First, let’s start out this blog by reassuring our seniors that millions of mosquitoes are not waiting to attack during their first opportunity. However, it is important to know just what threat mosquitoes can pose to the elderly both here in Southern New England as well as to those who are traveling to foreign countries. As with most illnesses spread by insects, seniors are most affected due to their weakened immune systems.
Last month, United States Health Officials issued a press release stating that the number of Americans that are sickened each year from infected mosquitoes, ticks or fleas have “tripled from 2004 through 2016” with infection rates “spiking sharply in 2016 as a result of the Zika outbreak”. In fact, infections in 2016 went up 73 percent from the previous year reflecting the emergence of Zika.
Earlier this year, Connelly Law Senior Issues blog discussed the increase in tick related infections and the emergence of new tick species here in the Northeast. Now with the onset of hot weather and seniors spending more time outside, we also need to be concerned with mosquito borne infections.
The concerns are not just what’s in our backyard, but what exists in the world. As we have stated multiple times, we have an aging nation but we also have seniors who have more money available to them than they did in the past. As a result, many are traveling more and becoming exposed to diseases that may not affect them here in the United States.
Others, who may have immigrated to this country, return home to visit family members and come in contact with various diseases and viruses not seen here. This includes travel to the Caribbean, Asia and parts of Africa.
“It’s great that our seniors are traveling and visiting other countries", said Attorney Connelly. “But with this travel come concerns that seniors must be aware of. This includes the infections carried by mosquitoes in parts of the world that don’t have the same standards of hygiene as we do here or have immunity that those living there may have. Traveling does come with risks.”
In this blog, we’re going to take a look at some of the major infections carried by mosquitoes here and in other parts of the world. These will include West Nile Virus, Eastern Equine Encephalitis, Chikungunya, Zika, Yellow Fever, Malaria and Dengue.
Let’s get started.
West Nile Virus
This virus was first isolated in Africa in 1937 and quickly spread throughout the
region. In 1999, a strain of the virus that was active in Israel and Tunisia was imported into New York and resulted in a huge outbreak that spread throughout the continental United States. Today, this virus is firmly established in this country.
West Nile is transmitted by the Culex mosquito, who acquire the virus by feeding on infected birds. The strain that is active in the United States is extremely deadly for crows, so the sight of dead birds may indicate the presence of this virus.
Most people who are bitten do not develop any symptoms (8 out of 10), but those who do develop fevers, aches and nausea. About 1 in 150 will develop encephalitis, a much more serious disease, that could result in death.
Unfortunately, people older than 50, especially those over 65, have the highest risk of developing encephalitis.
There is no vaccine for West Nile and treatment consists of addressing the symptoms such as fever and dehydration. In severe cases, hospitalization may become necessary.
Preliminary 2017 data map on West Nile Virus disease cases.
Eastern Equine Encephalitis Virus (EEEV)
Massachusetts appears to be ground zero for this infection. EEE was first found in horses in Massachusetts in 1831 and in 1938, the first confirmed human cases were found in New England. Today, EEE is present in North, Central and South America where it is also called “sleeping sickness”.
The mosquito that actually carries EEE does not usually bite humans but prefers animals. However other mosquitoes, who do feed on both humans and animals, carry the disease between the species. These mosquitoes include that Aedes, which we are most familiar with.
The risk of contracting the EEE virus is highest during the summer months, and those who live and work near wetland and swamp areas are at higher risk of infection. EEEV is only spread to humans via mosquito bite, and cannot be transmitted directly by other humans or horses.
EEE is a rare but very serious disease that involves inflammation and swelling of the brain. Fortunately, only 5% of human EEEV infections result in EEE. However, one out of three people who develop EEE will die, and many survivors have mild to severe brain damage.
Of those who contract the EEE virus, the elderly (ages 50 and older) and young (ages 15 and younger) are at the greatest risk of developing encephalitis.
