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Comparative vector competence of Culex tarsalis and Culex quinquefasciatus from the coachella, imperial, and San Joaquin Valleys of California for St. Louis encephalitis virus.

St. Louis encephalitis (SLE) virus has continued to be active in the Colorado Desert region of Southern California (Coachella and Imperial Valleys) since 1973, while it has virtually disappeared from the Sacramento and San Joaquin Valleys of Central California. Consequently, comparative vector competence studies were undertaken from 1978 to 1981 to evaluate the susceptibility of populations of Culex quinquefasciatus and Culex tarsalis from the San Joaquin and Coachella/Imperial Valleys to oral infection with representative SLE viral strains from each geographical area. Culex quinquefasciatus females from both areas were equally susceptible to infection with both viral strains by the pledget and viremic chick feeding techniques. Although susceptibility profiles were similar by both feeding techniques, infection thresholds (i.e., ID50S) obtained with Cx. quinquefasciatus females were at least 10,000-fold lower when fed on viremic chicks than on virus soaked pledgets. Culex tarslis females from the two geographical areas were equally susceptible to infection with the indigenous viral strain by feeding on pledgets, and were uniformly more susceptible than sympatric populations of Cx. quinquefasciatus. Thus, differences observed in SLE viral activity in different geographical areas of California since 1973 cannot be explained by differences in the susceptibility of Cx. quinquefasciatus or Cx. tarsalis to oral infection with SLE virus.

Animals↗

Genotypic and phenotypic variation of selected Saint Louis encephalitis viral strains isolated in California.

The mechanism for long-term maintenance of St. Louis encephalitis (SLE) virus in California is unknown. Two possibilities are 1) that the virus is maintained locally in discrete enzootic foci by one or more reservoir mechanisms, and/or 2) that the foci are ephemeral in nature and virus is reintroduced periodically from other enzootic areas by migratory birds or movement of vectors. We have investigated these epidemiologic alternatives by studies of genetic variation within a 277 nucleotide portion of the envelope-encoding region among 17 strains of SLE virus isolated since 1952 from different geographic locations in California. Three lineages of virus were detected. One lineage, Group A, consisted of four SLE virus strains isolated in California since 1972 from the Coachella, Sacramento, and San Joaquin Valleys. The group A strains were closely related to strain MSI-7 of SLE virus isolated in Mississippi in 1975. The 13 other strains formed the second and third lineages (Groups B1 and B2) that had geographically overlapping distributions. Group A (BFN 4585) and Group B2 (BFN 4820) appeared to be sympatric in the Sacramento Valley in 1972. Strains from the San Joaquin Valley isolated prior to 1989 (Groups B1 and B2) differed markedly from a 1989 isolate from the same location, Kern 373 (Group A). These results suggest that virus introduction(s) led to changes in genotype, or alternatively that the enzootic virus was subjected to selective pressure leading to rapid emergence of a new genotype. Nucleotide sequences of the envelope and 5' untranslated region of the viral genome of these virus strains did not correlate with virulence as measured by mortality in weanling mice, nor viremia levels and duration in chickens.

Animals↗

Prevalence of antibodies to western equine encephalomyelitis and St. Louis encephalitis viruses in residents of California exposed to sporadic and consistent enzootic transmission.

Sera from outpatients attending county health department clinics in areas of California with consistent (Imperial Valley) and sporadic (Sacramento Valley) enzootic transmission of western equine encephalomyelitis (WEE) and St. Louis encephalitis (SLE) viruses exhibited neutralizing antibody prevalence rates of 1.3% (n = 690) and 0.5% (n = 1,066) for WEE and 11.0% and 0.8% for SLE, respectively. Seroprevalence for SLE virus in Imperial County increased as a function of both age and years of residence, indicating that this virus was endemic with a low rate of annual infection. Of 26 sera that tested positive for SLE virus antibody by an enzyme immunoassay, but were negative by plaque reduction neutralization test, 14 (53%) had neutralizing antibody that reacted with > or = one type of dengue (DEN) virus. The DEN virus infections presumably were acquired elsewhere because neither the vectors nor DEN virus transmission occurs in California. The low prevalence of neutralizing antibody for WEE and SLE in the California human population indicated that despite recent increases in enzootic transmission, contact between humans and infectious mosquitoes have remained low.

