The Next West Nile Virus?

Two years ago, researchers from Johns Hopkins and the Centers for Disease Control

published a study about a how small community might react to a bioterrorist attack. They

imagined a scenario in which an infectious agent was sprayed in a semi-rural community in the

southern U.S. Then they videotaped a series of make-believe news reports covering the nine-

day period of their fictional crisis. Four groups of people (medical personnel, their spouses,

journalists, and others) were asked to watch the videos and answer questions about their

reactions to the fictitious events.

Two things are interesting about this imaginary exercise. First, the infectious agent they

chose for their pretend attack was Rift Valley Fever (RVF) virus.

RVF virus is an interesting choice because it really could show up in the U.S. one day—

not by intentionally being released by some lunatic, but rather in the same way West Nile Fever

virus did in New York in 1999. The West Nile virus probably made its way here by lurking

inside an infected bird or in a mosquito that got into the cargo hold of a jet plane and got out

again at JFK airport. The RVF virus could do much the same thing. And once here, there are

mosquito populations in various parts of the U.S. that could sustain it and transmit it.

Like the West Nile virus, RVF virus is from Africa. It was discovered in 1930 in the Rift

Valley in Kenya. It is primarily a disease of herd animals, and the most common victims are

cattle, buffalo, sheep, goats and camels. Epidemics among herd animals can cause serious

economic damage.

Humans are likely to come in contact with the virus during outbreaks among domestic

animals. They either become infected directly from the bite of an infected mosquito or from

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direct contact with infected animals. The result can be an uncomplicated flu-like illness.

Symptoms may include fever, nausea, diarrhea, headache, and muscle pain. RVF symptoms

usually last from four to seven days.

Usually RVF is a mild disease in people, but a small proportion of patients (about 1%)

can develop more severe forms of infection. Some of these forms include eye infections,

inflammation of the brain, and a hemorrhagic fever.

The hemorrhagic fever form causes jaundice, internal bleeding, vomiting of blood, and

some additional neurological symptoms. The case fatality rate for this type of RVF may be as

high as fifty percent.

The first big RVF epidemic killed about a 100,000 sheep in Kenya in 1950-51. In 1977, a

huge epidemic struck in Egypt affecting between 25% and 50% of the sheep and cattle. Two

hundred thousand people also became ill and almost 600 died from hemorrhagic RVF. More

recently, the virus has jumped across the Red Sea to cause outbreaks in Saudi Arabia and Yemen.

In the fall of 2000, an outbreak of RVF sent 516 people to the hospital; 87 of them died from the

hemorrhagic form of the infection.

The U.S. is not an agricultural or herd-based nation. Still, the appearance of this virus in

the U.S. could cause serious economic damage to the cattle industry and would present citizens

with yet another summertime bug to worry about. Last November, a mosquito expert at the

Army’s Ft. Detrick labs in Maryland said, “Rift is a much worse virus than West Nile. My

personal belief is it will get here.”

There are no specific human treatments for RVF. There are two veterinary vaccines

available for herd animals but both of them have some serious shortcomings. There is also an

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experimental vaccine for humans, but it has not been licensed and probably will not be for some

time. So we wait and hope the clock is not ticking on the arrival of another immigrant virus.

The other interesting thing about that fictional bioterrorism study was the reactions of the

journalists who took part in it. To quote the authors of the study: “Journalists are key

participants in risk communication, yet in this study, the media exhibited more fear than any

other group other than spouses, made high demands for vaccine, had the poorest understanding

of medical issues…and were most likely to stay away from work after terrorism was

recognized.” That’s not good news for journalists or the public, but it is something to bear in

mind the next time we find ourselves glued to the television watching some mysterious crisis

unfold.