Once bitten

Before he was diagnosed with the West Nile virus, Wally Gawrych was doing everything he could think of to make sure he and his family didn't contract the sickness.

He'd seen the reports and the advice from health officials in the news, so the 29-year-old Cape Girardeau resident made sure there was no free-standing water in his yard that would create a breeding ground for virus-carrying mosquitos.

Gawrych avoided the outdoors as much as possible, and when he couldn't he was careful to put on mosquito repellent. City crews even sprayed his neighborhood regularly with their mosquito-killing spray to keep the insect count down.

But a few days after mowing the lawn in August, flu-like symptoms kicked in. Then came the fatigue and soreness. The pounding headaches started. He couldn't sleep, didn't want to eat and he certainly couldn't work.

West Nile had arrived in Cape Girardeau, and Gawrych was its first human victim.

"They told me there was as good a chance that I could get struck by lightning as getting West Nile," Gawrych said Thursday. "Guess I should avoid storms."

Risk factor

Gawrych did everything right, but still contracted the virus that to date has caused 1,640 human cases in the United States, including 89 deaths.

That begs the question: What can anyone really do to combat this quickly spreading health risk?

Health officials still say protecting yourself from mosquito bites and keeping your property free from water is the best way to combat West Nile. But there's no way to be 100 percent safe.

"There's always that possibility, like with any disease, that you can do all the safeguards and, for whatever known or unknown reason, you'll still get it," said Jane Wernsman, a registered nurse and assistant director of the Cape Girardeau County Health Department.

And West Nile is not going to be a one-year problem that will die this winter along with mosquitos when temperatures turn colder.

"Look across the country," Wernsman said. "New York had their first cases back in 1999 and they are still having cases."

Dr. Christina Frazier, a Southeast Missouri State University epidemiologist and arbovirologist who specializes in mosquitos, agreed.

"When we have a killing frost, it will kill the mosquitos," she said. "A good hard killing will mean pretty much the virus will be done for the year."

The mosquitos will also become less active as the weather gets cooler, before a freeze. They aren't out as much at night, she said, in cooler temperatures. They are more active earlier in the day. They will probably be out more in the afternoon to seek warmth, she said.

People also will wear more clothing, which leaves skin less vulnerable to bites, she said.

Some female mosquitos also "over-winter," which means they don't die in cold weather but find a spot to go into a kind of hibernation. Those mosquitos might carry the virus into next year, though Frazier said it is not certain that a virus-carrying mosquito can survive in that condition.

"There are a lot of questions," Frazier said. "We just have to be prepared."

Repeat performance

Frazier's best guess is that the occurrence of West Nile will probably become cyclical. As more and more of the birds that have acted as virus carriers build up immunities to the virus, the number of mosquitos contracting the virus from those birds will dwindle. That could mean a decrease in sporadic activity of the virus, if any activity at all, she said.

But the virus could rejuvenate itself when new, non-immune birds are born, Frazier said.

"I don't have a crystal ball," Frazier said. "But it could become a virus that shows up every few years, maybe as few as five, or it could be as many as 10."

How often, she said, depends on bird migration patterns, habitats and on variables that might take their toll on a bird population, such as a drastic change in weather.

"It's going to be established here," she said. "It's just how much activity we see that might change."

Put into context

Some have suggested that the West Nile virus problem has been blown out of proportion. Health officials point out that there are about 20,000 influenza-related deaths each year.

"Not that it's not serious, but when put in context of other sources of mortality and morbidity, I'm not sure I'd put it at the top of the list of things we need to deal with," Frazier said.

Bernadette Burden, a spokeswoman with the Centers for Disease Control and Prevention in Atlanta, said only 1 in 150 of those diagnosed with West Nile will even become ill from the virus. She also pointed out that fewer than 1 percent of mosquitos have been infected with the virus.

But Burden said the CDC is not making any predictions about how many people might contract the virus because a healthy adult may be infected but never know it and never develop symptoms.