Adult↗

Detection of the agents of human ehrlichioses in ixodid ticks from California.

A study was conducted in northern California to estimate the prevalence and distribution in ixodid ticks of the rickettsial agents of human monocytic (HME) and human granulocytic (HGE) ehrlichioses. More than 650 ixodid ticks were collected from 17 sites in six California counties over a 15-month period. Ehrlichia chaffeensis, the causative agent of HME, was detected by a nested polymerase chain reaction (PCR) in Ixodes pacificus (minimum infection rate [MIR] = 13.3%) and Dermacentor variabilis (infection rate=20.0%) from a municipal park in Santa Cruz County. The HGE agent was detected by nested PCR in I. pacificus adults from a heavily used recreational area in Alameda County (MIR = 4.7%) and a semirural community in Sonoma County (MIR = 6.7%). Evidence of infection with Ehrlichia spp. was not detected in D. occidentalis adults or I. pacificus nymphs. This study represents the first detection of E. chaffeensis in California ticks and the first report of infection in Ixodes spp. The competency of I. pacificus to be coinfected with and to transmit multiple disease agents, including those of human ehrlichioses and Lyme disease, has yet to be determined.

Animals↗

Hantavirus (Bunyaviridae) infections in rodents from Orange and San Diego counties, California.

During a screening program to determine the extent of hantavirus activity in Orange and San Diego Counties, California, serum samples from 2,365 rodents representing nine genera and 15 species were tested for hantavirus antibodies. A reverse transcription-polymerase chain reaction on selected seropositive rodents was used to identify the specific hantavirus. Rodents positive for Sin Nombre virus (SNV) antibodies by Western blot included 86 (9.1%) of 948 deer mice (Peromyscus maniculatus), four (1.5%) of 275 California mice (Peromyscus californicus), one (0.5%) of 196 cactus mice (Peromyscus eremicus), 51 (12.2%) of 417 harvest mice (Reithrodontomys megalotis), and five (12.5%) of 40 California voles (Microtus californicus). All other specimens tested were negative for hantavirus antibodies. There was a correlation between age and sex of the reservoir host and prevalence of SNV antibody, especially among male deer mice and harvest mice. Few seasonal trends in antibody prevalence were observed and continued maintenance of SNV and El Moro Canyon virus was found at several foci over a 4-5-year period. Isla Vista virus was also found in voles and represents the first recorded in Orange County. Microhabitat selection on the part of these rodents based on plant density, plant height, and availability of food plants may explain, to some extent, all of the hantavirus-positive foci throughout the study area over a broad geographic range and the lack of antibody-positive rodents in dense chaparral, woodland, and riparian areas. The majority of rodents positive for SNV was identified from localities along coastal bluffs and the foothills of the Santa Ana Mountains, where trap success was high and P. maniculatus represented 43% of all rodents collected. Several residential, commercial, and industrial sites exist in these areas and the potential health risk should not be overlooked. This study represents an in-depth analysis of the prevalence, host distribution, and characteristics of rodent populations infected by three hantaviruses within a small, well-defined, geographic area.

Animals↗

Anti-arthropod saliva antibodies among residents of a community at high risk for Lyme disease in California.

