An Integrated Vector Management Approach Towards Emerging Infectious Diseases Prevention in Harris County and the City of Houston

State: CA Type: Model Practice Year: 2019

Harris County Public Health (HCPH) is the county health department for Harris County, Texas the third most populous county in the United States providing comprehensive health services to the community through an annual budget of $100 million and a workforce of over 700 public health professionals. The HCPH jurisdiction includes approximately 2.2 million people within Harris County's unincorporated areas and over 30 municipalities located in Harris County (not including the City of Houston). However, mosquito and vector control public health services encompass the entirety of the county including the City of Houston providing services to over 4.5 million people. Emerging Infectious Diseases (EID) are defined by the Centers for Disease Control and Prevention (CDC) as those diseases in which incidence in humans has increased in the past 2 decades or threaten to increase in the near future.” Many of the pathogens capable of causing EIDs are vector-borne, or those transmitted to humans and animals by arthropods, and the World Health Organization (WHO) estimates that 4 out of 5 people worldwide are at risk of contracting pathogens transmitted by kissing bugs, ticks, mosquitoes, and other arthropod vectors. Texas is uniquely positioned to support various vectors capable of transmitting multiple types of pathogens: most of the reported autochthonous cases of Chagas disease transmitted by kissing bugs have occurred in Texas, previous research has shown that 1 in 5 ticks in Texas carry various pathogenic bacteria, and Texas was the second state in the US to report local transmission of Zika virus by Aedes aegypti mosquitoes. HCPH Mosquito and Vector Control Division (MVCD) added a Vector Surveillance Branch in 2016 to further integrate our vector surveillance and EID prevention efforts. HCPH recognizes the increased risk of EIDs to Harris County residents and the City of Houston and has dedicated resources to address these emerging threats. Through optimizing resources to address these emerging threats, HCPH MVCD practices Integrated Vector Management encompassing a multi-faceted toolbox of surveillance and control measures. Goal: Integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 1. Utilize county and collaborative resources to support program components. 2. Maintain and adapt program processes as new methodologies and technologies become available. 3. Enhance and streamline the notification system for vector-borne disease presence. HCPH Mosquito & Vector Control Division is one of the largest and premier mosquito and vector control programs in the United States (US). The comprehensive integrated vector management (IVM) approach utilized makes the program a leader in EID surveillance, control, preparedness, and response. HCPH MVCD practices IVM through a multi-tactic program. Utilizing the 53 years of mosquito surveillance and control data, we can better understand the impact of vector-borne diseases on our communities. Combining this knowledge with ongoing mosquito, avian, and vector surveillance enables us to employ the most appropriate evidence-based control efforts per community. These control efforts include prevention, mechanical and physical methods, cultural methods, biological control, and continual program evaluation. Each MVCD program area is associated with one or more control methods. If and when an arthropod-borne pathogen is detected in the Houston/Harris County metropolitan area through our surveillance program, our response is initiated. Education specialists, mosquito inspectors, and pesticide applicators are alerted and deployed. Residents are educated on various mechanical, cultural, and physical methods to protect themselves and prevent vector-borne disease, while mosquito inspectors and pesticide applicators apply biological and chemical controls where needed. Insecticide resistance and alternative mosquito control research are conducted to evaluate overall program success and effectiveness. From April to November 2018, our surveillance program detected 310 arthropod-borne pathogens. In response, multiple control methods were initiated. A total of 2,038 pesticide applications were made, 2,642 inspections were conducted in impacted areas, 6 different novel surveillance and control research projects were implemented, and 56 insecticide resistance tests were completed. In addition, MVCD participated in 89 educational events. In addition to the IVM conducted by HCPH MVCD, our collaborative work with partnering entities allows us to further our reach to cover all areas of Harris County in the most efficient way possible saving time and valuable resources. Our program ensures the health of Houston/Harris County residents as a top priority as we strive to continuously enhance our program and notify the public of any increased disease risk. Additional information about our HCPH MVCD program can be found at:
EIDs are not limited by country borders. Many of these diseases initially thought to no longer be a threat in the US are now re-emerging, while others are emerging for the first time. The location of Texas provides a prime crossroads for these re-emergences and introductions. According to the Texas Department of State Health Services (DSHS), there have been 14 different vector-borne diseases reported in Texas in the past 5 years, 9 of which are classified as EIDs. The vector-borne EIDs with the most impact to Texas are Lyme disease, spotted fever group rickettsioses (both transmitted by ticks), malaria, chikungunya, and dengue (all vectored by mosquitoes), and Chagas disease (vectored by kissing bugs). West Nile virus (WNV) contributes 74% of all arboviral diseases reported in Texas; chikungunya 15%, dengue 9%, and Zika 2% of all arboviruses specifically vectored by mosquitoes in Texas. Three of these 4 arboviruses are EIDs. The following are all innovative techniques that MVCD has adopted into our IVM toolbox. Isolation