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Press Briefing Transcript

CDC Telebriefing on West Nile Virus Update

Wednesday, August 22 at Noon ET

OPERATOR: Thank you for holding.  Parties will be on a listen-only mode until the question and answer session.  At that time you can press star one to ask a question. This conference is being recorded.  I would like to introduce your speaker, Ms. Lola Russell.

LOLA RUSSELL: Good afternoon, thank you so much.  Today, CDC and the Texas Department of State Health Services will be hosting this briefing to discuss the West Nile virus, including our surveillance, our numbers, and put in context this very important outbreak investigation and our response to it.  We'll begin with Dr. Lyle Petersen, who is the director of the Division of Vector-borne Infectious Diseases here at the Centers for Disease Control and Prevention.  Followed by Dr. David Lakey, who's the commissioner for the Texas Department of State Health Services.  We also have a couple state departments available to discuss what's going on in their area if you so desire to do so.  Let's begin with our first speaker Dr. Petersen. 

LYLE PETERSEN: Thank you and good afternoon.  Thank you for joining us for this update on West Nile virus disease.  Today we're releasing new information about the number of people with a reported illness caused by West Nile virus.  The updated information which is based on reports from state health departments was posted this morning on CDC's West Nile virus website.  These data show that the number of West Nile virus disease cases in people has risen dramatically in recent weeks.  And indicate that we're in the midst of one of the largest West Nile virus outbreaks ever seen in the United States.  People around the country are understandably very concerned about the outbreak.  Especially in hard-hit areas like Texas, where almost half of the cases have been reported.  CDC is working closely with state and local public departments to control the outbreak.  We'll describe some of the public health actions that are under way as well as steps people can take to protect themselves from West Nile virus infections.

As of August 21, a total of 47 states have reported West Nile virus infections in people, birds or mosquitoes.  The only states not reporting activity are Alaska, Hawaii, and Vermont. Of the 47 states, that reported any West Nile virus activity, 38 had human cases of disease.  A total of 1,118 cases of West Nile virus disease in people, including 41 deaths, have been reported to CDC.  Of these, 629 or 56 percent were classified as neuroinvasive disease, such as meningitis or encephalitis, and 489, or 44 percent, were classified as non-neuroinvasive disease.  These 1,118 cases and 41 deaths identified thus far in 2012 are the highest numbers of West Nile virus disease cases reported to CDC through the third week in August since West Nile virus was first detected in the United States in 1999.  In comparison, one month ago, there were only 25 people with West Nile virus disease reported to the CDC. 

Approximately 75 percent of the cases have been reported from five states, Texas, Mississippi, Louisiana, South Dakota and Oklahoma.  And about half are from Texas.  The available information indicates that the numbers of reported cases are trending upward in most areas, including Texas.  In addition, 242 potentially viremic blood donors were reported from 26 states.  This compares with a total of 25 viremic blood donors reported just one month ago.  All blood donors in the United States are screened for West Nile virus.  By identifying these persons who could potentially spread West Nile virus through blood donations and deferring them from giving blood, we have taken an important step in preventing the spread of the virus and protecting the U.S. blood supply.  The peak of West Nile virus epidemics usually occur in mid-August, however it takes a couple of weeks before people get sick, go to the doctor and get diagnosed and then are reported.  Thus cases now being reported reflect infections from a week or more ago.  Thus, we expect many more cases to occur and the risk of West Nile virus infection will probably continue through the end of September.  Therefore, it's important for people to continue taking steps to protect themselves from mosquito bites. 

We encourage the public to use insect repellents when they go outdoors, wear long sleeves and pants during dawn and dusk, install or repair screens on windows and doors, use air conditioning if you have it, empty standing water from items outside of your home such as gutters, flower pots, buckets, kiddie pools, and birdbaths.  And support your local mosquito control program. It's not clear why there's more West Nile virus activity in 2012 than in recent years.  The weather, numbers of birds that maintain the virus, numbers of mosquitoes that spread the virus, and human behavior are all factors that can influence when and where outbreaks can occur.  Also, the unusually mild winter, early spring, and hot summer in many parts of the country might have fostered conditions favorable to the spread of West Nile virus to people.  It's difficult to predict how many more cases of West Nile virus disease we'll see this year.  CDC uses surveillance data from previous years to estimate trends of West Nile virus disease. But we don't have models to precisely predict the number of cases that will occur this season. 

