Get ready for a new -- and nastier -- West Nile season

Last year's experience was unprecedented, with the detection of new routes of transmission and resulting chaos. Now experts are bracing for more.

By Victoria Stagg Elliott, AMNews staff. March 10, 2003.

West Nile Virus is on its way back -- this time, probably sooner and stronger than before.

Epidemiologists expect that in the upcoming season the virus will reach into all 48 contiguous states. Its westward movement would build on 2002 momentum, in which confirmed human cases occurred in 39 states and the District of Columbia, killing hundreds and sickening thousands. What does that mean for health care professionals now?

"We're watching and waiting," said Sandra Kemmerly, MD, medical director of infection control at the Ochsner Clinic Foundation in New Orleans. "We know it's going to come, it's just a matter of when."

Specifically, physicians are bracing for patient anxieties and concerns. Health departments are readying public awareness campaigns and infection control mechanisms. Researchers are trying to learn why the virus kills a few but hardly fazes most. And everyone is hoping for a rapid test, and maybe even a vaccine.

It's all part of the reaction to West Nile's changing identity since its 1999 American debut. For instance, its first season did not begin until August. The dozens who became ill and handful who died were in New York state. Last year, the onslaught came earlier, in June, and was far more widespread. Now, four seasons into the experience, questions persist about the virus itself, as well as newly discovered routes of transmission that complicate the public health landscape.

In areas not yet hit, health officials say they have a hard time convincing people to prepare for an uncertain danger. But even in endemic areas, the most basic method of controlling transmission -- that of mosquito control -- is not always a done deal. Some municipalities have refused to fund programs either because of fears of new taxes or the widespread spraying it might involve.