Modified from Massachusetts Department of
Public Health Web site |
Two Fatal
Human Cases of Eastern Equine Encephalitis
One in a Five year old child an another in an 83 year old
man
Eastern Equine Encephalitis (EEE) characteristically
affects either the youngest or oldest members of the population. This
may be because most young children will not have had subclinical cases
of the disease and therefore developed immunity. It is also possible
that the virus may pass across the blood-brain barrier more readily in
the young. In the old, susceptibility to EEE probably results from a
compromised immune system.
In Massachussetts, a 5-year-old girl from Halifax and an 83-year-old man
from Kingston died after being diagnosed with EEE.
The young girl became ill August 26, 2005 and died September 4. Testing
at the Massachusetts State Laboratory Institute revealed EEE
infection. The elderly man became ill on August 21 and died on August
26. Confirmation of EEE in his case was made a week after his death and
was dependent on a blood specimen drawn before his death and testing of
tissue samples that were provided after his death.
Also a case in a 63-year-old woman from Duxbury was reported. Although
she was the first case diagnosed and reported, her onset was on August
26 after the man from Kingston had already developed symptoms.
“It’s critical that residents protect themselves from mosquito bites,”
said Dr. Al DeMaria, DPH Director of Communicable Disease Control.
“Mosquitoes will be biting until the first frost.”
The Massachusetts Department of Public Health (DPH) has also confirmed
reports of EEE in two horses: one in Haverhill and one in Wrentham. In
the 2005 season both EEE virus and West Nile virus (WNV) were detected
in mosquitoes and birds in a number of communities across the
Commonwealth. Thus, on the basis of testing of mosquitoes, birds and
horses, large parts of the state are at risk for EEE and WNV infection.
Many mosquito pools from the Kingston, Duxbury and Halifax area of
Plymouth County have been positive for EEE virus, with the first
evidence of EEE virus in the state in mosquitoes from that area
collected in late July. New Hampshire reported EEE in four people, 5
horses and in numerous birds.
In 2004, four human cases of EEE, resulting in two fatalities were
confirmed in Massachusetts residents from Brockton, Foxboro, Holbrook
and Middleboro. Among 222 specimens submitted to the State Laboratory in
2005, a human case of disease with West Nile virus (WNV) was not
identified. There were no confirmed cases of WNV infection in people in
2004 in Massachusetts.
The Plymouth County Mosquito Control Program has been applying
intensified control measures in the Kingston, Duxbury and Halifax area
for over a month, with interventions against both mosquito larvae in
standing water and adult mosquitoes. Enhanced mosquito surveillance has
also been in place. DPH is also contacting hospitals in Bristol, Norfolk
and Plymouth counties to review reporting and sample submission
protocols for suspect cases of encephalitis.
Mosquitoes are still actively biting and will be biting until the first
frost. Although their numbers may be down somewhat, they may be more
likely to be infected since the amount of virus increases over the warm
season. DPH advises the public to take special efforts in protective
measures to avoid mosquitoes and mosquito bites into September, one of
the highest risk months in Massachusetts for human infections from EEE
virus and WNV. There is special concern about exposure to mosquitoes
during outdoor recreational activities, related and unrelated to school
opening. An advisory will be going out to boards of health, health
departments, schools, libraries and other places about the threat from
mosquitoes and infections spread by them.
EEE virus infection, though rare, causes severe illness in nearly every
case and mortality of 30-50 percent in clinical cases. WNV causes severe
illness in less than 1 percent of those persons who are infected and
mortality is 20 percent among persons with severe disease. The risk of
severe illness from West Nile virus infection increases with age.
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