HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 06/10/2008 - WEST NILE VIRUS MANAGEMENT POLICY REVIEW DATE: June 10, 2008 WORK SESSION ITEM
STAFF: Tess Heffernan FORT COLLINS CITY COUNCIL
Wendy Williams
SUBJECT FOR DISCUSSION
West Nile Virus Management Policy Review.
EXECUTIVE SUMMARY
The City Manager formed the West Nile Virus Technical Advisory Committee in December 2007
for the purpose of reviewing and making recommendations about the City's policy related to West
Nile virus mitigation. The Committee has finalized its review and made a number of
recommendations. The overall goal of the West Nile Virus Management Policy-and the challenge
for the Committee and decision-makers - is to reduce the risk of human West Nile virus infection
while limiting adverse human health and environmental impacts.
GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED
1. What questions does Council have about the West Nile Virus Management Program or the
recommendations of the Technical Advisory Committee?
2. What feedback does Council have regarding the adulticiding options?
3. What direction does Council have for the City Manager regarding the funding needed to
implement any changes to the current program?
BACKGROUND
West Nile virus was first detected in Colorado in late summer of 2002 and an initial outbreak of
infections occurred in the Fort Collins area in 2003. The City's policy for responding to West Nile
virus evolved through a series of operational experiences and reviews with City Council,beginning
in 2003. The City employs a broad based,prevention-focused management program that includes
public information and education,adult and larval mosquito population monitoring,and direct larval
control(also known as larviciding). Additionally,the City has implemented adult mosquito control
by spraying(also known as adulticiding)as an emergency response to increasing human health risks
in some years.
It is generally accepted that West Nile virus will be present in the Fort Collins area for the
foreseeable future. Following the 2007 season, the City Manager decided to form a Technical
Advisory Committee for the purpose of reviewing and making recommendations about the City's
current policy and response plans. The Committee has been meeting weekly since January 2008
June 10, 2008 Page 2
discussing the various program components,reviewing research and consulting with outside experts.
An update on the Committee's progress was provided to City Council at a work session on April 22,
2008. That meeting outlined initial recommendations on program components related to public
information and education;mosquito surveillance,trapping and testing;and larval control. The June
10, 2008 work session will include recommendations related to adulticiding, along with more
discussion about the cost of the various recommendations and other data requested by Council.
Policy and Program Recommendations
The City currently has a detailed operational plan explaining how the threat of West Nile virus is
managed. There is not yet a written high-level policy to guide present and future decisions. The
Technical Advisory Committee recommends that Council adopt a West Nile Virus Management
Policy. Attachment 1 outlines key points and language that the Committee believes should be
included in the policy.
As noted earlier, the City employs a broad based, prevention-focused management program to
mitigate the threat of West Nile virus. The major components of the program include:
1. A wide range of effective public education and outreach.
2. Extensive on-going larval and adult mosquito population data collection and monitoring,
including extensive testing of samples of adult mosquitoes for West Nile infection.
3. An aggressive larval mosquito control program focused on Culex mosquitoes. This program
includes detailed mapping of larval habitat and ongoing monitoring of larval and adult
populations and larvicide applications.
4. Periodic evaluation of the program for continued efficacy.
Recommendations for the first three program components were outlined at the April 22,2008 work
session: public outreach and education,mosquito data collection,monitoring and testing,and larval
control. A detailed discussion of each of these components and the recommendations of the
Technical Advisory Committee related to each component is included in Attachment 2,the April 22,
2008 Work Session Item Summary.
Use of Adulticides
Despite efforts to mitigate the threat of West Nile virus through public education,mosquito trapping
and testing, and larval control, the City has deemed it necessary to apply adulticides in some years
in order to avert a public health emergency. This practice continues to be controversial, and much
of the analysis of the Technical Advisory Committee has focused on weighing the risks of West Nile
virus against the risks of the pesticides used in adulticiding. The Committee has reviewed a number
of studies (some recently published), consulted with outside experts and brought their individual
expertise and experience to the table.
West Nile virus can be a deadly disease, cause major illness and loss of productivity, or have little
or no symptoms. Pesticides,likewise,can be extremely toxic to humans and the environment,cause
June 10, 2008 Page 3
reactions in individuals who are chemically sensitive or have respiratory problems, or when used
properly and at the rates applied in adulticiding, have a scientific risk factor that is so low as to be
considered insignificant using standard assessment protocols. Of equal concern to the Committee
are the unknown long-tern human health effects of both West Nile virus and of pesticide exposure.
Despite all the research and known science that exists on both topics, there are degrees of
uncertainty.
One must also consider the question of how people perceive and evaluate risk. Many who are
concerned about contracting West Nile virus believe the City should do everything possible to reduce
the number of infected mosquitoes. On the other hand, others see prevention of West Nile virus as
a personal responsibility and not worth the risk of introducing additional chemicals into the
environment.
Technical Advisory Committee members were surprised to learn that there are no recent public
opinion surveys in Colorado that address public opinion about West Nile virus,personal protection
practices or adulticiding. The best data available comes from a survey conducted in 2004. In that
survey,the State of Colorado was contracted by the Larimer County Health Department to conduct
a survey designed to assess behavioral risk factors among Larimer County citizens. That survey
sampled 2,800 people,was broken out by communities,and included several questions about West
Nile virus among perhaps 50 questions total. Fort Collins results include the following:
Question Answer No. Percent
How worried were you, personally, about getting VERY WORRIED 60 13.30%
sick from West Nile virus? SOMEWHAT
229 53.70%
WORRIED
NOT AT ALL 134 33.00%
WORRIED
During the summer of 2003 did you or anyone YES 219 51.30%
you know become ill with West Nile Virus in
your community? NO 200 48.70%
Last summer, how often did you use any insect ALWAYS OR 183 45.00%
repellent that contained DEET on your skin or NEARLY ALWAYS
clothes when you were outdoors between early SOMETIMES
evening and early morning? SELDOM,NEVER 235 55.00%
During the summer of 2003, did you remove YES 192 45.80%
standing water from around your home? NO 67 15.90%
DIDN'T HAVE 165 38.20%
STANDING WATER
Considering the sources of information you just TOO MUCH 30 8.10%
mentioned, how do you feel about the amount of ABOUT RIGHT 351 82.80%
information you received on West Nile virus last
summer? Was it... TOO LITTLE 41 9.10%
June 10, 2008 Page 4
Question Answer No. Percent
If preventive mosquito control measures are used MORE LIKELY 139 33.00%
in your community this summer, would you be
more likely, less likely, or just as likely to spend LESS LIKELY 51 10.00%
time outdoors between early evening and early
morning? JUST AS LIKELY 230 57.00%
If preventive mosquito control measures are used MORE LIKELY 100 20.70%
in your community this summer, would you be
more likely, less likely, or just as likely to use LESS LIKELY 55 14.30%
repellent containing DEET between early evening
and early morning? JUST AS LIKELY 264 65.00%
To your knowledge, was there a preventive YES 332 84.80%
mosquito control program in your community last
summer? NO 59 15.20%
If your local health department determined it was YES 374 92.60%
necessary to spray mosquitoes to control West
Nile virus THIS summer [2004], would you NO 28 7.40%
support their recommendation?
This survey provides valuable information and the Committee recommends the City conduct a
survey to assess current public opinion on these issues. One low-cost option would be to add
questions to the existing Air Quality survey the next time it is conducted.
During the April 22,2008 work session,Councilmembers asked the question of how effective is the
practice of adulticiding. It has been difficult to obtain data on this subject because it is unethical to
conduct studies that include human controls in experiments. However,similar communities can be
studied — where one opts for treatment and another does not — and results can be compared. A
recently published study of adulticiding activities conducted in Sacramento County, California in
2005 provided a large enough sample and is statistically reliable;however it should be noted that this
analysis was based on only one year. The abstract of that paper notes "Statistical analysis of
geographic information system datasets indicated that adulticiding reduced the number of human
WNV cases within 2 treated areas compared with the untreated area of the county. When we
adjusted for maximum incubation period of the virus from infection to onset of symptoms,no new
cases were reported in either of the treated areas after adulticiding; 18 new cases were reported in
the untreated area of Sacramento County during this time. Results indicated that the odds of
infection after spraying were approximately 6 times higher in the untreated area than in treated areas,
and that the treatments successfully disrupted the WNV transmission cycle." This study clearly
demonstrates that adulticide spraying applications can be effective in reducing human infections,but
the efficacy of spraying can vary significantly based on a number of factors, especially the timing
of the spraying. More research is needed in this area.
In Larimer,Weld and Boulder Counties in 2007,the City of Boulder was the only major city that did
not use adulticides to control West Nile virus. The 2007 rates ofneuroinvasive disease(encephalitis
and meningitis) in these areas were:
June 10, 2008 Page 5
Geographic Area Neuroinvasive Rate per 100,000 Adult mosquito
Cases population control
Fort Collins 2 1.54 Yes
Loveland 0 0 Yes
Longmont 7* 8.46 Yes
Greeley 3 3.42 Yes
City of Boulder 7 7.65 No
Boulder County 10 5.24 Yes
excluding Boulder city
* 5 of 7 cases infected pre-spray
Additional information on the efficacy of adulticiding is contained in the Mesa County 2004 West
Nile virus after-action report,which states,"In 2004,Mesa County led Colorado with 127 reported
cases of illness due to West Nile virus. This included four deaths and twenty cases of neuroinvasive
(meningitis or encephalitis)disease. Analysis of data collected during the 2004 season suggests that
the outbreak could have been much worse if not for the combined efforts within the community and
the implementation of an aerial spraying campaign. A total of 210,916 acres were treated over three
aerial applications. The success of the aerial spraying is reflected in several indicators:
• A pronounced decrease in human cases of West Nile illness after spraying.This is especially
important because it occurred at a time when Mesa County would have expected peak
transmission of the virus.
