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Am Fam Physician. 2001;64(12):2019

West Nile Virus Activity Update

Surveillance data from the Centers for Disease Control and Prevention (CDC) indicate expansion of epizootic West Nile virus in the eastern United States into new areas in the southeast. A report in the July 27, 2001 issue of Morbidity and Mortality Weekly Report (MMWR) details the virus activity in the United States from January 1, 2001 through July 25, 2001, and highlights the need for control and preventive measures.

According to the CDC data, the virus, which is transmitted from mosquitoes and certain birds to humans and horses with encephalitis and meningitis the most serious outcomes, has now been documented in Florida and Georgia. This “extends substantially the known distribution of the virus” from its first occurrence in the United States in 1999. In addition, the pattern of occurrence in New York City during late spring and then southward (as far as North Carolina) during late summer and early fall follows the migration pattern of birds.

Data from an update appearing in the October 26, 2001 issue of MMWR, indicate 37 human cases of encephalitis or meningitis reported (from July 13 to October 7) in seven states: Florida, Maryland, New York, New Jersey, Connecticut, Pennsylvania, and Georgia. Crows and other birds (3,796 and 1,394, respectively) in 25 states tested positive for West Nile virus.

The first case of encephalitis in 2001 in humans occurred in Florida in July. According to the latest report, this raises concern about the transmission of the virus through various mosquito species; in particular, those that feed on mammals and humans. Preventive measures, outlined by the CDC, include mosquito-control programs and personal preventive measures to reduce exposure to mosquitoes.

Information about West Nile virus, including maps that track its occurrence, can be accessed at: and

AAP Policy on Safe Air Travel for Children

For maximum protection during air travel, children younger than two years should be secured in a child safety seat while traveling on an aircraft, according to the Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP). The statement, which appears in the November 2001 issue of Pediatrics, discusses regulations currently in place, their enforcement, and the certification and potential technology of child safety seats.

Currently, airlines do not require the purchase of a ticket for children younger than two years. Children can be held on an adult's lap while in an aircraft, increasing risk of injury, especially during turbulence. While the Federal Aviation Authority (FAA) recommends that all children be given a separate seat and that a child safety seat be used as indicated, it is not mandated. According to the AAP, the same national regulations currently in place to ensure the safety of children riding in motor vehicles should be the same for all airline passengers, including children. Physicians, federal agencies, and airlines are encouraged to work together to assure that proper safety regulations are created and enacted. Highlights of the AAP recommendations are listed below.

  • Mandatory requirements using approved restraints systems should be initiated, and children younger than two years should no longer be allowed to sit on an adult's lap while traveling by air.

  • Establish standard age and weight recommendations for the use of child safety seats, and add a section to the Federal Code of Regulations outlining the requirements for the use of appropriately securing children on aircraft.

  • Airlines should make child safety seats that meet established standards available for use.

In addition, the AAP recommends that physicians provide the following information to parents.

  • All children should be properly restrained while on an aircraft.

  • Parents should use child safety seats that meet the U.S. standards for aircraft use (after February 26, 1985), and assure that the seat is labeled as certified for such use.

  • Because the purchase of an additional airline ticket is necessary to properly secure a child, parents should inquire about discounts and take time to compare airline fees. Also recommended is taking a flight that may have more empty seats.

Information on safe air travel for children is available from the FAA Web site at or by telephoning 800-FAA-SURE.

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Copyright © 2001 by the American Academy of Family Physicians.

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