An Integrated Vector Management Approach Towards Emerging Infectious Diseases Prevention in Harris County and the City of Houston, Texas

State: TX Type: Promising Practice Year: 2018

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Harris County Public Health 
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An Integrated Vector Management Approach Towards Emerging Infectious Diseases Prevention in Harris County and the City of Houston, Texas
Harris County Public Health (HCPH) is the county Local Health Department (LHD) for Harris County, Texas the third most populous county in the United States providing comprehensive health services to the community through an annual budget of $100 million and a workforce of over 700 public health professionals. The HCPH jurisdiction includes approximately 2.2 million people within Harris County's unincorporated areas and over 30 municipalities located in Harris County, Texas (not including the City of Houston). However, mosquito and vector control public health services encompass the entirety of the county including the City of Houston providing services to 4.5 million people. Emerging Infectious Diseases (EID) are defined by the Centers for Disease Control and Prevention (CDC) as those diseases in which incidence in humans has increased in the past 2 decades or threaten to increase in the near future.” Many of the pathogens capable of causing EIDs are vector-borne, or those transmitted to humans and animals by arthropods, and the World Health Organization (WHO) estimates that 4 out of 5 people worldwide are at risk of contracting pathogens transmitted by kissing bugs, ticks, mosquitoes, and other vectors. Texas is uniquely positioned to support various vectors capable of transmitting multiple types of vector-borne pathogens: most of the reported autochthonous cases of Chagas disease transmitted by kissing bugs have occurred in Texas, previous research has shown that 1 in 5 ticks in Texas carry various pathogenic bacteria, and Texas was the second state in the US to report local transmission of Zika virus by Aedes aegypti mosquitoes. HCPH Mosquito and Vector Control Division (MVCD) added a Vector Surveillance Branch in 2016 to further integrate our vector surveillance and EID prevention efforts. HCPH recognizes the increased risk of EIDs to Harris County residents and the City of Houston and has dedicated resources to address these emerging threats. Goal: Integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 1. Utilize county and collaborative resources to support program components. 2. Maintain and adapt program processes as new methodologies and technologies become available. 3. Enhance and streamline the notification system for vector-borne disease presence. HCPH Mosquito & Vector Control is one of the largest mosquito and vector control programs in the U.S. Its comprehensive and holistic integrated vector management approach makes it a premier national leader in EID surveillance, control, preparedness, and response. To accomplish program goals that establish and maintain strong working relationships with internal and external partners, provides us with the foundation in which all program components depend on. Through these means, MVCD is able to follow the One Health concept by partnering with other internal divisions and offices in HCPH to focus through a health equity lens to accomplish broader goals related to public health practice in Harris County/Houston. These partners include other HCPH program areas such as Epidemiology, Communications, Public Health Preparedness, Veterinary Public Health, and Environmental Public Health, and other external partners such as University of Texas Medical Branch at Galveston (UTMB-G), University of Houston (UH), Baylor College of Medicine (BCM), Texas A&M University (TAMU), University of Texas Health Science Center-School of Public Health, Texas Mosquito Control Association (TMCA) and American Mosquito Control Association (AMCA) among others. In addition to the mosquito and vector surveillance conducted by MVCD, our collaborative work with partnering entities allows us to further our community outreach to cover all areas of Harris County/Houston in the most efficient way possible saving time and valuable resources. This carries over into our year-round disease surveillance efforts. Independent of seasonality, MVCD continuously tests collected vectors to detect vector-borne pathogens present, conducts inspections to determine areas at risk, and engages with stakeholders to provide health communication messages. The detection of mosquito and vector-borne pathogens through surveillance methods initiates control activities and public notification of possible potential increased risk. The success of these control measures is evaluated and the need for additional vector control efforts is determined. This process is repeated with adjustments being made as needed to ensure that program goals are met effectively and efficiently.