• A pronounced reduction in Culex mosquito populations.
• A major decrease in the number of positive mosquito pools.
• A decrease in positive blood donors.
• A decrease in individuals with meningitis and encephalitis due to West Nile virus."
The City of Fort Collins manages the threat of West Nile virus through a series of actions, each of
which is triggered by a number of factors. Attachment 3, "Program Response to Mosquito-Borne
Arboviral Activity," describes the approach taken by the City and its partners as the season
progresses, data is gathered, the situation is assessed and subsequent actions are taken.
The decision of whether or not the City will apply adulticides resides with the City Manager, who
is kept apprised by staff as the season evolves and preventive actions are implemented. The Director
of the Larimer County Department of Health and Environment uses a number of data sources to
assess the developing threat and,when deemed necessary,recommend to the City Manager that the
City implement adulticiding operations. Those data sources include the number and location of
infected mosquitoes(a 10-day delay),the number of human cases(a 3-week delay),blood donor data
from the State blood bank,the Vector Index(a measure of the density of infected mosquitoes in the
community), history (data on epidemic years, non-epidemic years and in-between) and weather
(including how it influences monitoring and impacts the Vector Index). As part of this process,the
Director also consults with a variety of people and organizations, including staff from the CDC,
Larimer County and Colorado State University.
June 10, 2008 Page 6
In summary, any recommendation to adulticide is developed after consideration of a combination
of factors:
• Vector Index
• Other surveillance information
• Context: weather, time of the season, location of infected mosquitoes, wind, etc.
• Expert interpretation of all available data
Once a decision is made to apply adulticides, operations are based on the following protocols:
• The City uses truck-based adulticide applications, not aerial applications.
• Adulticiding is targeted to areas where trapping and testing data indicate high levels of
infected Culex mosquitoes.
• Public notice of adulticiding operations is provided through a number of channels,including
subscription notification services and reverse 9-1-1.
• The City does not spray near individuals who are registered with the State of Colorado as
being chemically sensitive. There are currently 10 local residents on the State Pesticide
Sensitive Registry.
• The City does not allow individual members of the public to "opt out" of the spraying
program. People were permitted to opt out in 2003,but this practice was later discontinued
because it reduces the efficacy of the application. The Committee did not have time to
explore this issue in depth; however, members are interested to know if Council has any
views or questions on this practice.
Four adulticiding options for Council consideration are listed below, along with the pros and cons
of each option. The Committee discussed each of these at length and individual members were
asked if they had a preference. Some members' first preference is Option A or B,others Option C.
All agreed, however, that Option C would be an acceptable alternative, with the caveat that the
funding for adulticiding should be included in the base budget in future years. A detailed description
of the proposed Advisory Committee is included in Attachment 4.
Adulticiding Options
A. Adulticides applied as a standard component of an integrated pest management (IPM)
program; recommendation comes from the contractor.
Pro
• Scientific evidence indicates that adulticiding is a safe and reasonable practice when
properly timed and conducted under controlled conditions
• Proactive
• Only way to reduce adult mosquitoes infected with West Nile virus
• Less costly to have baseline adulticiding as part of base contract
Con
• May discourage individuals from using personal protection (repellents, etc.)
June 10, 2008 Page 7
• Community members wishing to avoid spray applications must close windows or
leave area
• Potential human health and environmental risks of pesticides;potential risk to those
who are chemically sensitive or have respiratory ailments
• Requires revision of contractor's IPM plan to incorporate adulticides
B. Maintain current policy: adulticiding considered only as an emergency response to
demonstrated increases in WNV risk; recommendation comes from the Larimer County
Health Department and advisors
Pro
• Scientific evidence indicates that adulticiding is a safe and reasonable practice when
properly timed and conducted under controlled conditions
• Only way to reduce adult mosquitoes infected with West Nile virus
Con
• May discourage individuals from using personal protection (repellents, etc.)
• Reactive
• Community members wishing to avoid spray applications must close windows or
leave area
• Potential human health and environmental risks of pesticides;potential risk to those
who are chemically sensitive or have respiratory ailments
• Increased financial cost to City
C. Adulticiding considered only as an emergency response to demonstrated increases in West
Nile virus risk; recommendation comes from Latimer County Health Department and
includes review by City-appointed advisory committee
Pro
• Scientific evidence indicates that adulticiding is a safe and reasonable practice when
properly timed and conducted under controlled conditions
• Only way to reduce adult mosquitoes infected with West Nile virus
• Broader input into reviewing recommendations for adulticiding
Con
• May discourage individuals from using personal protection(repellents, etc.)
• Potential to delay response to reduce the risk of West Nile virus in humans
• Reactive
• Community members wishing to avoid spray applications must close windows or
leave area
• Potential human health and environmental risks of pesticides;potential risk to those
who are chemically sensitive or have respiratory ailments
• Increased financial cost to City
June 10, 2008 Page 8
D. The City of Fort Collins will not apply adulticides under any circumstances
Pro
• Eliminates potential human health and environmental risks of pesticides applied by
the City
• May provide an incentive for individuals to use personal protection
• Less financial cost to the City
Con
• Increased risk of potential West Nile virus infections to the citizens of Fort Collins
• May result in increased, uncontrolled use of pesticides by private entities
• Does not eliminate risk; homeowners associations and others can still apply
adulticides if they wish but actions may not be based on surveillance or have City's
quality control
• Eliminates option to use a widely-accepted intervention tool to protect health in an
emergency situation
Committee members feel strongly that,no matter which of the above options is chosen,it is critical
to educate the public about preventive actions and inform people about the threat of West Nile virus.
The Committee's recommendations for public education (discussed at the April 22, 2008 work
session) include that of making information about mosquito infection rates and locations easily
accessible and timely. As noted in the Response Plan, public education messages should continue
throughout the season, and intensify if/when the threat escalates.
Additional Information
During the work session held April 22, 2008, Councilmembers asked a number of thoughtful
questions and requested additional information. Attachment 5 contains a memorandum summarizing
those requests. Several of the questions or requests for information have been addressed in the body
of this Agenda Item Summary; however a few remain:
• Supply information on influenza rates and deaths from 2004—2007. Show a comparison
of that illness with West Nile virus infections.
The table below shows rates for influenza hospitalizations and West Nile virus diagnosed cases in
Larimer County. Hospitalized influenza cases only are reportable since mid 2004; the 2 cases for
2004 are early cases for the 04/05 flu year. There are, of course, more flu cases than the ones
reported,just as there are more West Nile cases than the ones reported. The exact number of West
Nile hospitalizations is not available,however,it is thought that the 2003 outbreak of West Nile with
about 550 cases had more people hospitalized than the number hospitalized for any of the flu
outbreaks in recent years.
June 10, 2008 Page 9
This may or may not be a relevant comparison, as there is no environmental action that the City
could take to protect residents from influenza.
2003 200M20062007 Row
Total
Influenza Hospitalizations Unk Unk165
West Nile viruse (lab confirmed) 564 41757
• Provide information and analysis on West Nile virus infection in comparable states thathave
experienced the virus longer than Colorado.
The Culex tarsalis mosquito, the main vector of West Nile virus in Latimer County, is found
throughout western North America east to Ohio, and south to Florida. It is generally absent from
the Northeast and Mid-Atlantic states. The most comparable states have less than one additional
year of experience with West Nile virus compared to Colorado, as the virus was also first identified
in these states in 2002. West Nile virus is also transmitted by Culex pipiens, which occurs
throughout much of the United States north of the 36`s latitude.
The diagram below illustrates the 2002-2007 cumulative incidence of West Nile neuroinvasive
disease by county. Because of the great variability in West Nile fever reporting, only confirmed
neuroinvasive diseases are included in this analysis, i.e., meningitis, encephalitis, or acute flaccid
paralysis.
�y
F
F�
L
Larimer
g
County � �- _ j. �i t.#� oI• ��
2 y i
Cumulative Incidence PaN00,000
-39.13-19.24
79.25-145,77
1/5.78-309.90
(Attachment 6 contains this diagram in color)
June 10, 2008 Page 10
• Discuss the option of having an independent party carry out site inspections and mosquito
testing, rather than having a single contractor responsible for both this and subsequent
larviciding operations.
At the request of the City,this inquiry was analyzed in depth by Michael Doyle(formerly with CMC
and currently an independent researcher). Larval surveillance and treatment are extremely time-and
cost-intensive. With a few exceptions for extremely large sites, it would not be beneficial or cost
effective to separate these activities. The most effective way to accomplish the desired independent
oversight,therefore,would be to separate adult mosquito surveillance from the rest of the mosquito
program. There are several options for separating the entities that conduct adult surveillance from
those that do larval/adult control, e.g., two independent contractors could be used, or a single
contractor could do the majority of adult mosquito surveillance and a second entity(City staff or a
second contractor) could independently set a few traps to very the contractor's adult surveillance
data. No matter what option is chosen, a key requirement is that of honest and timely
communication between surveillance, larviciding and adulticiding staff.
