The Risk of West Nile Virus Infection Is Associated with Combined Sewer Overflow Streams in Urban Atlanta, Georgia, USA

Article excerpt

BACKGROUND: At present, the factors favoring transmission and amplification of West Nile Virus (WNV) within urban environments are poorly understood. In urban Atlanta, Georgia, the highly polluted waters of streams affected by combined sewer overflow (CSO) represent significant habitats for the WNV mosquito vector Culex quinquefasciatus. However, their contribution to the risk of WNV infection in humans and birds remains unclear.

OBJECTIVES: Our goals were to describe and quantify the spatial distribution of WNV infection in mosquitoes, humans, and corvids, such as blue jays and American crows that are particularly susceptible to WNV infection, and to assess the relationship between WNV infection and proximity to CSO-affected streams in the city of Atlanta, Georgia.

MATERIALS AND METHODS: We applied spatial statistics to human, corvid, and mosquito WNV surveillance data from 2001 through 2007. Multimodel analysis was used to estimate associations of WNV infection in Cx. quinquefasciatus, humans, and dead corvids with selected risk factors including distance to CSO streams and catch basins, land cover, median household income, and housing characteristics.

RESULTS: We found that WNV infection in mosquitoes, corvids, and humans was spatially clustered and statistically associated with CSO-affected streams. WNV infection in Cx. quinquefasciatus was significantly higher in CSO compared with non-CSO streams, and WNV infection rates among humans and corvids were significantly associated with proximity to CSO-affected streams, the extent of tree cover, and median household income.

CONCLUSIONS: Our study strongly suggests that CSO-affected streams are significant sources of Cx. quinquefasciatus mosquitoes that may facilitate WNV transmission to humans within urban environments. Our findings may have direct implications for the surveillance and control of WNV in other urban centers that continue to use CSO systems as a waste management practice.

KEY WORDS: arbovirus, Culex quinquefasciatus, risk factors, spatial clustering, spatial epidemiology, urban pollution. Environ Health Perspect 118:1382-1388 (2010). doi:10.1289/ehp.l001939 [Online 8 June 2010]


West Nile Virus (WNV) is a mosquito-transmitted virus (family Flaviviridae) and a human, equine, and avian neuropathogen (Kramer et al. 2008). The virus is indigenous to the old world (i.e., Africa and Middle East) and is maintained by a bird-mosquito-bird transmission cycle primarily involving Culex sp. mosquitoes; humans, horses, and other mammals are dead-end hosts for the virus (Kramer et al. 2008). Since its emergence in New York City in 1999, WNV has spread over much of North America and the Caribbean and has become a threat to public, equine, and wildlife health (Kramer et al. 2008; Lindsey et al. 2010). Human WNV infections cluster in space and time, with the highest concentrations of cases occurring in urban environments during the summer (Brown et al. 2008; Kramer et al. 2008). Factors that strongly influence WNV transmission dynamics in urban environments throughout the United States include variation in the occurrence and competence of mosquito vectors and vertebrate reservoirs (Kilpatrick et al. 2006a; Reisen et al. 2005, 2008a; Turell et al. 2005), local variation in mosquito feeding patterns (Hamer et al. 2009; Kilpatrick et al. 2006b), bird-herd immunity and infectiousness (Reisen et al. 2008b), WNV genotypes (Bertolotti et al. 2008; Kilpatrick et al. 2008), human population characteristics (Ruiz et al. 2004, 2007), climate, and other environmental variables (Kilpatrick et al. 2008; Soverow et al. 2009).

Information on the distribution and abundance of mosquito vectors in urban environments is paramount for assessing local risks of exposure to WNV. In the United States, members of the Culex pipiens complex (Cx. pipiens and Culex quinquefasciatus), Culex tarsalis, Culex stigmatosoma, Culex salinarius, Culex nigripalpus, and Culex restuans have been implicated as urban vectors of WNV (Hayes et al. …