1. The West Nile Virus (WNV) Working Group, chaired by the State Epidemiologist, will continue to meet on a monthly basis to plan and coordinate WNV response activities among involved agencies, to develop educational and outreach materials, and to plan and budget for future priorities and needs.

2. On March 30, 2004, the New Jersey Department of Health and Senior Services (DHSS) and the New Jersey Health Officer’s Association conducted the Fifth Annual Statewide WNV conference for local health officers, environmental health specialists, and mosquito control officials. A review of year 2003 WNV events was presented at the conference. Updated protocols for avian, human, mosquito and equine surveillance were distributed to all attendees, and DHSS provided an update on Geographical Information System (GIS) WNV Surveillance System.

3. Courier Service: In 2004, the Rutgers University mosquito courier will continue to provide supplemental courier service to pick up birds from specified county sites, in addition to the routine DHSS courier system.

4. A basic educational pamphlet entitled "West Nile Virus in New Jersey: What You Need to Know", developed by the WNV Educational Subcommittee in 2001, will be available to local health department, and other interested agencies for distribution to the public. A poster entitled "Stop WNV" will also be available for distribution.

5. The new surveillance database prototype developed to provide uniform data collection with analytical capabilities will be expanded to include seven more counties (Burlington, Cape May, Cumberland, Salem, Somerset, Warren and Morris) which will input data directly in the 2004 season; more counties may be included later in the season. The six counties on the system in 2003 were Atlantic, Bergen, Hunterdon, Middlesex, Mercer and Monmouth. Data from all other counties is entered by the DHSS. This spatially and web enabled data management system utilizes Geographic Information System (GIS) for data downloading and queries within the DHSS firewall, and externally via the Internet. Avian, mosquito, human, and equine laboratory and field surveillance data are integrated to enable spatial and temporal visualization of results. Environmental Systems Research Institute (ESRI) developed the program under contract with DHSS and the state’s Office of Information Technology, which matched federal funds designated for the prototype. This statewide surveillance system will facilitate interagency collaboration by providing centralized data storage and management of spatial data. The overall system provides a cost effective surveillance system by reducing data duplication and improving the accuracy and integrity of the data.

B. Department of Health & Senior Services (DHSS)

1. Epidemiology

Crow Surveillance: Submission protocols and forms for 2004 have been posted on the DHSS website. Local health departments are encouraged to report dead crows, regardless of whether they are suitable for testing. Last seasons’ stricter specimen submission protocols allowed more efficient triaging of crows at PHEL. In 2004, stringent submission protocols will continue, and decayed crows and other inappropriately submitted specimens will not be tested. Local health departments have been instructed to place crows in clear zip lock bags with appropriate labels and forms attached to facilitate specimen triaging. Laboratory personnel will be able to quickly examine specimens and discard them without opening the bag if decomposition is detected. Information packets, which included laboratory submission protocols, revised submission forms and information from other state agencies, were distributed to attendees at the Fifth Annual Statewide West Nile Virus meeting on March 30, 2004. Avian surveillance will focus primarily on crows. Crows continue to be effective sentinels for the detection of WNV in a geographical area. Receipt of ill/dead bird reports and testing of dead crows will begin on April 15, 2004. The 5 positive crows per municipality limit will commence at the beginning of the season this year. Geographically large municipalities will still be able to submit crows from unaffected areas of the municipality. Bird testing will end on August 15, 2004, though dead/ill bird reports will continue till October 31, 2004.

Mammals, non-equine: as in previous years, the DHSS does not plan to perform routine surveillance for WNV in dogs, cats or other nonequine mammals. Specimens will be accepted for testing on a case-by-case basis after review by the WNV Coordinator or State Public Health Veterinarian, and testing will be dependent on PHEL workload constraints.