The first year cost for equipment, operations and labor for these activities would be $12,000-
$16,000. The ongoing expense would be slightly less.
• Provide data on the risk and negative impacts of adulticides and larvicides, as well as the
risk and negative impacts of West Nile virus.
Information on the adulticide and larvicide products used by the City contractor can be found in
Attachment 7, which summarizes the Material Safety Data Sheet (MSDS) hazard information for
each product. MSDS sheets are intended primarily for use by a general contractor and focus on the
occupational hazards of working with concentrated forms of the materials.
The Committee has studied not only the human health risks of these chemicals, but also the risk to
the environment. Members additionally consulted with outside experts to better understand the
products' toxicity, concentrations, and factors that cause them to break down in the environment.
The City currently uses the safest products available and at the lowest concentrations possible. The
primary method of larval mosquito control is through bacterial bio-rational products,or varieties of
bacteria. When used properly, these products are effective and lack environmental impacts.
Permethrin,the product used in adulticiding,was chosen in part because it can be sprayed near crops
whereas other products cannot. (Permethrin is used widely in agriculture.) The City avoids spraying
near organic farms and known bee hives. Permethrin is very lethal to honeybees; therefore it is
normally applied after 10:00 p.m. when bees are least active.
A 2007 study specifically assessed the ecological risk of insecticides used in adult mosquito
management, including Permethrin and PBO, a synergist used to increase the effectiveness of
adulticiding. That study focused on both aquatic and terrestrial non-target organisms, including
small mammals,birds and aquatic vertebrates and invertebrates in ponds. It concludes,"... risks to
ecological receptors most likely are small from ULV(ultra low volume)insecticides applied within
a mosquito management program. Further, environmental exposures from adulticide applications
are not likely to add appreciably to background levels of the same active ingredients from
agricultural and urban uses." The assumption in this evaluation was that although mortality of
June 10, 2008 Page 11
"beneficial"organisms occurs from Permethrin applications,populations were able to recover fairly
quickly.
The above study did not consider the possibility of the role of Permethrin as an endocrine disruptor.
Endocrine disrupting compounds encompass a variety of chemical classes, including hormones,
pesticides and compounds used in the plastics industry and consumer products. The endocrine
system regulates all biological processes in the body from conception through adulthood,including
the development of the brain and nervous system and the growth and function of the reproductive
system. The Committee has attempted to evaluate the role of Permethrin as an endocrine disruptor.
The subject is beyond the Committee's expertise, as this is a very complex issue with much
discussion currently in the scientific literature. This debate is important for at least two reasons:
there might be unexpected impacts at very low doses,and most testing and evaluation is done above
these levels.
Attachment 8 speaks to the negative impacts of West Nile virus,and includes a table of the numbers
of West Nile virus cases in Latimer County, excerpts from a 2002 Louisiana study analyzing the
economic impacts of West Nile, and an excerpt from a recent article in the Journal of the American
Medical Association.
The Committee also reviewed a recent paper by Bob Peterson of Montana State University, one of
the outside experts consulted during the course of the analysis. That paper directly compares the risk
of West Nile virus disease to the risk from pesticide applications. The paper notes, "Results from
our risk assessment and the current weight of scientific evidence indicate that human-health risks
from residential exposure to mosquito insecticides are low and are not likely to exceed levels of
concern. Further, our results indicate that, based on human health criteria, the risks from WNV
exceed the risks from exposure to mosquito insecticides." A graphic representation of Dr.Peterson's
findings is included in Attachment 9, "Estimated Daily Human Exposure to Permethrin and PBO
by Source." The pie charts depict the relative source of exposure of humans to Permethrin and PBO
on a day when an adulticiding event has just occurred.
• Include information on how other Colorado communities address the threat of West Nile
virus, especially in terms of adulticiding. Also note the amount others spend on public
education.
The information below comes from an online request sent to public information staff of Colorado
jurisdictions and from Colorado Mosquito Control. While it does not capture the details of every
program, it does provide a"snapshot" of the mitigation efforts of several communities.
Jurisdiction Mosquito All Mosquitoes Budget for Use Adulticides?
Management or WNV Public
Policy Species? Education
Adams County Yes Unknown $8,500 Unknown
City of Boulder Yes WNV Overall program Yes - not assumed,
$300,000 (not but included in plan
specified for as a contingency
education
Boulder County Yes All $15,000 Yes
June 10, 2008 Page 12
Jurisdiction Mosquito All Mosquitoes Budget for Use Adulticides?
Management or WNV Public
Policy Species? Education
Breckenridge No, not n/a n/a n/a
needed (high
altitude
Brighton Yes All Assistance from Yes
Tri County
Health, but no
specified budget
City and County Yes All $8,200 Yes
of Broomfield
City of Fort Yes WNV $10,500 plus in- Yes—not assumed,
Collins kind from City but included in plan
and County staff as a contingency
City of Yes Unknown Unknown Yes
Lafayette
City of Yes All $2,500 Yes
Longmont
City of Yes All Unknown Yes
Loveland
Mesa County Yes WNV $6,000 Yes
Oak Creek No, not n/a n/a n/a
needed
(high altitude
City of Superior Yes Unknown Unknown Yes
rTi
wnof Yes all Assistance from Yes, if needed
mnath CMC; no
s ecified bud et
Summary of Technical Advisory Committee Recommendations
The table below summarizes key components of the existing program,changes recommended by the
Technical Advisory Committee, and the cost to implement those changes.
Current Policy or Practice Change(s) Recommended by TAC
-and- -and-
Current Budget Additional Cost
No written policy; set of operational Council adopts policy; operational practices
practices. overseen by City Manager.
Policy goal: reduce the risk of human West Nile
virus infection while limiting adverse human
health and environmental impacts.
• Budget: NA Cost: NA
June 10, 2008 Page 13
Current Policy or Practice Change(s) Recommended by TAC
-and- -and-
Current Budget Additional Cost
Conduct local public education and Devote more resources to public education and
outreach and support county-wide outreach, reaching more people and targeting
efforts at same. Contractor also specific groups.
provides mosquito hotline and Structure public information to coincide with
website. increasing level of threat and City response.
• Expand online information to include more timely
and specific data about Culex mosquito
populations and locations. Publish information in
newspapers.*
• Conduct a public opinion survey to gauge current
behaviors and attitudes towards West Nile virus
and preventive measures.
Budget: Cost:
• $10,500 CMC Additional staff, materials, advertising and
• $6,000 City staff/materials (in repellent: $11,500
kind) CMC website: NA
Public opinion survey: To be determined
Ensure extensive mosquito data Enhance the effectiveness of the larviciding
collection, monitoring, and testing program by requiring Quality Control become a
samples for WNV infection. standard provision of the contract, or conduct
independent quality control.
• Document the current design of the trapping grid.
• Consider conducting research to better understand
the sources of infected mosquitoes.
Amend the code to address stagnant
water/breeding habitats.
• Explore options for collaborating with surrounding
counties or the State for testing/lab services to
replace services CDC will discontinue in 2009
Budget: Cost:
$44,700 Quality Control: $10,600
• Grid documentation: NA
• Research: $3,000
Code amendment: NA
• Lab services: $ TBD (see below)
June 10, 2008 Page 14
Current Policy or Practice Change(s) Recommended by TAC
-and- -and-
Current Budget Additional Cost
Execute extensive larval site If research supports it, consider additional early
inspection and control program use of Altosid.
focused on Culex mosquitoes. Develop plan for using helicopters to larvicide
larger sites.
Budget: Cost:
$178,400 Additional Altosid: $90,000
• Helicopters: $67,200 per application
Conduct training for at-risk No changes recommended.
employees.
Budget:
Included in overall contract
Periodically evaluate program for Consider establishing an ongoing technical
continued efficacy. advisory committee. Annually conduct an
evaluation of the prior season.
Budget:
• Included in overall program Cost:
budget NA
LCDHE Director and advisors Recommendation comes from LCDHE Director
recommend if ground-based and advisors and includes review by City-
adulticiding warranted. If so, appointed advisory committee.
reverse 9-1-1 and subscription Add cost of adulticiding and reverse 9-1-1 to
services used to notify public in ongoing City budget.
affected areas. Notify people living near those on Pesticide
Registry that their area will not be sprayed.
Budget: Cost:
• Not included in budget; Adulticiding: $49,500
emergency funding when Reverse 9-1-1: $18,500
needed
"Since this need was identified by the Committee in March,staff at Colorado Mosquito Control(CMC)have
been working to enhance their website tools. CMC has committed to updating the trapping and testing
information on their website on a nightly basis beginning this season;no additional funds are required.
The CDC has notified the City that it will no longer offer free laboratory testing services beginning
in 2009. Staff members have been discussing the possibility of collaborating with Weld County for
West Nile virus laboratory testing services for several weeks. As this document was going to print,
the City was informed that Weld County does not have adequate staffing to meet the City's needs.