Latest numbers indicate that Massachusetts leads the country in EEE infections followed by Florida, North Carolina and New York.
There is no human vaccine for EEE and treatment consists of monitoring the symptoms and providing medical support as necessary.
Although rarely fatal, chikungunya is a virus that causes debilitating joint pain
accompanied by fever and rash. First found in the tropics of Africa, it rapidly spread east into Europe and then into the America’s. By 2017, there were more than 1.7 million infections in North and South America. Although not currently spreading in the United States, there have been nearly 1000 cases identified in 44 states as a result of travel where this virus is active in mosquitoes.
In countries where chikungunya is most active, health experts say there are more chances of elderly patients succumbing to the disease due to their low immunity levels, combined with chronic health problems like heart or kidney ailments.
"The problem can be severe among those who already have kidney problems, chest infections and heart diseases. The virus can stop the functioning of the organs. This is mostly common among elderly patients with low immunity power. The whole story is about immunity," said Dr. Sumit Ray, who heads the critical care unit at Sir Ganga Ram Hospital in India, where this virus has a stronghold.
There is no vaccine for chikungunya and the symptoms are treated. However during the first week of the virus, a mosquito can spread it from the infected person to another.
We have all been exposed to the stories about the emergence of the Zika virus.
What many remember the most are the effects of this disease on pregnant women and their unborn children.
Those who contract this virus usually experience no symptoms or only a mild disease that may involve fever, rash, and joint pain in most people who become infected. However, the disease can cause severe neurological defects in the developing fetuses of pregnant women who are infected with Zika virus. A significant number of the babies of these women are born with microcephaly, a rare disorder in which a baby’s head is much smaller than normal. This defect can lead to developmental problems ranging from mild to severe and is sometimes fatal.
Zika was an obscure virus that was not associated with serious disease until it emerged explosively in Brazil in 2015 and spread rapidly throughout Latin America. Because Zika virus had not been found in the Americas previously, there was no immunity to the virus in the population and nearly everyone was susceptible.
One thing that is unique is that Zika can be spread from human to human through sexual intercourse. So anyone traveling to countries where Zika is very active is recommended that the use of condoms. Zika can also be spread through blood transfusions.
Although Zika has been primarily discussed around the dangers for pregnant women, the elderly are also at risk.
In fact, Zika can have specific implications for older adults:
As people age, their immune systems weaken. This can make it harder to fight off illness and infection. It may be more difficult for an older person to recover from Zika than a younger person. It may also make the body more susceptible to other illnesses.
Guillain-Barré syndrome (GBS) is associated both with older age and Zika virus. GBS is a rare disorder that causes a person’s immune system—how the body fights off disease—to damage its own nerve cells. It can cause muscle weakness and paralysis, sometimes affecting the muscles that control a person’s breathing. In severe cases, GBS can result in death. Risk for GBS increases with age, and people age 50 and older are most affected.
Age does not protect you from sexually transmitted diseases. Zika can be passed from a person who has the virus to his or her sex partners. No matter how old you are, you should practice safe sex and use condoms if you or your partner show symptoms or have recently traveled to an area where Zika is found.
As with the previous viruses we discussed, there is no vaccine and treatment consists of addressing the symptoms.
Areas with reported Zika outbreaks, cases in 2017-2018
Yellow fever, you might ask? Why is this being discussed in the United States. Well, the United States has quite a history of Yellow Fever outbreaks.
One of the first Yellow Fever outbreaks here occurred during the late 1600s
followed by another during the summer of 1793 when refugees from a yellow fever epidemic fled the Caribbean and ended up in Philadelphia. Within weeks, the city was loaded with citizens reporting symptoms. By early fall, over 100 people were dying daily. By the time it was over, over 5000 people died in Philadelphia alone.
During the Civil War, more soldiers died from disease than from actual battle related injuries. Yellow Fever, called "Yellow Jack" by the soldiers, could wipe out a platoon in a matter of weeks.
