Eastern Equine Encephalitis: Reporting and Surveillance

DHS Surveillance Resources

• Arboviral Infection EpiNet, P-01930 (PDF): An arboviral infection case reporting and investigation protocol for health professionals.
• Arbovirus Management Protocol, P-00894 (PDF): Information for arboviral disease management, including surveillance, testing, reporting, and follow-up, in humans and animals.
• Vectorborne Disease Toolkit, P-01109 (PDF): Information on preparing for and responding to vectorborne disease for local governments, health departments, and citizens in Wisconsin.

Provider Resources

Eastern Equine Encephalitis Symptoms and Treatment: Information on Eastern equine encephalitis symptoms, diagnosis, and treatment from the Centers for Disease Control and Prevention (CDC).

DPH monitors for Eastern equine encephalitis as part of our enhanced arbovirus surveillance. Testing for Eastern equine encephalitis as part of a DPH investigation may be fee-exempt. Please contact a vectorborne disease epidemiologist at 608-267-9003 for fee-exempt approval.

Fee-exempt arboviral antibody testing will be offered to clinicians whose patients meet ONE of the following criteria:

• Request for confirmatory testing of positive arboviral IgM and IgG commercial test results (performed at laboratories other than the WSLH).
• The patient has signs and symptoms of meningitis (fever, headache, and stiff neck) or encephalitis (fever, headache, and altered mental status ranging from confusion to coma), or acute flaccid paralysis (AFP) with no other laboratory diagnosis.
• The patient has a diagnosis of Guillain-Barré syndrome and no other laboratory diagnosis.
• The local health department may request fee-exempt testing be performed if the case-patient lacks insurance coverage or the ability to pay.

Instructions for collection and shipping of clinical specimens to the WSLH:

• Collect specimens between three days and 12 weeks after symptom onset for reliable antibody detection. Samples collected less than eight days after illness onset may not demonstrate IgM reactivity due to the time required for the development of an antibody response, and a convalescent sample may be indicated.
• Submit 3-7 mL of serum and/or >1 mL of CSF in sterile screw-capped vials on cold packs using a WSLH kit #22 or equivalent within five days of collection. It is recommended that a paired serum specimen be submitted with a CSF specimen. Specimens should be triple packaged as a Category B Biological Substance (include UN3373 label).
• Fee-exempt testing submissions must include a WSLH Enhanced Wisconsin Arbovirus Surveillance form provided by a DPH vectorborne disease epidemiologist.
• Fee-for-service testing submissions must include a WSLH CDD Requisition Form B. Please contact the WSLH Clinical Orders at 800-862-1088 or 608-224-4275 to obtain blank copies of WSLH CDD Requisition Form B and to order specimen shipping kits.
• It is essential that the lab requisition form be as complete as possible, including patient name, city, date of birth, specimen type, submitting agency, onset date, signs and symptoms, and collection date. Note: Testing for Eastern equine encephalitis virus may be delayed on specimens missing the above data until information is available.
• Ships specimens with appropriate completed form to:

Wisconsin State Laboratory of Hygiene
2601 Agriculture Drive
PO Box 7904
Madison, WI 53718
Customer Service: 800-862-1013

Diagnosis of Eastern equine encephalitis can be challenging since many of the signs and symptoms can be similar to other viral infections. Furthermore, Eastern equine encephalitis IgM antibody cross-reactivity can occur, complicating timely diagnosis. A patient's clinical signs and symptoms and risk activities can help to inform a preliminary diagnosis prior to laboratory confirmation.

There is currently no treatment or vaccine for Eastern equine encephalitis. Over-the-counter pain relievers may be given to relieve the symptoms. In severe cases, patients may need to be hospitalized to receive supportive treatment.