 Hello, I'm Brandon Bennett and I'm the Code Compliance Director for the City of Fort Worth. This is a real brief update on the West Nile virus. The purpose of this presentation is to give you a real brief summary of what the virus is and how it's transmitted to go over the data from 2012 to look at how the city responded back in 2012 and then even more important to look at what our plan is for 2013. First of all, let's look at the life cycle of the mosquito. Mosquitoes are actually born from eggs that are placed in water and the source of the water is very critical to how mosquitoes breed and reproduce. In this case, they need stagnant water, which is water that has been sitting around anywhere between three and seven days. Good source pools would be, say, after it rains and there is water that pools in a bucket or in a tire in something as small as a soda bottle cap that is sitting upward to collect the rain water or an old can that collects water in it. What a good source is is also one that has grass clippings in it or is around grass, kind of marshy areas, because the mosquitoes will eventually need some nutrients in that water in order to develop into a mosquito. Rain pools, rivers, lakes beyond more than one feet deep, none of those are good source pools for mosquitoes. In fact, there is nothing better than a good gully washer rainstorm in the middle of the summer to wash out all the stagnant water for us in fighting mosquitoes because it also washes out the eggs and then we have to wait for that water to get stagnant again for the mosquitoes to lay eggs. After the eggs are laid in the water, they will go through a 10 to 14 day cycle. They'll turn into larvae. These kind of look like, might be mistaken at times, as maybe tadpoles or little fish. What happens is after about two weeks, the mosquito will develop, it will come out of a hard shell. It will initially walk across the top of the water. It will dry itself in the sun and then take to flight. After taking to flight, it will typically roost up in a tree, at least the Kulex type mosquito will. This is the type of mosquito which is most dangerous to human beings for giving us the West Nile virus. These are not the ankle-biter type mosquitoes that someone might see or someone might get bit by in the middle of the day. Those are a different breed of mosquito that typically live down low and foliage or down in the wet grass. The Kulex mosquito likes to live up in the 8 to 10 feet above ground area, which is critical when you're looking at how we attack the virus and keep it from infecting too many humans. Having this in mind, the mosquito, the first three to five days, it doesn't have the ability. Its mouth is still relatively spongy and it can't break through either the skin of a bird or a human. It'll live off of nectar, honeydew for a bit. Once their mouth hardens and it can take what's called a blood meal, then it will, in this case the Kulex, will seek out primarily birds. Remember the Kulex mosquito likes to live high in the tree. That's where birds are also roosting, so it's an easy blood meal for them. A blood meal is important for a mosquito because the only mosquitoes that bite, either mammals or reptiles or others, are the female. They have to have a blood meal before they can produce eggs to create more mosquitoes. The males, they only live for a few days after they move to the adult stage and they only live off of nectar and then they die off. One of the reasons why we talk about the number of days and the different stages is that by the time mid-summer rolls around and we start seeing a lot of human victims of the West Nile virus, we have to understand that that report isn't because of something that just occurred, it's something that occurred four to six weeks previous to the actual identification of the virus in the human. In this case, what I like about this slide is it really calls into play the difficulty in looking at this from a predictability or attack plan for the city and other agencies. Water first has to sit for four to seven days, mosquito will lay eggs in that dirty water. It can be 10 to 14 days for the eggs to develop into an adult. The adult needs about four days before it can take its first blood meal. It will bite birds, not all birds carry the West Nile virus, but if it is unfortunate enough to bite a bird that carries the West Nile virus, then it will take anywhere from 10 to 14 days for that virus to develop in the mosquito and give it the ability to either transfer that virus to other birds or to human beings. Then after an infected mosquito bites a human being. It will be 10 to 14 days before that human being becomes symptomatic where they start feeling maybe a little sick and they will go to the doctor and the doctor will test for West Nile virus and getting that test could take anywhere from four to seven days to get the results. This is why we really press for early treatment of source pools early in the summer because we won't know how big of a problem that we're going to have until four to six weeks after these little critters start getting up in the air. This slide in particular calls out what we see typically in any season and then calls out what we saw specifically in 2012 and that is that there is the majority of cases happen in reported cases for human West Nile virus occur in late July into late August. So remember if all of this starts six weeks prior to that, that means that we need to really be addressing mosquitoes and source pools and really combating this problem somewhere in late May to early June. This slide represents what is the traditional response of government agencies based on lessons learned from previous years that we start with a lot of education in May, telling people hey we need you to drain your source pools, turn your buckets upside down, don't let your birdbath water become stagnant, make sure that you swap out the water bowls or the water in the water bowls for your pets, wool burrows, make sure they're turned upside down. Anything that can hold water is a potential breeding ground for mosquitoes. So by addressing the mosquitoes on the front side, on the breeding, we reduce the number of mosquitoes that are in the air that could potentially take a blood mill from an infected bird and then transfer that virus to a human being. And then when we move into the June timeframe, that's when we really start pushing the general