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<article xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" article-type="research-article"><?properties manuscript?><front><journal-meta><journal-id journal-id-type="nlm-journal-id">0375400</journal-id><journal-id journal-id-type="pubmed-jr-id">4942</journal-id><journal-id journal-id-type="nlm-ta">J Med Entomol</journal-id><journal-id journal-id-type="iso-abbrev">J. Med. Entomol.</journal-id><journal-title-group><journal-title>Journal of medical entomology</journal-title></journal-title-group><issn pub-type="ppub">0022-2585</issn><issn pub-type="epub">1938-2928</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26718715</article-id><article-id pub-id-type="pmc">5778898</article-id><article-id pub-id-type="doi">10.1093/jme/tjv234</article-id><article-id pub-id-type="manuscript">HHSPA934547</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Temporal and Spatial Variability of Entomological Risk Indices for West Nile Virus Infection in Northern Colorado: 2006&#x02013;2013</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fauver</surname><given-names>Joseph R.</given-names></name><!--<email>Joseph.Fauver@colostate.edu</email>--><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Pecher</surname><given-names>Lauren</given-names></name><!--<email>lauren.pecher@gmail.com</email>--><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Schurich</surname><given-names>Jessica A.</given-names></name><!--<email>jessicaschurich@yahoo.com</email>--><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Bolling</surname><given-names>Bethany G.</given-names></name><!--<email>Bethany.Bolling@dshs.state.tx.us</email>--><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Calhoon</surname><given-names>Mike</given-names></name><!--<email>mcalhoon@fcgov.com</email>--><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Grubaugh</surname><given-names>Nathan D.</given-names></name><!--<email>nathan.grubaugh@yahoo.com</email>--><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Burkhalter</surname><given-names>Kristen L.</given-names></name><!--<email>ktb3@cdc.gov</email>--><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Eisen</surname><given-names>Lars</given-names></name><!--<email>evp4@cdc.gov</email>--><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Andre</surname><given-names>Barbara G.</given-names></name><!--<email>Barb.Andre@colostate.edu</email>--><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Nasci</surname><given-names>Roger S.</given-names></name><!--<email>rnasci@n-smad.com</email>--><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>LeBailly</surname><given-names>Adrienne</given-names></name><!--<email>lebailae@co.larimer.co.us</email>--><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Ebel</surname><given-names>Gregory D.</given-names></name><!--<email>Gregory.Ebel@colostate.edu</email>--><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Moore</surname><given-names>Chester G.</given-names></name><!--<email>Culex.tarsalis@comcast.ne</email>--><xref ref-type="aff" rid="A1">1</xref><xref ref-type="author-notes" rid="FN1">9</xref></contrib></contrib-group><aff id="A1">
<label>1</label>Arthropod-borne &#x00026; Infectious Diseases Laboratory, Department of Microbiology, Immunology &#x00026; Pathology, Colorado State University, 1690 Campus Delivery, Fort Collins, CO 80521</aff><aff id="A2">
<label>2</label>Larimer County Department of Health and Environment, 1525 Blue Spruce Dr., Fort Collins, CO 80524</aff><aff id="A3">
<label>3</label>106th Medical Detachment (Veterinary Service Support), Unit no. 15252, APO, AP 96205</aff><aff id="A4">
<label>4</label>Colorado Mosquito Control, Inc., 318 North Garfield Ave., Loveland, CO 80537</aff><aff id="A5">
<label>5</label>Texas Department of State Health Services, Austin, TX 78714</aff><aff id="A6">
<label>6</label>City of Fort Collins, Parks Deptartment, 413 S. Bryan Ave., Fort Collins, CO 80521</aff><aff id="A7">
<label>7</label>Division of Vector-Borne Diseases, Centers for Disease Control &#x00026; Prevention, Fort Collins, CO 80521</aff><aff id="A8">
<label>8</label>Deptartment of Microbiology, Immunology &#x00026; Pathology, Colorado State University, Fort Collins, CO 80523</aff><author-notes><corresp id="FN1"><label>9</label>Corresponding author, <email>Culex.tarsalis@comcast.net</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>17</day><month>1</month><year>2018</year></pub-date><pub-date pub-type="ppub"><month>3</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>23</day><month>1</month><year>2018</year></pub-date><volume>53</volume><issue>2</issue><fpage>425</fpage><lpage>434</lpage><!