Public Health Programs and Mosquito Control Programs: A Critical Need for Integration

by Peter H. Connelly | phconnelly@yahoo.com

In my current position, and in fact for close to a quarter of a century, I have had the great pleasure of traveling around the country and visiting many mosquito control programs. Throughout most of the U.S. there is currently a disconnect between two very important disciplines that impact our communities’ health. Why?

As of November 27, 2012, 48 states reported West Nile virus infections in people, birds, horses or mosquitoes. According to the CDC, a total of 5,245 human West Nile cases, including 236 deaths, have been reported in the U.S.

For those of us who live in the U.S., there are two professional groups involved in the protection of public health where mosquitoes are concerned – Public Health Programs (PHPs) and Mosquito Control Programs (MCPs). Both contribute to our quality of life and while rightfully autonomous, should be working together and sharing information. When they do not, the public health is unnecessarily put at risk. In a truly integrated system of public health, information travels between PHPs and MCPs that are responsible for controlling mosquito vectors. Public Health Programs have information that can be very helpful to MCPs. Because most vector-borne diseases affecting humans and domestic animals are required to be reported by veterinarians and doctors, PHPs by default have information about the location of a potential arbovirus transmission focus. If this information is transferred to the MCP in a timely fashion, taking all precautions to avoid HIPAA conflicts (see http://www.hhs.gov/ocr/privacy/index.html), then MCP resources can immediately be made available to control mosquitoes and reduce transmission in a specific area where infected mosquitoes are likely at dangerously high levels.

Likewise, information the MCPs have about entomological developments (such as population dynamics or viruspositive mosquito pools) in and around a specific transmission zone could aid PHPs in their efforts to alert the residents of these areas about elevated risk. The value of this information increases when it is used to create long term baseline data that can be used to place current year transmission data into a historical context.

Long term baseline data in the hands of PHP and MCP officials working together can be used to stress the importance of prevention of transmission in a region, county or even a much smaller area of focus and will in turn, limit unnecessary risk to residents of these areas. Yes, this costs money, but so do human lives and the treatment of affected individuals. Do we not install sprinkler systems in buildings as part of the construction cost? Do we not vaccinate against some diseases? Should we no longer evacuate the coastal areas when we have strong indicators of an imminent hurricane landfall?

Many PHPs around the country do not feel they can share information, especially case location information (even when requested in a general sense), with appropriate MCPs. The rationale is usually that HIPAA laws govern the use with the information. This information disconnect between PHPs and MCPs can, and does, have serious consequences. In some areas of the country, questions arise as to whether a concern for tourism delays the announcement of human vector-borne disease cases, especially in areas where tourism is an important economic driver of the local economy. Additionally, questions about why neighboring jurisdictions are not immediately alerted about epidemiologically significant events close to them raise concerns. Promising mathematical models capable of predicting where and when vector-borne disease transmission is most likely to occur are not supported by PHPs. In some locales, mosquito control must accept restrictions on the use of information, or is told flatly “not to use it”. In other areas, there is no information shared at all and the two disciplines operate totally independent of each other.

Two-way interagency communications must be established to effectively combat vector-borne disease epidemics. When workers at a local mosquito control program detect an increase in the infection rate in sentinel animals or mosquito pools, they should be obligated to share this information with the local PHP. Likewise, disease transmission information that a local PHP has about the location of a human case must be shared with the MCP’s if we ever hope to improve our ability to prevent needless cases of vector-borne diseases. If Mosquito Control Programs and Public Health Programs are not equal partners in a respected relationship between both parties, then the general public may be needlessly placed at risk. This is unnecessary, irresponsible, unethical and dangerous.