Posted: March 24th, 2023

Eastern Equine Encephalitis

Eastern Equine Encephalitis (EEE) is a rare viral brain infection spread by a zoonotic mosquito vectored Togavirus. The virus is prevalent in the Northern, Central, and Southern America, as well as the Caribbean. The infectious disease was discovered for the first time in Massachusetts in 1831. During the time, viral encephalitis affected horses. The infection in horses has continued since then in the United States and can affect zebras and donkeys. The disease does not only affect animals because cases of infections in humans have been reported (Cho et al., 2019). Although EEE is a rare infectious condition in the United States, it is fatal and can cause long-term adverse medical conditions.

Causes

Infected female mosquitoes transmit the EEE virus. The mosquitoes are common in the marshland and swampy regions and mostly depend on birds. Birds are usually the EEE virus’ reservoirs and can acquire the infection and fail to exhibit any sign of the disease (Cho et al., 2019). The birds pass the virus to mosquitoes, which in turn, bite mammals, including humans. Humans and horses are the most susceptible to the illness, although other mammals can be infected. The virus replicates inside the body and travels through the blood. In rare cases, it moves past the blood to the brain, causing brain tissue inflammation or encephalitis.

Symptoms

Signs and symptoms of EEE depend on the level of the infection and typically begin four to ten days after the initial infection. In milder forms of the condition, the symptoms include flu, fever, and headache. The person can also suffer chills and muscle and joint aches. The severe cases of the disease begin with flu-like signs, and around four days after the symptoms, the patient can exhibit signs of infection in the brain, such as excessive drowsiness, confusion, and a severe headache. The symptoms can progress from bad to worse to deterioration (Lad, Ong, & Proia, 2017). The infected person can develop seizures and coma, eventually leading to brain damage or, in severe cases, death.

Mode of Transmission

The disease is spread to humans by an infected mosquito. However, it is impossible to contract the disease from another human; one can only become infected if bitten by the transmitting mosquito. The condition causes an inflammation or swelling in the brain once infected (Lad, Ong, & Proia, 2017). The only practical approach to preventing the disease is to avoid mosquitoes’ bites, especially in high-risk areas.

Complications

The EEE infection can cause various complications depending on the level of progression of the infection. The main complication, though rare, result from the movement of the infection to the brain. Such an infection in the brain causes severe headaches and confusion. It can become worse, causing seizures, coma, and even death. EEE is among the most serious diseases transmitted by the mosquito in the United States (Lad, Ong, & Proia, 2017). Besides, people who survive the severe cases of EEE might suffer long-term brain damage, personality disorders, intellectual impairment, and paralysis.

Treatment

EEE does not have any effective treatment. However, one can lower the chances of infection by preventing mosquito bites by applying insect repellent that contains components, such as picaridin or DEET, treating clothes using permethrin, dressing up in long pants and long-sleeved shirts, using screens on doors and windows, and emptying standing water (Lad, Ong, & Proia, 2017). Effective control can contain a potential outbreak of the disease.

Demographic Break Down

Although the disease can affect people of all age groups, according to CDC statistics, those younger than 15 and older than 50 are most at risk of suffering from severe cases of the illness. Besides, people with weak immune systems, such as those undergoing treatment for cancer or organ transplant, are also a high-risk population for the infection. Furthermore, people who travel or live in the woods are in great danger of the virus (Lad, Ong, & Proia, 2017). Regardless of the risk, few people become infected by the disease each year. Most cases are reported in the eastern part of the country and Gulf Coast states. One in every three people with severe EEE infection dies from complications. Most people die only ten days after the evidence of the initial symptom. According to the CDC, between 2009 and 2018, an average of seven cases of EEE was reported every year in humans in the United States. Out of the infections, about 30% died, while majority of survivors receive ongoing neurological problems.

Determinants of Health

Social determinants of health are essential factors within the environment of a person that affects their health and quality of life. The CDC proposes some social determinants of health that affect various medical conditions and health outcomes of particular individuals and groups. Socioeconomic conditions affect the infection and spread of the EEE virus. The environment might encourage the thriving of mosquitoes that spread the disease due to poor living conditions, such as poorly managed drainages. Residential segregation is another factor that might affect the breeding of mosquitoes that spread the virus. Language/Literacy affects the disease because the most effective prevention method includes knowledge of effective measures to prevent mosquito bites. The natural environment, such a swampy and wetland affect the spread of the disease through mosquitoes. Creating policies and standards that affect these factors can prevent the spread of the disease and its complications, primarily due to the lack of effective treatment.

Epidemiological Triad

The model is one of the effective approaches that explain disease causation. It has three components, the external agent, a vulnerable host, and an environment. The third component allows the interaction between the agent and the host. The agent is the entity or micro-organism, bacteria, or virus that causes the infection (Bhopal, 2016).  Eastern equine encephalitis is the virus that causes the infection. Thus, the virus, which is spread by mosquitoes, must be present for the infection to occur. The host is the intrinsic factors influencing a person’s risk, exposure, susceptibility, or reaction to the causative factor. Some of the risk factors entail lifestyle, socioeconomic status, behaviors, and psychological factors. The EEE host includes the age of individuals at high risk (younger than 15 and older than 50), reduced immunity, and those who travel or live in the woods. The environment includes the extrinsic factors that affect the opportunity of transmission and the agent. Some of the factors that create a conducive environment for EEE include swampy and wetlands and the woods where the virus can thrive, and hence, transmitted by mosquitos.

The Role of NP

The nurse practitioners (NP) can play an essential role in the control and prevention of EEE in the country. The American Association of Nurse Practitioners defines NPs as “licensed, autonomous clinicians focused on managing people’s health conditions and preventing disease” (AANP 2016 as cited in Cooke, 2016). NPs work as advanced practice registered nurses (APRNs) with particular populations. The most critical role of an NP working in community health in a population at the risk of EEE is to ensure adequate disease prevention. Notably, the condition may lack effective treatment; hence, although nurse practitioners can diagnose and manage the condition, it is more effective to prevent mosquito bites to avoid the infection (Ruggiero, Pratt, & Antonelli, 2019). The nurse can work in the management of EEE in community health settings, as well as primary/secondary/tertiary interventions. They can help in monitoring, collection, and analysis of epidemiology data for use in policy-making on how to control EEE infection. They can help policy-makers to implement evidence-based practice in the prevention and management of the infectious disease. Effective steps could help in the successful control of EEE among the most at-risk populations.

Conclusion

The world faces various kinds of infectious diseases, which are common or rare. Among such conditions includes Eastern Equine Encephalitis (EEE), which is a rare viral infection in the United States. The disease is spread by a female mosquito that carries the infectious agent and deposits it into a person’s bloodstream. The virus is transmitted through the blood and sometimes reaches the brain, causing swelling or inflammation. Although the disease is rare, it is fatal, especially in severe cases. About 30% of the affected people die, while those who survive may suffer brain damage and other long-term neurological effects. Since the condition lacks an effective treatment, NPs and other healthcare providers should focus on prevention and health promotion strategies.