L.A. hit hard by West Nile virus
By Troy Anderson
Staff Writer
As the West Nile virus season winds down, health experts say the mosquito-borne disease caused far more serious health problems than initially expected, especially among an alarming number of healthy, young and middle-age adults.
While experts originally were most concerned about the potential for deaths among the elderly and those with immune deficiencies, they now say the virus also caused paralysis and other serious neurological complications among a significant number of people who were expected to suffer little more than flu symptoms.
"It's the new polio," said James J. Rahal, a professor at the Cornell University Weill College of Medicine in New York. "It's a devastating complication. The West Nile virus can cause the same paralysis and pathology as polio."
Of the 1,951 people infected this year in the United States, 37 percent developed paralysis, encephalitis and meningitis -- complications that can lead to death.
And, in Los Angeles County, 44 percent of the 266 residents diagnosed with the virus as of Oct. 7 suffered the neuroinvasive complications.
Of these 116 cases, 73 suffered meningitis; 39, encephalitis; and four, paralysis. Eight of the patients died -- including 91-year-old Hester Martin of Northridge -- the most of any county in California.
Officials provided updated figures Friday, saying 300 people had been diagnosed with the virus countywide. They did not have updated information on the number of patients with neuroinvasive complications.
Dr. Jonathan E. Fielding, the county's health officer, said differences in the way the disease has been reported might account for the higher percentage of neuroinvasive cases in the county, but he conceded that the virus is more serious than many originally believed.
"It appears that, at least, the neuroinvasive diseases are more serious and can cause a higher frequency of continuing problems than was originally thought," Fielding said. "There have been a significant number of people in early and middle adulthood who have been affected.
"If you look at the fatalities, they tend to be in older people, but in terms of the neuroinvasive cases, there was a significant number who were middle-aged and even younger who came down with this problem."
Dr. Carol Glaser, chief of the viral disease lab at the California Department of Health Services, said experts believe the virus in the United States is much stronger than first thought.
"The theory is that the virus we have here is more virulent than what they have in West Africa," Glaser said. "If you look at some of the recent outbreaks in Israel, that virus is almost identical to the one we have here.
"The problem is the virus is more virulent, and we have an entire population that is more susceptible to it. In Africa, kids get this as a childhood illness. By the time they are adults, 90 percent are immune. It may be it's indeed more virulent and on top of it we have a very large, immunologically naive population."
Glaser said officials were surprised by the large number of younger people who suffered neurological complications that could lead to long-term problems, such as continued muscle weakness or brain damage.
"I think the acute flaccid paralysis is very disturbing to a lot of people," Glaser said. "We had said it tends to hit the elderly and immunocompromised, but we know it's occurring in the younger adult population, those that don't have underlying medical problems and are in the prime of their life."
West Nile virus is carried by crows and other birds and can be transmitted to humans by mosquitoes. Most people display only mild, flulike symptoms, or none at all.
There is no cure for the virus, so authorities urged residents to use mosquito repellent and to clear their property of standing water where mosquitoes could breed.
In September, near the height of the epidemic, the Los Angeles City Council even made it easier for vector control officials to enter residents' back yards to check for standing water.
Pico Rivera resident Nancy Berny, whose 45-year-old husband, Mario Berny, suffered paralysis after he was bitten by an infected mosquito in early August, said he was now able to walk short distances, but his arms were still paralyzed.
He's undergoing therapy at a Pomona rehabilitation center along with another person paralyzed by the virus. Two other West Nile-related paralysis victims have finished their treatment and been released, officials said.
"The whole ordeal has been exhausting," Nancy Berny said.
"The doctors do feel he's going to recover, but over what period of time they don't know. It's been very difficult.
"He's a very, very good father, and he helps the kids with their homework and plays with them outside. The kids miss him a lot."
Since the virus first appeared in New York in 1999, more than 16,000 people have fallen ill, and 622 have died. With 750 cases in California this year and 20 deaths, California has been among the hardest-hit states.
Of the 266 cases in the county as of Oct. 7, the San Gabriel Valley was hardest hit, with 101 cases, followed by the southeast portion of the county with 71 cases and the San Fernando Valley with 69 cases.
U.S. Rep. Doug Ose, R-Sacramento, chairman of the House Government Reform Subcommittee on Energy Policy, Natural Resources and Regulatory Affairs, said the committee held a recent hearing to examine problems in minimizing the outbreak.
Because of a 2001 appellate court ruling, which found that pesticides used by vector control districts are pollutants, Ose said the government has been very limited in what it can do to stop the spread of the virus.
"It's amazing that, since March 2001, the disease has rapidly spread from east of the Mississippi all the way to the West Coast," Ose said. "It's frightening in the sense that the Grim Reaper doesn't know region, party or physical condition. We are all subject to this disease.
"We have a problem here, and we need to deal with it, or come next spring, California, and Northern California in particular, will see another significant outbreak of the virus. But to a great extent, it's avoidable."
Jack Hazelrigg, general manager of the Greater Los Angeles Vector Control District, said he was still encouraging people to wear insect repellent and take precautions through the end of the month, but said the mosquito season is pretty much over for this year.
"We have declared the end of the season at this point in time," Hazelrigg said.
"Next year, I'm predicting a reduction in the number of cases, at least fewer cases in Los Angeles County. Possibly, we'll see more cases in Northern California. They haven't had a full season of West Nile virus like we had this year."
Although mosquito season tapers off with cooler weather in the fall, Jennifer Brown, an epidemiologist with the Centers for Disease Control and Prevention, said people in Southern California can contract the virus all year long because of temperate weather.
"Even though the risk goes down in the winter and spring, it's not completely eliminated," Brown said. "This is especially true in the southern part of the country, particularly the L.A. region, where people need to be mindful of this all year long."
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