education, really pushing what are called the 4Ds. The Qlex mosquitoes, the ones that primarily carry this virus, are most active at dusk into the nighttime areas and then somewhat active at dawn. And so we want people to stay indoors as much as possible during those time periods. If they have to be outside during those time periods, then we want people to dress appropriately, try to wear pants, try to wear long-sleeve shirts, try to wear things that provide you some type of defense against mosquito bites. And then we also promote, as part of the Ds, is DEET. And that's a repellent. And there's lots of repellents on the market. You don't have to go with DEET, which is a chemical. There's Avon Skin So Soft and a lot of other natural products out there that work just as good. I would encourage you to go to the city's website for West Nile virus information. And there's a whole list of natural and chemical repellents and how long those repellents will give you some level of protection. And they're rated much like sunscreen is rated, you know, the higher the number, the more protection that you would receive. As we move into, you know, later June than into July, we start looking at some targeted outreach and education. And that's because it's at this time period that doctors will start seeing human beings that are showing the symptoms of West Nile virus, that they'll be tested for it. There's a positive finding that's reported to the health department, and then the health department notifies the city. We will go into these neighborhoods, we'll do door-to-door education, we'll do Reverse 9-1-1 education, we will encourage neighborhood associations and others to hold town hall type meetings to get the information out. And then we'll also do an environmental assessment around all human cases that we will look for source pools. You know, is there a source of water out there that is a breeding source for the mosquitoes? Because we do know that if we can reduce the number of adult mosquitoes, then we can also reduce the risk of transmission of the disease from bird to mosquito and then mosquito to human. And this includes also we will do flyovers in these areas where we will look for like green pools, like abandoned swimming pools. If it's a swimming pool that is chlorinated and that is used, that's not a good source pool for mosquitoes. The Trinity River, because it's flowing water, is not a good source pool. Lakes that are deeper than one foot are not good source pools. I mean, you're really talking about, you know, puddle type environments, wool burrows, buckets, things like that. We also really push real hard early summer a program called 5x5 and that is, you know, most people get bit by these Qlex mosquitoes because they're very weak flyers. These Qlex mosquitoes were, you know, they laid eggs and then they hatched as a mosquito on the person's property or within five properties on either side of the person that was infected. And so the 5x5 is check your property and then go and talk with five neighbors on each side of you and make sure they're checking their property. That's one of the best things you can do to protect yourself and protect your community. When we start getting into late July and early August, we do a lot more mosquito surveillance and samples. If we start seeing multiple victims at that point, we will hold far more public meetings. And those meetings are not only to raise awareness to the risk, but it's also to raise the awareness that we may have to do some targeted spraying. When there's mosquitoes that are up in the air and they are transferring the West Nile virus to human beings, one of the most effective ways of reducing that risk is for the city to go and spray public areas in the evening. And we would typically do that after 10 o'clock at night and before 3 in the morning. What we do is we make sure that the neighborhoods know when we're going to be there, how we're going to be there, and the type of chemicals that we may be using. We typically will hit the same targeted area, which is usually about a mile to a mile and a half from a center point, that center point being an area where we've had multiple folks that have been infected with the virus. And what we use, the chemical that we use, is about 3,500 times less potent than the typical insecticides that you could buy from your neighborhood hardware store. And so it's important that we let people know about the health risks that are very minimal to let them know when we're going to do it, how we're going to do it. And one of the benefits is here in Fort Worth that the particular chemical that we use is that it will, it's more of a vapor than a spray. It'll stay up in the air for about 15, 20 minutes, and then it'll settle to the ground. And when the sun comes up in the morning, those rays from the sun actually inactivate it. And so at that point, it is not a threat to honey bees or butterflies or ladybugs or any of the daytime insects that are very beneficial to the environment. And we continue these activities through September until the threat decreases. When you look at some of the data, you know, going back to 2007 into last year, as you can see, you know, there weren't a whole lot of West Nile cases. And there's two types of symptomatic type things that we look for on the virus. The blue line represents West Nile fever. And the vast majority of people that are infected with West Nile virus, they'll either not even know they were infected by it, that they're what's called asymptomatic, that there's no symptoms whatsoever, or they're developed flu-like symptoms, which is the blue line there. In less than 1% of all the cases, we'll get what's called neuro evasive form of West Nile virus. And this can lead to encephalitis, meningitis, some of the more serious diseases. This is what is most concerning and the highest risk of the disease itself. What we don't know is for 2013 is whether or not these numbers will remain high, go higher, or drop off. This for the entire nation and for all the scientists that are working on it, there's just no predictable model for West Nile virus that exists to tell us whether this trend will continue or not. So we're doing a lot of surveillance for 2013 and doing a lot more planning for 2013, just in case the numbers go higher. When you look at human case comparison among the Metroplex, Fort Worth had some of the lowest numbers so far as those