The State of Colorado could provide these services, however based on the current City mosquito
trapping network,the cost to have the State provide testing could be as high as $210,000 annually.
June 10, 2008 Page 15
Clearly,this has implications for the entire program operation and options must be developed. The
Technical Advisory Committee has not yet discussed this new finding.
Next Steps
City Council is scheduled to consider a resolution adopting a West Nile Virus Management Policy
on July 1,2008. Operations staff have worked with the Committee since its onset and are prepared
to implement those program changes that are applicable to the current season, such as increased
public education and some recommended operational adjustments.
Citizens of Fort Collins and other key stakeholders will be informed about the policy and any
significant changes. Stakeholders include members of the Air Quality Advisory Board and Natural
Resources Advisory Board, and partners such as Latimer County,the Centers for Disease Control,
and Colorado State University. Members of neighboring communities have also expressed a great
deal of interest in the work of the Technical Advisory Committee and staff will continue to respond
to requests to share information.
Looking farther into the future, a multi-county group called the Northern Colorado Vector-borne
Disease Advisory Group (VDAG) will soon be meeting with municipalities to discuss options for
a long-term,regional approach to mosquito management. VDAG is comprised of health department
staff from Boulder, Weld and Latimer counties. Their timeline is fluid and very much depends on
the level of interest they receive from the municipalities of the three counties. The Technical
Advisory Committee believes regional cooperation on this issue is important and looks forward to
hearing more about this effort.
Should any major modifications be made to the program in the future,the Committee recommends
that the Technical Advisory Committee or a similar group be reconvened to evaluate those changes.
ATTACHMENTS
1. Policy cover sheet.
2. April 22, 2008 work session item summary.
3. Program response to mosquito-borne arboviral activity.
4. Proposed WNV Advisory Committee.
5. April 23, 2008 memorandum: Council work session follow up on West Nile virus
management policy.
6. Diagram of the 2002-2007 Cumulative Incidence of West Nile Neuroinvasive Disease by
County.
7. Summary of Material Safety Data Sheet (MSDS) hazard information for products used by
City contractor.
8. Latimer County documented human WNV infections; WNV economic impact, Louisiana,
2002, JAMA article excerpt.
9. Estimated daily human exposure to Permethrin and PBO by source
10. List of publications, documents and websites reviewed by the Technical Advisory
Committee.
11. Powerpoint presentation.
ATTACHMENT
West Nile Virus Management Policy
June 2008
The City of Fort Collins recognizes West Nile virus to be a public health issue. This West Nile
Virus Management Policy has been developed to reduce the incidence of city residents
contracting West Nile virus (a mosquito-borne virus). The overall goal of this policy is to reduce
the risk of human West Nile virus infection while limiting adverse human health and
environmental impacts.
The City recognizes the State of Colorado Department of Health and the Larimer County
Department of Health and Environment as the authorities on local public health issues.
The City's primary role in managing the threat of West Nile virus is to inform and educate Fort
Collins citizens, participate in regional public education and outreach efforts, and administer a
prevention-oriented mosquito management program.
The City's West Nile virus management program focuses on the following:
1. Providing a wide range of public education and outreach
2. Ensuring extensive on-going mosquito population data collection and monitoring,
including extensive testing of samples for West Nile infection.
3. Executing an aggressive larval control program focused on Culex mosquitoes. This
program includes detailed mapping of larval habitat and ongoing monitoring and
larvicide applications.
4. Periodic evaluation of the program for continued efficacy.
(Insert policy for use of adulticides.)
The City uses a contractor to cant' out the majority of the program. A comprehensive scope of
services is developed and a qualified contractor selected following an open bid and evaluation
process.
ATTACHMENT
DATE: April 22, 2008 WORK SESSION ITEM
STAFF: Tess Heffernan FORT COLLINS CITY COUNCIL
Wendy Willams ..
p
s
SUBJECT FOR DISCUSSION
West Nile Virus Management Policy Update.
EXECUTIVE SUMMARY
The City Manager formed the West Nile Virus Technical Advisory Committee in December 2007
for the purpose of reviewing and making recommendations about the City's policy related to West
Nile virus mitigation. Components of the policy that have been reviewed thus far by the Committee
include mosquito trapping and testing,public education,and larva control. Committee members are
currently discussing the practice of adulticiding(the spraying of adult mosquitos). The Committee
hopes to finalize recommendati J 20fislizy
goal of the West Nile Virus
Management Policy - and the alien a or th`' ee and decision-makers - is to
reduce the risk of West Nile vi s infecti whi ial short and long-teen human
health risks and impacts to the ' ' riment
GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED
1. Is Council comfortable with the current direction of the West Nile Virus Technical Advisory
Committee?
2. Does Council have any questions or additional direction for the Committee?
BACKGROUND
West Nile virus first arrived in I-011—o ' s o 02 -d an initial outbreak occurred
in 2003. The City's policy for pondin o We N e s ed through a series of operational
experiences and reviews with ty Co '1, be g in 200 The City employs a broad based,
prevention-focused management ram cl s public' rmation and education,mosquito
data collection and monitoring, larva control and, in the case of a public health emergency,
adulticiding.
Since that first season, the research and knowledge about West Nile virus has increased
significantly. In 2003,the Air Quality Advisory Board convened a West Nile Task Force to review
the response of that first season and make recommendations. Since then, staff and community
members have reviewed findings and refined the response plan.
April 22, 2008 Page 2
Despite these efforts,in 2007 the community experienced a severe outbreak of West Nile virus and
adulticides were applied for the first time since 2004. Following that experience,the City Manager
formed a Technical Advisory rand
e(nse
f 'ewipg and making recommendations
about the City's current polis ittee began meeting in January.
Committee members are listect
Existing Policy and Program
The City's West Nile Virus Management Policy is focused on disease prevention. The overall goal
of the policy-and the challenge for the Advisory Committee and decision-makers-is to reduce the
risk of West Nile virus infection while minimizing potential short and long-term human health risks
and impacts to the environment.
As noted earlier, the basic components of the program are:
• Public information and education
• Surveillance, trapping and testing, focusing on the Culex species
• Larva control
• At-risk employee training.
The City's practice has been tifonly o ider u ci g emergency response to a public
health crisis.
d
The City recognizes the State of Colorado Department of Health and the Larimer County
Department of Health and Environment as the authorities on local public health issues. The City's
primary role in managing the threat of West Nile virus is to inform and educate citizens,participate
in regional public education and outreach efforts, and administer the pest management program.
The City selects a contractor to carry out many of the program components; the current contractor
is Colorado Mosquito Control.
Attachment 2, "Program Response to Mosquito-Borne Arboviral Activity," describes the potential
levels of response employed by the City throughout the season. This document is still in draft form
pending the outcome of the current review, however it provides an overview for those unfamiliar
with mosquito management practices.
The ongoing cost of the program includes the following:
• Contract with Colorad osq i " Cont
■ $ 44,700—s illance d tra i
■ $ 7,500—pub Zat
■ $ 178,400—larval site inspection and control
• Public information and education—direct costs and in-kind
■ $ 6,000— City Communications and Public Involvement
■ $ 12,000—County Department of Health and Environment
■ $ 300—Community donations of repellent
April 22, 2008 Page 3
• Program administration and oversight—in-kind
■ $ 4,900—City Parks Department
Additionally, emergency adulti ' w co ue n' 2 3, 4 and 2007. Costs for those
operations included: q
E,
• Truck-based adulticidin do 'sw na
■ $ 46,300—2003
■ $ 30,200—2004
■ $ 72,000 - 2007
• Reverse 9-1-1 notifications
■ $ 15,000—2003
■ $ 21,400—2004
■ $ 19,200—2007
Technical Advisory Committee Review Thus Far
The Committee has not yet finalized its recommendations; however members have discussed the
following modifications to the existing policy and program:
Public Information and EduCo"nMore public informatidu o 1 - ex methods of reaching people, use
more volunteers to communicate the risk and prevention measures.
• Better,more timely information about results of adult mosquito trapping program—clearer,
up-to-date maps illustrating risk areas should be posted online and in other media.
• More efforts to reach people at higher risk of contracting West Nile virus, e.g., transplant
recipients, people over 55, diabetics, persons with high blood pressure, those taking
immunosuppressant drugs and people who spend a lot of time outside.
• Pre-developed messages to be used when risk escalates.
• Contact community leaders and others in positions of trust for their assistance in
communicating with their constituencies when risk is elevated.
• Many people are apprehensive about using DEET, therefore emphasize CDC and EPA-
approved alternative products, e.g.,products containing Picaridin, oil of lemon eucalyptus,
etc. The City could also consider distributing samples of these products.
• Ensure the contract requires sufficient levels of staffing for back yard catch basin inspection,
related property owner io ho f
City and County public relatio staff ha beg eting to elop enhancements to the existing
program elements.
Surveillance,Trapping and Testing
• Document the current design of surveillance program and trapping grid: the number of trap
sites, types of traps used and number of trap nights per week. This provides data that
contributes to decisions regarding the level of risk.
April 22, 2008 Page 4
• Collect data to determine if backyard larval habitats are a significant source of infected adult
mosquitos.