Human Surveillance: Enhanced passive surveillance for human WNV cases will again be conducted in the 2004 season. Information on WNV will be sent to all members of the New Jersey Infectious Disease Society, emergency department and laboratory directors, hospital ICPs, and the Medical Society of New Jersey (MSNJ). This information will also be posted on the DHSS and MSNJ websites. Information will include WNV fact sheets, clinical diagnostic guidelines, reporting protocols, testing criteria and instructions for submitting specimens to the PHEL. Submission guidelines will be initially distributed to the medical care community at the beginning of the season and redistributed in July as a reminder to keep up surveillance efforts as the season commences. DHSS staff will perform follow-up with physicians and ICPs involved with suspect cases being tested for WNV.

2. Office of Local Health

Funding is being provided through Health Service Grants to local health departments to aid and improve surveillance, response, and coordination efforts for WNV, bioterrorism, and all infectious diseases on the local level. Funds are directed to 22 Local Information Network Communications System (LINCS) agencies to facilitate, enhance and coordinate disease surveillance, electronic reporting and communications, and response to public health issues and threats among the many small local health departments in New Jersey. LINCS Surveillance/Epidemiologist Coordinators with expertise in disease investigation and/or health education have been hired throughout the state. Epidemiologists work closely with staff at the state level and with local mosquito control agencies, health care providers, and community organizations. They assist in planning and coordinating county WNV and bioterrorism activities, infectious disease and surveillance activities. They also serve as a resource for technical information on WNV and other infectious diseases, maintain disease statistics at the county level, coordinate surveillance efforts, and use GIS and/or other mapping tools in analyzing surveillance data to identify trends and correlation with other occurrences to determine appropriate local response to viral activity. They also assess educational needs and coordinate regional educational efforts.

The Surveillance/Epidemiology Coordinators work closely with the DHSS and medical care professionals on immediately reportable infectious disease reports within their region, especially those suspected of being due to an act of bioterrorism. They network with representatives of appropriate professional organizations within their county and region, and participate on their county taskforce for counter -terrorism. Each interaction serves as an opportunity to reinforce notification protocols and share recent local/regional/state epidemiological summaries, studies or investigations. These Coordinators and other infectious disease staff from LINCS sites receive training in New Jersey’s Communicable Disease Service policies and procedures.

3. Public Health and Environmental Laboratory (PHEL)

During the 2003 WNV surveillance program, the PHEL tested 777 dead crows, 8,743 mosquito pools, and samples from 195 human patients for WNV infection. WNV was detected in approximately 509 dead crows, 359 mosquito pools, and 34 human patients. Since WNV surveillance began in 1999, test capacity, specificity, and sensitivity have been increased and test result turn-around-time decreased due to the purchase of an automated liquid handling device (BioRobot) and validation of a protocol to automatically extract WNV nucleic acids. During the 2004 surveillance season, PHEL expects to test a similar number of mosquito pools, dead crows, and human patients for WNV infection as in 2003. All human specimens will also be tested for EEE and SLE.

4. Communications

The West Nile Working Group meets monthly to share interagency updates. Test results from avian, mosquito, equine, and human samples are shared with state and local agencies each week via weekly reports sent electronically to all LINCS sites. Each LINCS site in turn shares those results with local health departments and mosquito agencies. Results are then posted on the state’s website (www.state.nj.us/health) for public viewing.

The thirteen counties participating in the WNV GIS surveillance application will have access to results and maps in real time via the Internet. They will be able to access results, query maps, and reports in real time.

C. The New Jersey State Mosquito Commission/New Jersey Office of Mosquito Control Coordination, Department of Environmental Protection/County Mosquito Control Agencies.

In 2004, WNV mosquito surveillance will be conducted in order to look for West Nile virus in a variety of mosquito species. It is anticipated that up to 10,000 pools will be tested by PHEL. County mosquito control agencies have been trained to collect, pool and submit mosquito collections directly to PHEL. Mosquito traps, dry ice machines, and chill tables have been provided to enhance this aspect of New Jersey's mosquito surveillance program. Additional ultra-low freezers have been purchased and placed in all 21 counties in the state to receive pooled mosquito specimens. A twice-weekly courier service has been provided to transport mosquito pools materials to from local agencies to PHEL for testing.

