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What You Should Know About EEE

Eastern equine encephalitis (EEE) is an infection passed through mosquito saliva. Dr. Amy Jaworek, infectious disease specialist, discusses the recent EEE outbreak.
What You Should Know About EEE
Amy Jaworek, MD
Amelia (Amy) Jaworek is a board-certified Infectious Disease physician at Harrington HealthCare System. She received her medical degree from Tufts University in Boston and completed a residency at Baystate Medical Center in Springfield.

Prakash Chandran (Host):  You may heard about the recent Triple E outbreak in the Massachusetts area, but what exactly is Triple E. how dangerous is it and what do you need to know to protect yourself? We’re going to talk about it today with Dr. Amy Jaworek, an Infectious Disease Specialist at Harrington Hospital.

This is Healthy Takeout, the podcast from Harrington Hospital. I’m Prakash Chandran. So, first of all, Dr. Jaworek, what exactly is the Triple E virus?

Amy Jaworek, MD (Guest):  Triple E virus is a kind of virus called a togavirus and it’s a virus that lives in mosquito salivary glands.

Host:  Okay. And what does the Triple E stand for?

Dr. Jaworek:  It stands for Eastern Equine Encephalitis.

Host:  Yeah because when I was doing some research, I always say Triple E mentioned but I didn’t have anyone break down exactly what that means. And so encephalitis, I hear that’s something related to the brain and brain swelling. Is that correct?

Dr. Jaworek:  That is and that’s the most serious complication of the virus. Not everyone gets the brain swelling. Some people get infected and don’t even know they have been infected. Other people get high fever, muscle pain and aches.

Host:  Okay and you were talking about how the virus lives in the mosquito’s salivary glands. So, is that how people contract the virus, a mosquito bites them and then they get Triple E?

Dr. Jaworek:  Right. It’s transmitted by mosquitoes that are endemic to our area among other areas. One is called the Culex C-U-L-E-X mosquito and they are biting at nighttime around dusk in the area of Massachusetts and other surrounding states.

Host:  I see, and it seems like the Triple E outbreak has been in the news as of recent. But I’m curious as to how long the virus has been around the Massachusetts area for.

Dr. Jaworek:  It’s been detected for decades. Actually the first cases were detected in 1931 when 75 horses died in Massachusetts and there now is a shot. I’m not sure how effective it is, because I’m not a veterinarian but there is a shot for horses that is available now and when I had horses, I did have them vaccinated.

Host:  Okay and so because the disease has equine in it, you assume that it and you mentioned horses, you assume that it maybe is just in animals but some of these recent cases have been affecting humans. So, maybe talk a little bit about what symptoms human experience when a mosquito with the Triple E virus bites them.

Dr. Jaworek:  If people have a bite and they develop symptoms, not everyone does. It’s a proportion of individuals which varies who develop symptoms. The first symptoms you would develop in about three to ten days after the infected mosquito bite would be muscle pain. Sort of walking and having extreme pain, even climbing stairs. You would have a high fever and some people develop shaking chills. If this is going to progress to encephalitis, people notice some changes in mental status or confusion, weakness and occasionally seizures. People then develop brain swelling and that which can become fatal. One individual died in Bristol County a few weeks ago at Tufts Medical Center in Boston. And this is the most serious consequence of the encephalitis. And as I had mentioned, not everyone does develop these symptoms, but these are the most severe symptoms in people.

There was an outbreak in the years – as we determine an outbreak it can be about several cases. This year we have had 7 people affected and one death so far. And there was an outbreak in 2010 to 2012 and there was another one in 2004 to 2006. And there was 22 infected individuals over those years. so, it comes in spurts. Not sure why. It might be climate related. It comes and goes depending on the years.

Host:  Yeah, I was just going to ask that. Why do these outbreaks happen, and it seems like if the climate is right to harvest these mosquitoes or allow them to propagate more than they normally would; then they are able to transmit the disease, is that correct?