to Treatment Time – In 1984, Harris County established one of only a few existing in-house virology laboratories in the country. The Virology Laboratory of MVCD continues to play a vital role in detecting EIDs through the testing and analyses of mosquito samples. The specific methodologies integrated into Virology's test program not only screen for, and target infectious pathogens that are endemic to our region, namely WNV, but also involve the incorporation of the latest in testing technology, thereby enhancing our capability to detect EIDs including chikungunya, dengue, and Zika. Such EIDs possess the potential for becoming epidemiological problems, not just for Texas, but for the communities that our MVCD serves. This enhanced testing capability can be transitioned to include other vectors as well. Having a laboratory capable of testing for arboviruses on site continues to be advantageous for MVCD, in particular, in terms of shortening the amount of time between virus isolation and appropriate treatment measures being used. Obtaining test typically within 3 days of vector collection is a key component in the expeditious application of control measures to help prevent the spread of EIDs. As a result, the reduced isolation to treatment time aids in the classification of MVCD as a Model Practice. In addition to the rapid test result system in-house at MVCD, we are also involved with testing new technologies in order to increase efficiency in our Avian Biology Program. HCPH MVCD was the first in the US to utilize Loop-mediated Isothermal Amplification (LAMP) technology to test for WNV in avian blood samples. This technique is currently only used for testing mosquito pool samples. An agreement with Pro-lab Diagnostics allows us free use of the Genie LAMP testing equipment (valued at $17,900) as long as we continue testing a sufficient number of avian samples, with an annual expenditure of approximately $10,000. Preliminary results for the 2018 period indicate that the time needed for testing was reduced while also saving precious PCR laboratory space for avian sample testing, resulting in efficient time and cost savings. Data Centric Initiative – Two recent data collection tools have been developed and are in use that expand information sharing capabilities in a way that not only enhance individual program area processes, but influence better decision making collectively. First, a database for all of MVCD collected data was constructed. Previously, each MVCD program area utilized a separate Access database on Sequel which made it difficult to access and share information internally and externally. Second, a Data Warehouse was created for the entirety of HCPH to consolidate department-wide and external data sources such as NOAA and the US Census. This allows all HCPH Divisions and Offices to analyze data that impacts multiple aspects of public health in a much more efficient manner, leading to better data-driven decisions. Insecticide Resistance Management – Beginning in 2004, the Testing and Evaluation Section started evaluating potential pesticide resistance in wild Culex quinquefasciatus mosquitoes from various regions in Harris County/Houston after WNV emerged in Texas. Testing was initially conducted with field-cage testing. In 2017, two additional mosquito species were added to our field cage testing protocols. The additional mosquitoes, Aedes aegypti and Ae. albopoictus, are known vectors of multiple EIDs in the Americas including Yellow fever, dengue fever, chikungunya, and Zika. Additionally, the Testing and Evaluation Section enhanced its insecticide resistance monitoring with the addition of the CDC bottle bioassay as a further level of resistance testing. A Bottle bioassay provides a relatively quick and efficient method of testing a fixed diagnostic concentration of a single toxicant in laboratory conditions. It is used as a method to increase the number of working areas tested as well as verify results of the field cage tests. Since its introduction, bottle bioassays have been conducted using all three key mosquito vectors (Culex quinquefasiatus, Ae. aegypti, and Ae. albopictus) collected from selected operational areas. The incorporation of insecticide resistance testing and evaluation as part of our comprehensive vector management program has proven to be critical in determining both efficacy of products tested and resistance in vector populations to current products in use. Adjustments to control efforts have been made based on our insecticide resistance testing and evaluation. The most significant adjustment made based on these findings was the rotation of chemicals used in a given area from treatment to treatment when multiple insecticide applications are conducted. The goal of this rotational strategy is a decrease in the level of insecticide resistance previously found. This strategy is used by other vector management programs; however, what makes our rotation unique is our ability to alternate between two different chemicals of two different classes within the same vehicle spray system. Applied Research – Operational research is conducted using scientific methods of novel mosquito control and surveillance products or improved existing surveillance and control strategies at HCPH MVCD. We are currently investigating several autodissemination vector control strategies including Attractive Toxic Sugar Baits (ATSB) and In2Care Mosquito Traps (In2Care B.V. Wageningen, The Netherlands). In2Care Traps utilize the egg laying behavior of mosquitoes to spread insecticidal toxins in mosquito breeding habitats, resulting in the suppression of mosquito vector populations. ProVector Tube (MEVLABS, Inc., Statesboro, GA, USA), a type of ATSB, utilizes the sugar feeding behavior of mosquitoes in addition to the egg laying behavior to also spread insecticidal toxins into mosquito breeding habitats. Both In2Care Traps and ProVector Tubes were evaluated in the summer of 2018 to reduce mosquito vector populations. The In2Care Mosquito trap was tested in urban areas of Harris County/Houston, and ProVector