--elocation-id from pubmed: 10.1093/jme/tjv234--><abstract><p id="P1">West Nile virus (WNV) is enzootic in northern Colorado. Annual surveillance activities in Fort Collins, CO, include collecting female <italic>Culex</italic> mosquitoes and testing them for the presence of WNV RNA in order to calculate 1) <italic>Culex</italic> female abundance, 2) WNV infection rate, and 3) the vector index (VI). These entomological risk indices inform public policy regarding the need for emergency adulticiding. Currently, these are calculated on a citywide basis. In this study, we present descriptive data from historical surveillance records spanning 2006&#x02013;2013 to discern seasonal and yearly patterns of entomological risk for WNV infection. Also, we retrospectively test the hypothesis that entomological risk is correlated with human transmission risk and is heterogeneous within the City of Fort Collins. Four logistically relevant zones within the city were established and used to test this hypothesis. Zones in the eastern portion of the city consistently had significantly higher <italic>Culex</italic> abundance and VI compared with zones in the west, leading to higher entomological risk indicators for human WNV infection in the east. Moreover, the relative risk of a reported human case of WNV infection was significantly higher in the eastern zones of the city. Our results suggest that a more spatially targeted WNV management program may better mitigate human risk for WNV infection in Fort Collins, and possibly other cities where transmission is enzootic, while at the same time reducing pesticide use.</p></abstract><kwd-group><kwd>West Nile virus</kwd><kwd><italic>Culex tarsalis</italic></kwd><kwd><italic>Culex pipiens</italic></kwd><kwd>surveillance</kwd><kwd>vector index</kwd></kwd-group></article-meta></front><body><p id="P2">West Nile virus (WNV, <italic>Flaviviridae: Flavivirus</italic>) is a mosquito-borne virus that was first detected in North America during the summer of 1999 in New York City (<xref rid="R29" ref-type="bibr">Lanciotti et al. 1999</xref>). The virus subsequently spread across the United States within 8 yr (<xref rid="R36" ref-type="bibr">Reisen 2013</xref>), including to Colorado in 2002 (<xref rid="R18" ref-type="bibr">Geiser et al. 2003</xref>) where it caused major epidemics in 2003 and 2004 (<xref rid="R3" ref-type="bibr">Bode et al. 2006</xref>). The virus has persisted in Colorado for more than a decade in an enzootic cycle mainly involving passerine birds (<xref rid="R23" ref-type="bibr">Kent et al. 2009</xref>) and peridomestic <italic>Culex</italic> mosquitoes, particularly <italic>Culex tarsalis</italic> Coquillett and <italic>Culex pipiens</italic> L. (<xref rid="R25" ref-type="bibr">Komar et al. 2003</xref>, <xref rid="R4" ref-type="bibr">Bolling et al. 2007</xref>). The northern Front Range of the Rocky Mountains has emerged as a high-risk area for WNV disease in humans. Larimer County alone reported &#x0003e;850 WNV disease cases from 2003&#x02013;2013 (<xref rid="R30" ref-type="bibr">Larimer County 2014</xref>). Therefore, the City of Fort Collins, Larimer County, developed an extensive WNV management program. The main priorities of this program are to provide a wide range of public education and outreach, execute routine larval control programs, extensively monitor mosquito populations, perform weekly testing for the presence of WNV in mosquito populations, and finally, to inform the need for emergency control campaigns on an as-needed basis when risk measures are elevated (<xref rid="R10" ref-type="bibr">City of Fort Collins 2014</xref>). This program was initiated in 2003 and is still in place, with annual surveillance activities spanning from June to late August or early September. Since the initiation of this program, emergency control campaigns have been executed in five trapping seasons, including three years in this study (2007, 2012, and 2013.)</p><p id="P3">Weekly data analysis included the calculation of three mosquito-based risk indices: 1) <italic>Culex</italic> female abundance, 2) WNV infection rate, and 3) the vector index (VI). The VI is an indicator of the abundance of WNV-infected female mosquitoes collected per trap night (<xref rid="R31" ref-type="bibr">Nasci et al. 2005</xref>), and has proven to be a useful predictor for human risk of WNV infection (<xref rid="R5" ref-type="bibr">Bolling et al. 2009</xref>, <xref rid="R22" ref-type="bibr">Jones et al. 2011</xref>, <xref rid="R26" ref-type="bibr">Kwan et al. 2012</xref>, <xref rid="R9" ref-type="bibr">Chung et al. 2013</xref>, <xref rid="R11" ref-type="bibr">Colborn et al. 2013</xref>). The City of Fort Collins traditionally based weekly risk on a city-wide VI. However, based on noticeably disparate trap counts within the city and multiple studies conducted with <italic>Cx. pipiens</italic> and <italic>Cx. tarsalis</italic> (<xref rid="R1" ref-type="bibr">Barker et al. 2010</xref>, <xref rid="R38" ref-type="bibr">Schurich et al. 2014</xref>), we hypothesized that the city is spatially and temporally heterogeneous for <italic>Culex</italic> female abundance, WNV infection rates, and subsequently VI. These dynamics would indicate the entomological risk for WNV infection may be higher in specific portions of the city compared with others.</p><p id="P4">In this report, we present descriptive data collected from 2006&#x02013;2013 to discern yearly and seasonal trends for all three entomological risk measures. Furthermore, we divided the city into logistically relevant and equal-sized zones to ascertain whether there are specific portions of the city that are at a higher entomological risk for human WNV infection. Our goal was to retrospectively determine if the newly defined zones varied in respect to <italic>Culex</italic> female abundance, WNV infection rate, and VI. In parallel with entomological risk measures, we measured relative risk for each zone in the study using historical human case data. This allowed us to determine if calculating the risk indices for more precisely defined areas within the City of Fort Collins, and perhaps other cities, will better inform emergency control campaigns and result in an improved WNV management program.