The EIDs are not limited by country borders. Many of these vector-borne diseases initially thought to no longer be a threat in the U.S. but are now re-emerging, while others are emerging for the first time. The location of Texas provides a prime crossroads for these re-emerging pathogens and introductions. According to the Texas Department of State Health Services (DSHS), there have been 14 different vector-borne diseases reported in Texas in the past 5 years, of which 9 are classified as EIDs. The vector-borne EIDs with the most impact to Texas are Lyme disease, spotted fever group rickettsioses (vectored by ticks), malaria, chikungunya, and dengue (vectored by mosquitoes), and Chagas disease (vectored by kissing bugs). West Nile virus (WNV) contributes 74% of all arboviral diseases reported in Texas; chikungunya virus 15%, dengue virus 9%, and Zika virus 2% of all arboviruses specifically vectored by mosquitoes in Texas. Three of these 4 arboviruses are EIDs. Diagnostic Isolation to Treatment Time – In 1984, Harris County established one of the only few existing in-house virology laboratories in the nation. The Virology Laboratory of MVCD continues to play a vital role in detecting EIDs through the testing and analyses of collected mosquitoes. The methodologies integrated into Virology's test program not only screen for and target infectious pathogens that are endemic to our region, i.e. WNV, but also incorporate the latest in testing technology, thereby enhancing our capability to detect EIDs such as chikungunya, dengue, and Zika viruses. Such EIDs possess the potential for becoming serious epidemiological problems, not just for Texas, but more specifically for the communities that our MVCD serves. This enhanced testing capability can be transitioned to include other vectors as well. Having a laboratory capable of testing for arboviruses on site continues to be advantageous for MVCD, particularly, in terms of shortening the amount of time between virus isolation and appropriate treatment measures used. Obtaining test results in a timely manner, typically within 3 days of vector collection, is a key component in the expeditious application of control measures to help prevent the spread of EIDs. As a result, the reduced diagnostic isolation to treatment time aids in the classification and recognition of MVCD as a Model Practice Leader. In addition to the rapid test result system in-house at MVCD, we also test new technologies to increase efficiency in our Avian Surveillance Program. HCPH MVCD was the first in the US to utilize Loop-mediated Isothermal Amplification (LAMP) technology to test for WNV in avian blood samples which is currently only used for testing mosquito pool samples. This technology will reduce the time needed for testing while also eliminating the need for additional PCR laboratory space for avian sample testing, resulting in time and cost savings. MVCD Web – This new database reduced information silos internally, thereby expanding information sharing capabilities that not only enhanced individual program area processes, but influenced better decision making collectively. Previously each program area utilized a separate Access database on Sequel. These stand-alone data collection sources made it difficult to access and share information internally and externally. Insecticide Resistance Management – In 2004, the Testing and Evaluation Section started evaluating potential pesticide resistance in wild Culex quinquefasciatus mosquitoes from various regions in Harris County/Houston after WNV emerged in Texas. Testing was initially run through field-cage testing. In 2017, two additional Aedes mosquito species were added to our field cage testing protocols, i.e. addition of bottle bioassays to enhance the pesticide resistance monitoring program. The additional mosquito vectors, Aedes aegypti and Aedes albopoictus, are known vectors of multiple EIDs in the Americas including dengue fever, yellow fever, chikungunya, and Zika virus. The incorporation of insecticide resistance testing and evaluation as part of our comprehensive vector management program has proven to be critical in determining both efficacy of pesticides tested and resistance in vector populations to current chemicals in use. Adjustments to control efforts were based on our insecticide resistance testing and evaluation. The most significant adjustment made was the rotation of chemicals used in a given area from treatment to treatment when multiple insecticide applications were conducted. What makes our rotation unique is our ability to alternate between two different chemicals of two different classes within the same vehicle spray system. Microsoft Corporation Mosquito Smart