Tubes were tested in recreational parks. We are also investigating a new potential larvicidal product in collaboration with the School of Public Health at Texas A&M University and a mosquito-microbial project with New Mexico State University and University of Texas at Austin, using LAMP as a molecular diagnostic tool to determine the prevalence of Wolbachia bacteria in mosquitoes of Houston/Harris County. The symbiotic Wolbachia is used for biological control of mosquitoes and the diseases they transmit. We have also been evaluating the new Biogents Sentinel Counter (Biogents AG, Regensburg, Germany) trap that electronically counts host-seeking mosquitoes in the field to monitor mosquito abundance pre- and post-treatment applications, and improve surveillance capabilities of HCPH MVCD. Microsoft Corporation Smart Trap– In symmetry with our rapid test isolation and treatment time, MVCD has partnered with Microsoft Corporation to develop a mosquito trap that will ultimately save time and resources in mosquito surveillance. This trap, a part of Project Premonition, aims to speciate mosquitoes as they fly into the trap. Precious time in the virus isolation process is eliminated as only certain species of mosquitoes are collected and the sorting process—which takes the longest portion of time—is significantly reduced. With the availability of this new technology, the entire EID detection and notification system can be adapted even further to protect Harris County residents. MosquitoMate Biological Control – HCPH MVCD also began an Aedes suppression project with MosquitoMate, Inc. releasing Wolbachia-infected male Ae. aegypti and Ae. albopictus mosquitoes. The male mosquitoes will mate with their conspecifics and the female mosquitoes' eggs will not hatch, thus decreasing the Aedes vector mosquito population in the tested area. A test trial was conducted in 2018, and the full scale releases will be conducted in the summer of 2019. HCPH MVCD's new Vector Surveillance Branch also aids in the unique and innovative ways we are impacting Harris County/Houston. For over 50 years, HCPH was a leader in mosquito surveillance in Harris County and throughout the nation, however mosquitoes are not the only vector capable of transmitting pathogens to humans. With the addition of surveillance of other arthropod vectors, HCPH MVCD can be a model program as well. HCPH MVCD currently surveys Harris County/Houston for both kissing bugs and ticks, and will expand to more vectors in the near future. Kissing bugs are collected through public submission, trapping, and active surveillance. All kissing bugs are sent to Baylor College of Medicine (BCM) for various tests including pathogen detection. Ticks are collected throughout the county through trapping and active surveillance; all ticks are sent to University of Texas Medical Branch at Galveston (UTMB-G) for pathogen detection. Through these surveillance avenues, HCPH MVCD can create a holistic view of EID risk and pathogen presence in Harris County/Houston. Vehicle Tracking System – HCPH MVCD has invested in a vehicle tracking system that allows it to carefully monitor our vehicles to catch any potential problems before they arise and provide our drivers with a safety net. The system allows us to check vehicle status rapidly to detect vehicle system failures and provides a safe and efficient interface to interact with applying pesticides. Following proven Integrated Pest Management (IPM) and Integrated Mosquito Management (IMM) set by MVCD's Pesticide Discharge Management Plan (PDMP), we can safely and accurately apply pesticides from our vehicles. Responsible and legal application of pesticides must be documented appropriately, and this vehicle tracking system records all vehicle operations automatically. When we respond to disease in the vector population, we can do so efficiently knowing our system is working for us by increasing time and cost savings. Communications and Community Engagement – Ongoing prevention messages are provided to county residents in an effort to impact the knowledge, attitudes and beliefs of the community towards EIDs. Community efforts to reduce vector populations and taking personal protective measures against these vectors and the EIDs they transmit are vital to the work conducted by HCPH MVCD. Providing these messages and facilitating community involvement to impact behavior change is even more critical when EIDs are detected in our community. Public notification of EID detection is provided utilizing a combination of delivery methods that include: person-to person communication, website, social media and traditional media (radio, print, television). Our community outreach footprint is currently expanding with the addition of two mobile outreach vehicles which allows us the opportunity to engage the community in an innovative, interactive learning experience. The first of two vehicles is the Skeeter School Bus, an extension of our Skeeter School Outreach Program for elementary age children that includes a teacher's edition with lessons and the availability of supplies and information to raise mosquitoes in the classroom to observe the mosquito life cycle as it occurs. The second is the Mobile Vector Unit (MVU). This vehicle is a museum style interactive display that includes information panels, video screens with public service announcements and an interactive quiz, microscopes with vector specimens, and mosquito hatcheries” that enable the participant to see each stage of the mosquito life cycle up close, and more. We worked with the Houston Museum of Natural Science to complete this learning experience and in the few short months the MVU has been in operation, we have seen an impact in the communities in which it has visited. AMCA Best Management Practices – HCPH MVCD follows AMCA best management practices and was selected by AMCA to teach these practices to others in the mosquito control industry. Two HCPH MVCD entomologists have been certified as Master Certification trainers and continue to work with AMCA to bring this training to the region.