</p><sec sec-type="materials|methods" id="S1"><title>Materials and Methods</title><sec id="S2"><title>Study Area</title><p id="P5">The study area consisted of the City of Fort Collins, CO. The city has a population of roughly 152,000 and covers ~84 km<sup>2</sup> (<xref rid="R43" ref-type="bibr">United States Census Bureau 2013b</xref>). Fort Collins is located near the foothills of the Rocky Mountains in the high plains ecological zone (<xref rid="R7" ref-type="bibr">Brown et al. 2011</xref>). The climate is semiarid, with cold winters and hot and dry summers, low humidity, and variable precipitation (<xref rid="R46" ref-type="bibr">Winters et al. 2008</xref>). Fort Collins borders on extensively irrigated agricultural lands to the north, east, and south, whereas the western edge lies along the uncultivated foothills. For analytical purposes, the city was divided into four zones using major thoroughfares: College Avenue was the East&#x02013;West boundary, and Drake Road was the North&#x02013;South boundary (<xref ref-type="fig" rid="F1">Fig. 1</xref>).</p></sec><sec id="S3"><title>Mosquito Trapping and Processing</title><p id="P6">Colorado Mosquito Control, Inc. conducted weekly trapping and identification of adult mosquitoes for the entirety of the study. Trap locations within Fort Collins were consistent over the 8-yr study period. Trapping was performed weekly using 42 CO<sub>2</sub> (dry ice)-baited Centers for Disease Control and Prevention (CDC) miniature light traps (BioQuip Products, CA) distributed in a grid-like pattern across the city, ~1.3km apart (<xref ref-type="fig" rid="F1">Fig. 1</xref>). In addition to the light traps, up to 10 gravid traps were operated in any given week to attract oviparous female mosquitoes. Trapping began in Morbidity and Mortality Weekly Report epidemiological week 23 (early June) and was continued through week 35 (early September) in all years except 2011 when trapping was concluded in week 32 due to low values for entomological risk indices. Each trap was run one night per week from late afternoon until the following morning. Mosquitoes were collected, and then sorted by site, date, species, and sex. Female <italic>Culex</italic> mosquitoes were pooled, typically in pools of no more than 50 specimens, and submitted for WNV screening. Pools were submitted as <italic>Cx. tarsalis</italic>, <italic>Cx. pipiens</italic>, or, for some specimens lacking certain body parts required for species identification, as <italic>Culex</italic> species (spp.). Based on the results from molecular identification assays showing that the vast majority of <italic>Culex</italic> spp. pool specimens were <italic>Cx. pipiens</italic> (CDC, unpublished data), <italic>Culex</italic> spp. mosquitoes were included as <italic>Cx. pipiens</italic> in calculations for mosquito abundance, infection rate, and VI.</p></sec><sec id="S4"><title>Screening of Mosquito Pools for WNV</title><p id="P7">From 2006&#x02013;2008, mosquito pools were processed by CDC Division of Vector-Borne Diseases personnel for the presence of WNV RNA as described previously (<xref rid="R28" ref-type="bibr">Lanciotti et al. 2000</xref>, <xref rid="R33" ref-type="bibr">Nasci et al. 2001b</xref>). From 2009&#x02013;2013, mosquito pools were processed by the Colorado State University Arthropod-Borne and Infectious Diseases Laboratory using the following methodology. Mosquito pools were homogenized in 1 ml of mosquito diluent (80% PBS, 20% FBS, supplemented with penicillin, streptomycin, gentamicin, and amphotericin B) with a single steel ball bearing using a Retsch Mixer Mill 400 (Retsch GmbH, Haan, Germany) at 24Hz for 45 s. Homogenates were then centrifuged at 20,000 &#x000d7; <italic>g</italic> for 5 min, and 50 &#x000b5;l of cleared supernatant was used for RNA extraction. RNA was extracted using either QIAamp Viral RNA Mini Kit (Qiagen, CA), or Mag-Bind Viral DNA/RNA kit (Omega, GA) with the KingFisher Flex Magnetic Particle Processor (Thermo Fisher Scientific, MA) according to manufacturer&#x02019;s protocol. The extracted RNA was amplified via reverse transcriptase polymerase chain reaction (RT-PCR) using the following primers: forward 212 5&#x02032; TTGTGTTGGCTCT CTTGGCGT 3&#x02032;, reverse 619c 5&#x02032; CAGCCGACAGCACTGGACATT 3&#x02032; (<xref rid="R19" ref-type="bibr">Giladi et al. 2001</xref>). RT-PCR products were run on a 1% agarose gel stained with ethidium bromide in order to visualize the 408 base pair target sequence.</p></sec><sec id="S5"><title>Entomological Data Analysis</title><p id="P8">Weekly <italic>Culex</italic> abundance and infection rate were calculated separately for females of 1) <italic>Cx. tarsalis</italic>, 2) <italic>Cx. pipiens</italic>, and 3) all <italic>Culex</italic>. Abundance was based solely on collections from light traps, whereas collections from both light traps and gravid traps were included in the WNV infection rate calculation, following the protocol established by <xref rid="R31" ref-type="bibr">Nasci et al. (2005</xref>). Infection rates were calculated per 1,000 females using the bias-corrected maximum likelihood estimate (MLE) in the Excel add-in, PooledInfRate (<xref rid="R2" ref-type="bibr">Biggerstaff 2009</xref>). MLE was used in favor of the minimum infection rate (MIR) because it is more accurate at high infection rates and mosquito abundances (<xref rid="R21" ref-type="bibr">Gu et al. 2003</xref>). The VI is calculated by multiplying the abundance per trap night of a given mosquito species with the estimated proportion of infected females for that species (<xref rid="R8" ref-type="bibr">CDC 2013</xref>);
