Stopping the Spread of E.

vil
Introduction
People are dying and the CDC now knows why. Escherichia vil, commonly referred to as E.
vil or simply Evil, is infecting citizens of the United States and Canada as a vector-borne
disease. E. vil was first identified in a middle-aged woman named Grace Clements from
Midland, Texas. She is now regarded as Patient Zero.
The disease shows no preference in age of human host, readily infecting healthy young
adults and the immunocompromised alike. E. vil is vectored primarily by Aedes vexans,
otherwise known as the inland floodwater mosquito, and harbored in a variety of wild rabbit
species which serve as reservoir hosts (Godsey 2010). Whether humans are dead-end hosts or
able to re-infect vectoring species is unknown.
Combating the disease has been difficult. It spreads very quickly and the vaccine, while
effective, has been received extremely negatively by the public (several claim it is linked to
sudden onset of paralysis). While the live attenuated vaccine boasts a 94% success rate in
preventing infection and the heat killed vaccine has been shown to be 71% effective, only 20%
of the patient population finds its administration acceptable. Therefore, educating the public on
the safety of this vaccine is a priority.
The CDC presents this plan as a means of eradicating this disease, or at least reducing
transmission to a manageable level while treatment can be researched further. In addition to
promoting the safety of the vaccine, the CDC will target all other links in the vector-borne
disease transmission cycle, hopefully halting the spread of E. vil once and for all.

The only thing necessary for the triumph of evil is for good men to do nothing.
Edmund Burke, 1770, E.vil vaccine promoter

Control Methods
Overview:

Figure 1: Disease Transmission Cycle of Escherichia vil

1. Pathogen infects reservoir host: In order to decrease likelihood of infection of
wild rabbit species, the CDC plans to consider the possibility of introducing rabbit
hemorrhagic disease to areas near patient outbreaks, as well as discussing open rabbit
season with wildlife officials. Additional wild rabbit traps will be set as a means of
monitoring the disease in the wild rabbit population. Caught rabbits will be euthanized
and tested for E. vil. The public will be advised to use various types of rabbit repellant if
they are in an area with a large population of rabbits.
2. Reservoir host infects vector species: In addition to the procedures stated above,
the CDC plans to release thousands of genetically-modified male Aedes vexans
mosquitoes (exact numbers will depend on the geographic area of focus). These
GMOsquitoes carry a dominantly-expressed gene that, when present, renders all offspring
of the mated female mosquito inviable. Varieties of this procedure have been shown to be
very successful in controlling screwworm populations in the United States and are likely
to reduce Aedes vexans populations dramatically (Benedict 2003).

3. Vector infects susceptible human host: While the vaccine was originally intended
to break this link in the cycle, it has not been publicized favorably. Nonetheless, both the
live attenuated and killed vaccine will continue to be administered.
4. Reinfection of vector by susceptible host: Infected persons will be quarantined in a
prepared environment until they are deemed cured or deceased.

Implementation:
The first step in the cycle we must disrupt is the infected reservoir host. The reservoir
hosts of E. vil are various species of North American rabbits. To reduce the rabbits numbers, the
CDC will consider introducing rabbit hemorrhagic disease (RHD) to closely monitored areas.
RHD only affects rabbits, has served as an efficient control method in Australia and New
Zealand, and can be vectored by many species of mosquitoes, flies and fleas (Cooke 2002). This
plan will not work for all of the reservoir hosts as black-tailed jackrabbits and some species of
cottontails are unaffected, however it can greatly reduce the numbers of the other host species
(Center for Food Security 2007). To implement this part of the plan, the CDC will release a
native infected species of flea or mosquito into rabbit populations that have tested positive for E.
vil and closely monitor the diseases progression. The CDC will also meet with wildlife officials
in affected areas to discuss loosening limits on rabbit hunting, including extending their season to
year-round and increasing the number that can be hunted per day. The CDC will set traps in areas
with growing numbers of E. vil patients to monitor the presence of the bacteria in the rabbits. The
public will be advised to use various rabbit control methods around their properties, including
cutting the grass in closely neighboring fields and using coyote urine as a natural repellent.
The second step in the cycle that we must disrupt is the mosquito vector of E. vil. Aedes
vexans is difficult to control because the females lay their eggs above water levels and the eggs
are resistant to desiccation (Briegel 2012). Typical larvicide methods are therefore useless, so
instead the CDC is proposing to employ the sterile insect technique (SIT). Male mosquitoes will
be sterilized by radiation and released into areas with a large numbers of Aedes vexans. The
males will compete with normal males, and any females they successfully mate with then
produce sterile eggs (Benedict 2003). To accomplish this, rearing facilities will need to be
established where we can raise the male mosquitoes for sterilization. To be effective, thousands
must be released at a time, and repeatedly. The sterile insect technique was first used in the
eradication of the screwworm, and has since been used for many other species. When used in
Libya against the New World screwworm fly, eradication took only 11 months (Lindguist 1992).
Eradication is not a realistic goal when dealing with mosquitoes, but studies have shown that the
SIT can reduce their population and its effects can hopefully be seen within a year of beginning
our sterilized male release program (Benedict 2003). This program will need to continue until
other links in the chain are successfully broken and the threat of E. vil is reduced.
The live attenuated vaccine has been 94% effective in preventing new cases of E. vil, but
the general public acceptance is only at 20%. Patients have reported many side-effects after
receiving the vaccine, including temporary paralysis, fever, rash, arthritis, and digestive distress.