The goal of HCPH MVCD is the integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. Establishing and maintaining strong working relationships with internal and external partners provides us with the foundation in which all program components depend. These relationships have a direct link to MVCD objectives; (1) utilize county and collaborative resources to support program components, (2) maintain and adapt program processes as new methodologies and technologies become available, (3) enhance and streamline the notification system for vector-borne disease presence. Internal partners and collaborators are vital to ensuring that HCPH MVCD is in alignment with One Health goals and initiatives of HCPH as well as ensuring that we are utilizing all pertinent data needed to make sound decisions regarding EID detection and response. HCPH One Health program areas that have a direct correlation with EID investigation, detection, and response include Entomology, Epidemiology, Communications, Public Health Preparedness, Veterinary Public Health, and Environmental Public Health. Working with these internal partners and collaborators broadens our knowledge base and enhances processes to encompass all needed information to make informed decisions that impact the health of our community. While our internal partners and collaborators are key to program goal success, we would not be able to achieve our goals as completely, effectively, and efficiently without our external partners and collaborators. These partners and collaborators include, but are not limited to UTMB-G, BCM) Texas A&M University (TAMU), University of Houston, New Mexico State University, University of Texas at Austin, Walter Reed Army Institute of Research, Texas Tech University, US Army Public Health Command –South, Microsoft Inc., MosquitoMate Inc., Entomological Society of America, Texas Mosquito Control Association, and American Mosquito Control Association (AMCA). Strong working relationships with these partnering and collaborating academic and research institutions, organizations, and associations allows us to further our reach to cover all areas of Harris County/Houston in the most efficient way possible saving time and valuable resources. An example of these partnerships and collaborations and their impact on attaining our program goal by meeting our objectives follows. In response to the threat of the emergence of Zika virus in Houston/Harris County, we have increased mosquito collections, enhanced testing capabilities, and increased community engagement activities. Making these program enhancements could not have successfully been achieved without the assistance of our internal and external partners. Their assistance with resources, both monetary and expertise, has been invaluable. Being awarded additional grant funds has provided a necessary benefit to enhance disease surveillance capabilities for Zika virus in Houston/Harris County. Equally as important as additional funding, is the assistance with laboratory space, professional consultation, and community engagement opportunities. Establishing and maintaining strong working relationships with colleagues and organizations in vector-borne disease management and related fields has proven to be vital in determining program needs and outcomes, writing processes and procedures that meet state and federal standards, and accessing appropriate target audiences for health promotion messages. Our collaborative efforts with UTMB-G, Centers for Disease Control and Prevention (CDC), and Texas Department of State Health Services (DSHS) has provided us the capacity to extend our surveillance in the community. Grant funding allowed us to purchase additional traps for mosquito collections of Ae. aegypti and Ae. albopictus mosquitoes and related supplies. In the event a locally acquired human case of Zika virus does occur in Houston/Harris County or Zika virus is detected in local mosquito populations, we have the capability of setting additional mosquito traps in those areas in addition to maintaining current mosquito collection operations. Initially, in an effort to begin testing for Zika virus in local mosquito populations as soon as possible, we contacted long-standing partners to assist us. Utilizing the resources of these partners, we began testing mosquito samples through UTMB-G and TAMU. These partners were able to test samples submitted on a weekly basis for a set time frame. The testing was done at no cost to us until their funding sources would no longer support this effort. Once those testing resources were exhausted, we were immediately able to seamlessly transition into testing at BCM. Another of our long-standing partners, BCM generously provided laboratory equipment and workspace to test mosquitoes collected for Zika virus until our Virology laboratory was fully renovated and outfitted to perform more advanced in-house virus testing. Working with these partners has been a tremendous benefit allowing us to maintain daily operations while adding the additional testing for Zika virus. The provision of grant and county funding to update our virology laboratory to include PCR testing for Zika virus expanded our laboratory capabilities. The cost of this expansion for the laboratory exceeded $750,000. These capabilities not only expanded our ability to test in-house, but reduced the time between EID detection and control as it eliminated the need to send samples to the state laboratory for testing. As part of the HCPH Zika Readiness Team, we have been able to work directly with our internal partners to plan and implement a department strategy for addressing this emerging health threat. Two areas where partnership has been integral are (1) investigations of suspected cases of locally acquired Zika cases, mosquito breeding site identification, and treatment of larval breeding habitats, and (2) health communications to healthcare providers and county residents. Grant funding provided from DSHS and the CDC enabled us to hire additional MVCD Inspectors