As part of CDC's ongoing work to prevent West Nile virus disease, we do a lot of work in the areas of disease tracking, laboratory studies, and technical assistance in education.  In response to the current West Nile virus outbreak, CDC has increased its outreach to provide additional support to state and local health departments.  For example, we have provided more than $2.5 million to support increase surveillance control including spraying for Texas, the state hardest hit by this epidemic.  At the request of Texas health officials, we also have sent two CDC teams to provide support to Texas state and local health departments.  In particular, I want to recognize the outstanding efforts being made by the Texas Department of State Health Services and Dallas County and other counties to control the outbreak.  For more information about what is happening in Texas, I would like to turn the mike over to Dr. Lakey. 

DAVID LAKEY: Good afternoon. This is David Lakey. I'm the commissioner of health for the state of Texas.  Before I begin, Dr. Petersen and the CDC, you have outlined part of your tremendous support for the state of Texas.  Again, I thank you and the CDC for that support.  I also want to thank the media. The media has been an essential partner in getting our basic public health messages across the state of Texas and across the nation.  Thank you for being a part of this teleconference today.  And before I get started I also want to note that it's not just about the numbers, we’re talking about a disease that’s impacting the lives of hundreds if not thousands of folks whose lives will be permanently changed because of the West Nile outbreak.  Our hearts go out to families impacted by this outbreak.  

I want to talk a little bit about the statistics, kind of where we are in this outbreak and then highlight different components of our overall response.  I think Dr. Petersen did a good job of outlining, you know, the huge impact that this disease is having in the state of Texas. Texas has really been the center of this outbreak.  You know, our numbers are a little bit different than the CDC numbers because of the way data is reported.  Our numbers will be updated at the end of today, at 4:00.  We do our reporting on Monday, Wednesday and Friday.  As of right now, we have 586 cases statewide, including 21 deaths.  And if you look at those cases, 323 with the neuroinvasive cases.  And 263 with fevers.  Again, 323 that had neuroinvasive.  Our data has shown almost over 90 percent, in some cases 95 plus percent of those individuals ended up being hospitalized.  Again, that data will be updated as we get more information.  We're in constant contact with our counties. I noted we have 21 official deaths, I know of at least 4 additional deaths. We have one death in Dallas that was reported to the media yesterday, two additional deaths in Tarrant County, and one additional death in Collin County.  So, again, lot of activity and this, as Dr. Petersen noted, will be our worst season. 

A little bit of perspective, prior to this, our worst season was 2003, at which time we had 439 cases of neuroinvasive disease and 40 deaths overall statewide.  I would like to focus in on Dallas, because Dallas, the county of Dallas has been the hardest-hit area for the state of Texas.  When we look at their data, Dallas health department has reported 270 cases.  Of which, 142 were the neuroinvasive disease, 128 were fever.  With that additional death that was reported yesterday, they now have 11 deaths in the county of Dallas.  And again, to give a little bit of perspective on that, if you look at Dallas County data and add up the total deaths from 2003 to 2011 they had ten deaths.  We're now in this year, in Dallas County, have more deaths than their entire history in the past. 

I want to talk about the efforts in the state of Texas and there are several components to our overall response and in a complicated response like this, one of the lessons that we learned from our disaster experiences we have to have a very organized response.  We set up what we call Incident Command using our emergency management system several weeks ago so that we could have that type of coordination between the local government, state government, federal government, public health emergency management all working together.  Couple of components of that effort, 1. we're working really hard to know where we are in the outbreak, trying to get as much detailed data as possible, working with our local health departments, other entities to make sure we have as much as we can real-time data to make decisions.  We're getting that from our local health departments.  We're looking at other ways beside this case reporting that we can track related to where we are in the outbreak, and we're looking at the National Electronic Data Surveillance System to get some of that laboratory diagnostic data to help guide where we are. 

