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Clinical:La Crosse Encephalitis

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Contents

Clinical Features

 * Frank encephalitis progressing to seizures, coma; majority of infections are subclinical or result in mild illness

Etiologic Agent

   * La Crosse virus - California serogroup virus in the family Bunyaviridae

Incidence

   * Approximately 70 cases reported per year

Sequale

   * Case-fatality ratio <1%
   * Hospitalization for CNS infection
   * Neurological sequelae that resolve within several years

Costs

   * Short-term hospitalization to long-term care exceeding
   * $450,000
   * Social costs from adverse effects on IQ and school performance

Transmission

   * Virus cycles in woodland habitats between the treehole mosquito (Aedes triseriatus) and vertebrate hosts (chipmunks, squirrels)
   * Virus survives winter in mosquito
   * Vector uses artificial containers (tires, buckets, etc.) in addition to treeholes

Risk Groups

   * Children <16 years old: biological risk factor
   * Residence in woodland habitats environmental risk factor
   * Containers at residence environmental risk factor
   * Outdoor activities: behavioral risk factor

Surveillance

   * Active case surveillance in collaboration with state and local health departments, and mosquito control districts

Trends

   * Traditional endemic foci in the great-Lakes states
   * Increased case incidence in mid-Atlantic states
   * Rural poor most affected

Challenges

   * Multiple environmental, biological and social factors contributing to disease occurrence
   * Disease is considerably under-reported
   * No vaccine available

Opportunities

   * Prevention through proactive surveillance of enzootic cycle and education of residents in risk-reduction practices

Research Priorities

   * Develop standardized national surveillance
   * Determine range and incidence of disease
   * Develop community education programs
   * Evaluate vector control strategies

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