Max del Hierro, California

Fighting West Nile's spread

BOUT WITH DISEASE SPURS SAN JOSE MAN

By John Woolfolk

Mercury News

Max del Hierro never saw the mosquito, and thought little of the itchy welt on his right ankle. But that bite in August was the start of a painful, crippling ordeal that nearly cost the San Jose computer engineer his life, and has since given him a new sense of purpose.

As the first and so far only person to contract the deadly West Nile fever in Santa Clara County, del Hierro has committed himself to helping people understand the threat posed by the mosquito-borne virus and the importance of fighting it.

``I'd really not like to see somebody else get as sick as I was,'' del Hierro, 51, said as he sipped a cup of black coffee one recent morning at the Coffee Cup, his favorite neighborhood cafe on McKee Road on the eastern edge of San Jose. ``I'm still recovering.''

Ten months after he was bitten, del Hierro is cheerful and high-spirited. But he still suffers numbness in the foot where the mosquito sucked his blood and injected him with the virus. He feels like he has lost his adrenaline. The mountain bike he loved to ride through the foothills near his home sits idle.

Del Hierro also suspects the virus may have contributed to his unemployment. The married father of three recently was laid off from the computer company where he had worked for 17 years, which was later sold. He wonders whether the dazed feeling he experienced during much of his recovery affected his job performance.

Del Hierro was well aware of West Nile virus before he contracted it. He knew that dead birds had been found infected with the virus in the hills where he liked to walk and bike. But it didn't occur to him that he might have caught the disease when he started feeling sick.

It was almost two weeks after he was bitten that he started feeling sick. It started on a Wednesday with stiffness and numbness in his legs, particularly the bitten limb. He was in pain, and had trouble walking. He soldiered through at work, where he was meeting some new bosses. By the time he got home Thursday, he was nauseated and feverish, and went to an urgent care clinic. He was told he had a routine virus and sent home.

Worsening illness

It was even worse the next morning. He had been up all night, twitching and tossing. He could barely get out of bed. Del Hierro checked in to an emergency room, but was sent home again. By that Sunday, Aug. 29, del Hierro was delirious with a 104-degree fever and taken by ambulance to Good Samaritan Hospital. He was so dehydrated, he recalled, that his skin seemed to sag off his bones.

Doctors pumped fluids into him, and gave him medicine to lower his fever and reduce his nausea. Del Hierro's field of vision narrowed; he said it was as if he was looking through a tunnel. Oddly, his eyesight temporarily sharpened to where he could see clearly without his glasses, something he suspects was caused by swelling in his head.

By Monday, del Hierro was fading in and out of consciousness and had resigned himself to the possibility that he might die. He was more dazed than afraid, and said he credits his strong faith in God with giving him courage to accept his fate.

Yet even as del Hierro lay in the hospital on the brink of death, no one was quite sure what ailed him. A frequent traveler, del Hierro had been to Malaysia, Los Angeles, Seattle and the Gold Country town of Angels Camp all in July, offering a host of possible sources of infection for his doctors to consider. They tested for malaria and yellow fever.

Del Hierro credits his family with pressing doctors to consider West Nile. His eldest son, a 28-year-old computer expert, ran his symptoms on the www.webmd.com Internet site. The symptoms were almost a perfect match -- all that was missing was a rash.

Del Hierro's wife of 30 years is a veterinarian, and his 24-year-old daughter is a physical therapist. He credits their medical knowledge, support of family and friends, his faith and the top-notch treatment he got at Good Samaritan with helping him pull through.

``Just imagine if I didn't have all these people around me,'' del Hierro said. ``I felt blessed and lucky.''

Illness confirmed

After four days in the hospital, he went home. A few days later, test results confirmed he had been stricken by West Nile virus, which has sickened more than 16,500 Americans and killed 656 since the first U.S. case was reported in 1999. This year's first human case was reported last week in Kansas. Ten stricken birds have been found this year in Santa Clara County.

