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Battle of the bite With mosquito season here and several human West Nile cases already confirmed in the West, Boulder residents can expect a feverish public campaign against the virus that last year reached epidemic proportions in Colorado, the state that claimed the most reported cases in the nation. This year Boulder County Health Department hired a marketing firm, Boulder-based Stratecom, to beef up its 2004 West Nile prevention campaign meant to raise public awareness around mosquito-prevention methods. Taking from its health reserve funds, the department spent $50,000 on the campaign, reviving last year's slogan, "One Bite. One Life Changed Forever." It represents how health officials here and nationwide are upping the battle against the virus-spreading insect. Learning from last year's West Nile outbreak, which appeared in 46 states and was linked to 9,389 illnesses and 246 deaths, local, state and federal health departments are amplifying their prevention messages with renewed public campaigns-and, in Boulder's case, by widening the scope of who's at risk. Boulder County health officials this year are saying 97 percent of all residents are at risk of contracting the virus. Fighting the bugs The virus, for which there is currently no human vaccination or accepted cure, is spread to birds, humans and horses through the bite of an infected mosquito-primarily from the sturdy, efficient Culex tarsalis variety here in Colorado and the West. It attacks the central nervous system and carries symptoms ranging from imperceptible to mild to severe and can cause encephalitis, meningitis and even death. Last year, Boulder County was the third most infected county in the state with 430 infections and seven deaths-only Larimer and Weld counties fared worse. Officials suspect the total number of unreported cases in Boulder County actually climbed into the thousands. Last year's epidemic also came with a hefty price tag, costing county residents $2.3 million in medical expenses, alternative care and lost wages, according to health department estimates. In early May this year, city officials responded to the pending West Nile season by approving a controversial though eco-minded countywide mosquito control plan using the fog pesticide permethrin. The pesticide is only to be used on a need-to basis. Placating concerned residents, the city has likewise taken an environmentally sounder approach with a non-pesticide mosquito plan that uses larva-killing bacteria to kill mosquitoes in their infancy. This is backed by a revved-up public-education campaign urging residents to protect themselves with mosquito repellent, to avoid the outdoors at dawn and dusk and to eliminate standing water (the mosquito's breeding grounds) on their property. Such integrative measures represent how, here and nationwide, the battle against West Nile is being fought. For their part, Boulder health officials have taken the traditional route, underscoring personal protection through the use of DEET-based (N, N-diethyl- methyl-meta-toluamide) repellant. The agency cites a July 2004 study in the New England Journal of Medicine, which concludes DEET as the superior product to soy-based repellants. A product containing 28.8 percent DEET, according the study, provides an average of five hours of protection from mosquito bites, compared to 4.7 percent DEET or 2 percent soybean oil, which provides roughly one and half to two hours of protection. The study also claims no correlation between the concentration of DEET used and risk of toxic effects. "We see DEET as the gold standard in repellants," said Heath Harmon, Boulder County Health Department epidemiologist. "The level of protection is really based on the duration of protection, with different percentages offering different protection. With soy-based repellants, you'll get some protection, just not for the same duration." The health department's self-protection message and strong endorsement of repellants, DEET or soy-based, was inspired by a Boulder County Health Department survey of Boulder residents, which found that although most knew West Nile was carried by mosquitoes, few did anything to protect themselves. This behavior is consistent with a nationwide survey conducted by the CDC last year that found that fewer than half of respondents used repellant. The study, presented at the Fifth National Conference on West Nile Virus in the United States in Denver last February, revealed a general misperception regarding who is at risk for contracting the illness. It even cited a general "mistrust of media hype" as a reason for the public's aversion to basic self-protection. "Raising public awareness around repellant use has been a real challenge," said Harmon, who is heading a city-sponsored study of last year's West Nile cases. Harmon says he has spent the past year analyzing data collected from last year's bird, mosquito and horse samples in order to help county officials better prepare the public for the 2004 season. Although last year's research did not include infected humans, Harmon and his colleagues did collect that information from county health providers. "The goal of the study is to better define risk and to determine who is at risk for developing long-lasting conditions as a result from the illness," he says. A growing threat Health officials began to worry when the Culex tarsalis mosquito began appearing in the city's 11 mosquito traps in record-high numbers early in June 2003, says Harmon. Last year's environmental conditions, a wet spring followed by a dry summer, were ideal for mosquito production and helped set the stage for what Harmon calls the "perfect season" in Colorado. "This species is a very efficient vector that just so happens to thrive in Colorado's warm, dry climate," he says. Heavy snowfall in March led to more standing water in the region than usual, areas that then became