We’ve also changed how we’re doing some of our tests. In our laboratory in the past, we did culture for the virus.  We’ve moved to molecular diagnostics.  So we’ve been able to cut down the turnaround time for tests from about 10 days to two days so that we can have better real-time information on the amount of virus that's out there in the mosquitoes in Texas.  We have also, as part of our Incident Command, we’ve placed staff in Dallas that are working with the city and county, we have had a lot of engagement with the media, with a variety of entities to get those public health messages that Dr. Petersen relayed a little bit out.  Using printed material, we put together PSAs and again working very closely with the media to get those basic messages out.  That, again, is the cornerstone of the response.  Those things such as draining water, controlling the mosquitoes, dressing appropriately, avoid being out at dusk and dawn.  But, we have noted that hasn't been sufficient so far, so we’ve complemented that with insecticide to kill mosquitoes.  We were using ground-based spraying but as described in the media over the last several weeks, through a lot of very deliberate conversations looking at data, looking at national experience, looking at where we are in this outbreak, the decision was made that we needed to step up our approach and provide aerial spraying in Dallas County.

Again, I want to thank the CDC, they worked side by side with us as we were looking through that data to make sure we were making the best decision possible.  Part of the challenge was the, you know, if you look at the linear miles of roadage in Dallas County it would have been impossible for us to cover the county with land-based spraying.  Again, as we’ve looked through the data, we felt very comfortable that aerial spraying was very safe and effective. And so last Thursday, we started our aerial spraying.  Used two planes.  And almost nightly since then, depending on the weather, we have used aerial spray in Dallas County.  So far, most of that effort has been in the city of Dallas and the area in the northern Dallas area, we worked very closely with the mayors throughout the city to make -- throughout the county to make sure we knew their opinions and their decisions on whether or not they wanted aerial spraying and in the cities that are in the southern part of the counties that told us they wanted aerial spraying, we're going to partner with them to provide that type of response over the next several days.  Again, a lot of activity is taking place.  

I want to thank the CDC for their support.  As it was noted, we’ve asked for two Epi-aids. One, here in Austin and one in our Arlington office to coordinate the response. Again, I really thank the media for their involvement.  They are an essential partner in getting the word out about these basic precautions. Again, reminding folks that spraying is only part of this.  If we spray and it rains and we don't take care of the larvae that are out there, the draining of water in individuals' yards, we won't be as successful as we need to be.  The media has been critical in getting that message out. That's the end of my comments.  But, thank you again for allowing me to be a part of this conference call today. 

LOLA RUSSELL: Operator, we're ready for the first question from the reporters. 

OPERATOR: If you would like to ask a question from the phone, press star 1.  To withdraw your question, press star 2.  Please stand by for the first question.  First question is from Mike Stobbe, AP. 

MIKE STOBBE: Hi, thank you for taking the question.  I wonder if you all could say more about why this might be such a bad year, you talked about the winter and the spring, the classic triangle, the agent, the host and the environment, if one of those changes it can affect the amount of illness that you have, is it just the environment, or was there any change in the mosquito or the virus, any other thoughts about what's going on this year? 

LOLA RUSSELL: Dr. Petersen?

LYLE PETERSEN: Yes, thank you, Mike, for the question, an excellent question.  The short answer is, we don't really know why it's worse this year than in previous years.  As you pointed out it's a very complicated ecological cycle out in nature with the interaction of mosquitoes, people and birds.  But, one observation that has occurred over many decades is that, in the United States, as well as elsewhere, has been that hot weather seems to promote West Nile virus outbreaks.  And most -- many major West Nile virus outbreaks in Europe, in Africa and now in the United States, have occurred during periods of abnormally hot weather.  Hot weather, we know, from experiments done in the laboratory, can increase the transmissibility of the virus through mosquitoes and that could be one contributing factor.  We have no information yet about whether the virus is mutated.  We are currently looking at that issue.  But, there are certainly plenty of reasons why this outbreak could be occurring now.  Other than that. 