<disp-formula id="FD1"><mml:math id="M1" display="block" overflow="scroll"><mml:mtext mathvariant="italic">VI</mml:mtext><mml:mo>=</mml:mo><mml:mo>&#x02211;</mml:mo><mml:msub><mml:mover><mml:mi>N</mml:mi><mml:mo>&#x000af;</mml:mo></mml:mover><mml:mi>i</mml:mi></mml:msub><mml:msub><mml:mover><mml:mi>P</mml:mi><mml:mo>^</mml:mo></mml:mover><mml:mi>i</mml:mi></mml:msub></mml:math></disp-formula>where <italic>i</italic> refers to the specific mosquito species, <italic>N</italic> is the abundance per trap night of the <italic>i</italic>th species, and <italic>P</italic> is the estimated infection rate per one female of the <italic>i</italic>th species. The VI is calculated separately for each vector species in a given area, in this case <italic>Cx. tarsalis</italic> and <italic>Cx. pipiens</italic>, and the subsequent addition of the VIs for all vector species provides an overall VI value. Abundance per trap night, which is the total <italic>Culex</italic> abundance divided by the number of traps operated in that zone, infection rates, and VI were calculated on a weekly basis for each year in the study for each zone.</p></sec><sec id="S6"><title>Weather Data Analysis</title><p id="P9">Weather data from 2006&#x02013;2013 were obtained from the Colorado Agricultural Meteorological Network. The average daily temperature and precipitation was recorded at the Fort Collins Agricultural Engineering Research Center on the CSU Foothills campus. The average weekly temperature for all years was calculated by taking the average of the daily temperatures for the week. Total precipitation was calculated by taking the sum of all precipitation for the week.</p></sec><sec id="S7"><title>Human Case Data</title><p id="P10">Anonymized human case data from 2006&#x02013;2013 were provided by the Larimer County Department of Health and Environment (LCDHE). Cases were assigned to zones by LCDHE using Google Fusion Tables (an open source geocoding service) based on the home address. Annual zone populations were estimated by determining the correspondence of 2000 and 2010 census blocks with a physical LCDHE map of Fort Collins (<xref rid="R42" ref-type="bibr">United States Census Bureau 2013a</xref>, <xref rid="R44" ref-type="bibr">2014</xref>). The resulting census block lists were verified by matching them to U.S. Census Bureau TIGER/Line 2000 and 2010 census block shapefiles using ArcGIS (<xref rid="R13" ref-type="bibr">Esri 2015</xref>, <xref rid="R45" ref-type="bibr">United States Census Bureau 2015</xref>). The 2000 and 2010 census population data for each zone by census block were then obtained using American Fact Finder (<xref rid="R40" ref-type="bibr">United States Census Bureau 2012a</xref>, <xref rid="R41" ref-type="bibr">b</xref>). Annual zone populations were estimated using a compound annual growth rate calculated based on the change between the 2000 and 2010 census population falling within each zone by census block (<xref rid="R35" ref-type="bibr">Parker 2002</xref>). These estimates were used with mapped case data to calculate annual and cumulative zone incidence rates. Relative risks among zones were calculated using cumulative zone incidence rates. The NW zone is used as the reference group for the analysis, as it has the lowest cumulative incidence.</p></sec><sec id="S8"><title>Statistics</title><p id="P11">Because the entomological data did not follow assumptions for normality or equal variance, a Friedman&#x02019;s test was conducted followed by Dunn&#x02019;s test of multiple comparisons to determine differences between zones for <italic>Culex</italic> abundance per trap night, infection rate, and VI. The Spearman correlation was used to determine the relationship between the VI and human cases. Significance of relative risk for human cases was determined through calculation of 95% confidence intervals; a 95% confidence interval that does not include 1 (reference zone risk) is considered statistically significant. Statistics were calculated with Prism (GraphPad, CA).