First identified in the New York City area in 1999, thanks to Tracey McNamara, an alert veterinarian at the Bronx Zoo, West Nile Virus (WNV) has marched across the United States and by now has been identified in almost every state. By the end of 2002, there were 4,156 laboratory-diagnosed human cases and 284 deaths (www.cdc.gov/ncidod/dvbid/westnile), the largest arboviral meningo-encephalitis outbreak ever recorded in North America (Petersen LR, et al. JAMA 2003;290:524-528). The vast majority of cases are subclinical or manifest as a mild febrile illness; fewer than 1% develop an acute neurologic illness.
The causative agent is a single-stranded RNA virus similar to the viruses that cause Japanese or St. Louis encephalitis. The vector is the Culex and some other types of mosquito that bite both humans and birds. More than 100 bird species have been infected; mortality varies but is nearly 100% in laboratory-infected crows. The house sparrow (Passer domesticus), which has a high-level viremia for several days, is an important amplifying species. Many mammals can be incidentally infected, and sick horses may be the first signal of WNV arrival in a rural area.
About 85% of human infections occur in August and September. Transmission by mosquito is by far the most common route, but transplacental infection and transmission in breast milk, blood, or transplanted organs has occurred.
Neurologic symptoms include stiff neck, photophobia, depressed or altered consciousness, or personality change. Movement disorders, including tremors, gait disturbance, and parkinsonism, may occur and persist for months. There is also a polio-like syndrome with flaccid paralysis that may be irreversible (Sejvar JJ et al. JAMA 2003;290:511-515).
Sentinel chicken flocks are used in public health surveillance. Some state and county health departments will collect and test freshly dead birds (not pigeons or doves); call your local health department for instructions.
WNV is believed to be of Middle Eastern origin; its route to North America is said to be unknown (Petersen op. cit.). In 2000, Saddam Hussein was quoted by a defector as referring to ``his final weapon, developed in laboratories outside Iraq...Free of UN inspection, the laboratories will develop strain SV 141 of the West Nile virus'' (Preston R, New Yorker 10/18-25/00). According to a letter from former Surgeon General David Satcher, the CDC actually sent Iraq samples of WNV in 1985, along with many other pathogens including plague (www.newsmax.com).
Proof of Saddam's WMD program has yet to be found-although it has been pointed out that he had 12 years to hide them and that Iraq was especially good at ``cleaning up after...defectors'' (Insight 5/13-26/03, pp. 24-29).
Some believe that one of Saddam's labs is but a 3-hour flight by migratory bird from the Florida Keys (La Nueva Cuba 11/18/02). Cuban defectors say that Fidel Castro's Biological Front studied ways of using migratory birds to spread infectious diseases to the U.S. (Arostegui M. Insight, Oct 1-14, 2002, pp. 31-33). Saddam Hussein did have close personal ties to Castro (Bethancourt EF. Med Sentinel 2001;6:121-122, www.aapsonline.org/jpands/hacienda/betan.html). According to Soviet defector Ken Alibek, Cuba, Iraq, Iran, and other former Russian allies simultaneously received transfers of Soviet biotechnology (Arostegui, op cit).
Alibek said he was told that Cuba had one of the most sophisticated genetic engineering labs in the world, capable of the kind of advanced weapons research done at Biopreparat (Alibek K, Biohazard, New York: Delta; 1999).
Whether WNV results from a bioterrorist attack or is a natural phenomenon, it is an increasing public health threat, especially difficult to control because of the reservoir of infection in many common birds. As with other viral central nervous system infections, there is no specific therapy. A vaccine is being sought, but even if found would not help someone already sick. To my knowledge, the only claim of a cure for viral encephalitis was made by a North Carolina family physician, Frederick Klenner, M.D., who used heroic doses of intravenous vitamin C. He also claimed cures for tetanus, polio, and snakebite, and considerable relief for serious burns. He called the mechanism ``flash oxidation''; vitamin C is known to degrade proteins and nucleic acids. His claims, made at a time when deviation from the ``standard of care'' was not so likely to result in delicensure, have never been subjected to rigorous study. His 1971 paper is available at www.cforyourself.com/Overview/Primer/Klenner/klenner.html.
Today's main defense is preventing mosquito bites. The CDC recommends applying insect repellent (DEET) whenever you are outdoors and at risk of a mosquito bite-``just as we buckle up our seat belts when we get into an auto,'' writes Dennis T. Avery of the Hudson Institute (Ariz Daily Star 8/12/02). (Do you have enough DEET in your emergency supplies?) Be sure to use the synthetic DEET, Avery warns. The ``natural'' repellent (p-menthane-3,8 diol) in a new version of Off is corrosive, irritating, not very effective, and not adequately tested.
Vector control projects, which drove malaria out of the US, have been crippled by the EPA's ban of DDT. Malaria is also making a comeback, with about 1,200 cases diagnosed annually in the US. Efforts to stop the WNV in the Northeast by pesticide spraying were met with vocal protests from conspiracy theorists and environmentalists. Malathion, used the first year, is toxic to fish and birds, and, incidentally, to human beings. The synthetic pyrethroids used later are toxic to fish and bees, and allegedly a risk factor for human breast cancer or thyroid disease. Will what Dr. Henry Miller of the Hoover Institution calls an ``indefensible epidemic'' (Wall St J 8/10/02) result in a comeback for DDT and exposure of the massive scientific fraud that resulted in the ban? We should ask that question at every opportunity. As Steve Milloy points out, malathion and pyrethroids are significantly limited because, unlike DDT, they do not have a residual effect. DDT lingers for a time in the environment in concentrations sufficient to harm mosquitoes but not nontarget species (Taylor JM, Environment & Climate News 10/02).
``I find it interesting that we stopped using DDT because it was alleged to be killing birds,'' observed Dale Anderson, President of the Pennsylvania Forest Industry Association. ``However, that was later disproved. Now, West Nile virus, which could be controlled by using DDT, is leaving dead birds in backyards around the country. Ironic'' (ibid.). Not to mention the dead or paralyzed human beings.
The Edward Teller Award for the Defense of Freedom was conferred on President George W. Bush specifically, writes Dr. Teller, ``for terminating the agreement with the extinct Soviet Union that promised to restrict our defense activities.... We hope that this is an appropriate expression of our deep appreciation of your actions, devoted to the survival of the United States and its continuing leadership on our path to world stability.''
The Petr Beckmann Award for ``courage and achievement in the defense of scientific truth and freedom'' was presented to Dr. Sherwood Idso for his work demonstrating the fertilizing effect of increased carbon dioxide on the biosphere. He now publishes a remarkable on-line science journal at www.co2science.org.
In an outstanding last-minute addition to the program, because Sallie Baliunas could not be with us, Dr. Robert Jastrow gave us an update on strategic missile defense, and Scott Carpenter presented reflections on the space program. Tapes are available (see enclosed order form).
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