However, no symptoms have been reported by any healthcare professionals, though many say
their patients do not return for booster shots, which will need to be stressed in the future. It is
possible that many patients are becoming sick or more aware of their previous ailments after
inoculation and are blaming the vaccine as the cause. The CDC will fund a study researching the
side-effects, if any, of the E. vil vaccine and report the findings after peer review. Until serious
symptoms are reported by professionals, efforts will be made to make the vaccine widely
available throughout United States and Canada; as well as creating programs advocating the
importance of this vaccine.
In stopping the spread of E. vil, the transmission rate of this bacteria must be greatly
reduced. In order to do this infected persons must be quarantined to prevent further spreading of
this disease. E. vil is not spread through direct human contact, but through the bite of an infected
mosquito, so it is important to keep infected persons isolated from mosquito contact. Persons that
are not infected with E. vil must take extra precautions when doing activities outside by wearing
protective clothing and bug sprays with DEET to prevent mosquito bites (Fradin 1998).
Expected Outcomes:
Rabbit hemorrhagic fever kills infected rabbits in an average of 42 hours, and based on
previous epidemics in other countries, it is expected to spread quickly through rabbit populations
(Cooke 2002). In some cases, the disease spread too quickly and too fast and almost wiped out
the rabbit populations of other countries. So we might accidentally kill all the rabbits.
We expect the SIT performed on Aedes vexans to be successful in greatly reducing the
population of the vector, but the mosquito is so widespread that eradication is deemed
impossible. However, we hope to have the population under control in a year. We also expect this
method to greatly reduce the transmission rate of E. vil.
Vaccines in general are still recovering from misinformed negative publicity, so any
vaccine will be difficult to convince the public to accept. However, hearing from researchers, as
well as their own physicians, may help sway some. Over time as research repeatedly proves the
benefits of vaccines, hopefully the public will come to trust them again.
As most of the original patients were bitten while camping or walking in forested areas,
using DEET and wearing protective clothing should help prevent further infection immediately.
Conclusion
The CDC is advising citizens to consider these methods as a means of preventing and
stopping the spread of this disease. The public is a critical link in the chain of infection for this
disease; therefore, it is of utmost importance that people protect themselves from mosquitoes, get
vaccinated, and go to the doctor at any first sign of symptoms of this disease. The CDC will
work with various government agencies, as well as the manufacture of the vaccine to ensure the
safety of citizens in the United States and Canada. The CDC will keep the public informed on the
progress of this campaign to stop the spread of this disease and believes that by implementing
these methods described above the spread of E. vil will be halted.

Sources
Godsey, M.S., Burkhalter, K., Delory, M., Savage, H. 2010. Seasonality and Time of HostSeeking Activity of Culex tarsalis and Floodwater Aedes in Northern Colorado, 2006-2007.
http://www.bioone.org/doi/full/10.2987/09-5966.1
Briegel, H., Waltert, A., R. Kuhn. 2012. Reproductive Physiology of Aedes (Aedimorphus)
vexans (Diptera: Culicidae) in Relation to Flight Potential.
http://jme.oxfordjournals.org/content/38/4/557
Lindguist, D.A., Abusowa M., Hall M.J. 1992. The New World screwworm fly in Libya: a
review of its introduction and eradication. http://www.ncbi.nlm.nih.gov/pubmed/1600222
Benedict, M.Q., Robinson, A.S. 2003. The first releases of transgenic mosquitoes: an argument
for the sterile insect technique.
http://www.sciencedirect.com/science/article/pii/S1471492203001442
Fradin, M. S. 1998. Mosquitoes and mosquito repellents: a clinician's guide.
Cooke, B.D. 2002. Rabbit Haemorrhagic Disease: field epidemiology and the management of
wild rabbit populations.
http://www.federaciongalegadecaza.com/biblioteca/coello/CIENTIFICAS_038.pdf
The Center for Food Security and Public Health. 2007. Rabbit Hemorrhagic Disease.
http://www.cfsph.iastate.edu/Factsheets/pdfs/rabbit_hemorrhagic_disease.pdf