Across Los Angeles County, human cases of West Nile virus have reached their highest level in 10 years, data shows. And while the South Bay is generally relatively safe from the virus, health officials say, it accounts for about 25% of human cases — almost all of which have progressed to neuroinvasive disease.
West Nile virus comes from wild birds and is transmitted by mosquitoes. So if a mosquito bites a bird carrying West Nile virus, it will then spread the disease to the next warm-blooded creature, often humans.
In California, West Nile virus is endemic, meaning that for the past 23 years, at least one human has contracted the virus each year. Since first detection in 2003, more than 8,000 people have contracted the virus, with more than 400 deaths, according to the Greater Los Angeles Vector Control District.
About 80% of people who contract West Nile virus will be asymptomatic, according to the Centers for Disease Control and Prevention. The remaining 20% can vary in severity of symptoms, with some experiencing flu-like symptoms and others developing severe illness, leading to meningitis or encephalitis, causing swelling of the brain and spinal cord. This can lead to brain damage, permanent neurological delays, paralysis and even death.
Since many people do not develop symptoms, West Nile virus itself is not necessarily rare, said Aaron Arugay, executive director of the Western Los Angeles County Vector Control District. But for the rare people who develop the neuroinvasive disease, it is fatal. There is no vaccine or treatment for the virus, he added, only hospitalization to administer fluids and painkillers.
Because of how dangerous the virus is, said Susanne Kluh, executive director of the Greater Los Angeles Vector Control District, Southern California has taken a proactive approach to detecting and eliminating the presence of the disease. This is done primarily by targeting female culex mosquitoes – the type of mosquito that contracts West Nile virus – from around May to November, when mosquitoes are most active.
“It’s really unusual for these coastal cities to have such early activity and such high activity,” Kluh said, “because most years they don’t really get a lot of West Nile virus there because the temperatures stay cool longer, the nights are cooler. But this has been our warmest winter on record and it has spread all the way to the coast.
Many South Bay residents might even learn about the virus until it’s too late. This was the case for Jonathan Mason, whose father, Richard Mason – a Torrance resident – died of West Nile virus on September 28. He was 88 years old.
“He was a healthy 88 years old,” Mason said. “He still drove and walked his dog every day.”
But what started as minor flu symptoms quickly turned into a major debilitating illness, ending in death within a week. Mason said he and his family were shocked when they were diagnosed with West Nile virus encephalitis.
“We are all devastated,” he said. “Unfortunately there’s not much they can do because there’s no vaccination – they’re just hoping they can fight off the infection.”
Infectious disease specialist Dr. James McKinnell was one of Mason’s senior doctors at Torrance Memorial Medical Center, and he said giving someone a West Nile virus diagnosis was one of the most “devastating” experiences he’s ever had.
“This diagnosis is truly catastrophic for some patients,” he said. “I have to go tell someone, ‘You’re never going to talk to your wife again. You had a conversation on Monday and now it’s Friday, and I’m telling you it’s unlikely you’ll talk to her again.’ It’s heartbreaking.
Even if a person with West Nile virus does not die, McKinnell added, many of those who came to the hospital with symptoms will have lifelong neurological consequences, some as serious as ending up bedridden in a long-term care facility for life.
Although he has made a number of West Nile virus diagnoses before, McKinnel said, he has never had so many cases in one year during his 17-year career at TMMC.
In fact, TMMC, Kaiser Permanente South Bay Medical Center, and Harbor-UCLA Medical Center all reported much higher West Nile virus cases than in previous years. Providence Little Company of Mary Torrance and San Pedro declined to comment for this story.
“We’ve seen an increase this year,” said Gunter Rieg, chief of infectious diseases at Kaiser Permanente South Bay Medical Center. “Kaiser Permanente South Bay Medical Center has treated 25 West Nile virus patients to date, compared to zero confirmed cases in the past two years. »
All responding hospitals also reported at least one West Nile virus-related death. And there have been 10 deaths countywide, according to the most recent report from the Los Angeles County Department of Public Health. However, this data is usually out of date due to a lag in reporting, McKinnell said.
