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    October 2019

    Managing the Risks of Eastern Equine Encephalitis and Other Mosquito-transmitted Viruses

    Schools and colleges located in, or hosting travel to, Eastern equine encephalitis (EEE) outbreak zones must take preventive measures. Mosquito-transmitted viruses such as EEE can have devastating effects. What begins as a small outbreak can quickly grow — with deadly consequences.

    The 2019 outbreak of EEE is the worst since authorities began monitoring the disease over a decade ago. More than 20 people have contracted the virus in Michigan, Connecticut, and Massachusetts alone, a marked increase from the six U.S. cases contracted in 2018.

    The high death rate associated with the EEE virus makes this growing outbreak an immediate concern. 


    What is Eastern Equine Encephalitis?

    EEE is a rare virus that causes brain infections. It is spread through mosquito bites, typically near swampy areas. Those infected begin experiencing symptoms four to 10 days after the bite. Symptoms may include chills, fever, malaise, and joint pain. In more severe cases, symptoms may eventually include headache, irritability, restlessness, drowsiness, anorexia, vomiting, diarrhea, bluish-colored skin (cyanosis), convulsions, and coma.

    People engaging in outdoor work or recreation in these areas are at highest risk of infection. Children and people over age 60 are likelier to get the more severe form of EEE.

    Although EEE is relatively rare for humans, about 30% of all people with the virus die from the disease, according to the Centers for Disease Control and Prevention (CDC). Those who recover from EEE are often left with disabling and progressive diseases.


    Prevent Mosquitoes on Campus

    Since there is no EEE vaccine, prevention relies on mitigating exposure to mosquitoes. Mosquitoes are attracted to standing water and lay eggs there. To control the population of mosquitoes at your institution, follow these CDC recommendations:

    • Eliminate standing water. Empty and scrub, turn over, cover, or throw out items that hold water. Tightly cover water storage containers or use wire mesh with holes smaller than an adult mosquito.
    • Repair cracked septic tanks. Cover open pipes with wire mesh with holes smaller than an adult mosquito.
    • Keep mosquitoes out of buildings. Use screens on windows and repair holes. Use air conditioning when available.
    • Spray pesticide. The National Institute for Occupational Safety and Health (NIOSH) recommends spraying pesticides during hours when school activities are not occurring. Provide written notification to the campus community in advance, and during the pesticide treatment post signage around the perimeter. Some states require notification at least 24 hours before applying pesticide. A NIOSH fact sheet and the Environmental Protection Agency website provide additional recommendations.

      If, for example, your state’s agriculture department plans to spray pesticides in a zone that includes your school, notify the campus community. For an example, see the notifications from Attleboro Public Schools in Massachusetts.

    Schools in outbreak locations also should avoid scheduling outdoor activities during dusk and evenings, when mosquitoes are most active. 


    Practice Enhanced Equine Care

    Schools that own horses should take additional action to prevent transmission. 

    • Vaccinate horses annually for the EEE virus (although there is no human EEE vaccine, a horse vaccine is available). Vaccinations are ideally conducted in spring, prior to the outbreak season. Visit the American Association of Equine Practitioners website for more vaccination information. 
    • Change water in horse troughs and buckets frequently to limit standing water sources that attract mosquitoes. 


    Monitor and Communicate

    Institutions in outbreak zones should relay outbreak and prevention information to the community. Among the precautions to address in a campus alert:

    • Prevent mosquito bites by wearing long-sleeved shirts and pants and using an EPA-registered insect repellent. (This CDC mosquito control fact sheet provides preferred ingredients and brand examples for repellent.) 
    • Talk to a doctor if you develop symptoms.

    Institutions with travel programs also should regularly check the CDC’s travel notices page for outbreak updates. Travelers to regions with mosquito-transmitted virus outbreaks should receive school guidance on enhanced precautions to prevent mosquito bites.


    Use Waivers and Assumption of Risk Forms

    Waivers and assumption of risk forms educate students about a location or activity’s inherent risks. These documents should include information about known dangers such as mosquito-transmitted viruses. Consider including the following in any waiver or assumption of risk form for outdoor activities in, or travel to, outbreak zones:

    • An acknowledgment that the signer received information about the virus from a trusted health organization (such as the CDC or state government)
    • Detailed information about locations or activities that may place an individual at risk of contracting the virus
    • Known health conditions associated with the virus 
    • An acknowledgment that the signer understands and assumes risks associated with the virus

    Institutions should consult with an attorney about drafting risk transfer documents, including whether a waiver or assumption of risk form is more appropriate.


    More From United Educators

    Preparing for Flu and Other Pandemics

    Heightened Vigilance Required in Study Abroad Risk Management

    Additional Resources

    CDC: Eastern Equine Encephalitis

    CDC: Mosquito Control


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