1. Lessons Learned from the West Nile Virus Outbreak
Pamela ward-demo, Lt Col, USAF, DVM, MD
Infectious disease physician
U. S. Africa Command, office of the command surgeon

2. Disclaimer
The content of this talk and these slides do not represent the views or opinions of the U.S Government or DoD.

3. Outline Course of the West Nile Virus Outbreak Lessons learned
Military coordination with civil authorities
Cornell University

4. General Accounting Office
independent, nonpartisan agency
works for Congress
“congressional watchdog”
mission “to improve the performance and ensure the accountability of the federal government for the benefit of the American people”

5. Distribution of West Nile Virus (American Family Physician 2003)
By 2008
28,000 human cases
11,000 encephalititis
1,000 died

6. The West Nile Outbreak Timeline
GAO West Nile Report

7. GAO Lessons Identified
Local Surveillance and Response Capabilities
What to report and to whom (initial undiagnosed cases)
Systems that rely on physicians have poor sensitivity and lack timeliness
Local Public health resources quickly overwhelmed
Communication among Public Health Agencies
lack of sufficient/secure channels for communication prevented sharing
Capabilities of Laboratories
only 3 labs in country able to run WNV (broaden capabilities)
ensuring adequate staffing and surge capacity to accommodate testing needs
10-20 samples/year vs 1,200 samples/year
Concern about laboratory capability to handle second concurrent outbreak

8. Coordination between Public Health and Animal Health Agencies
“Communication between public and animal health communities had not worked well and indicated that the West Nile events pointed to a need for better partnership between these communities.”
“This opinion was voiced even by those who at first disregarded animal health official’s views and questions about the potential links between the animal and human outbreaks.”
Demonstrated the importance of the “One Health” concept

9. One Health Changes Implemented as a Result of the Lessons Learned
Archived blood samples from zoo were tested by the CDC
CDC acceptance of samples for testing by pre-identified zoos across the country
South Dakota Department of Public Health
Dallas News

10. Military Support of Civilian Authorities
Case reporting to Public Health Authorities
Close working relationship with local PH allowed real time sharing of information
Collection and submission of dead birds on military installations
U.S. Army Medical Research Institute of Infectious Diseases
Mosquito trapping, species identification and viral testing
results shared with state authorities (worked both directions)
Coordinated spraying with state and local authorities
guided by our trapping data as well as the state/local data
Education for persons living on military installation
U.S. Army

12. Thank you