and Health Educators. The funded cost for 2 additional health educators was $117,046. The addition of health educators allowed us to participate in a total of 165 community events in 2017. In addition to conducting presentations and participating in community events, we were also able to provide outreach materials to a number of community organizations, as well as, provide them to our internal partners. The ability to provide these materials and targeted marketing campaigns was also grant funded by both DSHS and Community Health Choice at a total of $100,000 each. Working with our HCPH internal partners, we have begun an in-house One Health collaboration between Veterinary Public Health, Environmental Public Health, and Mosquito & Vector Control. The goal of this collaboration is for all participating internal partners to identify and treat for mosquito breeding sites when observed. This will allow for the breeding site to be eliminated and/or treated at the time of identification making it a more effective and timely application. Regular meetings and training opportunities are provided to collaborative members, including the Master Vector Certification Course, which has been offered at our local health department facility, through a collaboration with the CDC Western Gulf Center of Excellence for Vector-Borne Diseases. In addition to this in-house effort, we have included the City of Houston Community Development Department and Houston Health Department Bureau of Public Health Preparedness in our One Health practice. This allows us a further reach into Houston/Harris County neighborhoods to identify mosquito breeding sites and educate residents and business owners on breeding site elimination and personal protective measures. Training and outreach materials are provided to these partners as needed. The primary costs associated with this crucial One Health collaborative effort have been employee time, larvicides ($20,000), and printing of outreach materials ($25,000).
Goal: Integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 1. Utilize county and collaborative resources to support program components. 2. Maintain and adapt program processes as new methodologies and technologies become available. 3. Enhance and streamline the notification system for vector-borne disease presence. HCPH recognizes the need to provide public health services in an efficient manner as possible, and MVCD follows suit by continuously evaluating the IVM program as it is executed routinely or through emergency situations. Two tiers of MVCD's program that are continuous despite seasonality are the Communications and Community Engagement and Surveillance Programs. Communications and Community Engagement This program interacts face-to-face with the constituents of the county daily, and thus constant evaluation is extremely valuable to better serve the community. The program examines how many people are reached through the various programs provided throughout the year and the number of one-on-one contacts made. In collaboration with our Mosquito Inspection Section, various metrics are evaluated including the number of inspections conducted where resident contact is made and the number of health communication materials provided. 2018 Results: · Number of outreach and education events: 78 inside the City of Houston, 43 outside the City of Houston · Number of individuals reached in outreach events: 15,201 · Number of inspections conducted: 2,642 With a total of 121 events throughout Harris County and the City of Houston, HCPH MVCD was able to reach more areas of the county and attend more events than in previous years. The ability of the outreach and education team to provide information at events is directly related to funding and the number of education staff members. In 2018, the team of 3 was highly ambitious and accomplished much. Due to an increase in funding for MVCD and introduction of multiple EIDs in the past 3 years—namely chikungunya and Zika viruses—the number of staff for both the inspections and education teams was increased this year, resulting in a more integrated and thorough coverage of the county regarding all aspects of communication sand outreach, including special media campaigns. Surveillance The Surveillance Section is also evaluated constantly throughout the process in order to maintain the efficiency of the established notification system. HCPH MVCD evaluates and examines how many mosquito traps are set, how many mosquito pools are tested and their results, how many birds are tested and their results, how many kissing bugs and ticks are collected in the county, and their test results as well. Because the Surveillance Section is very efficient, data on these collections and testing results are highly valuable and monitored very closely. 2018 Results: · Number of mosquito traps set: 14,015 · Number of female mosquitoes collected: 750,336 · Number of female mosquito species pooled: 298,312 · Number of mosquito pools tested for WNV: 14,968 · Number of mosquito pools positive for WNV: 307 · Number of mosquito pools tested for St. Louis Encephalitis virus: 14,915 · Number of mosquito pools positive for St. Louis Encephalitis virus: 0 · Number of mosquito pools tested for dengue virus: 6,407 · Number of mosquito pools positive for dengue virus: 0 · Number of mosquito pools tested for chikungunya virus: 6,373 · Number of mosquito pools positive for chikungunya virus: 0 · Number of mosquito pools tested for Zika virus: 6,161 · Number of mosquito pools positive for Zika virus: 0 · Number of live birds tested for WNV: 888 · Number of live birds positive for HI WNV: 78 · Number of live birds positive for HI SLE: 0 · Number of live birds positive for HI EEE: 3 · Number of dead birds reported: 124 · Number of dead birds tested for WNV: 98 · Number of dead birds tested positive for WNV: 6 · Number of live birds tested for WNV via LAMP technology: 469 · Number of live birds positive for WNV via LAMP technology: 38 · Number of kissing bugs collected: 1 · Number