Trap– In symmetry with our rapid test isolation and treatment time, MVCD was chosen to partner with Microsoft Corporation to field test an innovative and automated mosquito trap that will revolutionize and ultimately save valuable time and resources in mosquito surveillance throughout the world. This innovative and automated trap, as part of Project Premonition, aims to differentiate mosquitoes as they fly into the trap. Precious time in the virus isolation process is eliminated as only certain mosquito species of public health importance are trapped and the significantly reducing the long and cumbersome sorting process. With the availability of this new technology, the entire EID detection and notification system can be adapted even further to protect Harris County/Houston residents. HCPH MVCD's new Vector Surveillance Branch also aids in the unique and innovative ways we are impacting Harris County/Houston. For over 50 years, HCPH has been a leader in mosquito surveillance in our region and throughout the nation, however, mosquitoes are not the only vectors capable of transmitting pathogens to humans. With the expansion of surveilling for other vectors, HCPH MVCD has added and established another model practice program to its important mission. MVCD currently surveys Harris County/Houston for both kissing bugs and ticks, and will expand to even more vectors in the near future. Kissing bugs are collected in the county through public submission, trapping, and active surveillance, and sent to BCM for various tests including pathogen detection. Ticks are also collected throughout the county through trapping and active surveillance, and transported to UTMB-G for pathogen detection. Through these surveillance avenues, MVCD can create a holistic view of EID risk and pathogen presence in Harris County/ Houston. Vehicle Spraying Tracking System – MVCD has invested in a vehicle tracking system that allows it to carefully monitor its vehicles to identify any potential pesticide application problems before they arise and provide our drivers with a safety net. The system allows MVCD personal to check vehicle status rapidly to detect vehicle system failures and provides a safe and efficient interface to interact with when applying pesticides. Following proven Integrated Pest Management (IPM) and Integrated Mosquito Management (IMM) set by MVCD's Pesticide Discharge Management Plan (PDMP), MVCD can safely and accurately apply pesticides from its own vehicles. Responsible and legal application of pesticides must be documented appropriately, and this vehicle tracking system records all vehicle operations automatically. When we respond to a vector-borne disease in the vector population, we can do so quickly knowing our system is working for us by increasing time and cost savings. Communication and Community Engagement – Ongoing prevention messages are provided to county residents in an effort to impact the knowledge, attitudes and beliefs of the community towards EIDs. Community efforts to reduce vector populations and teach personal protective measures against these vectors and the EIDs they transmit are vital extension to the work conducted by MVCD. Providing these messages and facilitating community involvement to impact behavior change is even more critical when EIDs are detected in our community. Public notification of EID detection is provided utilizing a combination of delivery methods that include: person-to person communication, website, social media, and traditional media (radio, print, television). Our community outreach footprint is currently expanding with the addition of two mobile outreach vehicles. The addition of these vehicles allows us the opportunity to engage the community in an innovative, interactive learning experience. The first of the two vehicles is the Skeeter School Bus, an extension of our Skeeter School Outreach Program that targets elementary age children that includes a teacher's edition with lessons and the availability of supplies and information to raise mosquitoes in the classroom to observe the mosquito lifecycle as it occurs. The second is the Mobile Vector Unit (MVU). This vehicle is an exploratory vector museum style interactive display that includes information panels, video screens with public service announcements and an interactive educational quiz, microscopes with vector specimens, and mosquito hatcheries” that enable the participants to see each stage of the mosquito lifecycle up close. We collaborated with the Houston Museum of Natural Science to complete this learning experience and in the few short months the MVU has been in operation, we have witnessde a very positive impact in the communities in which it has visited.
