West Nile Virus - Metro Atlanta Surveillance Task Force

State: GA Type: Model Practice Year: 2004

The 1999 West Nile virus outbreak caused public health officials in Atlanta to recognize the potential for the disease to spread to Georgia. Atlanta’s size (3.5 million residents) and number of political jurisdictions (10 counties each with a board of health) meant developing a coordinated response plan would be a challenging task. In addition to requiring a coordinated, multi-jurisdictional effort, the response had to address a new disease with little scientific data to predict how it might behave in a new location. An effective response would require closely coordinated communications among the local and state public health entities as well as with elected officials. To address these issues, in early 2000, staff from the five health districts in the metro Atlanta area, and the state health department voluntarily convened the Metropolitan Atlanta Surveillance Task Force (MASTF) to create a regional approach to this emerging infection. MASTF developed a plan for public education, environmental monitoring, and disease surveillance. In July 2001, the first human case of illness was detected in Atlanta. With the metro plan in place the public heard consistent health messages about preventive measures they could take to lower their risk of illness. Although there was some initial pressure by elected officials to begin spraying for adult mosquitoes, MASTF enabled the counties to form a uniform approach to mosquito control that did not include spraying. MASTF was and continues to be a successful staff-initiated effort to develop consistent policies and procedures for local health departments to employ for disease surveillance in a heavily populated area that is governed by multiple political jurisdictions.
Following the West Nile virus outbreak in 1999, and the associated large media coverage, public health officials in Atlanta recognized the potential for the virus to spread quickly given the long mosquito-breeding season. There was a need to rapidly develop a response plan that could be used in the Atlanta area. A regional and coordinated approach was needed. The aim was to construct a workable plan in the first few weeks of 2000 before the southern spring arrived and when the mosquitoes and birds began to show the presence of the virus. To address the issues, many partners were brought to the table in this effort and formed the Metro Atlanta Surveillance Task Force (MASTF) to create a regional approach to this emerging infection. MASTF developed a plan whose foundation was public education, environmental monitoring, and disease surveillance. One of the guiding principles was to create a plan that could be shared with other local and state public health entities. Three scenarios were developed to guide the content of the West Nile Virus Response Plan: first, the presence of a positive bird in Georgia (non-metro-Atlanta); second, a positive bird in the metropolitan Atlanta area; and third, a human case of West Nile infection in the Atlanta area. Each of these scenarios would require the same three critical elements and the following functions: public education, environmental monitoring, and disease surveillance. Given the variability across health districts, the response plan focused on generic functions that could be operationally defined within each jurisdiction. This enabled each local health entity to modify the response plan to address those issues that were unique to its jurisdiction.
Agency Community RolesPartners from the Department of Agriculture Pesticide Division, the Department of Natural Resources and the Centers for Disease Control and Prevention (CDC) all contributed vital parts of the plan. One of the most valuable assets was retired CDC entomologist, Dr. Jesse Hobbs, who had worked worldwide on mosquito problems and volunteered his time to this effort. With the rapid advance of the virus down the east coast, political connections were made throughout the metro Atlanta area. These meetings allowed local elected officials to understand the issues of this new disease and the implications for their constituents. It also allowed for emergency funding requests to be made to combat the virus and prevent human cases of the disease. These successful coordinated funding requests allowed a rapid educational campaign through the media and door-to-door outreach, emphasizing the importance of dumping out standing water and using larvicide to interrupt the early life cycle of the mosquito. Staff from the state Departments of Agriculture and Natural Resources attended meetings and contributed to the plan. Regular coordinated communications were developed and released to the media and community partners such as schools, public safety and hospitals. Emory University academics participated in the development of the plan and educational outreach. The project objectives required coordination and collaboration among the local and state public health entities. Working together, MASTF accomplished these objectives along with producing some ancillary benefits such as improved communications and relationships among the participating agencies.  Costs and ExpendituresGiven the variability in resources across local public health entities, those health districts that could dedicate staff and resources (e.g. telephone conferencing for daily calls) to this effort shared them widely. Once the virus arrived in July 2001, each health district approached their county commissioners to secure supplemental funding to support the public education, environmental monitoring, and disease surveillance efforts. Each health district developed proposals that outlined a set of activities and associated costs. While making presentations to county commissioners, health officials noted the regional efforts that MASTF had coordinated during the preceding 18 months. Some non-traditional sources of funding were also identified during the planning efforts. One local public health agency sought out a new partnership with the Georgia Environmental Protection Division’s Scrap Tire Program and was successful in securing funding to deal with the risk for mosquito breeding posed by scrap tires in their community. As a result of this grant, the local public health agency developed a new and collaborative relationship with their county code enforcement office.  ImplementationTo address the threat from West Nile virus, MASTF set out to accomplish the following three objectives. First, provide public education to the members of the communities. To be successful, credibility would depend upon capacity as local health officials to provide consistent and scientifically sound messages and advice. MASTF needed to earn and keep the trust of the public in a setting where the knowledge base was incomplete and continuing to evolve. Thus, MASTF needed to communicate the level of uncertainty in a fashion that did not engender panic or foster rumors. MASTF also needed to avoid situations in which elected officials or other spokespersons were broadcasting messages that ran counter to the evidence-based communications from health officials.Second, develop a consistent and phased approach to environmental monitoring that was formulated on the best available scientific information. Given what was known about the control measures that were implemented in several northeastern states, MASTF wanted to implement appropriate steps to control mosquitoes before the virus arrived, and wanted to be proactive, not simply reactive. Third, conduct human disease surveillance for West Nile virus. To conduct human surveillance, MASTF developed a standardized protocol that was implemented in all of the counties in the metropolitan Atlanta area. The local health department staff investigated any patients with suspected West Nile virus infection at a partnering hospital, regardless of their residence. After investigating a suspected case in a resident from another county, the health district would inform the resident’s health department of its findings. In July 2001, the first human case of West Nile illness was detected. During that season, all of the metro Atlanta counties subscribed to the MASTF plan. As a result, the public heard consistent health messages about preventive measures they could take to lower their risk of illness. Although there was some pressure to initiate spraying for adult mosquitoes, MASTF enabled the counties to form a uniform approach to mosquito control that did not include spraying. MASTF allowed the various counties within the metro Atlanta area to constantly reduce the risk of human infection of West Nile virus.
MASTF was not formally evaluated. However, if success were measured by the increased levels of cooperation, coordination, and consistency in dealing with the presence of West Nile virus among the local and state public health entities, MASTF would receive very high marks. MASTF provided the solution to the challenges posed by preparing for the emergence of West Nile virus in metropolitan Atlanta. The plan that was developed by MASTF became the planning template for the State of Georgia and has been shared with other local public health entities throughout the country. MASTF increased the collaboration among the state and local public health entities. It increased the sharing of critical information by increasing the communication among the participating agencies. A critical benchmark for MASTF as a model of multi-jurisdictional collaboration occurred during the fall of 2001. Following 9/11/2001, concern about West Nile virus dropped with the concomitant emergence of terrorism as a threat to public health. With the first case of anthrax in October 2001, public health was suddenly thrust to the forefront as a critical partner of the response community. MASTF seamlessly refocused its efforts around bioterrorism and again provided a framework for communication and collaboration in a setting where information was evolving rapidly.
As a testament to its sustainability, MASTF recently entered its fourth year of existence, with heavily attended and regularly scheduled monthly meetings. While West Nile has remained a central focus, MASTF has evolved into a forum where other emerging public health threats could be discussed. MASTF members, for example, recently shared strategies and plans around anthrax, smallpox vaccination, SARS, avian influenza and other new threats.