OPERATOR: Question is from Elizabeth Weiss from the USA Today.

ELIZABETH WEISE: Thank you so much for taking my call.  I have two questions, the first, are you concerned at all that, and you can take this perhaps last, that a lot of counties in mosquito abatement districts have had to cut back on mosquito abatement because of budget cuts, is that affecting this?  And that is nationwide. The first question I have, is looking at the numbers that you're giving for people who are getting neuroinvasive disease.  Most descriptions I read of this disease indicate that only 10 percent to 20 percent of people who get West Nile virus, actually fewer than that, would get neuroinvasive disease. But these numbers look higher. Do you think that is an artifact of reporting or is this for some reason this wave of it having higher number of neuroinvasive cases? 

LYLE PETERSEN: Thank you for the question.  Also, a very good question.  The way our surveillance works is that we certainly record all of the cases of West Nile virus disease that are reported to us from the states.  The neuroinvasive disease cases testing for these cases is routinely recommended.  As Dr. Lakey pointed out, all of the neuroinvasive cases end up in the hospital.  Reporting is very, very complete.  For West Nile virus, West Nile fever is -- I hate to use the word "milder" because it's not so mild any many people.  The non-neuroinvasive disease cases or West Nile fever cases are very underreported.  We think that only 2 to 3 percent actually of all the people who do get ill do get recorded.  The reasons for this are simple in that most people with West Nile virus disease, we don't recommend routine testing.  And they're recognized by their physicians, there's no specific treatment for these people and particularly during the course of an outbreak, routine testing is not necessary.  Also, many people who do have the milder symptoms don't go to the doctor or the doctor may not recognize that they do have West Nile disease.  The most important data that we have are data on neuroinvasive disease.  We do believe they are reasonable reported. Does that answer your question? 

ELIZABETH WEISE: It does.  Then about mosquito abatement and cutbacks? 

LYLE PETERSEN: well, certainly, the CDC doesn't collect routine data on funding for mosquito-controlled district and data on their operational capacities of mosquito control districts.  But, certainly one might suspect that budgetary cutbacks have impacted mosquito control districts.  We don't have specific data on that.  Perhaps Dr. Lakey may have some information about that in Texas. 

DAVID LAKEY: I don't have any specific information.  In the past, Dallas County, the last time Dallas County did aerial spraying was in the '60s.  Obviously, I'm concerned about overall public health funding part of that being mosquito abatement.  But, I think, also, this is a new virus that's been in the United States now for ten years and as Dr. Petersen alluded, I don't think we fully understand why it's emerged as dramatically as it did in the state of Texas.  I think we continue to watch that. 

LOLA RUSSELL: Next question, please? 

OPERATOR: The next question from Kevin Finnegan, from CBS News. 

KEVIN FINNEGAN: Thank you. We're looking at the previous outbreaks that we followed patients on a long-term basis, the effects of this outbreak even for those who have mild symptoms? 

LYLE PETERSEN: Yes, you can kind of categorize it into several different categories.  First, let's take the patients with West Nile fever or the non-neuroinvasive disease cases.  Several case series have been done, suggest that, for many people, West Nile fever is not such a mild disease, symptoms can last, you know, from weeks to even months.  And, we have heard reports of people with long-term symptoms even after West Nile fever.  So, it's not a mild disease.  Generally the symptoms will last from days to weeks to a couple of months.  But people do generally pretty well after having West Nile fever.  For the neuroinvasive disease cases, about -- there's been about a consistent 10 percent mortality rate among those people who do get neuroinvasive case diseases.  A high proportion of those who survive have long-standing symptoms, cognitive symptoms or otherwise.  People who get paralysis from the neuroinvasive disease, about 2/3 of those will persistent weakness or paralysis. 

