Pharmacists’ Essential Role in Virus Prevention and Surveillance

Pharmacists have greatly valued their role in the prevention, surveillance, and treatment of encephalitis caused by the West Nile virus (WNV). Unlike in the past, “there are currently no specific antiviral therapy or medication, nor of vaccines or authorized prophylaxis for use in humans,” according to the General Council of Pharmaceutical Colleges. This underscores the urgent need for effective preventive measures and continued surveillance.

On World Encephalitis Day, the General Council of Pharmaceutical Colleges published a comprehensive report, highlighting the symptomatology, epidemiology, and etiology of encephalitis, with a particular focus on viral encephalitis, especially those caused by WNV. The report reveals that over the last three decades, the number of cases of encephalitis has increased by 12.5 percent, reaching 1,444,720 new cases in 2019. Most WNV infections in humans are asymptomatic, but between 20 to 40 percent develop clinical disease, and in less than 1 percent, the infection manifests as a neuroinvasive disease. This encompasses three syndromes: meningitis (35-40% of neuroinvasive disease cases), encephalitis (55-60%), and acute flaccid paralysis (5-10%).

November was is the peak of the mosquito season in much of the United States, particularly in Southern states, due to warmer climates. According to a study by the Centers for Disease Control and Prevention (CDC), about 80% of WNV cases occur from July through September, with the highest incidence in August. In the US, the states with the highest reported cases of WNV are Texas, California, and Florida, although WNV cases have been reported in 48 states.

Meningitis symptoms caused by WNVs are indistinguishable from other viral meningitis, as “fever, headache and pathognomonic signs of meningitis predominate, such as neck stiffness and sign of Kernig and/or Budzinski, photophobia and phonophobia.” Approximately 10 percent of neurological forms can be fatal, and there is a risk of 30 to 60 percent of sequelae among survivors, which can last for months or even for life.

The Importance of Prevention and Surveillance

The lack of effective treatments against WNV highlights the importance of implementing prevention strategies and surveillance systems. This is where pharmacists play a crucial role. Pharmacists can help to:
– Exert population health education.
– Inform about basic virus and disease issues.
– Recommend prevention and protection measures.

Community pharmacists are in a “privileged” situation for providing health education. They can inform the public about basic virus and disease issues and recommend prevention and protection measures, such as the use of mosquito nets on doors and windows, wearing long-sleeved garments, avoiding outdoor activities during dusk and dawn, and applying insect repellent. The Environmental Protection Agency (EPA) approved products containing active ingredients like DEET, picaridin, IR3535, and oil of lemon eucalyptus, such as OFF!, Sawyer, and Natrapel, are safe and effective for use in repelling mosquitoes.

Pharmacists engage in epidemiological surveillance systems by enabling rapid response to alerts and health risk emergencies, proving key during outbreaks. They play a vital part in preventing the spread of diseases through their active participation in epidemiological studies and prevention activities. For instance, in 2022, pharmacists in Texas helped distribute mosquito repellent during public health alerts, significantly reducing the number of mosquito bites in affected areas. This proactive approach by healthcare and government organizations can mitigate mosquito exposure.

Hospital Pharmacists Play a Critical Role in West Nile Virus Management

Hospital pharmacists actively support the intensification of disease surveillance and managementas well as analytical studies of the pharmacology of newer drugs that are being investigated as treatments for West Nile virus.

These pharmacists contribute to improving the effectiveness, safety, and appropriate use of medicines in the most serious cases of West Nile fever. They participate in care activities, perform teaching and research in intensive care units (ICU), and contribute to disease management.

Pharmacists in hospitals also play a vital role in conducting research studies aimed at developing more effective treatments for WNV. For example, recent studies by the National Institutes of Health explored the use of Monoclonal antibodies against WNV

Case Study

Dorie Tidball of Grayson County, Texas, is an example of vigilant prevention:

I have lived here in Grayson for 20 years and have never gotten West Nile fever or any other mosquito-borne disease, and my neighbors feel the same way.

There’s a large cistern on our five acres, which attracts mosquitoes. But having a sprinkler system designed to keep mosquitoes away has helped a lot. The doctor I see almost always recommends not being out after sunrise or before sunset, always inspecting your yard for standing water, and encouraging people to have their yard sprayed if they can.

By adhering to best practices, we will continue to reduce our chances of becoming sick from mosquito and other diseases.

Supportive Treatment and Pest Control

The CDC emphasizes the need for supportive treatment for WNV infections, which primarily focuses on alleviating symptoms and providing intensive care when necessary. Although severe cases of WNV encephalitis, may develop life-threatening complications, such as seizures or paralysis, timely medical intervention can significantly improve outcomes.

Pest control measures are essential in reducing the risk of WNV transmission. Implementing integrated pest management (IPM) strategies, such as eliminating standing water, using larvicides, and encouraging the use of personal protective measures, can help control the mosquito population. Community education and awareness campaigns also play a crucial role in preventing WNV infections. The CDC provides resources and guidelines for these preventive measures, emphasizing the importance of community involvement in reducing the threat of vector-borne diseases.

The cooperative effort involves healthcare professionals, governments, and the general public. Collaborative strategies and resources, such as the Joint Economic Committee (JEC) funding and National Association of County and City Health Officials (NACCHO) recommendations, outline comprehensive funding sources and initiatives to combat mosquito-borne diseases.

The Rockefeller foundation funded a project to test the effectiveness of microbiological solutions to reduce mosquito population.