that were infected with the virus, and in particular those that were infected with the more severe form of it. When you look at Dallas, that got a lot of coverage in the news about 7.7 cases per 100,000 and Fort Worth down around 4.2. When you look at West Nile virus, the strategy towards addressing the virus itself and whether we spray or we don't spray and where we educate and how we educate and how we do surveillance, it's somewhat complicated and very much integrated with data that we can draw from multiple sources. So this particular map, we felt it would be easier to call out where our hot zones were last year using zip codes. And what I want you to know is that we did not spray the entire zip code where you see red and orange, which represents the highest number of cases. We did, in each one of the orange zones, we did spray about an area of about one square mile. And up in the red zone, we had another area about one square mile, which are really relatively small areas within that entire zip code. And what we found was that when we trapped mosquitoes and tested them for West Nile virus, there were a lot of positive West Nile virus mosquitoes in our traps. When we went back and tested after we sprayed, we saw fewer mosquitoes and we found no positive mosquitoes in the trap. So we know that the spraying was effective. We don't nuisance spray like some cities do, and that is where you spray throughout the year. We just spray targeted areas where there have been mosquitoes trapped that are carrying the virus and where we've had human cases of the virus reported. What's kind of interesting about this map, however, is when you look at the question of some cities aerial sprayed and some cities didn't aerial spray, when you look at the right side of the map there, and that would be the east side of Fort Worth, you can see that's where we had the majority of our cases. When you get about to the center of the map, moving over to the left, you can see that maybe there was one victim or no victims whatsoever. And if you look at the insert map there of State of Texas, what's kind of interesting is that the number of cases seems to follow the average rainfall map from the weather service. And that is the areas of the Metroplex that get higher amounts of rain tended to have higher numbers of West Nile virus victims. You can't really make a true relationship to this because that alone is fairly simple. You'd have to look at the demographics and the population density and that. But we wanted to call this out because one of the biggest problems that we have fighting the West Nile virus is reducing the number of mosquitoes that are in the environment in the first place. And because they need water as a breeding source, you can't turn a blind eye to the fact that the wetter areas, at least by rainfall of the city, at least this last year in tracking, had a higher incidence of West Nile virus. So we want to make sure we drive that home to folks. You have to make sure you will burrows are not collecting water buckets. You know, anything that can hold stagnant water needs to be drained and drained throughout the summer. We had a lot of partnerships this last year. We didn't act in isolation. We had a number of conversations and meetings with the CDC, the EPA. We worked with ASPCA. You know, there were rumors out there that the spray that we were going to use was harmful to cats. And what we found was what we were actually using would have to be a thousand times more concentrated to even cause a rash on a cat. And much more higher in order to actually impact its general health. You know, we benefit by having UNT health sciences right here in Fort Worth. They were a great partner. And in fact, this upcoming season, we have partnered with them to where they will be helping us with surveillance and testing and helping collect data to see if we can come up with a more predictable model for the future. The city had an all hands response. We had the parks, the streets, police and fire getting the word out. It was a really good response. And then we also worked with, you know, Fort Worth ISD and for that matter, all the ISDs with the hospital and the hospital community, the business community. You know, education is a real big piece to addressing this virus. But at the end of the year, when you look at the virus as a whole, looking at this from a national perspective, the health community came up with a consensus which was that cities need to either re-implement or implement comprehensive and consistent mosquito surveillance. This is where mosquitoes are trapped throughout the season to see if they are carrying the virus, and then if they are, even before there are human cases, to start taking efforts to reduce the source pool and reduce the number of adult mosquitoes that are up in the air. Also, source pool elimination activities and larvasciting, and this requires a lot of community engagement. This is the, you know, the five by five getting, not only you, but getting your neighbors involved in draining the source pools. And then emphasis of personal protection. If you look at Fort Worth and Tarrant County, that 70% of the people that contracted West Nile virus this last year, actually it was over 70%, didn't use any type of repellent, none whatsoever. And the vast majority of those were aware of the virus. They were aware that they needed to be using repellent just because of the lack of convenience to it or accessibility to it. They forgot, you know, no matter the reason, over 70% said they were not using repellent at the time that they would have been bit by a mosquito and contracted the virus. We have to work on that really, really hard. And when I say we, what I mean is you, me, and everybody else in the community, because this is where personal responsibility really plays a big role. And then lastly, adult deciding spraying, you know, I can tell you from the public meetings that we had this last year, that we had about a third of the people that were opposed to the spraying. We had a third that were in favor of it, and we had a third that just weren't really sure, but once they got all the education material that they typically would move to, yeah, let's go ahead and spray because that's the safest and the rightest thing to do. And we'll talk a little bit more about that on a later slide here. So what's our response plan for 2013? Well, we work very closely with