of kissing bugs tested positive for Trypanosoma cruzi parasite: 1 · Number of ticks collected: 179 · Number of tick species collected: 5 · Number of tick pools tested positive for Rickettsia: 6 · Number of tick pools tested positive Ehrlichia: 1 Before the explosive emergence of chikungunya and Zika viruses in South America, mosquito surveillance and testing concentrated on isolating WNV and dengue virus, thus data remained typically static throughout the years. However, after the introductions of these EIDs, many of these metrics have increased, and surveillance efforts were adjusted by reducing the number of WNV pools and increasing the number of pools for chikungunya and Zika viruses. The addition of Biogents Sentinel (BG) traps also increased the possibility of collecting the mosquito species responsible for transmitting these diseases. Thus, HCPH MVCD has increased the arboviruses and EIDs that we screen for in our mosquito samples. So far, no Zika, dengue, or chikungunya viruses have been detected in mosquito samples, however, we are ready to respond if and when these are detected. The number of birds able to be tested and the positive results have steadily increased over the past 3-5 years, mainly due to funding and the ability to hire additional seasonal workers and test additional samples. Even though none of the current emerging EIDs have affected avian surveillance as birds have not been found to be hosts of these new viruses, MVCD is primed for detecting additional potential EIDs in the bird population, such as Highly Pathogenic Avian Flu in Harris County/Houston area through our partnerships with UTMB-G. The new addition of the Vector Surveillance Branch has significantly impacted the reach of MVCD in regards to EID screening. Through our collaboration with BCM, HCPH MVCD has collected 9 total kissing bugs in the county since 2016, and HCPH MVCD was the first to establish a kissing bug and Chagas disease surveillance program in Harris County/Houston. In addition to the kissing bug collections and testing, the tick collections were also established for the county as well: 5 tick species have been documented and two genera of potential bacterial pathogens have been identified so far in these tick tested pools. With these additional vector testing collaborations, HCPH MVCD can monitor and better inform the residents regarding EID risk in Harris County/Houston. Whenever disease is detected in either the residents of Harris County or in vector populations, our IVM Program has a well-established response protocol to contain any vector-borne disease, especially EIDs, capable of impacting public health. The program crucial for this response is that of Field Operations Branch, which is responsible for inspections and control activities. Field Operations When a human vector-borne disease is suspected and documented by the HCPH Epidemiology Surveillance Unit, HCPH MVCD is informed and action is immediately taken. If the vector-borne disease is a certain EID, like Zika virus, then specialized teams of epidemiologists, mosquito inspectors, and environmental public health specialists will be sent to respond. The response is swift, and depends on the severity of the disease. When vector-borne disease is detected through our in-house virology laboratory, notice is given within 3 days of mosquito collection, and treatment activities are conducted within 24 hours. This process is evaluated through examining the number of inspections conducted for suspect vector-borne disease cases, and the number of larval and adulticide treatments conducted. 2018 Results: · Number of suspect vector-borne disease requests: 74 · Number of larvicide treatments (on inspections): 1,316 · Number of adulticide treatments: 722 · Number of MVCD Operation Areas treated through adulticide application: 144 The anticipation of and following introduction of Zika virus into the continental US, directly impacted the number of suspect disease cases and larvicidal treatments conducted in Harris County; these numbers have significantly increased over the past 3 years. With the integration and collaboration between HCPH Divisions with MVCD (Epidemiology and Environmental Public Health), the notification system and treatment timeline for vector-borne disease presence continues to be streamlined and effective. Every adulticide treatment conducted in 2018 was based off of detecting WNV in mosquito pools. As MVCD has focused on preventing and preparing for additional EID arboviruses, the Field Operations Branch is prepped to respond with the appropriate IVM control for any local introductions of these as well. HCPH MVCD is continually evolving toward more efficient treatment methodologies to bolster its IVM strategies. This includes the addition of small, unmanned aerial systems (sUAS), often referred to as drones for mosquito surveillance and treatment activities. The sUAS have the potential to revolutionize mosquito control by allowing access for breeding site identification and treatment in areas rendered inaccessible due to natural disasters. HCPH MVCD has acquired funding for 3 sUAS and is in the process of licensing 2 sUAS pilots through the Federal Aviation Administration. The incorporation of sUAS will increase MVCD's capacity to respond to natural disasters and public health emergencies. In order to maintain and adapt the current EID detection and prevention system as new technologies and even changes in the vector populations occur, MVCD also evaluates our own actions and the impacts on the environment—both regarding the vectors and the safety of our treatment applications. The MVCD sections heavily involved with our internal evaluations are the Testing and Evaluation Section and the Field Operations Branchwhich analyze the potential for insecticide resistance development, potential toxic effects from larvicide applications, and the efficacy of new products. 