1. Overview of Mosquito Control in New Jersey

The philosophy of mosquito control in New Jersey is to target mosquitoes and/or their habitat as specifically as possible in a financially efficient manner. Minimizing pesticide impact on non-target organisms has always been vital to public acceptance and has been incorporated into the goals of the mosquito control community. The present day need to be species specific in the selection and application of pesticides is fundamental to the mosquito control methodologies used in New Jersey.

2. New Jersey’s Concept of a Responsible Mosquito Control Program
(See Appendix I)

D. Mosquito Research and Control Unit (MRCU), Rutgers University

Ecologic Studies – MRCU will continue serologic surveillance of crows, other avians, and small mammals in New Jersey to ascertain prevalence levels of antibodies to WNV in different species.

Due to the large increase in WNV across the U.S. in the past two seasons, the Orange County Vector Control District (OCVCD) laboratory in CA was unable to test Rutgers University specimens. The Rutgers Entomology Laboratory, therefore, focused on development of the blocking ELISA test utilized by OCVCD. Rutgers personnel traveled to OCVD in California to learn testing techniques from Dr. Martine Jozan. Verification for this technique will be obtained from split samples sent to the CDC Vector-borne Lab in Ft. Collins. With the implementation of the blocking ELISA test in the Rutgers’s Entomology Laboratory, studies on the ecology and epidemiology of WNV in wild avian and mosquito systems will continue. Of particular focus will be the role of the house sparrow as a potential sentinel species and indicator of viral load in the environment. As crows become more immune to the effects of WNV, it is estimated that their role will as surveillance indicator may decrease and that of the house sparrow may increase. In addition to sampling crows and house sparrows, other wild avian species will be captured and blood samples obtained for testing in order to elucidate their potential role in the maintenance and transmission of WNV in the U.S.

E. Department of Agriculture (DOA)

Case Definition for West Nile Virus Infection in Horses
April 2004

Equine samples will be accepted by the Animal Health Laboratory for West Nile virus testing, throughout the year, but will only be considered “Suspect” or “Confirmed” cases based on the following parameters. This definition may be modified as more information is uncovered about the virus and its behavior in horses.
For a case to be considered ‘suspect’ the following criteria must apply:

Suspect Case:

1. Potential onset between June 15 and November 15, barring unusual weather conditions,
2. With onset of acute, severe clinical neurologic signs*, as described by the referring accredited veterinarian, or having
3. Positive preliminary WNV laboratory test results of samples submitted for general diagnostic purposes.

For a case to be considered ‘confirmed’ the following criteria must apply:

Confirmed Case

1. Onset between June 15 and November 15, barring unusual weather conditions,
2. West Nile Virus activity has been identified in the State of New Jersey, and
3. A positive IgM serology test and/or
4. WNV was isolated from brain tissue, if submitted;

Asymptomatic cases with confirmed test results will be considered subclinical cases.

Additional suspects and confirmed cases may be included in statistics when determined by the epidemiologist and approved by the Director, Division of Animal Health.

* Symptoms may include ataxia; muscle weakness, particularly of the hind limbs; falling down with inability to rise; requires assistance to stand; seizures; limb paralysis; muscle fasciculation; hyperesthesia; hypermetria.

EQUINE WEST NILE VIRUS REPORTING PROTOCOL 2003
NEW JERSEY DEPARTMENT OF AGRICULTURE
DIVISION OF ANIMAL HEALTH
609-292-3965

Equine viral encephalitis is a reportable disease in New Jersey. According to NJ A.C. 2:2-1-1.5, all suspected cases of equine encephalitis must be reported to the Department of Agriculture “without delay, and in any case within 48 hours”. The Division of Animal Health requests the referral of all inquiries regarding: equine health, illness, lameness, treatment or equine industry concerns to the Division at 609-292-3965.

