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An evaluation of St. Louis encephalitis surveillance in Memphis-Shelby County, Tennessee

School

School of Public Health

Document Type

Dissertation

Department (new version)

Public Health

Date of Award

1990

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

St. Louis encephalitis (SLE) is exclusively a viral disease of humans, with mosquitoes and birds serving as complementary links in the transmission cycle. Since 1933 the United States has experienced over 55 outbreaks, representing over 10,000 cases and 1,000 deaths. Efforts have been made to curb transmission of the virus through surveillance and mosquito control activities. SLE surveillance is based on the detection of virus in mosquitoes and antibody in birds. Unfortunately, these surveillance activities, which are primarily directed at Culex mosquitoes and birds, have been minimally effective. The purpose of this study was to determine the strength of association between SLE surveillance parameters and human cases and to assess the cost-benefit of the SLE surveillance program in Memphis-Shelby County, Tennessee. The surveillance data used included cases, mosquito counts and infection rates, and bird counts and antibody prevalence rates, and were obtained exclusively from the Memphis-Shelby County program. The costs of routine SLE surveillance for 1988 were compared with an estimated cost of a 1988 theoretical SLE epidemic in Memphis-Shelby County. Descriptive procedures, multiple regression, and economic analyses were used to answer the research questions. "Willingness to pay," an economic methodology, was used in an estimation of the morbidity and mortality costs of SLE-related disease. The sample for the morbidity and mortality cost estimations consisted of 159 subjects who were selected from subpopulations in Birmingham, Alabama. From the findings of this study, we concluded that SLE surveillance is cost-beneficial. That is, for every dollar spent on surveillance activities the public may save about $653 dollars. Also, {\it Culex salinarius\/} may be more important in SLE virus transmission in Memphis-Shelby county than previously thought. It is recommended that SLE surveillance continue but with some reduction in the number and scope of activities, since the economic and human costs of an SLE epidemic is exorbitant. Monitoring mosquito population density and serological testing of juvenile birds are recommended, as well as a determination of the proper role of Culex salinarius in SLE virus maintenance and transmission in Memphis-Shelby County.

ProQuest Publication Number

Document on ProQuest

ProQuest ID

9101306

ISBN

979-8-207-94018-2

Comments

DrPH

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