The role of the western black-legged tick (Ixodes pacificus) versus that of other potential arthropod vectors in the epidemiology of Lyme disease was evaluated by determining the prevalence of anti-arthropod saliva antibodies (AASA) among residents (n = 104) of a community at high-risk (CHR). Salivary gland extracts prepared from I. pacificus, the Pacific Coast tick (Dermacentor occidentalis), the western cone-nose bug (Triatoma protracta), and the western tree-hole mosquito (Aedes sierrensis) were used as antigens in an ELISA. Sera from 50 residents of the San Francisco Bay region in northern California and 51 residents of Imperial County in southern California served as comparison groups. The prevalence of AASA ranged from 2% for A. sierrensis to 79% for I. pacificus in study subjects, 0% for D. occidentalis to 36% for I. pacificus among residents of the San Francisco Bay region, and 6% for I. pacificus to 24% for A. sierrensis in residents of Imperial County. The associations between AASA and demographic factors, potential risk factors, probable Lyme disease, and seropositivity for Borrelia burgdorferi were assessed for 85 members of the CHR. Seropositivity for I. pacificus and B. burgdorferi were significantly correlated, the relative risk of seropositivity to B. burgdorferi was about 5 (31% versus 6%) for subjects who were seroreactive to I. pacificus, nearly every individual who was seropositive for B. burgdorferi had elevated levels of antibodies to I. pacificus, and the mean titer for antibodies to I. pacificus was significantly higher for subjects seropositive versus those seronegative for B. burgdorferi. Together, these findings support the widely held belief that I. pacificus is the primary vector of B. burgdorferi for humans in northern California, and they demonstrate the utility of the AASA method as an epidemiologic tool for studying emerging tick-borne infections.

Adolescent↗

California state Mosquito-Borne Virus Surveillance and Response Plan: a retrospective evaluation using conditional simulations.

The California Mosquito-Borne Virus Surveillance and Response Plan recently was developed to provide a semi-quantitative means for assessing risk for western equine encephalomyelitis (WEE) or St. Louis encephalitis (SLE) viruses and to provide intervention guidelines for mosquito control and public health agencies during periods of heightened risk for human infection. West Nile virus recently has arrived in California, and the response plan also will provide a baseline for assessing the risk for human and equine infection with this virus. In the response plan, overall risk is calculated by averaging risk due to 1) environmental conditions, 2) adult mosquito vector abundance, 3) vector infection rates, 4) sentinel chicken seroconversion rates, 5) equine cases (for WEE), 6) human cases, and 7) the proximity of virus activity to populated areas. Overall risk is categorized into three levels: normal season, emergency planning, or epidemic conditions. We evaluated this response plan using historical data from years with no, enzootic, and epidemic activity of WEE and SLE in several areas of California to determine whether calculated risk levels approximated actual conditions. Multiple methods of risk calculation were considered for both viruses. Assessed risk based on cumulative temperature, rainfall, and runoff levels over the entire season provided more or equally accurate assessments than biweekly assessments based solely on the previous half-month. For WEE, during years with enzootic activity or early-season periods of years with WEE epidemic activity, combining horse and human cases as a single risk factor improved the model's ability to forecast pending WEE activity, but separating the two factors allowed a better indication of WEE activity during epidemics and periods with no activity. For SLE, assignment of higher risk to drier conditions as measured by rainfall and runoff yielded the most accurate representation of actual virus activity during all recent study periods.

Animals↗

Coccidioidomycosis in a California sea otter (Enhydra lutris).

A weak and emaciated California sea otter (Enhydra lutris) was found stranded on Atascadero Beach in Morro Bay, California. It died three weeks after capture. A diagnosis of coccidioidomycosis was confirmed by histology, serology and culture. This is believed to be the first reported case of this disease from the Morro Bay area of San Luis Obispo County, California as well as the first reported case in a free-ranging marine mammal.

Animals↗

Findings in pinnipeds stranded along the central and northern California coast, 1984-1990.