LOLA RUSSELL: Next question, please. 

OPERATOR: The next question is from Jeffery Weiss, The Dallas morning news.

JEFFERY WEISS: Do we have any idea of what percentage of the population particularly here in north Texas has been infected with the virus and does it confirm long-term immunity?  Someone who got bit today doesn't have to worry so much the next year or two? 

LYLE PETERSEN:  We haven't modeled yet the number of people who have gotten, who we would have estimated gotten infected, the calculation, about 1 out of 150 people who do get infected develop neuroinvasive disease.  If you can multiply the number of people with neuroinvasive disease times 150, you'll get an approximate number of those infected.  What was the second part? 

JEFFERY WEISS: If you get it now, does it confirm immunity? 

LYLE PETERSEN:   If you get infected now, you will be immune for life. 

JEFFERY WEISS: That's good news. 

LYLE PETERSEN: I don't recommend getting infected now, however. 

LOLA RUSSELL: Next question? 

OPERATOR: The next question is from Richard Knox from National Public Radio. 

RICHARD KNOX: Yes, thank you very much.  You partially answered this before.  More detail on the neuroinvasive disease, can you describe something about the way that it onsets what, you know, over the course, what happens?  What symptoms arise?  How is it diagnosed?  A little bit clearer picture of that particular form of it. 

LYLE PETERSEN: Okay, first, let's start with how it's diagnosed.  The way it's diagnosed is, either a test of the blood or a test of this cerebral, spinal fluid, the fluid surrounding the brain.  The test that's generally done is an antibody test.  The test is very sensitive in people with neuroinvasive disease.  It's a great diagnostic test.  That's one thing.  As far as the symptoms go, there are three kinds of neuroinvasive diseases that happen.  The paralysis, that's accompanied by meningitis or encephalitis, the weakness of one or more limb.  It can also affect breathing or swallowing.  One of the more severe, dreaded complications of West Nile virus disease.  Meningitis, which is an infection of the tissues surrounding the brain, will cause symptoms like stiff necks, severe headache, eye pain, that kind of symptom-- Fever, Encephalitis, which is an infection of the brain itself, will cause symptoms, such as cognitive problems where people can't think properly, can cause coma, it can cause all of the other symptoms of meningitis as well.  The main difference is, it affects the brain itself and cognitive function.  Does that answer your question? 

RICHARD KNOX: Yes.  Thank you.  Also, in terms of the time course, do people who get exposed to West Nile, get infected, do some of them proceed rapidly to the neuroinvasive form? 

LYLE PETERSEN: The symptoms of West Nile virus infection come on three days to fourteen days after the person has been infected.  Symptoms can occur very rapidly.  I was -- I’ll give you my own example, I got infected with the virus back in 2003 and what happened is, I was out for a jog and within one mile of my jog, I went from perfectly normal to the point where I couldn't barely walk, so symptoms can happen rather rapidly and come on quickly.  So, and that's probably the norm rather than the exception.  How long symptoms last, as I mentioned before, many of the symptoms particularly with encephalitis or the paralysis can never resolve.  Some people have persistent symptoms throughout the rest of their lives.  With West Nile fever, generally, people who do get more ill with West Nile fever will be laid up in bed for days or weeks.  Followed by a period of just feeling awful.  There's a fatigue syndrome associated with West Nile fever where people are just fatigued for weeks or even months after the initial illness.  The illness lasts longer than we originally thought for many people with this disease. 

LOLA RUSSELL: Next question, please. 

OPERATOR: The next question is from Daniel DeNoon from WebMD. 

DANIEL DENOON: Thank you for taking my question.  There's that cohort of West Nile patients followed by Christi Murray and colleagues at Baylor, she finds a strikingly large percentage of people with which she sees as chronic infection and kidney disease.  Can you comment on that? 

LYLE PETERSEN: First of all, you have to talk to Christy Murray about her own results and her studies.  We find that her results intriguing and interesting.  But, we feel that definitely more work has to be done to confirm these findings and if true they are of importance.