• Amend the Code definition of public nuisance to include stagnant water creating potential
larval habitats for diseas iffpri
' luntary compliance is currently
very high,this would pfide ai a em property should an owner not
respond to requests to so. Tmphasis ould be
to educate the public and
proactively mitigate pro it• Conduct research to determine if there is a benefit to extending the buffer zone in some areas
around the city. This would be designed to more accurately identify the source of the
mosquitos—i.e., whether they are coming from within or outside the city limits—and thus
guide further mitigation efforts.
• Evaluate whether remote sensing technology should be used to identify habitats more
effectively than can be done using manual techniques.
• Require that Quality Control become a standard provision of the contract, including
monitoring and evaluating larval control efficacy to insure larval management is performing
optimally.
• Appoint an ongoing Technical Advisory Committee to annually review the prior season,and
assist in interpreting data during season
Larva Control
• IF
As noted previously, blic ation 's k c ent of a successful West Nile
prevention program. E and pu 'c ed ti ,Includifniformation on locations of likely
larval habitats and alte esfo ro on fro ase-carrying mosquitoes.
• Consider additional early use of Altosid as a pre-hatch time release formulation. Increasing
the use of this product in the appropriate habitats may save money in labor costs because it
could reduce the overall number of applications needed.
• Allocate funding and develop a plan for using helicopters to apply larvicides to larger sites.
While more expensive, helicopters are effective, minimize air pollution (as compared to
backpack blowers with two stroke engines and ATVs)and make it possible for the contractor
to focus on smaller sites, especially during critical peak periods.
Technical Advisory Committee Review Still Underway
Adulticiding
The Committee is unanimous in its support for an aggressive prevention and public education
program. There is also recognif Oa b * e o alternative to prevent a public
health crisis. Discussion has f used g d cing the human health risks from
West Nile virus vs. the hum and ec risks the pesticides used to reduce the
population of disease-carrying t.?n re dis ion is needed regarding what the
triggers should be for determining when and if adulticiding is employed.
Recommendations related to the current policy and program for adulticiding are not yet complete.
Members have reviewed a great deal of research and consulted with additional experts, including:
• Bob Peterson, PhD—Department of Entomology, Montana State University
• Theo Colborn, PhD and Lynn Carroll, PhD—TEDX/The Endocrine Disruption Exchange
April 22, 2008 Page 5
Additional Issues
Over the past several years the Centers for Disease Control and Prevention (CDC) has provided
mosquito testing services at no c e -' r Ciyty recently learned that the CDC
will no longer fund this service er 20 Staf g to re options for future cost-sharing
with surrounding cities and co ties. F exam e, e d Co y has a lab and facilities that could
possibly be utilized. R ,�si .
A multi-county group called the Northern Colorado Vector-borne Disease Advisory Council
(VDAG) will soon be meeting with municipalities to discuss options for a long-term, regional
approach to mosquito management. VDAG is comprised of health department staff from Boulder,
Weld and Larimer counties. Their timeline is very fluid at this point and very much depends on the
level of interest they receive from the municipalities of the three counties.
Finally, staff is exploring the possibility of performance contracting for future West Nile services.
This assessment will determine if incentives or other means could be used to increase the efficacy
of the current program.
Next Steps
It is hoped that the Technical Adjoiserg C Zee mpete ianalysis and recommendations
no later than June 1,2008. Th mal rec men ti s 11 be brought to Council,along with
a resolution supporting any m ificatio to th u nt polic
This summary has discussed only the City's response to the threat of West Nile virus. Citizens who
wish to learn more can begin with the City or County web sites:
www.fcgov.com/westnile
http://www.larimer.oriz/health/cd/westnile.asp
C/ Pp§
ATTACHMENT
City of Fort Collins
Program Response Guidelines to Mosquito-Borne Arboviral Activity
DRAFT— includes adulticide operations
Off Season Operational Activities
Status:
• No human cases occurring
• Mosquito activity none to very low
• Mosquito infection rates 0
• Vector index 0
Response:
1. Routine post-season analysis of previous season's data; assess response and efficacy.
2. Preseason preparations for upcoming season's strategy and activities, including
updating of public outreach plan with any new information(e.g. at-risk populations).
3. Map previous season's surveillance data.
4. No mosquito testing.
Level I Early Season -May to June
Status:
• No human cases reported
• Evidence of average or lower than average Culex species mosquito populations (as
compared to available historical population data for the area)
• Mosquito infection rates <2 per thousand (0.2%)
• Vector index < 0.5
Probability of Human Outbreak: Low
Response:
1. Analyze and map data from prior years to develop surveillance strategy and select
mosquito-trapping sites. Initiate surveillance program.
2. Initiate larval control activities.
3. Brief City Manager on surveillance activities, mosquito-borne virus epidemiology
and trigger points for recommendation of emergency control measures. Establish
communication channels between appropriate City and County staff.
4. Ensure online information is up to date and prepare for ongoing, timely updates.
5. Initiate public education program on mosquito source reduction and risk reduction
practices (e.g. elimination of breeding sites, use of repellents, etc.).
I
Level II Peak Season—July to August—Low West Nile Virus Activity
Status:
• Sporadic human cases are being reported
• No infected human blood donors have been reported
• Culex mosquito populations increasing, but below historical average for that time
period
• Mosquito infection rate <2 per thousand (0.2%)
• Vector index < 0.5
Probability of Human Outbreak: Low—Moderate
Response:
l. Analyze and map surveillance data to identify areas of increased risk.
2. Continue mosquito pool submissions from surveillance program for West Nile virus
testing with Centers for Disease Control (CDC).
3. Notify local agencies, media and the public of positive findings. Increase public
education activities (risk reduction practices, elimination of breeding habitat, focused
outreach with at-risk populations, etc.)
4. Continue to regularly update online information, including maps illustrating risk
areas.
5. Brief City Manager on surveillance findings and need for quick action if activity
rapidly increases.
6. Increase larval monitoring and control where necessary.
7. Begin planning for adulticide control in the event that virus activity and Culex
populations rapidly rise.
2
Level III Peak Season—July to August—Increasing West Nile Virus Activity
Status:
• More than one human case being reported per week in Fort Collins—OR—
• More than one positive human blood donor reported
-AND-
• Culex mosquito populations increasing and at or above historical average for that time
period—OR—
• Mosquito infection rates of> 3.0 per thousand (0.3%) and increasing—OR—
• Vector index> 0.5 and increasing
Probability of Human Outbreak: High
Response:
1. Enhanced communications between City and County regarding positive findings and
anticipated response activities. City Manager apprised of threat levels and activities
on an ongoing basis.
2. Identify geographic areas, by mapping surveillance data, where virus transmission
appears most active.
3. Continue larviciding activities.
4. Coordinate press releases and a wide range of other activities to keep the public
informed of affected areas, focusing on exposure risk reduction practices and public
education of the disease threat.
5. In the event the Health Department recommends adulticide spraying and the City
Manager decides to proceed, commence adulticide operations.
6. Intensify existing public education activities and initiate public education/information
on the adulticide program to include pesticides used, toxicity, application times, target
area, exposure reduction suggestions,justification, FAQ's, etc. Notify residents of
affected and adjacent areas and people on the subscription notification list.
7. Notify appropriate agricultural interests (i.e. bee keepers, organic growers, etc.) and
individuals on the Pesticide Sensitivity Registry of intended adulticiding activities,
times, affected areas, etc. Also notify residents in areas that will not be part of the
adulticide applications.
3
Level IV Peak Season—July to August—Emergency Level
Status:
• Multiple neuroinvasive human cases being reported in Fort Collins
- AND—
• Culex mosquito population above historical average for that time period
-AND—
• Sustained mosquito infection rates of> 5.0 per thousand (0.5%)—OR—
• Vector index> 0.75.
Probability of Human Outbreak: In progress
Response:
1. Focus as many resources as possible on public education and information; intensify
all activities and involve public officials as spokespersons. Consider emergency
measures to restrict outdoor activities.
2. Expand mosquito surveillance activities (i.e. population densities, vector index and
infection rates)to direct mosquito control efforts where risk to exposure is greatest
and to monitor pre- and post-adulticide treatment conditions.
3. In the event the Health Department recommends additional adulticide spraying and
the City Manager decides to proceed, continue spraying.
4. Continue public education and information on the adulticide program including
pesticides to be used, toxicity, application times, area of application, exposure
reduction suggestions,justification, FAQ's, etc. Notify residents of affected and
adjacent areas and people on the subscription notification list.
5. Notify appropriate agricultural interests (i.e. bee keepers, organic growers, etc.) and
individuals on the Pesticide Sensitivity Registry of any continued adulticiding
activities, times, affected areas, etc. Also notify residents in areas that will not be part
of the adulticide applications.
6. Secure any needed emergency funding and document costs associated with outbreak
control.
4
ATTACHMENT 4
Proposed "V Advisory Committee
Rationale
Since 2003 the City has contracted with a vendor to supply services to mitigate the risk of West
Nile virus ()vVNV). During that time the County Health Department has recommended
adulticiding four times to reduce the WNV risk. The decision of whether or not the City will
apply adulticides is the responsibility of the City Manager.
Any recommendation by the County to adulticide is preceded by a detailed analysis of a number
of factors; the recommendation is usually communicated to the City via e-mail. There is a desire
to make this process more transparent and include review by citizen representatives.
