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Health Officials Await Confirmation on Human West Nile Cases

A 65-year-old, central-Fairfax-area man went to Inova Fairfax Hospital Aug. 17 complaining of headaches and muscle aches. Initial tests performed at the hospital have led officials at the Virginia Department of Health to announce the man could be one of three probable human West Nile virus cases throughout the state. The other possible cases were reported in Richmond City and Hanover County.

The local man's laboratory samples have been sent to the Centers of Disease Control and Prevention for confirmation of the virus, which could take at least 10 days.

"Initial lab results said he probably has West Nile virus," said Kathy Simmons, a public information officer with the county's Office of Public Affairs. "He is recovering well at home."

Simmons said the man, who was released Aug. 23, declined to allow his personal information, including his name and residence, to be released to the media. So while officials cannot say specifically why they felt it was necessary to test the man for the virus, in general it is most likely because he was exhibiting symptoms of encephalitis, which is a viral and bacterial infection that causes inflammation of the brain.

"With West Nile fever, based on what we've seen in Africa and in New York, there are muscle aches and a little headache," said Dr. David Wheeler, an infectious-disease specialist with the Infectious Diseases Physicians. "With encephalitis, there are severe headaches and changes in the way a person thinks. They become confused and not their self. Every once in a while, we get cases of encephalitis in this part of the country, but you wouldn't be able to tell just by looking at the patient."

WHILE THERE were three probable cases reported in August, Wheeler said it is by no means an epidemic.

"Of every 100 people infected, only about 20 get sick, and of those, 19 will have a variation of a flulike illness, and most don't come and get medical attention. Only one out of that 100 will get West Vile encephalitis," Wheeler said.

There are no antibiotics to treat West Nile encephalitis available, so physicians just help keep the patient hydrated, watch the patient's blood pressure and provide supportive care until the body's own natural defenses take over, said Wheeler. A vaccine for West Nile is also in the works, but there has been no word when it might become available.

"If a person has flulike symptoms, we're not going to test for West Nile, and if they are doing OK, it doesn't matter anyway," Wheeler said. "If anybody with encephalitis symptoms comes in, we'll test to see what part is West Nile. Encephalitis is not common."

There are a variety of types of encephalitis including St. Louis encephalitis, Japanese encephalitis and Murray Valley encephalitis, however, in all cases it can cause neurological problems. In addition, in other cases of encephalitis, once a patient contracts the viral infection, the body builds up immunity to it. Wheeler said it is too early to know if the same is true with West Nile encephalitis.

WEST NILE VIRUS is spread to birds, humans, horses, and in some rare cases to other mammals, through a bite from an infected mosquito. In early August, the Fairfax County Health Department reported it had 57 dead crows that tested positive for the virus and that it would stop testing of the birds, instead focusing on controlling the breeding of mosquitoes.

"We have collected and tested a sufficient number of dead birds to confirm the presence of West Nile virus in our bird population," said Dr. Carol Sharrett, director of the Fairfax County Health Department, at the time. "Birds have been collected and tested from nearly every part of the county, indicating that the disease is not confined to a single specific area."

The state health department suggests that a simple mosquito bite is not cause to see a doctor, since most people who suffer from West Nile fever recover. Testing is only conducted on people suffering from the symptoms of encephalitis or meningitis, an inflammation of the lining of the brain or spinal cord.

To reduce exposure to mosquitoes, the state health department recommends people check their windows and screens to make sure mosquitoes cannot enter the home; wear long, loose and light-colored clothing; use insect repellent with no more than 35 percent DEET for adults and less than 10 percent for children; turn over or remove outside containers that collect water; eliminate standing water; clean out bird baths and wading pools once a week; and clean roof gutters and downspout screens regularly.

"While we reasonably have to expect more human cases in Virginia this year, the risk of serious illness from West Nile virus remains low," said Dr. Robert B. Stroube, the state health commissioner, in a press release. "People can reduce their risk even more by eliminating mosquito breeding areas around the home and protecting themselves from mosquito bites."