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The goal of HCPH MVCD is the integration of HCPH components to develop and implement an effective and efficient vector and pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. Establishing and maintaining strong working relationships with internal and external partners provide us with the foundation in which all program components depend on. These relationships have a direct link to MVCD objectives; (1) utilize county and collaborative resources to support program components, (2) maintain and adapt program processes as new methodologies and technologies become available, and (3) enhance and streamline the notification system for vector-borne disease presence. Internal partners and collaborators are vital to ensuring that MVCD is in alignment with One Health goals and initiatives of HCPH as well as ensuring that we are utilizing all pertinent data needed to make sound decisions regarding EID detection and response. The HCPH program areas that have a direct correlation with EID investigation, detection, and response include Epidemiology, Communications, Public Health Preparedness, Veterinary Public Health, and Environmental Public Health. Working with these internal partners and other external collaborators broadens our knowledge base and enhances processes to encompass all needed information to make informed decisions that help the health of our community. While our internal partners and external collaborators are key to program goal success, we would not have been able to achieve our goals as completely, effectively, and efficiently without their collaboration. These partners and collaborators include, but are not limited to UTMB-G, BCM, UH, TAMU, and the AMCA. Our strong working relationships with academic and research institutions, organizations, and associations allowed us to further our outreach and cover all areas of Harris County/ Houston in the most efficient way possible saving time and valuable resources. An example of these partnerships/collaborations and their impact on attaining our program goal by meeting our objectives is a follows. In response to the threat of the emergence of Zika virus in Houston/Harris County, we increased using mosquito collections, enhanced virology testing capabilities, and increased community engagement activities using the One Health concept. Making these program enhancements could not have successfully been achieved without the assistance of our internal and external partners. Grant funds also provided a necessary benefit to enhance disease surveillance capabilities for Zika virus in Houston/Harris County. Equally as important as additional funding, was the assistance with the renovation of the Virology Laboratory space, professional consultation, and community engagement opportunities. Establishing and maintaining strong working relationships with colleagues and organizations in vector-borne disease management and related fields proved to be vital in determining program needs and outcomes, writing processes and procedures that meet state and federal standards, and accessing appropriate target audiences for health promotion messages. Our collaborative efforts with UTMB-G, BCM, CDC, DSHS, and others enabled us to extend our vector surveillance capacity and capability in the community. Grant funds allowed us to purchase additional traps for mosquito collections of Aedes aegypti and Aedes albopictus and related supplies. In the event a locally acquired case of Zika virus occurs in Houston/Harris County or Zika virus is detected in local mosquito populations, we have the capability of setting additional mosquito traps in those areas and simultaneously maintaining current mosquito trapping operations for WNV Culex mosquitoes. Initially, in an effort to begin testing for Zika virus in local mosquito populations as soon as possible, we contacted long-standing partners to assist us. Utilizing the resources of these partners, we began testing mosquito samples through UTMB-G and TAMU. These partners tested our samples submitted on a weekly basis for a set time frame and was done at no cost until their funding ran out. Once those testing resources were exhausted, we were immediately able to seamlessly transition into testing at BCM, another long-standing partner providing laboratory equipment and workspace to test mosquitoes collected for Zika virus. Working with these partners has been a tremendous benefit allowing us to maintain daily operations while adding the additional testing for Zika virus. The provision of grant and county funding to update our virology laboratory to include cutting edge mosquito PCR testing for Zika virus will expand our laboratory capabilities. These capabilities not also expand our ability to test in-house, but reduce the time between EID detection and control as it eliminates the need to send samples to the external state laboratory for testing. As part of the HCPH Zika Readiness Team, we were able to work directly with our internal partners to plan and implement a department strategy for addressing this emerging health threat. Two areas where partnership has been integral were (1) investigations of suspected cases of locally acquired Zika cases, mosquito breeding site identification and treatment of locations where larvae were found, and (2) health communications to healthcare providers and county residents. Grant funding from DSHS and the CDC enabled us to hire additional MVCD Inspectors and Health Educators which allowed us to participate in over 165 community events in 2017. In addition to conducting presentations and participating in community events, we also provided outreach materials to many community organizations, as well as, to our internal partners. Working with our HCPH internal partners, we coordinated an in-house One Health collaboration between Veterinary Public Health, Environmental Public Health, and MVCD. The goal of this collaboration was to identify and treat mosquito breeding sites. This allows for the mosquito breeding site to be eliminated and/or treated at the time of identification making it a more effective and timely application. Regular meetings and vector training were provided to collaborative members. In addition to our in-house effort, we included the City of Houston Community Development Department and the City of Houston Health Department Bureau of Public Health Preparedness in our One Health best practice. This increased our outreach into Houston/Harris County neighborhoods to identify mosquito breeding sites and educate residents and business owners on mosquito breeding site elimination and personal protective measures. Training and outreach materials were provided to these partners as needed.