2018 Results: · Field Cage Testing: o Number of Culex mosquito populations with early indications of resistance to Malathion: 3 o Number of Culex mosquito populations with early indications of resistance to Permethrin: 3 o Number of Ae. aegypti mosquito populations with early indications of resistance to Permethrin: 2 o Number of Ae. albopictus mosquito populations with early indications of resistance to Permethrin: 0 · Bottle Bioassays: o Number of Culex mosquito populations with suspected resistance** to Permethrin: 3 o Number of Culex mosquito populations with suspected resistance to Malathion: 3 o Number of Ae. aegypti mosquito populations with suspected resistance to Permethrin: 1 o Number of Ae. aegypti mosquito populations with suspected resistance to Malathion: 1 o Number of Ae. albopictus mosquito populations with suspected resistance to Permethrin: 0 o Number of Ae. albopictus mosquito populations with suspected resistance to Malathion: 1 · Number of areas with toxic effects from larvicide applications: 0 ** Suspected resistance for CDC bottle bioassays is defined by WHO insecticide susceptibility criteria with <80% mortality labeled as ‘suggested resistance'. The Culex and Aedes mosquito populations that are discussed here are from 5 HCPH MVCD Operational Areas which were treated the most for detected vector-borne disease presence in 2016 and 7 populations from Operational Areas which were tested consistently every year. HCPH MVCD has noted that resistance began developing in Culex mosquitoes in the county to Malathion decades ago, and, as previously mentioned, the rotation of chemicals was employed to curb this trend. Since then, resistance has also began to develop to Permethrin, however at a much slower rate due to our efforts to limit this. EID preparedness and prevention significantly impacted the ability of MVCD to conduct these tests on additional species (Ae. aegypti and Ae. albopictus), as funding availability and dedicated personnel significantly increased in the past 3 years for this purpose. So far, no toxic effects have been noted from any of the larviciding activities across the county. HCPH MVCD is confident that the ability to conduct these in-house evaluations and checks and balances on our own vector-borne disease response efforts is due to our strongly integrated program and easily flexible practice components, ready to be adjusted when new EIDs threaten the residents of Harris County/Houston and Texas.
Goal: Integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 1. Utilize county and collaborative resources to support program components. 2. Maintain and adapt program processes as new methodologies and technologies become available. 3. Enhance and streamline the notification system for vector-borne disease presence. HCPH recognizes the importance of not only beginning new practices and programs to provide services to the residents of Harris County/Houston, but sustaining these practices to provide as many benefits to the county constituents as possible for extended periods of time. Sustainability is crucial to MVCD as the results of our rapid test result system and other notification components provide pertinent information regarding public health prevention and vector-borne disease risk. Multiple programs in HCPH MVCD maintain essential relationships with collaborators, explained thoroughly in the LHD and Community Collaboration section. Examples of some of the programs which depend on sustainable and maintained agreements with stakeholders are the Communications and Community Engagement, Test and Evaluation, Virology laboratory, and Surveillance. Communications and Community Engagement – Community connections have always been important to HCPH MVCD by providing needed support and assistance to supply quality community education programs. HCPH MVCD partners with the Texas Department of Agriculture (TDA) and Texas AgriLife Extension to provide many training services to the county. A changing marketplace and diminished resources has made those connections invaluable to sustaining those programs by providing target audience access, information distribution capabilities, and expanding community education program outreach. A significant commitment from stakeholders is required to host the Annual CEU Workshop for Certified Pesticide Applicators in Harris County which ensures that insecticide and pesticide applicators in our communities are applying the best practices for integrated mosquito and pest management. Buy-in and input from these regional partners is an important factor in data collection and program implementation throughout Harris County/Houston neighborhoods. The return on investment is immeasurable as the participants receive state required continuing education units and valuable resources in conducting day-to-day operations. The plans for sustaining this program at HCPH MVCD are as follows: · Maintain our designation as a TDA Recertification Sponsor. · Maintain our partnership with both TDA and Texas AgriLife Extension to provide required information and support for workshop attendees. · Provide workshop to vector control programs with a focus on those in the Houston/Harris County region. · The most important lesson learned through these collaborations is that community engagement at any level is community involvement. Testing and Evaluation – Since the Testing and Evaluation section performs much of the internal evaluation work regarding treatment activities, this section is extremely important to maintain. HCPH MVCD would not be able to ethically and accurately practice IVM without the knowledge that our treatment response was providing real results in vector populations. This section relies on support from multiple collaborators including UTMB-Galveston, TAMU, BCM, the City of Houston, and more. In order to sustain these working relationships and sustain this crucial program, cost-benefit analyses and constant communication are required. The expense of conducting field-cage testing without having a less expensive laboratory assay (bottle bioassays) to align and correct results left a gap in the data HCPH MVCD was collecting