Personnel at The Marine Mammal Center (The Center) treated 1,446 stranded marine mammals recovered from the central and northern California (USA) coast from 1984 through 1990, including California sea lions (Zalophus californianus), northern elephant seals (Mirounga angustirostris), Pacific harbor seals (Phoca vitulina richardsi), northern fur seals (Callorhinus ursinus), Steller sea lions (Eumetopias jubatus), and Guadalupe fur seals (Arctocephalus townsendi). The primary disease findings in stranded California sea lions were renal disease, renal disease complicated by severe verminous pneumonia, verminous pneumonia, seizures of unknown etiology, and renal disease complicated by severe pneumonia of unknown etiology. Stranded elephant seals included pups, yearlings with dermatological problems, and neonates. Most harbor seals admitted to The Center were underweight and premature pups. Stranded northern fur seals included animals with seizures of unknown etiology and emaciated pups. Stranded Steller sea lions included underweight pups and aged adult females with pneumonia. Two Guadalupe fur seals had hemorrhagic gastroenteritis. Incidental findings at the time of stranding among the six species included verminous pneumonia and pneumonia of unknown etiology, renal disease, internal parasitism, ophthalmologic problems, gastrointestinal disorders, otitis externa, and external wounds.

Animals↗

Antibody prevalence of eight ruminant infectious diseases in California mule and black-tailed deer (Odocoileus hemionus).

We tested 276 sera from 18 free-ranging black-tailed and mule deer (Odocoileus hemionus) herds in California (USA) collected from 1987 to 1991 in five biogeographical habitat types, for antibodies against eight infectious disease agents. Overall antibody prevalence was 56% for Anaplasma marginale, 31% for Borrelia burgdorferi, 16% for bluetongue virus serotype 17, 15% for epizootic hemorrhagic disease virus, 7% for Coxiella burnetii and Toxoplasma gondii, respectively, and 0% for bovine leukosis virus and caprine arthritis/encephalitis virus, respectively. Antibodies against Lyme borreliosis and anaplasmosis were found in deer throughout California, but antibodies against bluetongue and epizootic hemorrhagic disease were most prevalent in deer from southern California.

Age Factors↗

Herpesvirus particles associated with oral and respiratory lesions in a California desert tortoise (Gopherus agassizii).

A 60-year-old captive California desert tortoise (Gopherus agassizii) which died in August 1990 at the University of California, Davis, California (USA), during treatment for colonic impaction had marked caseous necrosis of the oral cavity, choana, trachea, and lungs. Numerous intranuclear inclusion bodies and a large number of syncytial giant cells were seen in the oral cavity and respiratory tract along with bacterial granulomas. Pasteurella testudinis, Streptococcus veridans, and coagulase-negative Staphilococcus spp. were cultured from the lesions. Using electron microscopy, herpesvirus particles were observed in intranuclear inclusions and cytoplasm. Viral stomatitis, tracheitis, and bronchopneumonia complicated by bacterial infection were diagnosed. Although respiratory disease is common in desert tortoises, this is believed to be the first report of association with a viral infection.

Animals↗

Columbian black-tailed deer (Odocoileus hemionus columbianus) as hosts for Borrelia spp. in northern California.

The prevalence of infection of Columbian black-tailed deer (Odocoileus hemionus columbianus) with Borrelia spp. was evaluated in an area of northwestern California (USA) where Lyme disease is endemic and the relapsing-fever group spirochete Borrelia coriaceae is enzootic, and in a far-removed comparison area having a disparate climate and lower density of vector ticks. Blood samples collected from both deer herds in 1987, 1988, and from 2000-02 were assayed for borrelial infection with microscopic and molecular methods. Serum specimens from two (5%) of 39 deer from the Dye Creek Preserve in Tehama County versus 13 (20%) of 64 animals from the Hopland Research and Extension Center (HREC) in Mendocino County, California were polymerase chain reaction (PCR) test positive for B. burgdorferi sensu lato. DNA sequencing analyses revealed that eight animals were infected with B. bissettii, six with three unclassified genotypes, and one with B. burgdorferi sensu stricto. One serum sample (2%) from HREC was positive for a relapsing-fever group spirochete that had a 16S rRNA sequence homology of 99% with the C053 type strain of B. coriaceae. Spirochetes undetermined to geno-species were detected in thick-blood drops prepared from three (8%) of 36 deer from the HREC by direct immunofluorescence. Adults of the hippoboscid flies Lipoptena depressa (n=73) and Neolipoptena ferrisi (n=24), the Pacific Coast tick (Dermacentor occidentalis) (n=22), and the western black-legged tick (Ixodes pacificus) (n=1) that had been removed from deer from both study areas in 2002 were PCR test negative for borreliae. The occurrence of diverse borreliae in deer from northern California confounds and, consequently, reduces the utility of borrelial serosurveys for detecting specific genospecies, unless they are complemented by more specific assays (e.g., immunoblotting, PCR/sequencing analysis).

