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2004 Model Practice Application (Public)

Application Name: 2004 Model Practice Application (Public) : Louisville Metro Department of Public Health and Wellness : Mosquito Control Program
Applicant Name: Dr. LaQuandra S. Nesbitt
Practice Title
Mosquito Control Program
Submitting LHD/Agency/Organization
Louisville Metro Health Department

Overview

In 2003, the Louisville Metro Health Department initiated a new practice, “A Community Approach to Mosquito Control.” The goal was to reduce the mosquito population in Metro Louisville and subsequently reduce mosquito-borne disease transmission, improving the health and quality of life for the nearly 700,000 residents. During 2002, 28 confirmed cases of West Nile virus were diagnosed in Louisville, including two West Nile virus-related deaths. West Nile virus transmission was also identified in numerous equine, bird, and mosquito samples.

The new practice was a collaborative effort of eight departments of the newly merged government and numerous community partners, working to eliminate standing water on their property or service/maintenance area, applying larvacides, and educating the public on mosquito control activities. There are over 200 employees trained, state certified and applying mosquito larvacides in Louisville, compared to the 12 Health Department employees of years past. This enabled the Health Department staff to accomplish other practice objectives, including increased mosquito population surveillance, disease surveillance, and public education.

Health Department staff, along with a partnering agency, responded to record number of requests for service from community residents: nearly 4000 requests in 2003, compared to 2200 requests in 2002. Larvacide applications more than doubled compared to the previous year. This practice contributed to the significant decrease in West Nile Virus activity. In 2003, there were no confirmed human cases of West Nile virus in Louisville, even though human cases were diagnosed in neighboring communities. West Nile virus-positive equine, bird, and mosquito samples also decreased in 2003 compared to 2002. The newly merged government, the citywide mosquito control ordinance, and support of the Mayor were essential in guaranteeing the commitment of the partners in this new practice. With this infrastructure in place, the health department is working to improve this practice by increasing communication and sharing resources.

Responsiveness and Innovation
The public health need the practice addresses is increased mosquito control for the community. In 2002, there were 28 confirmed human cases of West Nile virus in the Louisville Metro area, including two West Nile virus related deaths. West Nile virus was also found in 10 horses, 63 birds, and 19 mosquito samples in Metro Louisville during 2002. By developing this community approach to mosquito control, partnering with numerous metro government agencies and community partners, more people were working towards reducing the mosquito population, therefore, reducing the chance for mosquito borne disease transmission.

Mosquito control activities are usually performed by a single agency within a community or contracted to a private pest control company. Some communities may incorporate two different agencies, but usually one handles the control activities while the other is responsible for disease surveillance. Louisville’s Mosquito Control Program incorporates numerous agencies across Louisville Metro government and several community partners, organizations that either own or maintain large areas of property that may contain mosquito-breeding sites. These organizations also help distribute mosquito education materials.

Agency Community Roles
The Louisville Metro Health Department’s Mosquito Control Program is responsible for coordinating, training, and monitoring this multi-agency effort. Partners in this collaboration are responsible for providing staff and the cost of their larvacides. Once staff from each agency were trained and certified they began mosquito larvacide treatments on their properties and service areas. By eliminating breeding sites, each partner helps minimize mosquito-borne disease transmission and improve quality of life for their staff, visitors, and neighboring residents.

Government agencies that partnered with the Louisville Metro Health Department in this program included the Louisville Metro Office of the Mayor; Public Works, Parks Department, Metropolitan Sewer District, Office of Inspections, License &Permits (Zoning and Code Enforcement); Louisville Zoo; Facilities Management; and Solid Waste Management & Services. The community partners included Jefferson County Public Schools, Louisville Water Company, Churchill Downs, and the Louisville Gas and Electric Company. Partners like the Louisville Zoo and Churchill have animal populations that are extremely sensitive to mosquito-born disease, Jefferson County Public Schools and Parks Department want to reduce mosquito populations for students and visitors. All agencies have a responsibility to the residents of their community.

Costs and Expenditures
The Louisville Metro Health Department has an annual budget of $382,000 for mosquito control activities. Thanks to this new practice, the Health Department should incur less cost annually after the initial year or be able to provide additional services for the same amount of funding. By having other agencies and property owners take responsibility for mosquito control on their property or in their maintenance areas, Health Department staff should spend less time treating and more time on other activities, such as surveillance and monitoring.