regarding potential pesticide resistance. Through cost-benefit analyses, this assay was determined to be critical for this program to maintain its position as a leader in treatment assessment, and our partners are needed to sustain the continuation of this assay. With this guiding laboratory assay, performing field cage testing could actually become less frequent (saving time and money) and also provide a secondary check at more prudent expense. Constant communication with collaborators allows HCPH MVCD to sustain this section, ensuring proper management of resources and the overall health of Harris County/Houston residents is protected. The plans for sustaining this program are as follows: · Train technologically-capable and motivated personnel to cover all aspects of this vital work. · Continue to be flexible with the goal to maximize Insecticide Resistance Management (IRM). · Keep accountability a top priority. Virology Laboratory - The Virology laboratory continues to efficiently perform extensive testing of vectors that can transmit arboviruses, including EIDs. Such testing, even during periods of departmental financial shortfall, has continued without disruption, with the support of vital partnerships throughout the medical/research community. The resources these entities have provided have been invaluable in not only helping the Virology laboratory sustain current testing methodologies, but also, through training and financial sponsorship, assisting in the incorporation of the most effective new innovative equipment and proven test procedures for sample analyses. The arrival of Zika virus in the United States, posed a special challenge for Harris County in that there was no existing means of testing for this virus. To address this issue, progressive strategies were immediately devised to make provisions for Zika testing of vectors via qPCR methodology, including wide-ranging renovation of the Virology laboratory to facilitate the processes, as well as, the procurement of necessary equipment and consumables identified as most efficient for testing. In the interim, top priority was also given to ensure that vectors known for transmitting Zika virus would be tested. Initiating communication with partners that could assist with our goal of providing current, ongoing testing of vectors involved in the spread of this EID in particular, led to collaborations specifically geared towards meeting testing demands off-site until our renovated laboratory was completed. Not limited to this endeavor, our main stakeholders have included UTMB-Galveston (through a collaboration in the Western Gulf Center of Excellence for Vector Borne Diseases), which offered assistance with molecular testing of our samples; TAMU's Department of Entomology, which committed to covering test costs until their funding source became depleted, and BCM, which also provided arbovirus testing support. Following a cost/benefit analysis to determine if testing for a fee per sample by one of our other collaborators was feasible, the outcome determined that it was not. The collaboration with BCM proved very instrumental for our program, not only providing expertise with the build out of the Virology laboratory, but also granting dedicated Virology staff access to laboratory facilities at BCM and permission to use necessary supplies and equipment to perform EID testing, which in turn enabled us to remain current with vital EID testing. Through collaborations we've learned that clear communication of goals, agreement regarding desired outcomes, and commitment to accountability produce the most successful partnerships. Our partners have remained committed to assisting us in sustaining our testing practices, and the plans remain in place to: · Continue to capitalize on departmental support as well as financial contributions from our stakeholders to ensure coverage in every area of infectious disease testing. · Ensure that Virology personnel are trained in the most proficient methodologies and laboratory practices for efficient infectious disease testing. · Continue to operate within the parameters of One Health lens as we work with internal and external partners in the mission to prevent and control infectious diseases. Avian Surveillance – Collaborations are essential to the efficient running and sustainability of the Avian Surveillance Program and are most successful when the goals of the partners are aligned. The stable long-term partnership with UTMB-G has been based solely on the exchange of information. The Avian Surveillance Section provides test samples, and UTMB-G provides test results, with the resulting data being shared. Similarly, the Audubon Society, a non-profit organization that focuses on avian conservation and education, is willing to train its own personnel on our avian sampling techniques so that it can use them to provide hands-on encounters with avian wildlife in its educational programs, while providing us with additional samples for surveillance. These important collaborations emphasize an innovative One Health approach to community engagement, drawing mutually beneficial partnerships between organizations that may not be obvious at first glance. The Avian section's sustainability plan includes, but is not limited, to the following: · Extension of LAMP testing – The Avian Surveillance Section will continue to expand on the 2017 program using novel LAMP testing to detect WNV RNA in avian samples. An agreement with Pro-lab Diagnostics allows us free use of the Genie LAMP testing equipment (valued at $18,000) as long as we continue testing a sufficient number of avian samples with an annual expenditure of approximately $10,000. · Woodlands Township – The Woodlands Township is a small local governmental organization with overlapping jurisdiction in the northwestern part of Harris County. They have expressed interest in partnering with HCPH MVCD, so that avian sampling can be added to its own WNV surveillance capabilities.
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