The report also said there were 216 West Nile virus infections this year, compared to 22 last year. And 189 of them developed neuroinvasive disease. Of those who had confirmed infections, 161 were men and 55 were women. The median age is 64 years, with patients ranging in age from 4 to 101 years.
It’s more common for older or immunocompromised people to contract West Nile virus, McKinnell said, but he has seen several cases of young, otherwise healthy people becoming very ill. One example is Joseph Vazquez, 13, of Long Beach.
According to the GoFundMe page set up by Vazquez’s family, he accidentally started experiencing a rash all over his body and a mild headache. This led to leg pain and a slight fever. After being hospitalized, he lost all mobility in his legs and control of his bowels.
He was quickly diagnosed with transverse myelitis due to West Nile virus and was transported to Children’s Hospital Los Angeles, where he is receiving treatment.
“Joseph faces challenges that no 13-year-old should ever have to face,” the GoFundMe page states. “He lost the use of his legs, lost control of his bladder and bowels, and suffered excruciating nerve pain from his lower back all the way down to his feet. Joseph’s experience opened our family’s eyes to how quickly a mosquito-borne illness can become a serious medical emergency. We never imagined that something that started with what seemed like minor symptoms could change Joseph’s life so quickly.”
Mason also said he wants local, state and federal governments to increase awareness and prevention of the virus. Additionally, he wants to see an increase in medical research and education on how to treat West Nile virus, because while there is no vaccine for humans, there is one for horses.
“For the pharmaceutical industry, unless they can make a lot of money, it doesn’t matter to them,” Mason said. “To hear that there is a vaccine for horses, but not for humans, is really worrying.”
Because so few people actually develop symptoms, McKinnell said, it’s difficult to get funding for clinical trials and advanced medical research.
“In fact, seven different vaccines have been tested against West Nile virus,” he said. “They all had promising candidates, but one of the challenges is getting them to market. This is one of those cases where, if the disease is relatively rare, it’s difficult for a pharmaceutical company to invest money to develop this vaccine.”
There have also been some “promising” studies of treatments using immunoglobulins and steroids, McKinnell said, but few have been able to move beyond the initial stages.
Many clinical trials have indicated in their findings that these products have been and may be beneficial, but more research needs to be done. A clinical trial is currently underway in Tel Aviv, but all clinical trials in the United States have been paused, according to the National Institute of Health.
“There are limited data on the use of various therapies to treat patients with WNV disease, such as standard and hyperimmune polyclonal immunoglobulin, monoclonal immunoglobulin, interferon, ribavirin, and corticosteroids,” the CDC said in a written statement. “Most published data relate to case reports and case series describing the use of different products in patients with WNV disease, with different dosages, times of administration and patient populations.
“Several products have been studied in controlled clinical trials, but the trials were often underpowered and the products showed no benefit,” the CDC added. “Larger prospective, controlled clinical trials are needed to evaluate the effectiveness and impact of factors such as dosage, timing, and patient populations who may benefit from certain treatments. »
South Bay hospitals, meanwhile, need to be more aware of the possibility of West Nile virus because it often goes undiagnosed, which can make it seem like there’s no need to invest in treatments and vaccines, McKinnell said.
“We have a massive team of infectious disease doctors here at Torrance Memorial,” he said. “We have the capacity to test for West Nile. It’s not a standard diagnosis and I guarantee there are hundreds, if not thousands, of cases that go undetected because they don’t have access to an infectious disease doctor to make the diagnosis.”
Testing for West Nile virus is not routine in most hospitals, so the treating physician should recognize the symptoms and refer the patient to an infectious disease physician who should then order the test.
“It’s really important for our emergency staff to be aware of this and identify it because it’s a pretty rare thing for us to have to deal with this in the South Bay area,” McKinnell said, adding that he recently diagnosed a patient whose family was…
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