Since the 2003 merger of Jefferson County and City of Louisville governments, the entire metro area has had a local ordinance that addresses mosquito breeding and the enforcement capabilities of the Health Department and allows for the Health Department to recoup costs incurred when treating the property of noncompliant owners. This ordinance is in addition to contractual agreements between the Health Department and other agencies for reimbursement of mosquito control activities performed on their property. The ordinance helps ensure that property owners, including some partners in this practice, will continue mosquito control activities.

The cost of new computer equipment for the program is approximately $20,000, with an additional $6000 annually for wireless service connection. Also, the Health Department incurred an expense of $3,000 in staff time for approximately 150 hours spent on developing and administering the trainings.

Implementation
Training with partners for this practice began in late March 2003. With the support of the Louisville Metro Mayor, agency directors met in early May 2003 to better coordinate this collaborative practice. In the following weeks, the Health Department trained over 130 staff members from other agencies to identify mosquito breeding sites and properly apply larvacides. State certification is required to apply pesticides in Kentucky so The Department of Health also provided a series of trainings for the KY Department of Agriculture Division of Pesticides certification exam. Later, workshops were also provided to earn CEUs needed to retain this certification.

The Health Department begins treatment activities as early as April every year. Due to lack of training, certifications and pesticides, other agencies started later, but by mid-July 2003 most of the partners began mosquito control activities. There was no set timeline for control activities, although the goal was to have this practice in place in time for the 2003 mosquito season, which typically runs May-September. The goal is to prevent mosquito larva from hatching into adults, thereby preventing mosquito populations from transmitting disease to humans.

To better coordinate everyone’s efforts, the Health Department began integrating Louisville residents’ mosquito control service requests into a new computer information system, Metro Call/HANSEN. This system, already being used by some of the metro agencies, contained customer service, property ownership, drainage, topography, mapping, and other information. The Health Department field staff used wireless notebook computers, connected to the information system, to track treatments with the newly implemented mapping program. Staff was able to respond more efficiently to citizen requests, and other agencies were able to access this treatment activity to prevent overlap.

Sustainability
Outcome Process Evaluation
There were several challenges encountered while implementing the new practice. The health department had hoped to begin the collaborative effort early in the spring, but there were delays in coordinating the 130 employees for training. It was more difficult to train staff than had been anticipated. Training programs designed for Health Department staff, were modified to address a wider audience. There were delays in purchasing mosquito larvacides, many suppliers were out of stock and shipments were backordered. Activity reports by participating agencies were delayed or missing, creating holes in communication and causing some duplication or interruption in services. It was July before the Health Department was online with the new computer information system, due to delays in equipment and availability of technical services. Once online, activities were easier to track. An unexpected challenge was the heavy rainfall in 2003, creating more flooding and standing water problems than usual. Another unexpected challenge was the large number of requests from city residents, in response to the standing water and to the press releases of this new mosquito control collaborative effort. In a normal season the health department receives 1200 requests for service, in 2003, the health department received almost 4000, fortunately these service requests were shared with other another agency participating in the program. From these experiences, health department staff learned to begin coordination earlier in the season and to create specific guidelines and procedures including better defining responsibilities for each participant.

The Health Department population and disease surveillance activities helped serve as evaluation methods for this practice. Staff set up weekly adult mosquito collection traps, gravid and light, throughout the city. The mosquitoes are counted, identified for species and tested for presence of arboviruses. The Health Department also monitors mosquito borne disease transmission in the community by testing birds for the disease and tracking potential equine and human cases with the KY Department for Public Health, local hospitals, physicians and veterinarians. West Nile Virus activity was significantly lower for 2003, compared to the 28 human cases, 10 horse, 63 bird and 19 mosquito samples in 2002. There were no confirmed human cases of West Nile virus in Metro Louisville for 2003. Three horses, five birds and one mosquito sample tested positive for West Nile virus. The gravid trap collection numbers decreased in all sites from June through August, with the exception of one location. This time period correlated with the onset of expanded treatment activities. Additional factors could have possibly affected the results, including disease cycles, rainfall, temperatures, and disease resistance. Regionally, West virus activity was also decreased, but not as low as in Louisville. In 2002, 28 of the 75 confirmed cases of West Nile virus activity in Kentucky was found in Louisville. In 2003 there were 14 cases in the state, but none in Louisville and numerous human cases were diagnosed in bordering states.

Lessons Learned
Key Elements Replication