</p></sec></sec><sec sec-type="results" id="S9"><title>Results</title><sec id="S10"><title>Seasonal Trends for <italic>Culex</italic> Abundance, Infection Rate, and VI</title><p id="P12">Over the 8-yr study period a total of 602,420 female mosquitoes were trapped city wide, of which 131,777 were <italic>Culex</italic> species (21.9%). Of the <italic>Culex</italic>, 115,882 (87.9%) were identified as <italic>Cx. tarsalis</italic>, and 15,895 (12.1%) were identified either as <italic>Cx. pipiens</italic> or <italic>Culex</italic> spp. and assigned to <italic>Cx. pipiens</italic>. Using data from the whole city for all years, weekly 8-yr averages for abundance, infection rate, and VI were calculated (<xref ref-type="fig" rid="F2">Fig. 2</xref>). <italic>Cx. tarsalis</italic> weekly 8-yr average abundance peaked in week 29, whereas <italic>Cx. pipiens</italic> abundance peaked in week 32 (<xref ref-type="fig" rid="F2">Fig. 2A</xref>). There was no discernible difference between the two species for the seasonal peak in WNV infection rate (<xref ref-type="fig" rid="F2">Fig. 2B</xref>). Infection rates did not exceed 1 per 1,000 females until week 29, and gradually increased through the end of the trapping season. Infection rates tended to peak at the end of the trapping season in week 35. The weekly 8-yr average VI rose sharply and peaked in week 29 for <italic>Cx. tarsalis</italic>, and rose gradually and peaked in week 32 for <italic>Cx. pipiens</italic> (<xref ref-type="fig" rid="F2">Fig. 2C</xref>). The 8-yr average VI was higher for <italic>Cx. tarsalis</italic>.</p></sec><sec id="S11"><title>Yearly Trends for <italic>Culex</italic> Abundance, Infection Rate, and VI</title><p id="P13">The general trends for <italic>Culex</italic> abundance, infection rate, and VI remained constant year to year; however, the values varied substantially between years (<xref ref-type="fig" rid="F3">Fig. 3</xref>). <italic>Culex</italic> abundance peaked prior to infection rate and VI in all years. The infection rate continued to rise throughout the trapping season, while the VI decreased with <italic>Culex</italic> abundance late in the season. 2007 had the highest <italic>Culex</italic> abundance with a total of 34,608 females captured, which accounted for over 25% of the total abundance for the 8-yr study. The majority of <italic>Culex</italic> captured in 2007 were <italic>Cx. tarsalis</italic> (32,314; 93.3%) as opposed to <italic>Cx. pipiens</italic> (2,294; 6.7%). 2012 had the highest average weekly infection rate with 10.3 per 1,000 females infected. 2007 and 2013 had the highest average weekly VIs of 0.40 and 0.43, respectively. Average weekly temperature fluctuated mildly within years, typically being lowest at the beginning of the season (May), rising throughout the season, and decreasing at the end (September). The temperatures between years varied more substantially. Weekly precipitation was sporadic and varied between years. In several years, there appeared to be a positive relationship between peaks in precipitation and subsequent peaks in vector abundance (<xref ref-type="fig" rid="F3">Fig. 3</xref>&#x02014;2006, 2009, 2010), but in other years that pattern was missing or greatly reduced (<xref ref-type="fig" rid="F3">Fig. 3</xref>&#x02014;2007, 2008, 2012).</p></sec><sec id="S12"><title>Zone Comparisons</title><p id="P14">Fort Collins was divided into four zones in order to test the hypothesis that the city is heterogeneous for mosquito-based risk measures (<xref ref-type="fig" rid="F1">Fig. 1</xref>). We found significant differences for each zone comparison for <italic>Cx. tarsalis</italic> and <italic>Cx. pipiens</italic> abundance per trap night (CO<sub>2</sub>-baited light traps), save the NE versus SE zones for <italic>Cx. tarsalis</italic> (<xref ref-type="table" rid="T1">Table 1</xref>). The only significant difference in infection rate was between the NW and SE zones for <italic>Cx. tarsalis</italic>, with the SE zone having a higher infection rate. The SE zone had a significantly higher VI when compared with the NW and SW zones for <italic>Cx. tarsalis</italic> and all <italic>Culex</italic> VI. The differences in VI for each zone, week, and year are visually represented in <xref ref-type="fig" rid="F4">Fig. 4</xref>. In general, the eastern zones had higher <italic>Culex</italic> abundance and VI when compared with the western zones. Total human cases for each zone in each year are highly correlated with the sum of the zone VI in the same year (<xref ref-type="fig" rid="F5">Fig. 5</xref>). Relative risk follows the same pattern as the VI. Inhabitants of the SE and NE zones have a significantly higher risk (<italic>P</italic>-value &#x0003c; 0.05) of contracting WNV as opposed to those living in the western zones (<xref ref-type="table" rid="T2">Table 2</xref>).</p></sec></sec><sec sec-type="discussion" id="S13"><title>Discussion</title><p id="P15">Entomological risk of WNV, summarized in the VI, can be affected by several factors. These include ecological variables such as temperature, precipitation, and land usage and cover (<xref rid="R15" ref-type="bibr">Ezenwa et al. 2007</xref>, <xref rid="R6" ref-type="bibr">Brown et al. 2008</xref>, <xref rid="R12" ref-type="bibr">Eisen et al. 2010</xref>, <xref rid="R24" ref-type="bibr">Kilpatrick 2011</xref>). In addition, mosquito feeding preferences (<xref rid="R27" ref-type="bibr">LaDeau et al. 2007</xref>, <xref rid="R16" ref-type="bibr">Farajollahi et al. 2011</xref>), availability of larval and adult habitats (<xref rid="R38" ref-type="bibr">Schurich et al. 2014</xref>), and local avian species diversity (<xref rid="R14" ref-type="bibr">Ezenwa et al. 2006</xref>) can also influence WNV transmission. These factors and others likely contributed to the seasonal and spatial differences in VI we observed during the study period.