in which data on WN virus surveillance data has been made available include:

  • An electronic database (ArboNET), developed by CDC, provides a national database holding all the states' surveillance information in a protected and confidential formal, allowing summaries and access to non-confidential data for all public health professionals.
  • Data from the CDC database is uploaded to USGS Mapping, to display national maps of WN virus surveillance information on a weekly basis.
  • Summary information on equine cases across the USA provided by APHIS/USDA during 2000 and 2001, and during 2002 APHIS/USDA displayed weekly updated national equine case data and maps.
  • Maps to 2003 are available in: Spread of West Nile Virus in the USA (2000-2003)
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Public Education: Target Audiences

Public education about West Nile virus, disease caused by the virus and measures which may be required to control it, needs to be targeted at a wide variety of different audiences. It is important to recognise the different audiences in order to ensure that education is tailored to meet their needs and to reach the intended recipients.

The New York State WN virus Response plan recommends that the specific target audiences should include but not be limited to:

  • Property owners (homeowners, businesses, municipalities)
  • Government officials and local opinion leaders
  • Doctors
  • Nurses
  • Physician assistants
  • Nurse practitioners
  • Media representatives
  • Operators of elder care facilities
  • Independent older adults (aged 50+)
  • School superintendent/ officials and School Nurse-Teachers/ Health Educators/ Athletic Directors
  • Youth organizations
  • Operators of day care and preschool facilities
  • Operators of children's camps
  • Parents
  • Campground operators, Resort operators
  • Beach, pool and parks and recreation managers
  • Hikers, campers, hunting and fishing enthusiasts
  • Tourism offices, Chambers of Commerce
  • Environmental groups
  • Nature preserves, Botanical Gardens, Arboretums
  • Farmers
  • Migrant workers
  • Veterinarians
  • Outdoor workers, unions
  • Faith community
  • Government agencies
  • Other audiences, as may be appropriate.


  • It is important to make sure that information is reaching the target communities. This may require research to identify different local communities and then provide information tailored to those communities, down to the level of individual neighbourhoods. (J133.951.w25).
  • Older people, who have a greater risk of developing severe disease, should be targeted specifically. (P39.4.w26)
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Public Education: Means of Communication
Public education about WNV infection, its transmission and how the risk of exposure may be decreased or prevented is recognised to be a critical component of any vector-borne disease control and prevention program. (J115.13.w2)

A variety of means of communication are available. Different means of communication may be appropriate for different types of information and for different target audiences. It is also necessary to consider the costs of communication and the cost effectiveness of different means of communication.

  • The source of information must be considered trustworthy and authoritative if recommendations are to be followed.

For information on local risk, explanations of local mosquito management actions and requests for local assistance with surveillance, mosquito source reduction and personal protection, communication efforts should be targeted at the local community. This may involve the use of public service announcements in local media (newspapers, radio, television), distribution of leaflets, provision of information to children in schools, both for themselves and for further dissemination to their families, exhibits at local fairs, speaking at local meetings etc. (J133.951.w25).

  • Local newspapers, radio stations or television stations may provide a discussion of mosquito control as a free public service, if requested to do so.
  • Information distributed via schools may include for example providing children with "check lists" to take home and "check off" whether typical mosquito breeding places exist on their property).
  • Exhibits at local/county/state fairs may attract increased attention by including live mosquitoes of different life stages in the exhibit. This provides an excellent opportunity to teach basic mosquito biology.
  • Telephone enquiries should always be answered knowledgeably and courteously.
  • Mosquito control organisations may disseminate information by buying a page of their local newspaper in which to publish their annual report, with appropriate pictures.



  • For adequate perception of local risk it may be necessary to ensure that the message is communicated by a local source. (P39.4.w26)
  • Receiving information "personally" may be important in order for the information to be not just understood but also acted upon. (P39.4.w26)
  • It is important to ensure that information is available in different languages as appropriate. For example in the USA while information in English may reach most of the population, greater coverage will require provision of key information in other languages. A survey in Connecticut showed that personal protective efforts by persons whose primary language in the home was not English was less than for those with English as their primary language. (J133.951.w31)

Wide area and national communication may involve telephone hotline information sources (particularly applicable during an epidemic and/or when public concern is high) and, increasingly, the Internet.