Goal: Integration of HCPH components to develop and implement an effective and efficient vector and vector-borne pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 1. Utilize county and collaborative resources to support vector control program components. 2. Maintain and adapt program processes as new methodologies and technologies become available. 3. Enhance and streamline the notification system for vector-borne disease presence. HCPH recognizes the need to provide public health services in an efficient manner, and MVCD follows suit by continuously evaluating our services as they are conducted routinely or through emergency situations. Two tiers of MVCD's program that are continuous despite seasonality are the Communication and Community Engagement and the Surveillance Programs. Communications and Community Engagement This program is face-to-face with the constituents of the county daily, and thus constant evaluation is extremely valuable to better serve the community. The program examines how many people are reached through the various programs provided throughout the year and the number of one-on-one contacts made. In collaboration with the MVCD Inspection Section, various metrics are evaluated including the number of inspections conducted where resident contact is made and the number of health communication materials provided. This was particularly important and was very successful during our mosquito and vector response efforts post Hurricane Harvey. 2017 Results: Number of outreach and education events: 132 inside the City of Houston, 33 outside the City of Houston Number of individuals reached in outreach events: 19,931 Number of mosquito inspections conducted: 4,570 Number of mosquito repellent cans provided: 9,510 Number of mosquito larvicide dunks provided: 1,115 With a total of 165 events throughout Harris County/Houston, MVCD reached more areas and attended more events than in the previous 3 years. In addition, in 2017, a team of 3 MVCD Health Educators was highly ambitious and accomplished much in our education and outreach campaigns. Due to the introduction of multiple EIDs in the past 3 years—namely chikungunya and Zika viruses—the number of staff for both the inspections and education teams was increased this year, resulting in a more integrated and thorough coverage of the county regarding all aspects of communications and outreach, including special media and educational outreach campaigns. MVCD recognizes the importance of follow up with residents after home mosquito inspections and has implemented it in the inspection process. Surveillance The Mosquito Surveillance Section is also evaluated constantly throughout the process to maintain the efficiency of the established notification system. The MVCD evaluates and examines how many mosquito traps are set, how many mosquito pools are tested and their results, how many birds are tested and their results, how many kissing bugs and ticks are collected and their results. Because the surveillance section is very efficient and well organized, data on these collections and testing results are highly valuable and monitored very closely. 2017 Results: Number of mosquito traps set: 14,124 Number of female mosquitoes collected: 889,084 Number of female mosquito species pooled: 361,340 Number of mosquito pools tested for WNV: 15,480 Number of mosquito pools positive for WNV: 112 Number of mosquito pools tested for St. Louis Encephalitis virus (SLE): 15,480 Number of mosquito pools positive for SLE: 0 Number of mosquito pools tested for dengue virus: 6,300 Number of mosquito pools positive for dengue virus: 0 Number of mosquito pools tested for chikungunya virus: 6,258 Number of mosquito pools positive for chikungunya virus: 0 Number of mosquito pools tested for Zika virus: 6,597 Number of mosquito pools positive for Zika virus: 0 Number of live birds tested for WNV: 1,068 Number of live birds positive for Hemagglutination Inhibition (HI) WNV: 125 Number of live birds positive for HI SLE: 39 Number of live birds positive for HI EEE: 6 Number of dead birds reported: 174 Number of dead birds tested for WNV: 118 Number of dead birds tested positive for WNV: 3 Number of live birds tested for WNV via LAMP technology: 234 Number of live birds positive for WNV via LAMP technology: 22 Number of kissing bugs collected: 8 Number of kissing bugs tested positive for Trypansoma cruzi parasite: 0 Number of ticks collected: 36 Number of tick species collected: 4 Number of tick pools tested positive for Rickettsiae: 4 Number of tick pools tested positive Ehrlichia: 1 Before the explosive emergence of chikungunya and Zika viruses in South America, mosquito surveillance and testing concentrated on isolating WNV and dengue virus, thus data remained typically static throughout the years. However, after the introduction of these EIDs, many of these metrics were increased and surveillance efforts were adjusted by reducing the number of WNV pools and increasing that for chikungunya and Zika viruses. The addition of Biogents Sentinel (BG) traps also increased the possibility of collecting the mosquito vectors responsible for transmitting these diseases. Thus, MVCD has increased the arboviruses and EIDs that we screen for in our mosquito samples. So far, no Zika, dengue, or chikungunya viruses have been detected in mosquito pools, however MVCD is ready to respond if and when they are detected. The number of birds tested and the positive results have steadily increased over the past 3-5 years. Even though none of the current emerging EIDs have affected avian surveillance as birds have not been found to be hosts of these new viruses, MVCD is ready and prepared to detect additional potential EIDs in the bird population in Harris County/Houston