Dr. Jaworek:  I think so. I think so unfortunately. And we can’t always hit at the cures or the causes of actually predict these outbreaks. They have been doing some aerial spraying and ground spraying as well this year especially in the communities that are classified as critical risk. There are 36 critical, 42 high and 115 moderate risk and the highest of critical is areas where there’s a human case and then there’s animal cases in areas of high concern. So, if you look at the map, the Mass Department of Public Health puts out a map and you can see where the areas are highlighted in red or yellow throughout the state depending on the current situation that’s updated pretty regularly.

Host:  So, I want to move into how Triple E is diagnosed. I know that people listening to this they may have heard some of the symptoms that you mentioned like fevers, trouble walking up the stairs. It almost sounds like severe flulike symptoms. If they are experiencing that, should they immediately go into the doctor? Is there anything that distinguishes Triple E from a severe flu?

Dr. Jaworek:  In particular, flu generally doesn’t cause confusion. It doesn’t cause – at this time of year, it usually would come with some respiratory symptoms, some sore throat and this doesn’t usually have that. It’s more just the plain muscle aches and the general fogginess and the severe fever. And as I had mentioned, if it is severe, it is up to a 33% fatality so if you are feeling – actually it would be the family member at this point if the patients are that sick with confusion; they should definitely go to the emergency room instead of urgent care. If they have just general symptoms that are concerning, maybe tick borne Lyme or lycoris babesiosis goes around at this time of year also so that can easily be confused with what we call Triple E. So, I would seek – if there is no confusion or mental status changes or neurologic changes you could seek care at urgent care or ER as that can be easily – not easily but can be diagnosed by clinical exam.

The Eastern Equine diagnosis is oftentimes done by a spinal tap or a blood test and that can take weeks – days to weeks to come back all of the information. We kind of have a fast track now so it shouldn’t be that long, but it is still something that you may not know immediately especially if you are not having encephalitis and in the hospital.

Host:  So, let’s say I live in the Massachusetts area and I notice that I get bitten by a mosquito. When is it too early to come in? should I come in immediately because there’s this outbreak happening? I’m sure people listening to this want to get ahead of it as much as possible. So, talk a little bit about that.

Dr. Jaworek:  First, number one, prevention. I would try to avoid getting bit by the mosquito. I would be careful of – until the first frost as far as covering up your skin, make sure there is no place for them to bite kind of hang out in an area of fewer mosquitoes like in a screened porch for instance. You can use some anti-mosquito spray, long pants. But if you do get bit by a mosquito, unfortunately there is no treatment or prevention for this virus. I would just kind of take note of if you got several bites, when that was and then keep that in a differential to tell your doctor if three to ten days later you develop any high fever or muscle aches.

Host:  So, you were mentioning a shot earlier. I was just curious about if you detect that a patient has contracted Triple E, is there a certain treatment protocol. I know you said that there is no cure but talk a little bit about how you can alleviate potentially some of the pain the patient is going through.

Dr. Jaworek:  What I would do is after I’ve rather ruled out or hopefully ruled out some other infections such as tick-borne illness, I would use symptomatic measures, Tylenol, acetaminophen or ibuprofen is appropriate for the muscle aches and pains. I would keep a close eye on the person. Make sure they are not having any progression. As I said, I think that this is sort of symptomatic what I would do for the flu.

Host:  And so, you talked a little bit about prevention earlier and I was going to ask how people can avoid exposure to the Triple E virus. It really just sounds like putting on that bug spray, long sleeve shirts, pants, everything to really avoid getting bitten by a mosquito. Is there anything else that you recommend?

Dr. Jaworek:  I would wear the insect repellent and as we mentioned long sleeves and avoiding outdoors at nighttime.

Host:  Yeah and is there a demographic of people who are more susceptible to contracting the virus than others or does it really just affect everyone equally?

Dr. Jaworek:  Unfortunately, persons at opposite ends of the age spectrum are affected, children disproportionately two years old and the persons over 65 can be more prone to get severe complications and symptomatic disease. It doesn’t really, as far as HIV or immunosuppressed have as much of an affect but oftentimes as I mentioned, very young and the very old are disproportionately affected.

Host:  Thank you so much for your time and this information Dr. Jaworek. I really appreciate it. that’s Dr. Amy Jaworek, an Infectious Disease Specialist at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. Head to to get connected with Dr. Jaworek or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.