Though his fever was gone and the swelling had subsided, del Hierro's ordeal wasn't over. He felt disoriented and had trouble walking.

Santa Clara County public health officer Dr. Marty Fenstersheib said del Hierro had an unusually severe case. Eight out of 10 people infected with West Nile virus develop no symptoms, and most of the rest experience only mild illness, he said. Only about one out of 150 infected people develop severe symptoms like del Hierro's, he said.

Del Hierro also had been reluctant to identify himself publicly as a West Nile survivor. Among other things, he worried neighbors would not appreciate having their street identified with the virus.

But eventually, he grew more troubled by what seemed to be a complete lack of public awareness about West Nile. Co-workers wouldn't shake his hand, apparently fearing they would catch it from him, even though it is only spread through the blood.

Even more careful

Careful about mosquitoes even before he got sick, del Hierro is even more so now. He dispenses encyclopedic knowledge of mosquito biology and the benefits and drawbacks of various repellents. His personal favorite is the Malibu Mosquito Inhibitor, a $15 lamp-like device that blocks the bugs' ability to home in on a person's scent.

Recently, after Santa Clara County vector control officials launched a campaign to raise homeowners' yearly assessment $8.36 to $13.44 for mosquito abatement, del Hierro was alarmed to hear friends and neighbors complain about the fee increase. To del Hierro, the cost -- a little less than 2 cents a day -- seems a small price to help fight something so dangerous.

``They're all upset about the 2 cents,'' del Hierro said. ``They don't understand.''

Del Hierro said near-death experiences like surviving West Nile changes people, a sense other survivors he has met over the Internet have shared. For del Hierro, it inspired him to take a more active role educating people about the disease.

On Tuesday, del Hierro spoke before a public hearing on the vector control assessment, urging fellow residents to support it.

``I think I've been given a chance to live again,'' del Hierro explained later. ``You see life totally differently. I've been given a chance to educate people. I feel strongly that people not get this virus. My getting sick was one too many.''
Contact John Woolfolk at jwoolfolk@mercurynews.com or (408) 278-3410.

Genevie Cook, Maitoba Canada

CNEWS
Sun, July 24, 2005

Victim's W. Nile warning, Reality check for protesters on grave risks
By ROSS ROMANIUK, CITY HALL REPORTER

Before picking up an anti-fog placard, try suffering in my shoes.

That message comes from a Winnipeg woman who was once severely affected by the deadly mosquito-borne West Nile virus.

And she says protesters of the city's fogging operations are putting themselves and others at grave risk.

Genevie Cook contracted West Nile two years ago, becoming one of Manitoba's 35 serious human cases during a summer when the disease emerged as a serious threat in Canada.

"I was vomiting, shaking, I was weak and my hair was like straw," Cook, a 40-year-old health-care aide, told The Sun.

"I lost a lot of weight, I had a rash all over my body and a major headache. And I had no strength."

The symptoms sent Cook to Seven Oaks General Hospital in August 2003 for a week-long stay due to West Nile's neurological syndrome.

She was at the hospital "bodily," she says, "but in mind, no," while losing consciousness for long stretches.

"It was really scary. I was basically comatose. They didn't know what was wrong with me," Cook recalled.

"And when I was awake and alert, all I was doing was trembling. I was dizzy and nauseated. I had to take Gravol to even go for a car ride or just walk. I was so weak I had to have someone pretty much lift me off the couch or pull me so I could sit up."

Cook wants those protesting the city's use of malathion to understand how their disruptions could hurt the public far more than help.

Her warning is echoed by the Winnipeg Regional Health Authority.

"That's something I keep repeating -- that West Nile virus has to be given a great deal of respect," said WRHA medical officer Dr. Pierre Plourde.

Opponents of Winnipeg's skeeter spraying have long charged that malathion harms human immune systems.

