Socioeconomic impacts of La Crosse encephalitis in western North Carolina

Project Summary La Crosse virus (LACV, family Peribunyaviridae, genus Orthobunyavirus) is the leading cause of arboviral pediatric encephalitis (neuroinvasive LACV disease; NLACVD) in the United States (US) and is endemic in western North Carolina (WNC) and several mosquito species (primary vector: Aedes triseriatus;

invasive/established: Aedes albopictus and Ae. japonicus) are competent LACV vectors. In NC, most cases occur in WNC within Southern Appalachia, where primary and invasive vectors are commonly found peridomestically. The economic wellbeing of these rural counties is generally low; with almost all counties

being classified as Tier 1 (most distressed) or 2, which likely contributes to disparities related to low awareness of risk, poor adherence to personal protection measures, and limited clinical recognition in the absence of severe disease. While the total number of cases each year is relatively low, socioeconomic (SE) and public

health burden is substantial and long-lasting. Clinical, developmental, and SE impacts of LACVD/NLACVD will be examined in an endemic area. We will also examine whether incidence of mosquito vectors is associated with LACVD/NLACVD incidence. We hypothesize that (a) SE impact of LACVD/NLACVD in rural areas is

significant and not known at hospital discharge, (b) there is a need for community education about risks, prevention, treatment, and recovery resources, and (c) incidence of vectors is related to LACVD/NLACVD. To examine these hypotheses, we propose the following Specific Aims: Aim 1: Assess acute and persistent

medical, social, and cognitive LACVD/NLACVD impacts. Clinical assessment and survey methods will be used to assess patient and family perceptions and behaviors related to LACVD/NLACVD. Medical evaluations will be conducted via chart review (to estimate severity), survivor survey, follow-up (virtual and/or in person)

interviews, and clinical assessment. Aim 2: Determine and quantify economic hardship in LACVD/NLACVD survivors & families. Interview methods will be used to collect information from LACVD/NLACVD survivors and family members. Completing this aim will allow us to estimate direct economic costs such as healthcare (e.g., physical/occupational therapy, mental health counseling, medication),

academic support (e.g., tutoring), and indirect costs (e.g., related travel, missed work, caregiver mental health). Aim 3: Assess environmental risk factors at LACVD/NLACVD case residences. Laboratory/field methods will be used related to site assessments (e.g., oviposition sites, land cover) and mosquito collections at case

properties and surrounding areas and/or non-case neighborhoods. This study will fill a gap regarding suffering of victims and families after illness and will open new possibilities for future research, public education campaigns, and social/regulatory interventions.