A three-person WNV Advisory Committee, appointed by the City Manager, would be tasked
with staying abreast of unfolding information about mosquito activity, WNV infection rates, and
the many issues that come into play as the season progresses. This effort is coupled with
expanded public outreach activities on the part of City and County staff. In the event that a
recommendation of adulticiding is potentially forthcoming from the County, a series of updates
will be scheduled by City staff to ensure all relevant information is promptly distributed. In the
event that adulticiding is recommended by the County, the City Manager and the WNV Advisory
Committee will be prepared.
The intent of the Advisory Committee is not to debate the merits of adulticiding or its potential
human health effects during an outbreak, but rather to stay aware of the situation, air any
questions or concerns, and act as an information conduit between the City Manager and
members' respective Boards or organizations.
Advisors makeup and role
1. The Committee would be made up of one representative each from
- Air Quality Advisory Board
- Natural Resources Advisory Board
- Fort Collins medical community, e.g. physician/member of the Larimer County
Medical Society
2. Advisors are people with technical expertise who can give timely advice to the City Manager
when needed, especially in the event adulticiding is recommended by the County.
3. Advisors are expected to stay well-informed and abreast of the most recent data available.
4. Advisors act as liaisons to their respective Board or organization.
5. Advisors are not decision makers, nor do they have veto power; decisions lie with the City
Manager.
1
Process
1. Advisory Committee members will be included on distribution list for informational c-mails
from the Health Department and City staff group. They are also expected to access relevant
online data sites, e.g. Colorado Mosquito Control.
2. One meeting will be held early in season with the City Manager; the Committee and City
Manager will discuss and agree on communication protocols.
3. Advisors will stay in touch with City Manager as season progresses, share perspectives.
4. Should adulticiding be recommended by Health Department, advisors will immediately
inform the City Manager of any concerns and/or suggestions.
2
ATTACHMENT 5
r
City of F rt C 11 s MEMORANDUM
Date: April 23, 2008
To: Mayor and City Council Members
Thru: Darin A. Atteberry, City Manager
From: Wendy Williams, Assistant City Manager
Tess Heffernan, Policy and Project Manager
RE: Council Work Session Follow Up on West Nile Virus Management Policy
On April 22, 2008 the City Council provided feedback on the West Nile Virus Management
Policy Update. Additional information was requested on the items below. This will be provided
on or before the next Work Session on this topic, scheduled for June 10, 2008.
1. Provide evidence that adulticiding works as intended; discuss the most recent research
and findings on this subject.
2. Supply information on influenza rates and deaths from 2004—2007. Show a comparison
of that illness with West Nile virus infections.
3. Provide information and analysis on West Nile virus infection in comparable states that
have experienced the virus longer than Colorado.
4. Discuss the option of having an independent party carry out site inspections and mosquito
testing, rather than having a single contractor responsible for both this and subsequent
larviciding operations.
5. Provide data on the risk and negative impacts of adulticides and larvicides, as well as the
risk and negative impacts of West Nile virus.
6. Include cost estimates for any Committee recommendations that will require additional
funds to implement.
7. Summarize the Committee's recommendations in a chart format to capture a snapshot of
current practices vs. recommended changes.
8. Include information on how other Colorado communities address the threat of West Nile
virus, especially in terms of adulticiding. Also note the amount others spend on public
education.
ATTACHMENT 6
Diagram of the 2002-2007 Cumulative Incidence of West Nile Neuroinvasive
Disease by County.
r
�a
i
� 4
i
' L
it rr
i
Larimer
County
J � q
Cumulative Incidence Per 100 ,000 -
0. 10 - 14. 16 l
� 14.17 - 39.42
39.43 - 79.24
79.25 - 145.77
145.78 - 309.60
r
ATTACHMENT 7
Summary of Material Safety Data Sheet(MSDS) hazard information
for products used by City contractor
Larvicides:
VectoLex CG- Bacillus sphaericus Valent BioSciences Corp
Emergency overview: Product is non-toxic by ingestion, skin contact, or inhalation. Direct
contact with eyes or skin may cause mild irritation.
VectoBac CG- Bacillus thuringiensis Valent BioSciences Corp.
Emergency overview: Product is non-toxic by ingestion, skin contact, or inhalation. Direct
contact with eyes or skin may cause mild irritation.
Zoecon Altosid pellets - Methoprene Wellmark International
Signs and symptoms of overexposure: No adverse reactions have resulted from normal human
exposure during research and testing. Adverse animal reactions to this product have not been
shown.
Bonide Mosquito Larvicide - Mineral Oil Bonide Products, Inc.
Precautions: Avoid breathing spray. If swallowed, do not induce vomiting. Notify physician.
Adulticide:
Aqualuer 20-20 Permethrin and Piperonyl Butoxide AIIPro Vector
Precautionary statements: Harmful if swallowed or absorbed through skin. Avoid contact with
eyes, skin or clothing. Prolonged or frequently repeated skin contact may cause allergic reaction
in some individuals. Wash hands before eating, drinking, chewing gum, using tobacco or using
the toilet.
Environmental hazards: This product is extremely toxic to aquatic organisms, including fish and
aquatic invertebrates. Runoff from treated areas or deposition of spray droplets into a body of
water may be hazardous to fish and aquatic invertebrates. Do not apply over bodies of water
(lakes, etc.) except when necessary to target areas where adult mosquitoes are present, and
weather conditions will facilitate movement of applied material away from the water in order to
minimize incidental deposition into the water body. Do not contaminate bodies of water when
disposing of equipment rinsate or washwaters.
1
Bee Warning: This product is highly toxic to bees exposed to direct treatment on blooming
crops or weeds. Do not apply to blooming crops or weed while bees are visiting the treatment
areas, except where applications are made to prevent or control a threat to public and/or animal
health determined ... on the basis of documented evidence of disease causing agents in vector
mosquitoes or the occurrence of mosquito-borne disease in animal or human populations, or if
specifically approved during a natural disaster recovery effort.
2
ATTACHMENT8
Larimer County
Documented Human West Nile Virus Infections
Source: State of Colorado
Year Clinical Dia nosis Total cases Total deaths
Fever Meningitis Encephalitis
2003 483 38 25 546 9
2004 16 0 1 14 0
2005 11 1 1 13 0
2006 35 5 2 42 1
2007 90 3 1 94 0
Excerpts from: West Nile Virus Economic Impact, Louisiana,2002
Zohrabian A,Meltzer MI,Ratard R,Billah K,Molinari NA,Roy K,et al.,
Emerging Infectious Diseases,2004 October
Authors calculated the costs of the West Nile virus epidemic as the sum of:
1) medical costs (inpatient and outpatient)
2) nonmedical costs, such as productivity losses caused by illness and premature death,
costs of transportation for a patient to visit a healthcare provider, and childcare expenses
3) costs incurred by public health and other government agencies for epidemic control
Medical Costs
Acute-Care Inpatient Costs and Inpatient Rehabilitation Costs
We received information about acute-care hospital inpatient charges for 119 patients. The
median hospital stay was 8 days, with a median of 7 days for intensive care. Nineteen (14%) of
139 survey respondents received inpatient treatment at a rehabilitation facility. Hospital charges
were available for seven patients; the total cost for inpatient rehabilitation treatment for those
seven patients was $96,556.
Costs of Outpatient Hospital Treatment and Physician Visits
Of 159 patients for whom hospital charges were available, 50 (32%) received outpatient hospital
treatment at a total cost of$14,539. The estimated total cost of visits to see a primary care
doctor, specialist, or both for 139 patients who responded to the survey was $54,572.
Costs of Outpatient Rehabilitation Therapies and Durable Medical Equipment
Thirty-one (22%) of 139 respondents reported receiving outpatient physical therapy, with an
estimated cost of$110,184. Ten of 139 patients reported receiving occupational therapy, with a
1
total estimated cost of$35,207. Two patients received speech therapy, at a total estimated cost of
$1,025.
Nonmedical Costs
Productivity Losses from Illness and Death
For 53 patients who missed work but did not stop working entirely, the estimated productivity
losses were $443,000 (the average number of days missed was 50, and the median number of
days missed was 37, with a range of 1 to 212 days). For the 10 patients who stopped working
entirely, the estimated productivity losses were $157,950. Thirty-six of 139 respondents
indicated that someone missed work to take care of them; the resulting productivity loss totaled
$82,669 dollars. Twenty-four deaths were attributed to WNV illness in Louisiana in 2002.
Nursing Home, Transportation, and Miscellaneous Costs
Five (4%) of 139 patients 45-86 years of age were reported to have spent 21-170 days in a
nursing home because of complications from WNV infection. The estimated total payment for
nursing home care for the five patients was $36,956.
The estimated transportation cost for 139 respondents was $8,354.
Twenty survey respondents reported having used home health aides or other services, such as
babysitting, house cleaning, or yard work, at a reported total cost of$29,225.
Costs of Public Agencies
Mosquito Surveillance and Abatement
From June 1 to mid-August, 2002, a total of 93 public offices requested $4,879,070 as state
reimbursement from the Louisiana Office of Emergency Preparedness.
Public Health Office Costs
From June to November 2002, the central state public health office incurred an estimated
$886,000 in expenses because of WNV. From this total amount, basic operating expenses cost
$586,000, contracts such as for veterinary diagnostic and entomologic services cost $166,000,
and laboratory expenses cost $134,000.