area as a result of our integrated surveillance methods of both PCR and LAMP technologies. The new addition of the Vector Surveillance Branch has significantly enhanced the reach of MVCD in regards to EID screening. MVCD is the first organization in the region to develop and establish a kissing bug and Chagas disease surveillance program in Harris County/Houston. In addition to the kissing bug collections and testing, new tick collections were conducted as well: 4 species have been documented and verified and two genera of potential bacterial pathogens have been identified in these tested tick pools. With these additional vector testing collaborations, MVCD can monitor and better inform the residents of Harris County/Houston regarding EID risk in the region. Whenever a vector-borne pathogen is detected in either the residents of Harris County/Houston or in vector populations, MVCD has a well-established response protocol to manage any vector-borne disease, especially EIDs, capable of impacting public health. The program that is crucial for this response is Field Mosquito Control Operations Branch, which is responsible for inspections and treatments. Field Mosquito Control Operations When a vector-borne disease is suspected and documented through the Epidemiology Program of HCPH, MVCD is informed and action is immediately taken. If the vector-borne disease is a certain EID, like Zika virus for example, then specialized teams of epidemiologists, mosquito inspectors, and environmental public health specialists will be mobilized to respond. The response is immediate, swift, and depends on the severity of the disease. When vector-borne disease is detected through our in-house virology laboratory, notice is given within 3 days of mosquito collections, and treatments are conducted within 24 hours. This process is evaluated through examining the number of inspections conducted for suspect vector-borne disease cases, and the number of mosquito larval and adulticide treatments conducted. 2017 Results: Number of suspect disease requests: 593 Number of larvicide treatments during mosquito inspections: 1,785 Number of adulticide treatments: 325 Number of MVCD Operation Areas treated through adulticide application: 85 Number of Acres treated by ground and aerial: over 1 Million The anticipation of and following introduction of Zika virus into the continental US directly impacted the number of suspect disease cases and larvicidal treatments conducted in Harris County/Houston which significantly increased over the past 3 years. With the integration and collaboration between HCPH divisions with MVCD, Epidemiology, Environmental Public Health, and Veterinary Public Health, the notification system and treatment timeline for vector-borne disease presence continues to be streamlined and effective. Every adulticide treatment conducted in 2017 was based on the detection of WNV in mosquito pools. As MVCD has focused on preventing and preparing for additional EID arboviruses, the Field Mosquito Control Operations Branch is prepared to respond with the appropriate treatment for any local vector-borne disease introduction as well. To maintain and adapt the current EID detection and prevention system as new technologies and even changes in the vector populations occur, MVCD also evaluates its own actions and the impacts on the environment—both regarding the vectors and the safety of our treatment applications. The MVCD sections heavily involved with our internal evaluations are the Testing and Evaluation and Field Mosquito Control Operations sections which analyze the potential for insecticide resistance development, potential toxic effects from larvicide applications, and the efficacy of new products. 2017 Results: Field Cage Testing: o Number of WNV Culex mosquito populations with resistance to malathion: 3 o Number of WNV Culex mosquito populations losing susceptibility to malathion: 1 o Number of WNV Culex mosquito populations with resistance to permethrin: 2 o Number of WNV Culex mosquito populations losing susceptibility to permethrin: 5 o Number of Aedes mosquito populations with resistance to permethrin: 2 Bottle Bioassays: o Number of Aedes mosquito populations losing susceptibility to malathion: 2 o Number of Aedes mosquito populations losing susceptibility to permethrin: 2 Number of areas with toxic effects from larvicide applications: 0 The Culex and Aedes mosquito populations tested are from 3 MVCD Operational Areas which were treated the most for detection of vector-borne disease presence in 2016 and 5 populations from Operational Areas which are tested consistently every year. MVCD has noted that resistance began developing in Culex mosquitoes in Harris County to malathion decades ago, and, as previously mentioned, the rotation of chemicals was used to curb this trend. Since then, resistance has also started to develop to permethrin, however at a much slower rate due to our control and testing efforts to limit this. Our determined EID preparedness and prevention of Zika led us to be the first in the region to establish and conduct insecticide resistance tests on additional species, i.e. Aedes aegypti and Aedes albopictus, as also funding availability increased. Our 2017 tests were the first field and wild Aedes species specific insecticide resistance tests. So far, no toxic effects were detected from any of the larviciding activities across Harris County/Houston. MVCD is confident that the ability to conduct these in-house evaluations and checks and balances on our own vector-borne disease response efforts is due to our strongly integrated mosquito and vector management best practices that are ready to be adjusted when new EIDs threaten the residents of Harris County/Houston.