Below is a chart representing the flow of information to be followed for all suspicious equine WNV cases in 2003. The Department of Agriculture’s PIO will provide all information regarding equine cases to the public via press contacts and websites. The NJDA is the sole source of public information on confirmed equine cases

*Horse information will include age, sex, travel history, vaccination history, length and outcome of illness, when known

APPENDIX I

New Jersey's Concept of a Responsible Mosquito Control Program

1. Surveillance: New Jersey believes that mosquito control begins with a surveillance program that targets pest and vector species and justifies the need for control. Mosquito control professionals believe that species-specific records should be kept on the composition of mosquito populations prior to enacting control of any kind. Mosquito control programs should also maintain records on the composition of mosquito populations after management to determine the effectiveness of control operations. Most mosquito control agencies use New Jersey light traps in their programs but have additional tools that provide data to guide their activities. The following list of surveillance methodologies is available for utilization by mosquito control agencies in New Jersey.

a. Larval Surveillance: Larval surveillance involves sampling a wide range of aquatic habitats for the presence of pest species during their developmental stages. Most counties have a team of inspectors to collect larval specimens on a regular basis. Properly trained mosquito identification specialists can separate mosquito species that cause nuisance and disease from those that are non-pests or beneficial species. Responsible control programs target pest populations for control and avoid managing habitat that supports benign species.
b. Adult Surveillance: Adult surveillance measures mosquito populations that have successfully developed and emerged from aquatic habitats. The New Jersey light trap has been the standard for collecting adult mosquitoes and most county agencies operate light traps from early May through October. Portable traps baited with carbon dioxide are useful in areas where electricity is not available. Not all pest species are attracted to light and other forms of adult surveillance are frequently employed. In coastal areas of New Jersey, one minute landing rates are used to assess the comparative size of host seeking salt marsh mosquitoes during daylight hours. At inland areas, ten minute bite counts measure annoyance after dark. Resting boxes are frequently used to measure populations of Culiseta melanura, a bird-feeding mosquito that functions in the amplification of eastern equine encephalitis (EEE) virus.
c. Virus Surveillance: The New Jersey State Mosquito Control Commission (SMCC) funds a virus surveillance program that measures the size of mosquito borne encephalitis virus vector populations during the summer season and tests specimens for virus on a weekly basis. Mosquito collections are made at permanent study sites by staff from the NJAES. A wide range of assistance and support is provided by local mosquito control agencies in this effort. Specimens are tested for virus at the NJDHSS laboratories by immunoflourescent antibody (IFA) and polymerase chain reaction (PCR) technology. In addition, some county mosquito control agencies run sentinel chicken programs to identify areas where mosquito borne encephalitis virus is active.

2. Source Reduction: Source Reduction is the alteration or elimination of mosquito larval habitat. This remains the most effective and economical method of providing long-term mosquito control in New Jersey. Source reduction can include activities as simple as the removal of used tires and the cleaning of rain gutters and bird baths by individual property owners, to extensive regional water management projects conducted by mosquito control agencies on state and/or federal lands. All of these activities eliminate or substantially reduce mosquito breeding and the need for repeated applications of insecticides in the affected habitat. Source reduction activities within New Jersey can be separated into the following two general categories:

a. Sanitation: The by-products of the activities of man have been a major contributor to the creation of mosquito breeding habitats. An item as small as a bottle cap or as large as the foundation of a demolished building can serve as a mosquito breeding area. Sanitation is a major part of all Integrated Pest Management Programs exemplified by tire removal, de-snagging waterways, catch basin cleaning and container removal.

Mosquito control agencies in New Jersey have statutory police powers that allow for due process and summary abatement of mosquito-related public health nuisances created on both public and private property. The sanitation problems most often resolved by agency inspectors are problems of ignorance, neglect, oversight or laziness on the part of property owners. Collectively, they result in a major use of agency manpower and resources.

