West Nile, an emerging infectious disease sounds exotic and far away. At least, that’s what Canadians would like to think. The deadly disease first appeared in Uganda, in 1937. Then somehow in 1999, an infected mosquito made its way across the Atlantic and into New YorkÉand now it is one of the many more health risks in Ontario. Last year, Ontarians had their first West Nile outbreak, and this year it was Saskatchewan that had it the worst.
“In Saskatchewan, it’s probably not just in the city,” says Dr. James Brunton, Director of the Division of Infectious Diseases, University of Toronto, “If people are getting sick and being admitted to hospitals then obviously there is a failing in the public health measures. We need to know about that so we can take further actions. The other thing is hospitals recognizing it and putting people into treatment, and having protocolsÉcall it West Nile Centres, and make sure research is available so we can give some guidance.”
At the physio or neurological state however, West Nile is considered a relatively rare disease. “Is this problematic now or could it be in the future because there is always changing patterns of diseases?” questions Dr. Raisa De Beer, Professor, University of Toronto. “Epidemic doesn’t say anything about mortality rate. Epidemic is talking about the number of cases you have. We can’t just get hung up on how many cases because if you start reviewing some of these cases, you have serious neurological damages, and this can be unbelievably expensive. Think of one severely, mentally handicapped kid, and how much does it cost for that kid? So it’s not just how many cases you have, it’s not just what’s going on in the third world because we know that it’s the third world that makes what we have look trivial.”
“Having the availability of diagnostic services that can help us identify and manage these patients, is critical when you are dealing with patients with these kinds of diseases,” says Dr. Donald Lo, Chief Microbiologist, Mt. Sinai Hospital. “Not only to use certain treatments if they are available, but also to prevent transmission.” Lo points out the Canadian Blood Services’ West Nile test quite effectively screens all blood that comes into the lab. Prior to the CBS test, “It’s a rare event, but last year we saw West Nile being transmitted in blood products as well as in organs that were donated.” Lo advocates that the more expertise that can be brought to bear against this problem, the better the health protection will be for patients.
“We looked at seven hospitals last year, around Toronto to the west, we collected a total of 64 (cases),” says Brunton. “Fifty-seven had serious neurological disease, and 10 of those people, or 18 per cent died. That is a high percentage to get hospitalized. To get it bad enough to be admitted to hospital, then yes, it’s a serious disease. Last year it was clearly an urban problem in Ontario Ñwe’ve seen more of it in the last ten years and I think we are just going to continue to see more.
“At the moment we don’t have a satisfactory treatment for it. That’s a particular problem for any health suppressed people and any transplant patients, or people who are undergoing major chemo therapy.” Brunton describes how during SARS Two, a pilot study was done using Interferon, and that it actually made people get better faster. For West Nile a similar trial would need to be done for Interferon. “It’s possible that giving them the antibodies made from other people’s blood donations who have high antibody fighters to West Nile might be helpful.”
Brunton also considers it important for hospitals to do MRIs or CT scans of the brain to make sure the person is not suffering from something else. Then, have the intensive care unit support these people during their paralysis because a significant number of them became ventilator dependent. Then finally after that, have the rehabilitation to help support people. But not all rural hospitals have extensive inpatient rehab programs for neurological damage.
“We have speech therapy and we have physio therapy,” says Nancy Kelly, Vice President Patient Care Services, Renfrew Victoria Hospital. “Patients may have to go to another facility, such as the Ottawa Hospital, so there would be transportation for the family, removal from the home community, maybe needs for specialized equipment, etc.”
When the first case was reported in Renfrew county this summer, Renfrew Victoria Hospital had already made arrangements for testing for West Nile to find out if people presented the symptoms, and to get the diagnosis even though there isn’t a whole lot that can be done at present.
“When we’re confronted with new diseases that we’re unable to fix, and we don’t have the drug to kill it or cure it, it’s disconcerting,” adds Kelly. Kelly thinks it causes all of us to reevaluate what we are doing to look at prevention. At the hospital end, diseases are often looked at after they’ve occurred. To Kelly, the idea of prevention and public education is a good one. “It’s heightened awareness, and I think we’re all challenged in terms of our everyday clinical practice to insure that we give good information to peopleÉ in getting people to take personal responsibility for their health as opposed to dealing with it after the fact. Although it’s still possible with things like West Nile that something could happen and that’s frightening for people.