Good communication is also essential if members of the public are to communicate information to a central point, as for effective dead bird surveillance:

  • "If the public does not know to report dead crows, or if there is not a system set up to receive such reports, this surveillance will not be effective." (J133.951.w8)

The Internet is increasing in importance as a means of informing members of the public. Many Internet-literate people now turn to this as their first or major source of information. If maximum benefit is to be gained from the Internet as a means of communicating with the public, information presented must be:

  • Accessible. It should be easy for interested persons to find the information both from search engines and from the home pages of appropriate governmental and non-governmental organisations.
  • Set at the right level. This is not always easy to determine; if possible information should be presented at two or more levels, allowing understanding by those without a scientific background while not frustrating the desire of those with a greater scientific knowledge to know more. An example of this approach are the paired "General" and "Technical" Fact Sheets produced by the National Pesticide Telecommunications Network for some pesticides.
  • Printable to allow repeated reading off-line and sharing with those who do not have direct computer or Internet access.
  • Available in different languages as appropriate for maximum coverage of the target audience..
  • Perceived as trustworthy by the target audience.

(J133.916.w1, V.w5)

  • The Internet provides a widely-accessible means of providing the public with much more information on prevention, disease updates, control measures and rational for application of control measures than is possible in information sources such as news spots. (P32.1.w25)
  • The potential importance of the Internet as a source of information for members of the public may be illustrated by the case of WNV infection in a woman in the Netherlands who had recently visited Israel and presented with fever and neurological signs. Health professionals were alerted to the possibility of WNV infection by the patient's partner, who had read about WN virus on the Internet. (J134.145.w1)
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Public Education: Timelines and Purposes of Messages
Public education should inform the reader regarding risks, steps which individuals may take to reduce risk to themselves and their families (also horses and other animals), and actions which governmental organisations are and will be taking to protect public health.
  • "To be of maximum effectiveness, mosquito control must be understood and supported by the people for whom protection is provided. People who are informed about mosquito biology and control are more likely to mosquito-proof their homes, and to control mosquito breeding places on their own property" (D70)

It is important to recognise that people's perceptions of risk, for example regarding the use of pesticides as well as regarding the risk of West Nile infection, will affect their behaviour. If public support is to be gathered for mosquito control efforts, people must be provided with information on WN virus and WNV infection including the role of mosquitoes, mosquito biology, integrated mosquito management and pesticides (including appropriate use, risks to human health, risks to the environment, measures which are taken to minimise risks). Public education may also need to counter misinformation. (J133.951.w25)

There are several areas in which public cooperation is helpful or even vital, such as:

  • Dead bird reporting for surveillance
  • Local source reduction efforts 
  • Use of personal protective measures

For each of these, particular messages need to be communicated to the public.

Public education should:

  • Emphasize the greater risk of contracting encephalitis from WNV infection in persons 50 years old or older. (D72, P39.4.w28)
  • Explain that children are not in the group at "high risk" of developing serious illness with WNV infection. (D72)
  • Provide information on personal protective measures and their relative merits and limits. (D72)
  • Provide information on WN virus reservoirs and vectors.(D72)
  • Encourage local source reduction (D72, J257.168.w1, P32.1.w22)
  • Encourage the use of personal protection measures appropriate to the level of risk at a given time and place.(D72, J257.168.w1, J259.2.w1)
  • Explain the need for multiple actions to reduce risk, e.g. personal protection and source reduction and mosquito control. (P39.4.w26)
  • Provide information on the signs and symptoms of WNV infection. (D72)
  • Explain what mosquito control involves, how it works and why it is important. (J257.168.w1)
  • Provide accurate information regarding possible health risks and environmental impacts from use of insecticides. (D72, J257.168.w1, P32.1.w22)
  • Publicize times and locations at which spraying of larvicides or adulticides are to be carried out, via print and broadcast media, at least 24 hours in advance of the commencement of the spraying (this may be a legal requirement).(D72)
  • Provide information on what measures are being taken by responsible agencies, including proactive efforts as well as reactive responses to a WNV disease outbreak. (P32.1.w22)
  • Provide information on the legal decision-making channels and constraints to decision making regarding for example mosquito control activities such as spraying of pesticides. (P32.1.w22)
  • N.B. information should be provided as easy to follow guidelines but this should be coupled with detailed in-depth information for those who wish to follow the subject further. (P32.1.w17)

The following example of the 2001 Public Education "Fight the Bite" campaign from the New York State WNV Response plan indicates the types of information which may be appropriate at different times of year, depending on the activity of the mosquito population and associated risk levels. This campaign was designed to commence in the early spring, and be maintained, enhanced and expanded as required, reaching different segments of the target audiences, over the course of the mosquito breeding season (April-December):

Level 1: Pre- and Post Mosquito Season (lower risk) Messages: [Text copied directly]

  • Your health department is prepared.
  • Mosquitoes can carry disease.
  • Find and eliminate mosquito-breeding sites. Clean up standing water around your home and your place of business.
  • Mosquitoes can breed in unlikely locations – a bottle cap filled with water, leaf debris or clogged rain gutters. Discarded tires are a particular problem.
  • Eliminating breeding sites will help lower your risk of being bitten, and may help reduce the need for spraying later on.
  • Children are not in the high-risk group for serious illness from WNV.
  • Persons aged 50 and older are at highest risk for serious illness from WNV.
  • Dead crows [Corvus brachyrhynchos - American Crow] could be a sign of WNV. Be sure to report them to your local health department. Note that not all dead birds will or should be picked up for testing.