Excerpt from Effects of West Nile Virus May Persist
Rebecca Voelker, Journal of the American Medical Association, May 2008
Kristy Murray, DVM, PhD, of the University of Texas Health Science Center, Houston,
presented findings showing that severe symptoms from West Nile virus infection can last at least
5 years and that many patients may experience clinical depression following infection. "Clinical
sequelae following infection are important and certainly can cause a lot of long-term, costly
morbidity," she said.
2
ATTACHMENT 9
Estimated Daily Human Exposure to Permethrin and PBO by source
Permethrin exposure per day by source PBO exposure per day by source
Adulticiding AdutticidingD.OD3%
0.050% Food
23 .452 %
Home Use
35. 164 % i
iy
Food
64.786%
Home Use
76 . 545%
Risk assessment of chemicals used for West Nile Virus prevention
(EPA ' s Margin of Exposure Method)
In "margin of exposure" (MOE) assessments, higher numbers mean lower risks. EPA prefers to see
MOE's of 100 or more to allow for uncertainties and individual susceptibility. An MOE of 100 means
that a person's actual exposure is at least 100 times less than the level that produces no effects in
mammals.
Margin of
Margin of Exposure for Exposure for
Adults Children
Permethrin from daily food 2,280 1 ,020
Permethrin from indoor home pesticide use 45200 330
Permethrin from backyard mosquito mister 1605000 891000
Permethrin from adulticiding 257505000 4005000
Pi eron 1 butoxide from daily food 200 903
Pi eron 1 butoxide from indoor home pesticide use 90 30
Piperonyl butoxide from backyard mosquito mister 730 190
Pi eron 1 butoxide from adulticiding 179000,000 21000,000
DEET at 25% concentration 394 135
DEET at 5% concentration 15971 676
Picaridin at 15 % concentration 19314 451
Picaridin at 5% concentration 3 ,941 11351
1
Data based on communications with Robert K. D. Peterson, Ph.D, Dept. of Land Resources
and Environmental Sciences, Montana State University.
Percentage of exposures by source estimated from data from EPA 's Re-registration
Eligibility Decision(RED) for Permethrin, Revised December 2007. and Re-registration
Eligibility Decision (RED) for Piperonyl Butoxide PBO, June 2005.
MOE 's are from the REDS above, as well as from Davis RS, Peterson RKD, Macedo PA
(2007) An ecological risk assessment for insecticides used in adult mosquito management, Integr
Environ Assess Manag 3 :373382; Peterson RKD, Macedo PA, Davis RS (2006) A human-
health risk assessment for West Nile virus and insecticides used in mosquito management,
Environ Health Perspect 114: 366 372; Schleier JJ, Macedo PA, Davis, R, Shama, LM, and
Peterson,RKD A two-dimensional probabilistic acute human-health risk assessment of
insecticide exposure after adult mosquito management, Stoch Environ Res Risk Assess (in press);
and Antwi FB, Shama, LM, Peterson, RKD, Risk assessments for the insect repellents DEET and
Picaridin Regulatory Toxicology and Pharmacology 51 (2008) 3136. All conversions from
RQ 's to MOE 's done by Dr. Peterson.
2
ATTACHMENT 10
List of Publications, Documents and Websites Reviewed by Technical Advisory Committee
1. Calculation and application of a vector index (VI) reflecting the number of west nile virus
infected mosquitoes in a population, Roger S. Nasci, Michael Doyle, Brad J. Biggerstaff,
Adrienne LeBailly, revised 2007
2. State of Colorado program response to mosquito-borne arboviral activity
3. Public health confronts the mosquito: developing sustainable state and local mosquito
control programs, Association of State and Territorial Health Officials, 2005
4. Material Safety Data Sheets (MSDS) for larvicides and adulticides used in Fort Collins
by Colorado Mosquito Control
5. Active ingredients found in insect repellents, US EPA, 2007
6. Safety of pesticides used to control adult mosquitoes (pyrethrins, pyrethroids and
piperonyl butoxide): questions and answers for public health officials, California
Department of Health Services, 2005
7. Pyrethrins & pyrethroids fact sheet,National Pesticide Telecommunications Network,
1998
8. Information sheet: Anvil and mosquito control,New York State Department of Health,
2004
9. Larviciding in the City of Fort Collins: methods, challenges, and possible improvements,
Michael Doyle, Larimer County Department of Health and Environment, 2008
10. Methoprene and eye deformities, University of California, Berkeley
11. Surveillance for acute insecticide-related illness associated with mosquito-control efforts,
nine states, 1999-2002, CDC Morbidity and Mortality Weekly Report, 2003
12. Study suggests DDT breast cancer link, Los Angeles Times, September 30, 2007
13. Chemical watch fact sheet: synthetic pyrethroids,National Coalition Against the Misuse
of Pesticides, 1988
14. Methoprene, a review of the impacts of the insect growth regulator methoprene on non-
target aquatic organisms in fish bearing waters (ver. 2.0), Steven Antunes-Kenyon and
Gerard Kennedy, 2001
1
15. Assessment of environmental stressors potentially responsibly for malformations in
North American anuran amphibians, Gerald T. Ankley, S.J. Degitz, S.A. Diamond, and
J.E. Tietge, 2004
16. Developmental toxicity of methoprene and several degradation products in Xenopus
laevis, Sigmund J Degitz, Elizabeth J. Durban, Joseph E. Tietge, Patricia A. Kosian, Gary
W. Holcombe and Gerald T. Ankley, 2003
17. Investigation of the relationship between methoprene and deformities in anurans, Clive
A. Henrick, Jinren Ko, Jack Nguyen, Jim Burleson, George Lindahl, Douglas Van Gundy
and Julie M. Edge, 2002
18. Effects of ultraviolet light and methoprene on survival and development of rana pipiens,
Gerald T. Ankley, Joseph E. Tietge, David L. DeFoe, Kathleen M. Jensen, Gary W.
Holcombe, Elizabeth J. Durban, and Stephen A. Diamond, 1998
19. Permethrin spot-on toxicoses in cats, Jill A. Richardson, 2000
20. Ag chemicals may cause prostate cancer—farm harm—exposure to agricultural
chemicals, Science News, May 10, 2003
21. Household pesticides and risk of pediatric brain tumors, Janice M. Pogoda and Susan
Preston-Marin, 1997
22. Chromosome/genetic damage evident in immune system cells from permethrin,
Teratogenesis, Carcinogenesis, and Mutagenesis, 1994
23. Human exposure to mosquito-control pesticides—Mississippi,North Carolina and
Virginia, 2002 and 2003, CDC Morbidity and Mortality Weekly Report, June 3, 2005
24. Permethrin, Caroline Cox/Joumal of Pesticide Reform, 1998
25. A human-health risk assessment for West Nile virus and insecticides used in mosquito
management, Robert K.D. Peterson, Paula A. Macedo and Ryan S. Davis, 2006
26. Evaluating pesticides for carcinogenic potential, EPA website
27. Our stolen future, Myers, Dumanoski, Colbom, Plume Pub. ISBN 0-452-2741401, 1996
28. Follow-up of 2003 human West Nile virus infections, Denver, Colorado, Jennifer L.
Patnaik, Heath Harmon and Richard L. Vogt, 2006
29. The long-term outcomes of human West Nile virus infection, James J. Sejvar, 2007
30. DEET repellent fact sheet, Caroline Cox/Journal of Pesticide Reform, 2005
2
31. Modulation in acetylcholinesterase of rat brain by pyrethroids in vivo and an in vitro
kinetic study, Gazula Valeswara and Kosagi Sharaf Jagannatha Rao, 1995
32. Duke pharmacologist says animal studies on DEET's brain effects warrant further testing
and caution in human use, DukeMed News, May 1, 2002
33. Certified letter: registration with conditions of the new active ingredient Picaridin
contained in the new pesticide product OFF! Skintastic insect repellent, 2005
34. EPA fact sheet on DEET, 1998
35. Gulf war illness strongly linked to chemical exposure, washingtonpost.com, March 10,
2008
36. An ecological risk assessment for insecticides used in adult mosquito management, Ryan
S. Davis, Robert KD Peterson, and Paula Macedo, 2007
37. Diagrammatic illustrations of events during the seasonal arbovirus transmission cycle,
C.G. Moore
38. Soapbox: mosquito spraying carries long-term risks, The Coloradoan, September 18,
2003
39. California mosquito surveillance and response plan, State of California website, 2007
40. Numerous abstracts of papers dealing with permethrin and human/rodent studies and
wildlife studies provided by Lynn Carroll, The Endocrine Disruption Exchange (TEDX)
41. Efficacy of aerial spraying of mosquito adulticide in reducing incidence of West Nile
virus, California, 2005, Ryan M. Carney, Stan Husted, Cynthia Jean, Carol Glaser, and
Vicki Kramer, 2008
42. Evaluation primer on health risk communication programs, Agency for Toxic Substances
& Disease Registry, Department of Health and Human Services website
43. Community aerial mosquito control and naled exposure, Zandra Duprey, Samantha
Rivers, George Luber, Alan Becker, Carina Blackmore, Dana Barr, Gayanga
Weerasekera, Stephanie Kieszak, W. Dana Flanders and Carol Rubin, 2008
44. Prostate enlargement in mice due to fetal exposure to low doses of estradiol or
diethylstilbestrol and opposite effects at high doses, Frederick S. vom Saal, Barry G.