She said there has been heightened media attention that may have caused people to panic.

"West Nile virus is something that we are encouraging people to be concerned about, but not get alarmed about," Burden said. "There are prevention measures, but we're not discouraging anyone from direct outdoor activity."

Wernsman of the Cape Girardeau County Health Department said she appreciated media attention because it helped people learn how to protect themselves.

"We know West Nile is here to stay," she said.

Last week, the CDC announced it was awarding $6.3 million to 25 states -- not including Missouri -- to pay for technical and scientific support.

That money is in addition to $11.3 million that was awarded to states in August to help them strengthen their efforts to combat the virus. At that time, Missouri got $548,798.

The CDC has also deployed epidemiologists to Louisiana, Mississippi, Arkansas and Illinois. The total in federal funding for the year is $35 million.

At the state level, 104 people have been diagnosed with West Nile, and three of those have died, said Nanci Gonders, a spokeswoman for the Missouri Department of Health. All the deaths and many of the West Nile cases are in the St. Louis area, she said.

Gonders said that the state has launched an informational campaign, sending public service announcements to all television and radio stations reminding people of preventive measures.

They are also doing surveillance, tracking the cases in animals and humans. They are testing mosquitos and birds.

"A lot of what we're doing is targeting the St. Louis area, because that's where the majority of the cases are," she said. "But we're putting posters all over and putting out information in the media every day about case counts, precautions they can take. Next spring, we'll be ready to continue those activities."

Monitoring in Cape County

Similar efforts are taking place on the local level, Wernsman said. The Cape Girardeau County Health Department monitors both hospitals, day cares and physicians' offices, checking for new cases of the virus.

Cape Girardeau has upped its frequency of spraying neighborhoods with the insecticide malathion. Cape Girardeau public works director Doug Leslie said that -- acting on the advice of Dr. Frazier -- spraying increased to three times a week from twice a week.

"We cover most of the city, though not every street," he said. "We focus on low-lying areas, such as creek channels and places where there's been standing water and where we've had some complaints."

City environmental services coordinator Steve Cook said that meant they went from 60 gallons a week of the solution to 90 gallons a week.

"We'll continue that dosage until the first cold snap," he said. "Probably somewhere in the first of November."

Jackson public works director Rodney Bollinger said his city doesn't have a spraying program. He said that mosquito-killing pellets were placed where there was some standing water in the city park.

As for Gawrych, who to date is the only person to contract the virus in Cape Girardeau County, a brief stint in the hospital and some bed rest have helped him get back to work.

He said that he still feels run down, has some minor headaches, but otherwise is feeling better. Gawrych said the doctors told him he'd just have to give it time until he's completely recovered.

Gawrych said that his doctors have also told him he's now immune from the virus, but his brush with West Nile and all its uncertainties have left him unsure.

"They tell me I'm immune, but am I?" he said. "I tried to avoid the outdoors before, and I still do. And I don't let my son go outside much. There are just too many unanswered questions about this thing."

But he said he doesn't have any advice to give.

"I don't know," he said. "Does anybody know everything about this yet? I'm just hoping somebody finds some answers so nobody else has to go through this."

smoyers@semissourian.com

335-6611, extension 137

ABOUT WEST NILE VIRUS

HOW IT SPREADS

The West Nile virus is spread by mosquito bites and has been found in birds and horses, but health officials do not believe it can be spread by other animals or humans.

THE ILLNESS

Most people have no symptoms, but some become ill three to 15 days after they are bitten by an infected mosquito. Symptoms range from fever, headache and body aches to convulsions and potentially fatal swelling of the brain.

HOW TO PROTECT YOURSELF

Avoid the outdoors at times mosquitoes are likely to bite, generally just before and after sunset and again before dawn.

Wear long-sleeved tops and long pants made of tightly woven, light-colored materials.

Use repellent that contains DEET, although not on infants.

Eliminate mosquito breeding sites, such as buckets or old tires where water can collect.