Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1 - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 7—July 2015
Assessment of Arbovirus Surveillance 13 Years after Introduction of West Nile Virus, United States1
Before 1999, there was no appropriated funding in the United States for arboviral surveillance, and many states had no arboviral surveillance systems (2). After the emergence of West Nile virus (WNV) in New York, New York, in 1999 (3), Congress appropriated annual funding to support WNV surveillance activities in affected states and large cities; funds were awarded to these areas through epidemiology and laboratory capacity (ELC) cooperative agreements from the Centers for Disease Control and Prevention. CDC collaborated with state, local health, and academic partners to develop WNV detection, monitoring, and prevention guidance (4,5). By 2004, WNV had spread across the continental United States (6), and transmission to humans had been documented by multiple routes, including blood transfusions and organ transplantation (7–10). That year, CDC distributed nearly $24 million to all states and 6 large city/county health departments for WNV surveillance and prevention.
In 2000, CDC established ArboNET, a comprehensive national surveillance data capture platform to monitor WNV patterns. In 2003, CDC expanded ArboNET to include other arboviral diseases. ArboNET relies on a distributed surveillance system, whereby ELC-supported state and local health departments report data weekly on detection of arboviruses in humans, animals, and mosquitoes. CDC posts all data on the Internet with weekly updates (11). In 2004, the Council of State and Territorial Epidemiologists (CSTE) conducted a WNV surveillance capacity assessment and found that WNV surveillance programs were in place and well developed in jurisdictions receiving WNV surveillance funding (12). CSTE attributed the success of capacity development primarily to availability of federal funds and technical guidance from CDC.
Annual funding for WNV and other arbovirus surveillance distributed through the ELC cooperative agreements has steadily decreased since 2006 to 39% of its 2004 zenith, reaching lows of $9.3 million in 2012 and in 2013 (R.S. Nasci, unpub. data). Concomitantly in 2012, the nation experienced the highest incidence of confirmed WNV neuroinvasive disease since 2003 and the highest number of confirmed deaths (286) for any year thus far (13). In addition to the continued challenge of WNV to financially stressed arbovirus surveillance systems, there is the growing threat of other arboviral diseases, such as dengue (14), chikungunya (15–17), and Powassan virus encephalitis (18).
In August 2013, CSTE conducted another assessment of state and selected local health departments (LHDs) to measure their current surveillance and staffing capacity for WNV and other arboviruses and compare findings with those from the 2004 assessment (19). Its objectives were to describe 1) national capacities for surveillance for WNV and other arboviruses in the 50 states and 6 ELC-funded LHDs in 2012 and changes since 2004; 2) surveillance capacities of LHDs with historically high WNV burdens but no direct federal funding and how they compare with those in ELC-supported LHDs; and 3) the outstanding needs to bring US arbovirus surveillance to full capacity.
Dr. Hadler is clinical professor of epidemiology and public health at Yale School of Public Health and consultant to the New York City Department of Health and Mental Hygiene and to CSTE. His main research interests include the epidemiology and prevention of infectious diseases, disease surveillance, and health disparities.
We thank the workgroup for developing the assessment tool and providing valuable insights on interpretation of findings. In addition to the authors, workgroup members are Jane Getchell and Kelly Wroblewski (Association of Public Health Laboratories), James Blumenstock and Abraham Kulungara (Association of State and Territorial Health Officials), and Alfred DeMaria, Catherine Brown, Carina Blackmore, and Jennifer Lemmings (CSTE). We also thank Kimberly Miller, Rebecca Rutledge and Jessica Wurster for assistance with data analysis.
This study was supported by Cooperative Agreement no. 1U38HM000414-05 from the Centers for Disease Control and Prevention. K.B. is listed as principal investigator on the ELC cooperative agreement for Oklahoma.
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Suggested citation for this article: Hadler JL, Patel D, Nasci RS, Petersen LR, Hughes JM, Bradley K, et al. Assessment of arbovirus surveillance 13 years after introduction of West Nile virus, United States. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.140858
1A shorter version of this report has been published previously (1).