the different counties because most of the city is in Tarrant County. That's the one we work with primarily. We share public education with them. They help us by doing disease reporting and the epidemiology. They run the lab for testing the mosquitoes, and then they're helping us out this year by providing additional mosquito traps. In fact, this year we'll be locating mosquito traps at every one of the city's fire stations, which are dispersed around the different zip codes throughout the city. And then the city, along with public education, will actually conduct the surveillance and we'll take the samples to the county, to their lab for testing. We'll help with larva sighting and draining source pools when private property owners cannot be located or unable to address the issue. And then adult sighting, which is the ground spraying, is something the city will do once again on a targeted basis based on a high incidence of adult mosquitoes carrying the virus along with humans contracting the virus. We'll once again have a phased response. We're moving from the off season now to the start of the season, so we have started up our surveillance program and our outreach and our education. We're starting to do some larva sighting. Larva sighting is essentially, if I didn't cover this earlier, is where you can either drain the water, but if the water is, the source is too big to drain. There are these commonly referred to as donuts. One of the brand names is BTI and it's really a bacteria that will kill off the mosquito larvae and the eggs, which is kind of cool because it's a naturally occurring bacteria. It's not harmful to humans or pets. Pets can still drink from the water, bathe in the water, and in many cases you can get these little donuts with their time release as long as you don't break them up and they can last for as much as 30 days. And then once again, we'll continue to, as we move forward to look at the data that comes in to decide whether or not we should ground spray. And if we get to epidemic proportions like we did last summer, we would once again consider, although we did not implement aerial spraying and that consideration typically comes from the Tarrant County Public Health Department. It would be upon their recommendation and then consideration by the city on whether we participate or not. This shows on the surveillance side where our traps will be. You can see that they're very evenly distributed throughout the city and we'll be paying particular attention to those areas where we had positive mosquitoes last year. And then spraying, I wanted to touch base on it here quickly because that tends to be the thing that we get the most questions about. Really, there's two types of spraying. There's nuisance spraying and there's disease spraying. And nuisance spraying are what some communities do where there is a lot of either waterborne mosquitoes or where there's a lot of wetlands where you can't control mosquitoes through the typical drain the buckets and make sure that the small puddles of water are drained. So what they would typically do is in these areas is would have either a ground or aerial spraying that would go throughout the summer months. You see this in Dallas and other cities where from early summer to late summer, they're driving the fog trucks up and down city streets, whether or not the West Nile virus is present or not. And then you have disease spraying and disease spraying is where you target specific and defined areas just trying to kill those mosquitoes that are infected with the West Nile virus. The city of Fort Worth does not do nuisance spraying. We do do disease spraying and we do that in a very specific and targeted area. And it was very effective this last year. In fact, Fort Worth was one of the cities that was used as an example of how to effectively deploy ground spraying in those communities that have not adopted a more broad or widespread nuisance spraying program or that have not opted into some type of aerial spraying. And then aerial spraying is when West Nile virus reaches epidemic status. That's when you really have to look at, okay, what are our options and which option should we implement now, tomorrow, a week from tomorrow, et cetera. In our case, if you recall the map that I showed you earlier about where our cases were, we really had most of our cases in a very small and defined area. They weren't dispersed throughout the entire city and it wasn't a big area like Dallas had. And so spraying was, as an option, was somewhat overkill to the problem that we were seeing here locally. That is, we would have sprayed the entire city just trying to get at the mosquitoes in an area that was less than one third of the city. And so that's why we elected to go with the ground spraying. I know for myself, I consider the over-the-counter products to be fairly safe, you know, the off and deep woods. But I am like I think most of you that do you ever really feel comfortable spraying a chemical on yourself or do you really feel comfortable with a truck driving up and down the street putting a fog up in the air to kill mosquitoes at night in a community spraying program. So we try to balance the risks on both sides, you know, the chemical risk and the virus risk. And I hope you found this information, summary information helpful. I can tell you that the city's website, www.fortworthtexas.gov forward slash West Nile virus. We have lots of helpful links there to how to control mosquitoes in your backyard, repellents that you can use both natural and chemical. What our game plan is, whether we're going to be spraying in your neighborhood, you can request, you know, public meeting with us through your neighborhood association or business group or just get all your neighbors together and we'll come out and talk with you. We maintain a helpful phone number there where people can call and get more information. So I'd encourage you to work with the city, to work with your neighbors so that we can make this a safe and enjoyable summer and hopefully get those West Nile virus numbers back down to where we're not seeing any victims this summer or at least a small number of victims that are only facing the very mild form. Of the virus and not the one that can leave people in a state of long term rehabilitation or disability. Once again, I'm Brandon Bennett, then I'm your code compliance director and thank you for listening.