The nerve agent comes with risks, Plourde says, but adds that it's safe at the city's low-volume fog levels.

'UNPREDICTABLE'

"The risk of malathion is minuscule," he explained. "So now you balance that against the risk of West Nile virus -- it's low, but it's increasing in our setting. It's unpredictable.

"We have a new virus that's only been around for a few years -- a new strain of the virus. It's mutated and it's become much more aggressive and lethal, potentially, than it was in Africa where it originated. And it's unpredictable. No one can tell you right now what we're going to see in the next few weeks. The worst-case scenario could be pretty bad, so one has to prepare for that."

Still occasionally suffering what she calls "the shakes," Cook says fogging opponents are "pretty naive" about mosquito season.

"They have to know what a person has to go through and feel -- when you lose your mobility and independence and have to build yourself up to start walking again," she said, noting she was off the job for about four months after entering the hospital.

Two Manitobans died from West Nile in 2003, while 142 people were infected.

Cook may have been among the lucky ones. Though only 20% of those who contract West Nile become ill, one of every 150 of that group might require hospital care.

Those victims have up to a 20% chance of dying.

"And your chance of being in chronic rehabilitation, of never being normal again, is upwards of 75%," Plourde said. "Only about one-quarter or so of those people who are hospitalized have full recovery, and can say they feel normal again."

Jack Raney again

rticle Published: Saturday, July 23, 2005 - 9:53:22 PM PST
Victim gives West Nile warning, Virus infects without bias

By L.C. Greene
Staff Writer

ONTARIO - Jack Raney told of his near-death battle with West Nile virus for the umpteenth time Saturday, but this time, he appeared markedly stronger and more self-assured.

Recovery is brutally slow, though, and the 46-year-old Upland man admits he's far from recovered.

Speaking at a West Nile virus town hall meeting, Raney warned that infected mosquitoes can bite anyone, and anyone can get sick.

"All of you are at risk," he said.

Almost a year ago, the former bricklayer lay in a coma and breathing on a respirator at the Pomona Valley Hospital Medical Center. The mosquito-borne viral infection was ravaging his brain and spinal cord.

Raney came out of the coma after four days and began the long recovery process.

"I had to learn how to walk again," he said.

One arm was partially paralyzed and remains weak. The damage to Raney's central nervous system left him unable to work, depressed and emotionally frail.

Resuming the role of family breadwinner, or even helping his children with their homework lay beyond his capabilities.

"My life lacked self-worth," Raney said.

The opportunity to take on a new role and possibly regain some self-worth presented itself, however, and Raney seized it.

He has become a kind of West Nile poster child, profiled in the media, featured in documentaries, addressing legislators and speaking at town hall meetings such as this one.

"This disease does not discriminate," Raney told the group.

Therefore, everyone should take precautions to avoid being bitten by mosquitoes.

That was the underlying message at the two-hour town meeting, sponsored by Assemblywoman Gloria N. McLeod, D-Montclair, and held at the De Anza Center in Ontario.

"It's not going to go away," she said of the virus. "We as citizens of the community must be very aware."

Residents are advised to look for and eliminate standing water around their properties. Mosquitoes need water, and not very much of it, to breed.

"No water - no mosquitoes," said West Valley Mosquito and Vector Control District general manager Min-Lee Chen, who gave the assembled a primer on the virus and its spread across the country.

Most cases of West Nile are probably contracted in and around people's homes, he said.

So far this year in California, 21 people from nine counties have contracted either West Nile fever or, like Raney, the more serious West Nile encephalitis or meningitis. An elderly Kings County man was the first fatality.

In 2004, the state recorded 830 confirmed cases and 28 deaths.

Residents are advised to not only eliminate standing water, but also to repair screens, avoid going out during the evening or morning hours when mosquitoes are most active, and if outside during those times, to use repellent containing DEET, picaridin, or oil of lemon eucalyptus.

