Parkinson’s Disease Unfolding Case Study You are providing care for

The first part of this exercise was based on a paper in the New England Journal of Medicine, June 14, 2001 issue, titled “The Outbreak of West Nile Virus in the New York City Area in 1999” by Nash et al. They describe the first known outbreak of WNV in the Western Hemisphere. Why was it important to continue the investigation and identify the causative agent as WNV once they knew it was similar to St. Louis encephalitis and mosquito control was important (give one reason with a brief explanation)? (2pts) The authors conclude “West Nile virus will most likely spread beyond the northeast and may cause sporadic cases or outbreaks of West Nile virus disease in other regions of the United States.” Why did they not believe it could be eradicated and would spread? (2 pts) For questions 14-16 consider these hypothetical reports made to the health department in each state and then determine if this would be an outbreak to immediately investigate. You will need to look for additional real information to answer teach question and give your source (it can just be the URL) Ten cases of WNV are reported in Hawaii 2021. (2 pts) Twenty cases of WNV are reported in Arizona over the summer of 2021. (2 pts) One hundred cases of WNV are reported in Illinois in April of 2021? (2pts) In this first outbreak of WNV, 7 of the 59 cases were reported to have died of their illness. What was the case fatality rate (CFR)?(2pts) Why is this CFR so much higher than what is currently given for WNV? (2pts) How would you describe WNV, using current information from the CDC or other appropriate sites, in terms of high, moderate or low*: a) virulence, b) pathogenicity and c) immunogenicity? Give some quantitative justification for each answer (6pts) * don’t worry about exact cut offs for these categories – just a reasonable choice based on data. To date there is no vaccine available for WNV, although there are some studies underway to develop one. Let us suppose a study of a potential vaccine was done on 150 individuals – all of whom test negative for any past exposure to WNV. A double blind randomized clinical trial is used to compare the vaccine to a placebo, with twice the number in the treatment group as in the placebo group. All individuals reside in the same area and WNV is endemic to this area. 40 of those who received the placebo contract WNV (indicated by regular blood tests), but among those who receive the vaccine only 4 do at the end of 1 year of follow-up. What is the vaccine efficacy and how would you explain it to a layperson? (3pts) Addressed in Exercise 3 Prep Work

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