</p><p id="P16">Annual variation in these factors resulted in fluctuations in all mosquito-based risk measures (<xref ref-type="fig" rid="F3">Fig. 3</xref>). However, our city-wide data demonstrate consistent patterns for entomological risk. <italic>Culex</italic> abundance gradually rose through the middle of the trapping season and fell at the end, as late season emerging females prepared to enter diapause and are no longer seeking bloodmeals. <italic>Cx. tarsalis</italic> tended to reach peak abundance prior to <italic>Cx. pipiens</italic>, which is consistent with previous local studies (<xref rid="R5" ref-type="bibr">Bolling et al. 2009</xref>, <xref rid="R1" ref-type="bibr">Barker et al. 2010</xref>). The abundance values of these two important vector species varied substantially. However, this can partly be attributed to the sampling bias of CDC miniature light traps, which preferentially collects <italic>Cx. tarsalis</italic> (<xref rid="R39" ref-type="bibr">Tsai et al. 1988</xref>, <xref rid="R37" ref-type="bibr">Reisen et al. 1999</xref>). The infection rate typically remained at zero until week 29 and then continued to rise steadily through the remainder of the season, even while abundance decreased. This is expected as the host-seeking (nondiapausing) population ages due to a lack of new emerging females entering the population. As the population ages, the likelihood of infection increases with multiple blood-feeding cycles and the overall increasing intensity of enzootic WNV transmission. Interestingly, the VI more closely followed the trend of <italic>Culex</italic> abundance than infection rate. While an infection rate above zero is necessary to have a VI above zero, the VI tended to be dictated more by <italic>Culex</italic> abundance than infection rate when the latter is above zero. Overall, we found that the seasonal trends remained relatively consistent despite dramatic year-to-year variability in values.</p><p id="P17">2007&#x02013;2008 provided an example of this variation: in 2007, almost 35,000 <italic>Culex</italic> females were trapped in the 13-wk trapping season as opposed to just 9,000 trapped the following summer in 2008. The WNV infection rate was highest in 2012, where it exceeded 20 per 1,000 females in two sampling weeks. We observed WNV infection early in the trapping seasons (week 23) in 2012 and 2013. This may have been due to infections in newly emerged offspring of overwintering mosquitoes. WNV has been detected in pools of overwintering <italic>Culex</italic> mosquitoes (<xref rid="R32" ref-type="bibr">Nasci et al. 2001a</xref>, <xref rid="R17" ref-type="bibr">Farajollahi et al. 2005</xref>), and natural vertical transmission of WNV has been demonstrated on multiple occasions (<xref rid="R20" ref-type="bibr">Goddard et al. 2003</xref>, <xref rid="R34" ref-type="bibr">Nelms et al. 2013</xref>). This mechanism could play an important role in maintaining WNV endemicity in northern Colorado, although <xref rid="R4" ref-type="bibr">Bolling et al. (2007)</xref> tested over 9,000 overwintering <italic>Culex</italic> females from the Front Range without detecting WNV. Although 2012 had the highest WNV infection rate throughout the season, 2007 and 2013, which had the highest abundances, also proved to have the highest VIs. A weak association exists within our data in regard to seasonal rainfall and mosquito population increases. As noted above, in multiple years, increased precipitation was followed by an increase in <italic>Culex</italic> abundance 1&#x02013;3 wk later. In other years, however, that pattern was not observed. Precipitation will increase the amount of available larval habitat for adult female <italic>Culex</italic> to oviposit. There is also a casual association between warmer weekly temperatures and increased <italic>Culex</italic> abundance. These associations do not appear to be reflected in infection rate or VI. Neither precipitation nor temperature appears to be predictive of entomological risk alone. This demonstrates the dynamic nature of WNV transmission within our study area. The impact of weather on seasonal WNV patterns is complex and will require further study.</p><p id="P18">Four zones, of approximately equal size, within the City of Fort Collins were established and retrospectively analyzed to determine if the city was homogenous for <italic>Culex</italic> abundance, WNV infection rate, and VI. We found significant differences between all zones, save the NE versus SE, for both <italic>Cx. tarsalis</italic> and <italic>Cx. pipiens</italic> abundance per trap night, leading us to conclude that the city was heterogeneous for <italic>Culex</italic> abundance. We found fewer significant differences in infection rate between zones, with the only significant difference occurring between the NW versus SE zones for <italic>Cx. tarsalis</italic>. This result indicates that the city was more homogenous for WNV infection rate than for <italic>Culex</italic> abundance. Evaluating zone comparisons for the VI, we took into account both species of <italic>Culex</italic> and a combined VI. We found significant differences between the SE zone and both western zones for <italic>Cx. tarsalis</italic> VI and all <italic>Culex</italic> VI. Our data provided no evidence of mosquitoes becoming infected at a higher rate in particular portions of the city. Rather, there was a larger abundance of mosquitoes in the eastern portion of the city as opposed to the western portion, resulting in a higher VI and higher risk for WNV infection in