Animals↗

Farm worker illness following exposure to carbofuran and other pesticides--Fresno County California, 1998.

In California, suspected pesticide-related illnesses and suspected work-related illnesses and injuries are reportable conditions. On July 31, 1998, the Occupational Health Branch of the California Department of Health Services (CDHS) received a report from the California Department of Pesticide Regulation (CDPR) of a pesticide exposure incident in Fresno County involving 34 farm workers. CDHS investigated this incident by reviewing medical records of the 34 workers and interviewing 29. The findings indicated that the workers became ill after early reentry into a cotton field that had been sprayed with a cholinesterase-inhibiting carbamate pesticides

Adolescent↗

Update: TB regulations from California.

As might be expected, the California Occupational Safety and Health Administration (Cal OSHA) has taken the lead in issuing regulations to protect healthcare workers from occupational TB infection. CHEM believes the Cal OSHA regulations will provide a template for the general shape of regulations that will be issued by other states and federal OSHA. Therefore, the regulations are printed here in full, along with the resolution of the California State Assembly that empowered Cal OSHA to issue the regulations. Some references to other sections of the California Code of Regulations have been deleted. CHEM's comments are at the end.

California↗

California's Wickline decision revisited.

In a recent California appellate decision, Wilson v. Blue Cross of Southern California, 222 Cal. App 3d 660, 271 Cal Rptr 876 (2d Dist., 1990), the court cut back on its earlier decision in Wickline v. State of California, 192 Cal. App. 3d 1630, 239 Cal Rptr 810 (2d Dist. 1986), which had provided substantial protection for third-party payers against liability for utilization review decisions. The Wilson decision not only limits Wickline to its particular facts, but also criticizes some of its rationale.

Alabama↗

Do California trends foreshadow national ones?

Take a look at what's in California's future, and maybe yours as well, through the California Healthcare Association's recently released report, California Health Care 1998-2005: View of the Future. Key themes in this year's report include incremental health care reform, expanded access to health care coverage for the uninsured, purchasers refocusing on price and quality, and integration in rural health care. Preferred provider organizations will regain popularity, and fewer physicians will remain in solo practice.

Annual Reports as Topic↗

New California strategy for medical assistance favors public health and organized plans.

In coming months, county governments in California will begin implementing regulations enacted by State Assembly that will change the settings for treatment of Medi-Cal (Medicaid) patients. The change will be dramatic, channeling medical assistance patients out of the offices of individual private practice physicians and into the offices of salaried doctors in public health settings or offices of doctors participating in organized health plans. Negotiated contracts with counties, institutions and non-institutional providers, patients, and fixed rates of reimbursement will become the parameters of medical service for providers of health care in the state's medical assistance program. For urban private solo practitioners in California whose practices rely heavily on publicly-supported patients, these changes hold a major threat, and for physicians throughout the nation it is a situation which should be watched carefully, because California is well known as a state which gives birth to changes that later appear in other states.

California↗

Medicaid Tape-to-Tape findings: California, New York, and Michigan, 1981.

Presented in this report is an overview of Medicaid enrollment, utilization, and expenditures in California during 1981. The California Medicaid program, called Medi-Cal, is the largest in the Nation in terms of program beneficiaries. During 1981, California had one of the most generous Medicaid programs in the country in terms of eligibility and covered services. At the same time, there were benefit limitations and reimbursement restrictions in place that were designed to restrict program expenditures. The data in this report were provided by the State to the Health Care Financing Administration as part of the Medicaid Tape-to-Tape Project. Data from Michigan and New York are also included for comparison purposes.

Adult↗