Level 2: Early WNV-Mosquito Season (medium risk) Messages: [Text copied directly]

  • Continue Level 1 messages.
  • Your health department is working to protect you.
  • Mosquitoes are starting to appear.
  • The potential for human cases of WNV is increasing.
  • Continue to find and eliminate mosquito-breeding sites.
  • Continue to report dead crows [Corvus brachyrhynchos - American Crow] to your LHU [Local Health Unit] and follow their recommendations for disposal.


Level 3: High WNV-Mosquito Season (higher risk) Messages: [Text copied directly]

  • Continue Level 1 and/or Level 2 messages.
  • Mosquitoes are at their height.
  • Continue to find and eliminate mosquito-breeding sites. Eliminating breeding sites will help lower your risk of being bitten, and may help reduce the need for spraying later on.
  • The elderly have the highest risk of serious illness from WNV.
  • Unless there is evidence of mosquito-borne disease, there is no need to avoid outdoor activities. If it is advisable to take precautions, health officials will provide that information.
  • People at highest risk should protect themselves from mosquito bites. Consider use of a mosquito repellent containing DEET; wear appropriate clothing (long sleeves, long pants); or stay indoors when mosquitoes are biting.
  • Recognize the signs and symptoms of encephalitis and seek medical care if needed.
  • Mild, flu-like symptoms are not dangerous. Symptoms to be concerned about include headache with high fever, disorientation, and muscle pain and weakness.
  • Continue to report dead crows [Corvus brachyrhynchos - American Crow] to your LHU [Local Health Unit] and follow their recommendations for disposal.
  • Recognize that other animals could be affected. Contact your veterinarian if you have a particular concern about a domestic or farm animal.
  • If spraying becomes necessary, here are the facts you need (e.g., spraying schedules, chemical facts, known health effects).


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Recommended roles and activities of State Health Departments, Local Health Units and other partners/organisations
The departments responsible for different activities, including education and communication may vary between states. The following is an example of the roles and activities which may be appropriate for various agencies.

The New York State WNV Response plan recommends that the following roles and activities be adopted: [Text copied directly]

a. NYSDOH Roles and Activities:

The NYSDOH [New York State Department of Health], with guidance from members of the WNV Communications Workgroup, should develop, produce, distribute and evaluate the above-referenced educational and risk communications materials and/or services; solicit statewide media support in the form of public service airtime/space; and, as necessary, purchase advertising airtime/space to communicate appropriate educational messages statewide. The NYSDOH [New York State Department of Health] should also assist and support LHUs [Local Health Units] with the application of the "Fight the Bite" theme/logo to their targeted outreach and education efforts; and with press announcements about new human, bird, animal and mosquito cases.

b. [Local Health Unit] Roles and Activities:

As appropriate, LHUs [Local Health Units] should disseminate "Fight the Bite" educational materials produced by the NYSDOH [New York State Department of Health] and, to the extent possible, provide outreach to target audiences within their counties. LHU [Local Health Unit] representatives should participate on the Public Communication Workgroup and will provide advice and guidance to NYSDOH [New York State Department of Health] staff through discussion, materials review and information exchange. LHU [Local Health Unit] representatives also should share materials they produce for use in their local WNV education campaigns that may be adaptable for use by other counties. As per the legal requirements, localities should publicize spraying locations and times via print and broadcast media at least 24 hours in advance.

c. Other Partners’/Organizations’ Roles and Activities:

Other workgroup members should assist the Public Communication activities by providing advice and guidance relative to communication strategies; by participating in materials review; and, as appropriate, by helping to engage other members of the environmental advocate community in promoting individual efforts to reduce or eliminate breeding sites for mosquitoes. To the extent possible, these partners also should assist in the dissemination of "Fight the Bite" educational materials.


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Authors & Referees

Authors Suzanne I Boardman (V.w6), Debra Bourne (V.w5)
Referee Suzanne I. Boardman (V.w6); Becki Lawson (V.w26)

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