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HUMAN EASTERN EQUINE ENCEPHALITIS IN MASSACHUSETTS: PREDICTIVE INDICATORS FROM MOSQUITOES COLLECTED AT 10 LONG-TERM TRAP SITES, 1979–2004

Human eastern equine encephalitis (EEE) is a life-threatening mosquito-borne disease. To determine whether mosquito abundance and EEE virus infection rates are associated with human EEE disease, we evaluated retrospectively a total of 592,637 mosquitoes and onset dates for 20 confirmed human cases over 26 years in Massachusetts. Annual Culiseta melanura populations at 10 defined sites decreased over the study period (P = 0.002). Weekly infection rates and number of infected Culiseta melanura captured per trap night were positively associated EEE cases (P < 0.023 and P < 0.001, respectively), whereas abundance was not (P = 0.077). The infection rate for Culiseta melanura of 0.39 per 1,000 tested mosquitoes identified human cases with a sensitivity of 0.87, a specificity of 0.82, a positive predictive value of 0.14, and a negative predictive value of 0.995. Timely mosquito testing and infection rate calculation are critical for disease risk estimation and outbreak control efforts.

Received December 30, 2005. Accepted for publication November 13, 2006.

Acknowledgments: We are grateful to the field, laboratory, and epidemiology staff of the Arbovirus Surveillance Program at the Massachusetts State Laboratory over the course of the study period, especially former laboratory directors, G. F. Grady and R. J. Timperi. The authors thank A. DeMaria and J. Yasuoka for critical review of the manuscript; H. Uno for suggestions about the statistical analyses; and A. Spielman, R. Pollack, A. Kiszewski, S. Telford, and colleagues for discussions about arboviral surveillance. Our special thanks to the Mosquito Control District personnel, local health departments, and health care providers who make arbovirus surveillance possible in Massachusetts. M.H. was supported in part by Drs K. and H. Mukaiyama Fund, Yokohama Medical Association.

^* Address correspondence to Barbara G. Werner, State Laboratory Institute, 305 South Street, Boston, MA 02130. E-mail: barbara. werner{at}state.ma.us

Authors’ addresses: Masahiko Hachiya, Matthew Osborne, Cynthia Stinson, and Barbara G. Werner, State Laboratory Institute, 305 South Street, Boston, MA 02130, Telephone: 617-983-6365, Fax: 617-983-6363, E-mails: barbara.werner{at}state.ma.us, hachiya.masahiko{at}post.harvard.edu, matthew.a.osborne{at}dph.state.ma.us, and cynthia.stinson{at}state.ma.us.

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