Dianne Fluty - Cara Keilman - Roger Wilkins MO

Posted on Thu, Jul. 14, 2005
West Nile virus can disable for months, years
BY ALAN BAVLEY
Knight Ridder Newspapers

KANSAS CITY, Mo. - (KRT) - Two summers ago, West Nile virus invaded Cara Keilman's brain and likely caused a stroke that the 11-year-old Ness City, Kan., girl is still striving to overcome.

After mosquitoes swarmed Roger Wilkins of Bucyrus, Kan., in 2003, he spent a month in the hospital feverish, dizzy and delirious with a West Nile infection. Months of physical therapy later, he still feels weak and less steady on his feet.

Dianne Fluty suffered through the summer of 2002 with headaches, insomnia and tremors. The Sedalia, Mo., woman spent a year recovering from the West Nile virus infection that caused her symptoms. But even now, the tremors and headaches make regular visits.

As hundreds of its victims have discovered, West Nile virus is a ferocious enemy. Once thought to be a serious threat mainly to the elderly and infirm, researchers have found that the virus can cause months of debilitating illness, and even poliolike paralysis, in healthy people of all ages.

And even relatively mild cases of West Nile illness that doctors used to compare to a weeklong bout of flu have turned out to have serious lingering symptoms.

"West Nile is a frightening disease," said Daniel Hinthorn, an infectious disease specialist and West Nile researcher at the University of Kansas Medical Center.

Scientists estimate that less than 1 percent of mosquitoes carry the virus. Only small percentages of people become infected.
About one in five people who are infected with the virus become ill, Hinthorn said. "Most people who are infected won't know they have it. But if they do get the disease, it can be devastating."
Among the most serious cases are infections that attack the spinal cord and cause paralysis.

Investigators at the Centers for Disease Control and Prevention have been reporting these cases for several years. In 2003 they tracked West Nile virus illnesses in three Colorado counties and identified 27 such serious cases.

That translated into a paralysis rate of 3.7 cases per 100,000 people, a level comparable to what is seen during polio epidemics.
"A surprising number of people who develop this syndrome can be in their 30s or 40s and otherwise healthy," said James Sejvar, a CDC medical epidemiologist who is studying these West Nile paralysis cases. "You don't have to be a frail old person to become severely ill from West Nile."

West Nile typically is passed to people by mosquitoes that pick up the virus from infected birds. Since West Nile made its first North American appearance in New York City in 1999, it has spread across the continent.

The results: Nearly 17,000 cases of West Nile virus illnesses and more than 650 deaths nationwide.

Doctors used to describe West Nile fever as a flulike illness with nausea and headaches lasting three to six days. But that hasn't turned out to be the case.

When researchers with the Chicago Department of Public Health surveyed 98 persons who developed West Nile fever in 2002, they found that large numbers suffered from fatigue, muscle weakness and difficulty concentrating for a month or longer. On average, it took these patients two months to feel they were back to normal.The patients' age had no bearing on the length of their illness, the researchers found.

"Adults of any age can get West Nile fever, which can put them on their backs for a long time," said William Paul, deputy commissioner of the Chicago health department. "We were surprised at the duration of symptoms and the degree of symptoms people had. The common knowledge of West Nile fever previously was that it was a mild illness that lasted a few days."

Still more serious infections occur where West Nile virus attacks the central nervous system. These infections can inflame membranes covering the brain and spinal cord, a condition called meningitis; or inflame the brain itself, causing encephalitis.

The New York City Department of Health came up with some disturbing findings when it followed the progress of people hospitalized with West Nile meningitis, encephalitis or fever in 1999.

A year after their illness, 37 percent of these patients had fully recovered. Nearly half required physical therapy.

Even after 18 months, more than 40 percent still suffered from some combination of muscle weakness, fatigue, insomnia and difficulty walking; 30 percent still experienced memory loss, confusion, depression and irritability.