the east. These data are consistent with other studies done in the area. <xref rid="R12" ref-type="bibr">Eisen et al. (2010)</xref> found a positive association between proximity to irrigated agriculture and elevated WNV incidence. <xref rid="R38" ref-type="bibr">Schurich et al. (2014)</xref> demonstrated a negative correlation between elevation and <italic>Cx. tarsalis</italic> abundance within Fort Collins. They also showed proximity to irrigated agriculture is highly associated with increased <italic>Cx. tarsalis</italic> abundance. As the elevation is higher on the western side of the city and irrigated agriculture is the predominant landscape on the eastern edge, these data help to provide an explanation for the greater <italic>Culex</italic> abundance and VI seen in the eastern portion of the city in this study.</p><p id="P19">Our data clearly establish that Fort Collins is heterogeneous for VI. The disparity in VI within the city is reflected in the relative risk for human WNV infection. These data suggest that the entomological risk and relative risk for human WNV infection is correlated, and is higher on the eastern portion of the city than the west. This observation has implications for control policy and public outreach. Currently, the City of Fort Collins&#x02019;s control policy is dictated by a rise in the city-wide VI over the established threshold of 0.75, although a more thorough evaluation of specific VI values in relation to human risk of WNV exposure is necessary and currently being addressed. The assumption that the city is spatially homogenous for mosquito-based risk measures and relative risk is not supported by our data. Moreover, this assumption and the use of a city-wide VI prevent early recognition of increased risk in portions of the city where the inhabitants are at greatest risk for contracting WNV. With growing public concern against emergency adulticiding and pesticide use in general, a more targeted spray policy (based on zones rather than the entire city) likely would result in less overall pesticide usage by only spraying areas at elevated risk levels and avoiding treatment of areas that present little or no risk. This also allows for more targeted public health interventions by letting citizens know which areas of the city are at the highest risk. Overall, our data demonstrate that seasonal trends can be discerned and that dividing the city into zones may better inform spray policy and help mitigate human risk for WNV infection in Fort Collins.</p></sec></body><back><ack id="S14"><p id="P20">We would like to thank Kamaria Price, Kacy Cobble, Amanda Hardison, Stacey Elmore, Scott Sieke, Abhishek Prasad, and Benjamin Dodd for their assistance in the Laboratory at AIDL; we would also like to thank Erin McCool, Sarah Yoder, Stacy Marshall, Casey Funderburk, Monica Heersink, and Dominic Rose for their support at CMC. We would like to thank Claudia Ruckert and Kristen Davenport for their assistance in reviewing the manuscript. This work was supported, in part, by the annual City of Fort Collins West Nile virus Surveillance grant. 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Historical city-wide data were averaged together for each week to discern seasonal trends for (A) <italic>Culex</italic> abundance, (B) WNV infection rate (per 1,000 mosquitoes), and (C) VI. Error bars represent the range for each week.</p></caption><graphic xlink:href="nihms934547f2"/></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p id="P23"><italic>Culex pipiens</italic> and <italic>Cx. tarsalis</italic> abundance, WNV infection rate, and VI, 2006&#x02013;2013. These measures varied substantially between years. Each year in the study is represented by two graphs: The upper graph shows yearly weather data and the lower shows entomological risk indices. Yearly seasonal data show that <italic>Culex</italic> female abundance rises prior to WNV infection rate and VI each year, although the values for these entomological risk indices vary substantially from year to year. Average weekly temperature remains relatively consistent between years. Total weekly precipitation varies within and between years.</p></caption><graphic xlink:href="nihms934547f3a"/><graphic xlink:href="nihms934547f3b"/></fig><fig id="F4" orientation="portrait" position="float"><label>Fig. 4</label><caption><p id="P24">Heat map showing VI by week, zone, and year, 2006&#x02013;2013, Fort Collins, CO. The VI is heterogeneous between zones. There is dramatic variation in VI within years and between years; however, the NE and SE zones consistently produce a higher VI, and therefore, reflect higher entomological risk for human exposure to WNV compared with the NW and SW zones. Total annual reported human cases are listed in the far right column. This figure is available in color in online edition.</p></caption><graphic xlink:href="nihms934547f4"/></fig><fig id="F5" orientation="portrait" position="float"><label>Fig. 5</label><caption><p id="P25">Incidence rates (cases per 10,000 population) and VI in Fort Collins, CO, 2006&#x02013;2013. The VI is highly correlated with human WNV cases. The sum of the VI for each zone in each year is related to the total number of human WNV cases in the same year and zone. <italic>r</italic> = 0.8171, <italic>P</italic>-value &#x0003c; 0.0001.</p></caption><graphic xlink:href="nihms934547f5"/></fig><table-wrap id="T1" position="float" orientation="landscape"><label>Table 1</label><caption><p id="P26">Statistical analysis of entomological risk indices between zones, 2006&#x02013;2013</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Zone comparison<xref ref-type="table-fn" rid="TFN6">a</xref></th><th align="left" colspan="2" rowspan="1">Abundance per trap night</th><th align="left" colspan="2" rowspan="1">WNV infection rate</th><th align="left" colspan="3" rowspan="1">Vector index</th></tr><tr><th align="left" rowspan="1" colspan="1"/><th align="left" colspan="2" valign="bottom" rowspan="1">