Goal: Integration of HCPH components to develop and implement an effective and efficient vector andvector-borne pathogen surveillance program to protect Harris County/Houston residents from vector-borne diseases. 4. Utilize county and collaborative resources to support program components. 5. Maintain and adapt program processes as new methodologies and technologies become available. 6. Enhance and streamline the notification system for vector-borne disease presence. HCPH recognizes the importance of not only starting new practices and programs to provide services to the residents of Harris County, but sustaining them to provide as many benefits to the county constituents as possible for extended periods of time. Sustainability is crucial to MVCD as the results of our rapid test result system and other notification components provide pertinent information regarding public health prevention and vector-borne disease risk. Multiple programs in MVCD maintain essential relationships with collaborators, explained thoroughly earlier in the LHD and Community Collaboration section. Examples of some of the programs which depend on sustainable and maintained agreements with stakeholders are the Communication and Community Engagement, Test and Evaluation, Virology laboratory, and Surveillance. Communication and Community Engagement – Community connections have always been important to HCPH MVCD by providing needed support and assistance to supply quality community education programs. MVCD partners with the Texas Department of Agriculture (TDA) and Texas AgriLife Extension to provide many educational services to the County. A changing marketplace and diminished resources have made those connections invaluable to sustaining those programs by providing target audience access, information distribution capabilities, and expanding community education program outreach. A significant commitment from stakeholders is required to host the Annual CEU Workshop for Certified Pesticide Applicators in Harris County which ensures that insecticide and pesticide applicators in our communities are applying the best practices for integrated mosquito and pest management. Buy-in and input from these regional partners is an important factor in data collection and program implementation throughout Harris County/Houston neighborhoods. The return on investment is immeasurable as the participants receive state required continuing education units and valuable resources in conducting day-to-day operations. The plans for sustaining this program at MVCD are as follows: Maintain our designation as a TDA Recertification Sponsor Maintain our partnership with both TDA and Texas AgriLife Extension to provide required information and support for workshop attendees Provide an annual workshop to vector control programs with a focus on those in the Houston/Harris County region The most important lesson learned from these collaborations is that community engagement at any level is community involvement Testing and Evaluation – Since the Testing and Evaluation Section performs much of the internal evaluation work regarding treatment activities, this section is extremely important to maintain and sustain. MVCD would not be able to ethically and accurately treat for vector-borne diseases in the county without the knowledge that our treatment response was providing real results in vector populations. This section relies on support from multiple collaborators including UTMB-Galveston, TAMU, BCM, and UH. To sustain these working relationships and this crucial program, cost-benefit analyses and constant communications are required. Through cost-benefit analyses, the laboratory bottle assay was determined to be critical for our program to maintain our position as a leader in treatment assessment, and our partners are needed to sustain the continuation of this assay. With this guiding laboratory assay, performing field cage testing could actually become less frequent (saving time and money) and also provide a secondary check at more prudent expense. Constant communication with collaborators allows MVCD to sustain this section, ensuring proper management of resources and the overall health of Harris County/Houston residents is protected. The plans for sustaining this program are as follows: Train technologically-capable and motivated personnel to cover all aspects of this vital work Continue to be flexible with the goal to maximize Insecticide Resistance Management (IRM) Keep accountability a top priority Virology Laboratory - The MVCD Virology laboratory continues to perform extensive virological testing of vectors that transmit arboviruses, including EIDs. Such testing, even during periods of departmental financial shortfall, has continued