LOLA RUSSELL: Next question, please. 

OPERATOR: The next question is from Donald McNeil from the New York Times. 

DONALD MCNEIL: Hi, could you talk about the spread of the disease, where do you see it spreading now, in what directions?  And can you address why might be or not be spreading since lots more of the country have had hot weather, the summer than the sections you see in the outbreak right now? 

LYLE PETERSEN:  That's an excellent question.  And first of all, what typically happens with West Nile virus disease cases or incidents in the U.S. is that the southern states, if they're affected are affected somewhat earlier than the northern states.  Probably because, the spring appears earlier, et cetera.  And so, it's not surprising to find places like Texas and Louisiana, hard hit earlier than the more northern states.  This is a pattern that we have observed over the last 12 years.  So, I think what we're doing, we're following that pattern.  Now, the other interesting question that you brought up; why is this occurring in Dallas and elsewhere as opposed to Houston or some other cities?  And the answer is, we don't really know.  Oftentimes West Nile virus is a very local disease, you can have a lot of cases in one area and it has a lot to do with the local ecology of that area.  How many birds might be susceptible?  The particular population of mosquitoes, But it's one of the -- frankly, they're difficult to predict and know why outbreaks occur in certain areas and not others. 

DONALD MCNEIL:  So you can't predict that it's going to spread in any particular direction now? 

LYLE PETERSEN:  When you use the word "spread" you're talking about moving from one area to another.  That's not quite what's happening.  What is happening is West Nile virus is epidemic throughout the United States.  You'll find West Nile virus throughout the continental United States.  And it's just a matter of whether enough amplification of the virus is everywhere. 

LOLA RUSSELL: Next question, please. 

OPERATOR: The next question is from Brook Blanton from Fox News. 

BROOKS BLANTON:  Hi.  I have questions for both Dr. Petersen and Dr. Lakey.  Dr. Petersen, if you could elaborate more on the size of this outbreak.  We mentioned one of the largest outbreaks, if it's not the largest, how does it rank against the past years? 

LYLE PETERSEN:  Because the magnitude of the outbreak is very difficult to predict until it's almost over.  I can't tell you how many cases are going to occur.  But what I can tell you, as of this date, there's more cases reported to us than ever before.  At this particular point in time.  So, you know, if things continue on their trajectory, it looks like we have seen in previous years, this will be amongst the biggest or the biggest outbreak that we have experienced in the United States. 

BROOKS BLANTON: Okay, also, for Dr.  Lakey, you mentioned when you were speaking about communities that wanted spraying in Dallas counties versus communities that didn't, I know some people are concerned about aerial spraying, Are you finding that a lot of communities in your state are receptive to that? 

DAVID LAKEY:  In Dallas county, they haven't had a lot of experience with aerial spraying and so, you know, we spent quite a bit of time working with the county judge, listening to the medical society, listening to our federal partners and listening to a large number of folks who weighed the risk if you do and the risk if you don't and came to the conclusion, with the amount of outbreaks, aerial spraying has been safe and effective.  The experience in Sacramento, in Houston, in Boston and many other cities across the United States, believe that the best way that we can protect the public's health is through aerial spraying.  There are folks concerned related to long-term effects on human health, long-term effects on the environment.  Communicating messages relating to potential effects on bees, butterflies, we have a lot of questions related to those issues and we're able to show from the experience in other places, the way that the spraying takes place is that the effects have been very minimal, if any, on those types of beneficial insects.  No demonstrated effects on human health.  So the county judge made the decision that this would be a tool that would be available to the areas.  Then it came up to -- it became the responsibility of the mayors then to say, yes, we want this.  Or no, we do not.  And you see a little bit of a mix. 

