Edward T. Ryan, M.D.
The United States Centers for Disease Control (CDC) function as the national public health authority. Within the Centers is the Division of Vector Borne Infectious Diseases (DVBID). Its mission is to provide, at the national level, surveillance, research, diagnostic testing and assistance to state, local and foreign governments with regard to vector borne diseases. Those are illnesses carried by mosquitoes, ticks, fleas and other animals that can be transmitted to humans.
The budget for the DVBID in 2010 was $26.7 million. That line has been defunded in the Administration's 2011 proposal, with $18.9 million added to the emerging infectious diseases area. Here is the budget request description from page 14 of the Executive Summary:
The FY 2011 budget request does not include funding for Vector-borne Diseases. No specific funding is included for vector-borne activities, including West Nile Virus surveillance (WNV).
Several years of CDC funds have allowed states to develop and enhance their WNV activities. FY 2011 funds include $155.2 million for the emerging infectious disease budget line, an increase of $18.9 million above the FY 2010 Omnibus. These emerging Infectious disease funds can support vector-borne activities in FY 2011, including WNV if determined a priority by States and the CDC.
The American Society for Tropical Medicine and Hygiene (ASTMH) has called for restoration of the funding for DVBID. Edward T. Ryan, M.D., President of the ASTMH, spoke with me recently about this issue.
According to Dr. Ryan, 1 in 50 people worldwide die from an illness resulting from an insect bite. In the United States, diseases carried by insects such as Lyme disease, spotted fever and West Nile affect tens of thousands of people every year.
Dr. Ryan pointed to the current outbreak of dengue fever in South Florida. The only national facility with dengue testing capability is operated by DVBID, in Puerto Rico. He described the lab as more than a national asset. The World Health Organization has designated it the testing lab for the region.
The increase in the budget for emerging infectious disease will not make up for the cuts to the DVBID program, Ryan said. Emerging infectious disease includes many illnesses that are not vector borne. There is no assurance that the new funds will be utilized for illnesses carried by mosquitoes, ticks, fleas and other animal carriers.
Dr. Ryan pointed out that a patient can become infected through an insect bite overseas and in three hours be in the United States. That patient can then become the center of an outbreak if bitten by some of the local insect population. The several local malaria outbreaks that have been seen since it was declared eradicated in the 1950's demonstrate that point.
The Senate has restored funding to the Division of Vector Borne Infectious Diseases in its present version of the 2011 budget, Dr. Ryan states. The House has yet to act so the potential remains that the DVBID may not have a budget next year.
Ryan described the progress of another mosquito borne illness, chikungunya fever, from Africa. It moved, first to India, and then to Italy. The varieties of mosquitoes that can carry this illness are found throughout the United States. While many patients recover in several weeks from the illness, the doctor described a prolonged arthritis or incapacitating joint pain that some patients suffer for months. The CDC itself has this warning:
Given the current large chikungunya virus epidemics and the worldwide distribution of Aedes aegypti and Aedes albopictus mosquitoes, there is a risk of importing chikungunya virus into new areas through infected travelers.
The American Society for Tropical Medicine and Hygiene, with Dr. Ryan in the lead, believes that it is important to have the Division of Vector Borne Infectious Diseases fully funded. Dengue fever, West Nile, and Lyme disease are already in the United States. Other illnesses carried by insects such as chikungunya fever are expanding the areas they affect. Vector borne illnesses are not going away.
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