West Nile Virus has been detected in the Bay Area. It is 2022; this should not be a surprise to anyone. What else are we dealing with? Oh yes, Covid is still here, Monkeypox, Polio, headlines in the news about future devastating floods. Can we all just give a loud OY?
Even if they weren’t carrying any diseases, I hate mosquitoes. Yes I am aware that they are part of nature's vast food chain but that doesn't stop my loathing. For the record, it is a mutual dislike and fortunately I rarely get bitten. The rest of my family, both of my daughters in particular, are tasty targets, and are feasted on when given the opportunity.
Of all the mosquito-borne illnesses, the West Nile virus is the one that has gotten the most local media coverage lately. It is thought to have originated in Africa (hence the name.) It has spread throughout the world and it was first detected in this country in 1999. Unfortunately we now have it in most states, including California.
Mosquitoes get this virus from feeding on infected birds and then transmit it to humans. Humans are referred to as "dead end hosts"; they get the virus from being bitten by the infected insect, but then cannot spread it to each other.
It is possible that it can be transmitted from blood transfusions, pregnancy or breastfeeding but there are no known cases of infants who have gotten seriously ill from these transmissions.
The good news is that most of the time it is actually not such a big deal. Children under 5 seem to be at relatively low risk for getting terribly ill, and folks over 50 seem to get hit the hardest. It can be found year round but seems to peak in late summer/early fall. 80% of folks who get WNV have no idea that they are infected and feel perfectly fine. There are probably thousands of cases that go under the radar since we would never consider testing if someone is only showing mild symptoms of a mystery illness. The unfortunate other 20% of infected folks may have
Not everyone will have every symptom. Most people showing these mild to moderate symptoms will recover completely, although there are reports that some of these folks can remain fatigued and achy for several weeks. 1% of infected people can get more serious neurological complications including encephalitis and meningitis. It can be fatal for those with serious cases. People with troubled immune systems are at the greatest risk.
The incubation period is usually between 2-14 days after the bite from an infected mosquito (most commonly 2-6 days.) There is, alas, no treatment beyond supportive care. It is thought that most people who have fought off the illness end up with some level of immunity. Keep in mind that any severe headache-fever-stiff neck combination always needs to be evaluated right away. If West Nile virus is suspected there are blood tests that can help with the diagnosis.
Since there is no vaccination at this point, and no treatment, the key is prevention.
Of course right now with Covid circulating, any fever is something that we pay attention to, but if there have been recent mosquito bites, make sure you report those as part of the relevant history. I am not worried about any fever is gone after several days. It is the mystery fevers that are lingering that should get attention.
Prevention is the key when it comes to dealing with mosquitoes.
Alas, long sleeves alone aren’t going to do the trick if you are out in a buggy area. There are plenty of natural products on the market that claim to be repellents, ranging from Vitamin B to catnip. Most of these are generally safe, but unfortunately the scientific studies show that they are mostly ineffective. We have the luxury in the Bay Area of not having some of the more notorious mosquitoes, so the bites are mostly an aggravation rather than a health risk. If you are in San Francisco, it is not a big deal to give something a try to see how it works on your family members. However, If you are traveling to an area where there are more dangerous mosquitoes, I would stick with the strong stuff. No kidding around.
The EPA has five registered insect repellents.
Before applying anything topical to the skin for the first time, do a little test patch on the skin to make sure there is no sensitivity before you widely spritz or wipe on any of these products. You will need to read the labels to see how often you need to reapply. Avoid contact with eyes and keep all of these safely away from kids.
I would also be cautious about getting any insect repellents on the hands, especially if your child is young enough that those hands are going into the mouth a lot. If you are also using sunscreen, apply sunscreen first and insect repellent second.
All of the EPA recommendations are considered safe, and they are clearly better than getting bitten, but at the same time, let’s use them wisely. The EPA has created the following tool to help you find the proper product for you needs
EPA guide to finding the right repellent
Some products are more effective than others for certain types of mosquitoes, so the product you choose might depend on where you are going and what you might be most at risk for. Trusting that someday we will be able to move around the globe again, it is always good to check in at https://wwwnc.cdc.gov/travel prior to any travel.
DEALING WITH A BITE
If the prevention has failed the most important thing is to treat the itching. Scratching at a bite will make it worse. Make sure their nails are trimmed! There is a product called a mosquito zapper that some folks find useful. Young kids might be startled from the noise, but others claim that it is great for minimizing the reaction if you use it quickly.
Over the counter hydrocortisone cream probably works the best, but other topical treatments can include calamine lotion, or mixing up a paste of baking soda with a bit of water. A cold black tea bag compress can also be very soothing. Black tea contains tannins, which seem to help.
Some kids can have enormous reactions. Eyes and ears can be remarkably swollen. Topical treatment won’t be enough for these. Give a dose of Zyrtec or Benadryl right away. Scroll to the bottom for dosing info. If the antihistamine doesn’t make a difference or if there is fever or severe discomfort, those kids need to be evaluated by a doctor.
If your little one is getting bitten, check the bedroom carefully. Look at the mattress and all the corners of the room; bites could be from spiders, fleas or other culprits.
Zyrtec Dosage Chart The dose of cetirizine depends on age:
· 6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily)
· 12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily)
· 2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily)
· Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily)
Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). Make sure you check the strength of the solution.
Benadryl dosage will be the same volume as your Tylenol dose. The liquid says for children 4 and over; we still use it for our younger patients who need it. Benadryl makes most kids sleepy but can have the opposite effect.
If you are interested, Here is some current info on some of the mosquito borne illnesses that have been in the headlines the most in the past year or so.
West Nile Virus
If you see any dead birds, give them a wide berth and report them to 1-877-968-2473 (WNV -BIRD) or online at http://westnile.ca.gov/ That website also will give you the up to date numbers on how many West Nile virus cases there are in California, county by county. It is updated weekly.
https://www.cdc.gov/zika/
https://www.cdc.gov/
Here are some bonus facts about mosquitoes:
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