without disruption, with the support of vital partnerships throughout the medical/research community. The resources these entities have provided have been invaluable in not only helping the Virology laboratory sustain current testing methodologies, but also, through training and financial sponsorship, assisting in the incorporation of the most effective new innovative equipment and proven test procedures for sample analyses. The arrival of Zika virus in the US posed a special challenge for Harris County/Houston in that there was no existing means of testing for Zika virus. To address this issue, progressive strategies were immediately deployed to make provisions for Zika testing of vectors via qPCR methodology, including renovation of the Virology laboratory to facilitate the processes, as well as, the procurement of necessary equipment and consumable reagents identified as most efficient for testing. In the interim, top priority was also given to ensure that vectors known to transmit Zika virus would be tested. Initiating communication with partners that could assist with our goal of providing current, ongoing testing of vectors involved in the spread of this EID led to collaborations specifically geared towards meeting testing demands off-site until MVCD could carry out testing within our renovated laboratory. Not limited to this endeavor, its own main stakeholders have included UTMB-Galveston (through a collaboration in the Western Gulf Center of Excellence for Vector Borne Diseases), which offered assistance with molecular testing of our samples; TAMU's Department of Entomology which committed to covering test costs until their funding source was depleted, and BCM, which also provided arbovirus testing support. Following a cost/benefit analysis to determine if testing for a fee per sample by one of our other collaborators was feasible, the outcome determined that it was not. The collaboration with BCM proved very instrumental for our program, not only providing expertise with the renovation design of the Virology laboratory, but also granting our Virology staff access to laboratory facilities at BCM and permission to use necessary supplies and equipment to perform EID testing, which in turn enables our Virology laboratory to remain current and relevant with vital EID testing. Through collaborations we've learned that clear communication of goals, agreement regarding desired outcomes, and commitment to accountability produce the most successful partnerships. Our partners have remained committed to collaborating with us in sustaining our testing practices, and the plans remain in place to: Continue testing at BCM until our facility is available to resume EID Zika virus testing. Continue to capitalize on departmental support as well as financial contributions from our stakeholders to ensure coverage in every area of infectious disease testing Ensure that Virology personnel are trained in the most proficient methodologies and laboratory practices for efficient infectious disease testing Continue to operate within the parameters of One Health as we work with internal and external partners in the mission to prevent and control infectious diseases Avian Surveillance Section – Collaborations are essential to the efficient, sustainability of our Avian Program, not only providing financial support for our processes, but also allowing us to expand its reach. Utilizing the One Health concept allows us to reduce program operating costs. MVCD has learned that partnerships, beyond financial support, are most successful when the goals of the partners are aligned. The Avian Surveillance Section has established collaborations which are positioned to give us the best outcome regarding program goals, and we look forward to performing a cost/benefit analysis to improve the program by providing an objective way to evaluate competing processes, and ensure the most beneficial processes are kept, allowing the current best-practices to improve over time. Stakeholders do play an essential role in helping sustain the Avian Program. One such partner, The Audubon Society, has expressed interest in expanding the program and we have an agreement with Pro-lab Diagnostics that allows us free use of their Genie device (valued at $17,900), with our dedication to testing a minimum of 600 bird samples per year, which we are committed to accomplishing. The Avian section's sustainability plan includes: A long-term stable partnership with UTMB-G where our Avian section provides test samples, and UTMB-G provides test results. A collaborative Genie trapping project requiring a minimal monetary cost for supplies. Sustaining an innovation LAMP Avian testing project.
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