breeding grounds for the mosquito. The increase in the number of virus-bearing mosquitoes was coupled with what Harmon calls the "second-year factor," a common epidemiological reaction that makes both birds and humans highly susceptible to the virus in its second year. Harmon's study revealed something else. "We'd always said that about 80 percent would have no symptoms at all, 20 percent would have flu-like symptoms that last three to seven days, and less than 1 percent would develop complications from what we now call Œneuro-invasive disease'," says Harmon. "While those proportions have not changed, we found instead that what those 20 percent experienced can hardly be considered Œmild'. One out of every five people who get bit by that infected mosquito is going to develop significant, debilitating, possibly long-lasting complications." Boulder's health officials are not alone in their battle to understand the epidemiology of West Nile. Medical researchers and public health officials nationwide have scrambled to understand the virus, which has moved steadily westward with the vigorous Culex tarsalis mosquito since the first human case was reported in New York in 1999. That same year, Bethesda, Md.-based National Institute of Health began researching vaccines in anticipation of West Nile virus becoming established here in the U.S. "We initially underestimated its potential," says NIH program officer in virology Dr. James Meegan, who oversees NIH-funded clinical trials and vaccination studies across the country. Meegan reports several encouraging vaccine therapies underway, the most promising of which comes from a Boston-based lab. Still, he reports any vaccination, once approved, is several years away. "The challenge with West Nile is that it is a virus, which cannot be treated with antibiotics," says Dr. Nelson Gantz, chief epidemiologist at Boulder Community Hospital. Gantz ran clinical trials last year using a drug made by Oregon-based pharmaceutical company, AVI BioPharma Inc. After success in treating penguins in the Milwaukee Zoo, the drug was tested on its first human subjects in Boulder with positive results, says Gantz. Although last season's trials have ended, he is currently lobbying the FDA for funding in order to continue the trials this year. A mega-dose of relief Meanwhile, as mainstream medicos grapple with funding and FDA-approvals for the perfect West Nile pill, those suffering from prolonged effects of the illness have sought respite in medical alternatives. Boulder resident Jack Butler, 68, contracted West Nile last summer while in his backyard. After a week of typical symptoms-persistent headaches, low-grade fever, confusion-Butler went to Boulder Community and tested positive for West Nile. Rather than accept the conventional approach that addresses the illness symptomatically, chasing the illness around the body with localized treatment, Butler came across information on the effectiveness of mega-doses of vitamin C, administered intravenously, in treating a variety of viral infections. He and other West Nile patients underwent the treatment with Denver-based medical researcher and IV-C-proponent Dr. Thomas E. Levy, and today both claim having no symptoms of the virus. In Butler's case, one mega-dose of IV-C knocked out the virus in 30 hours. The other patient, Boulder resident John Howard, 55, had chronic, prolonged effects six months after contracting the virus last July. After undergoing three consecutive sessions of IV-C, Howard claims to have no remaining symptoms. "It's almost like a miracle," he says. A conventionally trained doctor, Dr. Levy has spent the last decade researching and conducting clinical trials using mega-doses-50 to 150 grams at a time-of vitamin C to treat infectious diseases such as viral hepatitis, viral pneumonia, influenza and Rocky Mountain Spotted Fever. His most recent book, Vitamin C, Infectious Diseases and Toxins, documents his findings and details the larger history of IV-C treatment over the past 80 years. According to Levy, vitamin C in large doses has cured virtually every acute virus that he has treated. His research, however, makes a distinction between IV-C's success in treating "acute" versus "chronic" illness. "We've cured acute hepatitis with IV-C, for instance, but we haven't cured chronic hepatitis," says Levy. He says the evidence suggests that the effectiveness of IV-C treatment is predicated on whether or not you can get a high-enough dosage of the vitamin within the direct proximity of the virus. "While I will not announce this is a cure for West Nile, I can say that the two cases I treated with IV-C have been successful," says Levy. He and Butler have collaborated to fund a study on a handful IV-C and West Nile patients this season and are currently looking for viable subjects. While Butler himself has become a strong proponent of IV-C, he harbors no delusions about what he is up against in its gaining acceptance in the wider, mainstream medical community. "There's just no way a big drug company is going to spend a significant amount of money researching the benefits of vitamin C. In fact it would be a big embarrassment to them and a great boon to natural therapy if the word got out that vitamin C in mega-doses can help cure West Nile," he says. Nor is it likely the FDA will endorse such therapy anytime soon. In the meantime, health officials maintain the public's primary means of combating the virus is through mosquito control and self-protection. Boulder County health officials say a key factor in whether or not this season will be a replay of the last will be measured in the community's response. "We're putting out the message that it's now kind of a fact of life, that regardless of all ages, all of us are at risk, which is why we all have to protect ourselves-in addition to whatever mosquito control is in place," says Harmon.
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