Educational information including videos, slide shows and fact sheets distributed at press briefings, fairs, schools and other public areas have information regarding the importance of sanitation. Public officials must continue to emphasize the role of sanitation as an effective mosquito control modality that is a cost effective, low tech, high result method of preventing disease potential and mosquito interference with our ability to enjoy the outdoors.
b. Water Management: Fresh water and salt marsh water management for mosquito control are forms of source reduction conducted in fresh and saltwater breeding habitats.

3. Chemical Control: When source reduction and water management are not feasible, chemicals are judiciously used to control both adult and immature mosquito populations. The chemicals used by New Jersey's mosquito control agencies comply with state and federal requirements, as well as recommendations provided annually by the NJAES. All pesticide applicators and operators in New Jersey are required to be licensed by the NJDEP.

a. Larviciding: Larviciding is the application of chemicals to kill the immature stages of mosquitoes by ground or aerial treatments are typically more effective and target specific than focusing on adults. The larvicides used for mosquito control in New Jersey include: Bacillus thuringiensis israelensis and Bacillus sphaericus (bacterial larvicides), methoprene (insect growth regulator), temephos (organophosphate), and petroleum oils.
b. Adulticiding: Adulticiding is the use of chemicals to reduce adult mosquitoes by ground or aerial applications. Adulticiding is utilized when biting populations reach critical levels. In New Jersey, adulticides are commonly applied as an Ultra-Low Volume (ULV) spray in which the small amounts of active ingredient range from 0.0035 to 0.24 lb/ac. The adulticides are dispensed through properly maintained and calibrated equipment. Adulticides used in New Jersey include pyrethroids and malathion (organophosphate).
c. The New Jersey State Airspray Program: This program was established by state legislation in 1949 to assist coastal counties in the control of salt marsh mosquitoes. This ongoing program is now coordinated through the Office of Mosquito Control Commission within the NJDEP. Emphasis is now focused on larviciding and an increased reliance on biorational pesticides.

5. Education

a. Continuing Education: Continuing education is directed toward operational workers to instill or refresh knowledge related to practical mosquito control. Training is primarily in safety, applied technology and requirements for our state's regulated certification program.

b. Public Education: Public education is directed toward the general public to teach mosquito biology and encourage citizens to utilize prevention techniques. Examples include: fact sheets and brochures, classroom lectures at schools, slide shows, films and videos on mosquitoes and their control, and exhibits at fairs. New Jersey Mosquito Control Association regularly interacts with civic leaders, politicians and professionals through the annual conventions of the NJ Educational Association and the NJ League of Municipalities.

c. Pesticide / Spraying Notification: Anyone who applies pesticides in New Jersey must be certified to do so by the New Jersey Department of Environmental Protection (NJDEP). All pesticides are reviewed and recommended by the New Jersey Agricultural Experiment Station. No persons can apply any pesticide without prior notification to persons residing in the vicinity of the target site. Notification is made by advertisement in 2 newspapers and must be given a maximum of 30 days and a minimum of 7 days prior to the proposed application date. The notification will include the following information: a) application date, b) location of application, c) name, address and license of responsible applicator, d) brand name and active ingredient of pesticide, e) type of equipment, f) name, address and phone number of person responsible for supplying information about application, g) telephone number of New Jersey Poison Information and Education System, and h) telephone number of National Pesticide Telecommunication Network.

Upon request of a person residing in the vicinity of a target site the designated contact person will provide a minimum 12 hours notification prior to application including the following information: a) actual time and date of application, b) actual pesticide to be applied, and c) any precautionary statements on the pesticide label. Records should be kept of all these telephone calls.

Notification stated above does not apply to larvicide applications or the applications of granular formulations in non-resident areas. In the case of an emergency outbreak, the Commissioner of the Department of Environmental Protection can waive these regulations.

(This overview of mosquito control in New Jersey is excerpted from: Environmental Protection Agency's Pesticide Environmental Stewardship Program, under the auspices of the American Mosquito Control Association "Partnership Strategy Document" for the New Jersey Mosquito Control Association, Inc.)