But overall, I see equal -- we see especially as we're getting more experience with it, more acceptance that this has been an effective tool and a safe tool.  City councils throughout the county are having their votes, some councils have said, we'll take land-based spraying instead of aerial spraying.  Lot of areas have had unanimous votes for the spraying.  Support the localities to implement those control measures.  We're providing the aerial spraying in the areas that they said they wanted it and assisting them in the land-based spraying.  And pushing those basic public health messages throughout the community on what they can do to protect themselves.  The media has been an essential part in conveying those risks.  Again, a central partner in getting that information throughout the Dallas and not just Dallas, but the north Texas area.  I guess that's one of the areas, one of the messages as we had our meetings, lot of focus is in Dallas, but if you look at the data, there's a lot of disease throughout the north Texas area and making sure that all of those areas get the type of support they need to respond to this event.  Did I answer your question, sir? 

LOLA RUSSELL: Peggy?  Peggy?  Hello hello? 

LYLE PETERSEN: I'm still here. 

LOLA RUSSELL: We'll take our last question. 

OPERATOR: The next question is from Mary Ann Roser from Austin American Statesman. 

MARY ANN ROSER: Thank you.  On the question of spraying, Dr. Lakey, who pays for that and how much does it cost and are other cities in Texas -- or other counties outside of Dallas County requesting spraying at this point. 

DAVID LAKEY:  I'll discuss how we're funding this.  We have a contract put in place because of our experiences with hurricane, we have ready to activate, we activated this contract, it cost us $1.87 per acre.  It depends on the amount of area that we cover and so it's a pretty straightforward calculation, the number of acres times $1.87 gives us that cost.  So, the way that we're paying for this, we have been working very closely with the CDC related to one of our funding streams from the CDC, called public health emergency preparedness fund.  These are dollars that they go from the CDC to the state of Texas. And communities across the state of Texas, mainly focused on preparing for disasters.  We have Dallas that we called carry forward.  So we have been working with the CDC to make sure that we can use those funds to help respond to the disaster.  And we are also complementing those funds with, we have dollars that we have been reimbursed from FEMA related to our previous expenditures for previous disasters and so we're using -- we're working with the CDC on an exact percentage.  Seventy-five percent of those funds, and about twenty-five percent of those dollars coming out of those dollars that we have been reimbursed recently from previous disasters. 

MARY ANN ROSER: So it's a combination of federal and state money?  The locals don't pay for it directly. 

DAVID LAKEY:  That is correct.  Our policy has been that, following hurricanes, we're spraying because of nuisance mosquitoes.  We asked the localities to take part in that and in midst of an outbreak, we're paying for that through the state again using that mixture of federal funds in our budget that haven't been used and some dollars that we have been reimbursed from previous disasters. 

MARY ANN ROSER: how much has been spent so far?  And are other cities questioning aerial spraying or other kinds of spraying? 

DAVID LAKEY:  We're about $3 million.  $2.9 million, total cost.  We are supporting not only Dallas, but other communities, there have been requests related to, you know, chemicals for land-based spraying.  We have contracts pulled in trust to supplement the land-based spraying and other components to supplement that.  I think other communities, i know, are looking at this right now and looking at their overall approach and deciding whether they may need to change their policy but there hasn't been officially requested additional aerial spraying as of now. 

MARY ANN ROSER:  So only in Dallas County as of this point? 

DAVID LAKEY:  As of this point.  Other areas are looking at that hard.  So there may be additional requests coming. 

MARY ANN ROSER: Okay, thank you. 

DAVID LAKEY:  And that $2.9 million I need to confirm that, I know it has been at least $2.5 million.  Approaching $3 million. 

MARY ANN ROSER: Thank you. 

DAVID LAKEY:  Thank you. 

LOLA RUSSELL: This concludes our call for today.  I want to thank everyone for joining us.  I want to remind all of the reporters who were on the call the West Nile virus human case count and additional information is available on our website.  We'll be updating those human case counts every Wednesday.  Starting and if you would like to additional information reach out to CDC press office or the Texas department of state health services office.  Again, thank you for joining us.  And also, the transcript will be available later on today within a couple of hours, the transcript from this meeting -- from this telebriefing will be available.  Thank you so much for your time. 

OPERATOR: That concludes today's conference.  Please disconnect at this time.  

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