The sign in the window at Beaver Janitor Supply in Cape Girardeau is alarming enough to send a hypochondriac into a panic: "Worried about West Nile?" scream the thick, black letters.
The store isn't trying to frighten anyone -- the message goes on to encourage consumers to come in and check out their full line of insecticides -- but the message is clear.
It's time to start bracing ourselves for West Nile, Round II.
"We knew it was time for mosquitoes to start getting bad," said store manager Tammy Sanders. "So we beefed up our flying insect sprays. And we've had quite a few people come in and buy them."
It was in the month of July last year when the Cape Girardeau area for the first time detected the West Nile virus in area mosquitoes, which carry the potentially deadly virus from birds to humans and horses.
"Last year, the news was all 'It's coming, it's coming, it's coming,'" said Dr. Christine Frazier, an epidemiologist at Southeast Missouri State University who specializes in mosquitoes. "This year, people should expect it."
So far, Frazier has tested 601 pools of area mosquitoes for the virus and all have been negative, she said. Each pool, or group, includes up to 50 mosquitoes. But that doesn't mean the virus is absent.
"I suspect the virus is here already," Frazier said. "It's probably just in low levels."
There are other indicators that caution is warranted. Last week saw the nation's first human case in South Carolina. Birds have tested positive for the virus in Sedalia and St. Charles and a horse infection has been confirmed in southwest Missouri's McDonald County.
"That's why it's not too soon to educate the population about what they need to do," Frazier said. "I know I sound like Johnny One Note, but it's the same thing as last year."
That message includes avoiding mosquito bites by using insect repellents with an ingredient called DEET and wearing light, long-sleeved clothing; mosquito proofing your home by emptying standing water and installing screens; and helping communities by reporting dead birds to local health authorities.
Spray, spray, spray
Wally Gawrych was the one Cape Girardeau County human victim of West Nile virus last year. He doesn't need to be reminded of how to avoid the virus.
"I'm more than paying attention," he said last week. "I'm spraying the crap out of everything to kill them."
Gawrych has invested in a bug sprayer, he keeps his two young children indoors at peak mosquito hours, and he doesn't let water sit for a second in his yard.
"If my kids go outside, they're getting sprayed," Gawrych said. "I've done my homework. If anybody knows how bad it can get, it's me."
Gawrych said his short-term memory was severely affected by the brain swelling that was caused when he contracted the virus last year. He said he has trouble remembering things he's just heard, especially phone numbers.
The county saw several cases of horse infections last year. No local horses have been confirmed for the virus either, said horse vet Dr. Linus Huck.
Last year, Huck treated 126 horses for the virus and 11 died, but this year there's hope for horse owners that a new vaccine will make most horses immune.
"We're waiting to see if this stuff works," Huck said. "They say it's 95 percent effective. It's not perfect, but it's supposedly the best we have."
Everyone hopes it isn't as bad as last year. According to the Missouri Department of Health and Senior Services, last year Missouri had 168 human cases of West Nile in 29 counties -- including one in Cape Girardeau. Seven deaths were linked to the virus, which placed Missouri ninth in the nation. Across the country, the virus sickened 4,156 people in 44 states and killed 284.
In Missouri, there were 662 West Nile virus-positive and clinically ill horses that were reported from 103 counties and 227 lab-confirmed dead birds from 82 counties.
Working together
The state health department has worked with a variety of local, state and federal agencies to coordinate an approach to prepare for this year's mosquito season, said Dr. Howard Pue, chief of the department's office of veterinary public health.
"We learned very quickly last year that it would take a comprehensive, coordinated team effort to effectively deal with the West Nile virus because it affects so many different aspects of our lives," Pue said.
For it's part, the city of Cape Girardeau put larvicide in standing water along roadways and in low-lying areas this spring. Since April, it has also been spraying three times a week with a mixture of the insecticide malathion with a mineral oil carrier.
The state health department has held planning meetings, continues surveillance, educates the public and works with local health departments like the Cape Girardeau County Public Health Center, Pue said.
Charlotte Craig, who is director of the local health department, said West Nile has been on medical workers' minds for months.
The local department monitors hospitals and free-standing clinics for those with West Nile-like symptoms, such as fever, headache, body aches, nausea, vomiting and sometimes swollen lymph glands or a skin rash on the chest, stomach and back.
Craig said there hasn't been as much concern this year as there was last year.
"It could be that people are much more aware," she said. "They know what to do. There's really no reason to panic. Awareness is the name of the game. If people aren't aware, it could become a serious health threat."
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