A lot of these people were significantly impaired down the road. It had a significant impact on their lives for a long time," said Annie Fine, an epidemiologist who participated in the study.
Patients under 65 were nearly three times as likely as older patients to make a full recovery. But even so, more than a third of the younger patients still had lingering problems after a year.
"Even among young people it can be a serious infection and have a long-lasting impact," Fine said.

Cara Keilman felt the full force of West Nile virus two years ago, when she was just 9.
She was riding her bike when her right foot slipped off the pedal and her right hand couldn't grasp the handlebar. Paralyzed on her right side, she struggled for 20 minutes to finish the short ride to her Ness City home.

Doctors in Hays diagnosed a massive stroke. Cara was flown to Children's Mercy Hospital in Kansas City.
"They did brain scans. They did every test you could do. You name it, they did it," Cara's mother, Faye Keilman, recalled.

A blood test for West Nile virus turned up positive. Doctors told Faye Keilman that the virus probably inflamed blood vessels in Cara's brain. That led to her stroke and to the seizures.

Cara needed months of drug treatment to bring down the inflammation and physical therapy to regain the use of the right side of her body.
She can write again with her right hand, although with her limited muscle control she clenches the pen too hard. And she's even resumed playing a full roster of sports –– basketball, volleyball, track and softball.
"She's not going to let it slow her down," her mother said.

Dianne Fluty knew there were plenty of mosquitoes buzzing around her Sedalia home three years ago, but she didn't take precautions to avoid bites.
"I took it lightly," she said. "Oh, this is crazy, West Nile."

But through the summer she had headaches. She couldn't sleep. Tremors shook her body. She was hospitalized several times with meningitis and encephalitis caused by West Nile virus.

"It was a really rough time and it was a long recovery," said Fluty, 55. "Once in a while I still get tremors. I'm better than I was, but I am not right. I don't have the memory or mind I used to have."

Roger Wilkins, 65, recalled sitting on the deck of his Bucyrus home when mosquitoes attacked. It wasn't long after that Wilkins was feverish, dizzy and too tired to do anything but sleep or watch television.

A trip to the St. Luke's South emergency room turned into a four-week hospital stay for meningitis and encephalitis.
"He was in and out of reality," said Wilkins' wife, Melanie. "A nurse found him standing on his bed acting as if he was trying to change a light bulb."

Wilkins went through five months of physical, occupational and speech therapy. He's back at his job supervising work sites for home builders. But West Nile has taken its toll.
Wilkins said he tires easily. He's less steady on his feet. His muscles ache constantly.
"People say West Nile, they think it's something you get over. I'm sorry. I think they're wrong," Wilkins said.
"A lot of this, I think, is a problem that will stay with me until I leave this earth."

Insect repellents containing the chemical DEET have long been considered the most effective protection against mosquitoes.
But this year, the Centers for Disease Control and Prevention added two alternatives to their list. The chemical picaridin has been used successfully in repellents for years in other countries. CDC officials say its effectiveness often is comparable to that of DEET.

The other newly recommended ingredient is oil of lemon eucalyptus, a plant-based product. It appears to be as effective as low concentrations of DEET, the CDC said.

Consumer Reports recently tested Cutter Advanced, a new spray repellent with picaridin, and found its effectiveness comparable to a spray containing 10 percent DEET. The picaridin spray didn't have the chemical odor or greasy feel of DEET sprays.

The University of Kansas Medical Center is participating in a nationwide study of whether immune globulin collected from donors in Israel is an effective treatment for West Nile virus illnesses.
West Nile is common in Israel, so the immune globulin collected there contains high levels of antibodies against the virus.

The immune globulin, called Omr-IgG-am, has to be given soon after an infection to be effective. Persons with West Nile fever symptoms who want to participate in the study should come to the medical center within a week after symptoms appear. Patients may seek help through the medical center's emergency room or ask their personal physician to contact the center's infectious disease division.
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