Timms, Monica M. Montano, Paola Palanza, Kristine A. Thayer, Susan C. Nagel, Minati
D. Dhar, V.K. Ganjam, Stefano Parmigiani, and Wade V. Welshons, 1997
45. Endocrine-disrupting chemicals threaten animal—and human—reproduction, Center for
Children's Health and the Environment website
3
46. West Nile virus economic impact, Louisiana, 2002, Armineh Zohrabian, Martin I.
Meltzer, Raoult Ratard, Kaafee Billah,Noelle A. Molinari, Kakoli Roy, R. Douglas Scott
II, and Lyle R. Petersen, 2004
47. Reproductive malformation of the male offspring following maternal exposure to
estrogenic chemicals, Chanda Gupta, 2000
48. The inverted "u-shaped" dose-effect relationships in learning and memory: modulation of
arousal and consolidation, Elisabetta Baldi and Corrado Bucherelli, 2005
49. Antibacterial chemical disrupts hormone activities, study finds, ScienceDaily, December
8, 2007
50. Effects of early exposure to xenoestrogens on the prostate gland, Gail S. Prins, 2001
51. Ten years of mixing cocktails: a review of combination effects of endocrine-disrupting
chemicals, Andreas Kortenkamp, 2006
52. Mosquito testing and response timeline, Michael Doyle, 2008
53. Environmental concentrations, fact, and risk assessment of pyrethrins and piperonyl
butoxide after aerial ultralow-volume applications for adult mosquito management,
Jerome J. Schleier II, Robert KD Peterson, Paula A. Macedo, and David A. Brown, 2007
54. West Nile virus neuroinvasive disease incidence in the United States, 2002—2006,
Nicole P. Lindsey, Stephanie Kuhn, Grant L. Campbell, and Edward B. Hayes, 2008
55. Combining mosquito vector and human disease data for improved assessment of spatial
West Nile virus disease risk, Anna M. Winters, Bethany G. Bolling, Barry J. Beaty, Carol
D. Blair, Rebecca J. Eisen, Andrew M. Meyer, W. John Pape, Chester G. Moore, and
Lars Eisen, 2008
56. Large effects from small exposures; mechanisms for endocrine-disrupting chemicals with
estrogenic activity, Wade V. Welshons, Kristina A. Thayer, Barbara M. Judy, Julie A.
Taylor, Edward M. Curran, and Frederick S. vom Saal, 2003
57. Vector index quantitative association to cases with onset 2 weeks later, data from 2003-
2007 in Fort Collins, Colorado, Roger Nasci, 2008
58. Communicating pesticide risks, Robert KD Peterson and Leon G. Higley, American
Entomologist 39(4):206-211,1993
59. Risk comparison—chemical exposure or West Nile virus? Bob Peterson, 2008
(presentation handout)
4
60. Effects of West Nile virus may persist, Journal of the American Medical Association
(JAMA), May 14, 2008
61. Mesa County 2004 West Nile virus outbreak, Mesa County Health Department, May 9,
2005
62. Risk assessments for the insect repellents DEET and Picaridin, Frank B. Antwi, Leslie M.
Shama, Robert K.D. Peterson, 2008
63. Loveland/Fort Collins Survey, Larimer County Department of Health, Spring 2004
5
S
Management Po cy Review
ical o Comm
Recommen tions
June 10 , 2008
Direction Souyffiliu
im
1 . What questions does Council have about
the West Nile Virus Management Program
or the recommendations of the Technical
Advisory Committee ?
2 . What feedback does Council have
regarding the adulticiding options ?
3 . What direction does Council have for the
City Manager regarding the funding needed
to implement any changes to the current
program ?
M
Bal"MUM;F
• West Nile virus first in Colorado in 2002
• City response : broad based , preventio
focused management plan
• Each year knowledge grows
• 2007 : severe outbreak , emergency use
of adulticides ; Technical Advisory
Committee formed in December
cal Advisory Committee
( TAC )
• Charge : review West Nile virus policy
and make recommendations regarding
possible revisions
• Initial update to City Council : April 22 ,
2008
TAC Membership
Boris Kondratieff, PhD — Entomologist , CSU
Adrienne LeBailly , MD — Director , LCDHE
Eric Levine - Chair, Air Quality Advisory Board
Greg McMaster, PhD - Plant physiologist / ecologist ,
USDA ; member Air Quality Advisory Board
Chester G . Moore , PhD - Entomologist , CSU
Roger S . Nasci , PhD - Entomologist , CDC
Former members :
Jackie Fields , MD - Physician specializing in treating
people with chemical sensitivities
Amy Dean - Ecologist ; member Natural Resources
Advisory Board
Existing Policy ram
• Goal : Reduce the risk of West Nile virus
infection while limiting adverse human and
environmental impacts
• Disease prevention , not nuisance control
• Basic program components :
. Public information and education
. Mosquito surveillance , trapping and testing
. Larva control focusing on Culex mosquitoes
. Periodic program evaluation
�& Progral
t�
• Adulticiding ( spraying adult mosquitoes
considered emergency response to
potential public health crisis
Roles
• Larimer County Department of Health and
Environment
— Local authority on health issues , recommends
actions
• City of Fort Collins
— Inform and educate citizens
— Participate in regional public education , outreach
— Administer, oversee contract
• Contractor
— Implement majority of program components
City Council Policy
• April 22 , 2008 : TAC recommendations
for public outreach , mosquito
surveillance , trapping and testing , and
larva control
• June 10 , 2008 : TAC recommendations
on adulticiding and other issues
MLOf A '
The challenge :
• Understanding human health risks from West
Nile virus
• Understanding human and ecological health
risks from pesticides used to reduce population
of disease - carrying adult mosquitoes
TAC process :
• Review literature and research , consult with
experts , utilize Committee expertise
,activeness
• 2005 Sacramento County study
• Colorado 2007 neuroinvasive disease
cases
• Mesa County 2004 West Nile virus
after- action report
Responding to the threat of
W e virus
Program response = series of actions
• Off season
• Level 1 — early season
• Level 2 — peak season , low West Nile
virus activity
• Level 3 — peak season , increasing Wes
Nile virus activity
• Level 4 — peak season , emergency level
Deciding whether or n
apply adulticides
• Recommendation made by Larimer
County Dept of Health and Environmen
• Based on several factors , including :
. Vector Index (density of infected
mosquitoes )
. Other surveillance information
. Context : weather, time of season , location
of infected mosquitoes , wind , etc .
. Expert interpretation of all available data
• Decision resides with City Manager
d p roto
• Truck- based applications , not aerial
• Targeted to areas where high level of infected
Culex mosquitoes
• Public notified through several channels ,
including reverse 9 - 1 - 1 and subscription
service
• No spraying near those on state Pesticide
Sensitivity Registry
• Individual residents not permitted to 96opt out"
■
A . Standard component of an integrated
pest management ( IPM ) program ;
recommendation comes from
contractor
B . Considered only as emergency
response to elevated WNV risk ;
recommendation comes from Larimer
County DHE ( current policy )
Four Adultici ng Options
C . Considered only as emergency
response to elevated WNV risk ;
recommendation comes from Larimer
County DHE and includes review by
City- appointed advisory committee
D . The City will not apply adulticides
under any circumstances
qM0SL
• Number of influe ospitalizations ,
West Nile virus lab - confirmed cases
• West Nile neuroinvasive disease across
United States
• Option of having an independent party
validate/conduct some operations
• How other communities address the
threat of West Nile virus ( including
public education and adulticiding )
io alysis ( cont )
• Data on the risk and negative impacts of
larvicides and /or adulticides used
. Risks to humans
. Risks to the environment
• Data on the risk and negative impacts
West Nile virus
. Numbers , types of illness
. Economic and social impact
Summary of
Recommendati
• Adopt written policy ; City Manager
oversees operations
• Devote additional resources to public
10
education , including expansion of onlin
and published mosquito infection data
• Enhance the larviciding program : add
Quality Control , amend the Code to
address stagnant water , document the
grid ( locations of mosquito traps )
Summar
• Conduct research to better understand
sources of infected mosquitoes
• If research supports it , consider using
helicopters for larval control , and
additional early use of Altosid
• Replace lab testing services that will be
discontinued by CDC in 2009
• Conduct annual evaluation of prior
season ; establish an ongoing TAC
Summary of
Recommendations - ont )
• Appoint advisory panel to review
adulticiding recommendations
• Add cost of adulticiding and public
notification to ongoing budget
• Notify people near those on Pesticide
Registry when their area will not be
sprayed
Next Steps
• July 1 , 2008 resolution adopting West
Nile Virus Management Policy
• Inform stakeholders
• Vector Disease Advisory Group —
exploring options for long -term , region
approach to mosquito management
1 . What questions does Council have about
the West Nile Virus Management Program
or the recommendations of the Technical
Advisory Committee ?
2 . What feedback does Council have
regarding the adulticiding options ?
3 . What direction does Council have for the
City Manager regarding the funding needed
to implement any changes to the current
program ?