But with better sanitation, knowledge of mosquito control methods and education on protection against the bites of this insect, diseases like Yellow Fever have all but disappeared from the United States. But it is still widespread in areas where Americans travel and where many have relatives.
This does not mean that we will never experience another Yellow Fever outbreak here. In April of this year, the World Health Organization identified Miami, Florida as one of the global cities that is susceptible to the spread of this disease because travel here does not require an immunization. Infected travelers arriving in South Florida could be bitten by mosquitoes here, which could then spread the disease through bites to other people.
The good thing is, there does exist a vaccine for Yellow Fever. But it comes with caution – it does contain the live virus. Yellow fever vaccine should be given cautiously to people older than 60 years, and it should not be given at all to people with certain immune-suppressing conditions. Seniors should discuss their detailed travel plans with their doctors and, if necessary, alternatives to vaccination.
Once yellow fever is contracted, the symptoms are treated and not the disease. Because Yellow Fever can cause bleeding, certain medications that interfere with clotting need to be avoided.
Dengue has emerged as a worldwide problem only since the 1950s. Although dengue rarely occurs in the continental United States, it is endemic in Puerto Rico and in many popular tourist destinations in Latin America, Southeast Asia and the Pacific islands.
The principal symptoms of dengue fever are high fever, severe headache, severe
pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g., nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.
Dengue is a neglected tropical disease that is increasingly affecting elderly patients. However, with aging population there has been an increase in dengue incidence rates in older adults. In Taiwan older adults have the highest reported dengue incidence rate and risk of fatality. Likewise in Singapore elderly patients accounted disproportionately for the majority of dengue deaths highlighting the urgent need for enhanced understanding of dengue in the elderly to improve clinical management and outcome.
Once dengue is contracted, the symptoms are treated.
The Dengue fever risk is very close to the continental United States and very active in frequent vacation spots frequented by seniors, including Caribbean hotspots, Mexico and South America.
Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2016 an estimated 216 million cases of malaria occurred worldwide and 445,000 people died, mostly children in the African Region.
About 1,700 cases of malaria are diagnosed in the United States each year. The
vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia.
Researchers from the London School of Hygiene and Tropical Medicine and the University of Oxford found that the risk of dying from the disease for tourists who have visited a malaria-infected country increases steadily with age.
Travelers over the age of 65 are almost 10 times more likely to die from the disease than those who are aged 18-35, they revealed in a study published online by the British Medical Journal
There are currently several vaccines that can provide some protection and recent research is suggesting combining them for better outcomes. If malaria is contracted, there are multiple medications used to treat it.
This map, from the CDC, was last updated in February, 2018. As you can see, Malaria is active just south of our border and in destination spots in South America and Asia.
If you are in your backyard around dusk or relaxing on a beach in the Virgin Island, protecting yourself is the best way to avoid getting sick. The CDC says that modern mosquito control methods are great at keeping these insects at bay, but all bets are off outside of this country.
According to the Centers for Disease Control, there are some things you can do to keep yourself safe:
Reduce the number of bites you get by using EPA approved insect repellent products.
Mosquitoes are most active from dusk to dawn. Avoid being outside during these hours or wear repellent and protective clothing during these hours.
Reduce the number of mosquitoes by emptying standing water, change bird bath water and maintain clean gutters.
Help seniors by repairing window screens or screen doors.
If you plan to travel, check with your doctor about vaccines or boosters that may be helpful. Also, know where you are going and know what diseases or viruses are most active there. Knowing you may have a chronic health condition should factor in on your travel destinations.
“When we do blogs like this, we are not sounding the alarm bell or trying to scare seniors as contracting these diseases are relatively uncommon," states Attorney Connelly. “But what we are doing is acknowledging that we live in a different time where travel and outdoor activities are now the norm for people of all ages. We look to educate and hopefully help our seniors make better decisions around personal safety."
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.