<hr/></th><th align="left" colspan="2" valign="bottom" rowspan="1">
<hr/></th><th align="left" colspan="3" valign="bottom" rowspan="1">
<hr/></th></tr><tr><th align="left" rowspan="1" colspan="1"/><th align="left" rowspan="1" colspan="1"><italic>Cx. tarsalis</italic></th><th align="left" rowspan="1" colspan="1"><italic>Cx. pipiens</italic></th><th align="left" rowspan="1" colspan="1"><italic>Cx. tarsalis</italic></th><th align="left" rowspan="1" colspan="1"><italic>Cx. pipiens</italic></th><th align="left" rowspan="1" colspan="1"><italic>Cx. tarsalis</italic></th><th align="left" rowspan="1" colspan="1"><italic>Cx. pipiens</italic></th><th align="left" rowspan="1" colspan="1">All <italic>Culex</italic></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">NE vs. NW</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (NE)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN3">**</xref> (NE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td></tr><tr><td align="left" rowspan="1" colspan="1">NE vs. SE</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (NE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td></tr><tr><td align="left" rowspan="1" colspan="1">NE vs. SW</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (NE)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref>(NE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td></tr><tr><td align="left" rowspan="1" colspan="1">NW vs. SE</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN4">***</xref> (SE)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN3">**</xref> (NW)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN2">*</xref> (SE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN2">*</xref> (SE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN2">*</xref> (SE)</td></tr><tr><td align="left" rowspan="1" colspan="1">NW vs. SW</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (NW)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (NW)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td></tr><tr><td align="left" rowspan="1" colspan="1">SE vs. SW</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN5">****</xref> (SE)</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN4">***</xref> (SE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN4">***</xref> (SE)</td><td align="left" rowspan="1" colspan="1">ns</td><td align="left" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="TFN3">**</xref> (SE)</td></tr><tr><td align="left" rowspan="1" colspan="1">Friedman Stat</td><td align="left" rowspan="1" colspan="1">205.1</td><td align="left" rowspan="1" colspan="1">161.2</td><td align="left" rowspan="1" colspan="1">23.43</td><td align="left" rowspan="1" colspan="1">4.87</td><td align="left" rowspan="1" colspan="1">35.21</td><td align="left" rowspan="1" colspan="1">5.85</td><td align="left" rowspan="1" colspan="1">29.68</td></tr><tr><td align="left" rowspan="1" colspan="1">Treatments</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td></tr><tr><td align="left" rowspan="1" colspan="1">Subjects</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td><td align="left" rowspan="1" colspan="1">104</td></tr><tr><td align="left" rowspan="1" colspan="1">df</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><p id="P27">Significance was determined with a Friedman test and Dunn&#x02019;s post test.</p></fn><fn id="TFN2"><label>*</label><p id="P28"><italic>P</italic> &#x02264; 0.05,</p></fn><fn id="TFN3"><label>**</label><p id="P29"><italic>P</italic> &#x02264; 0.01,</p></fn><fn id="TFN4"><label>***</label><p id="P30"><italic>P</italic> &#x02264; 0.001,</p></fn><fn id="TFN5"><label>****</label><p id="P31"><italic>P</italic> &#x02264; 0.0001; ns&#x02014;not significant. The zone with the higher value is in parenthesis.</p></fn><fn id="TFN6"><label>a</label><p id="P32">NW, nohwest; NE, northeast; SE, southeast; SW, southwest.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float" orientation="landscape"><label>Table 2</label><caption><p id="P33">Relative risk compared between zones, 2006&#x02013;2013</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Zone</th><th align="center" valign="top" rowspan="1" colspan="1">Total cases</th><th align="right" rowspan="1" colspan="1">Cumulative<break/>incidence rate</th><th align="left" rowspan="1" colspan="1">Relative<break/>risk</th><th align="left" colspan="2" valign="top" rowspan="1">95% CI</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">NW</td><td align="center" rowspan="1" colspan="1">39</td><td align="right" rowspan="1" colspan="1">9.04</td><td align="left" rowspan="1" colspan="1">1.00</td><td align="left" rowspan="1" colspan="1"/><td align="left" rowspan="1" colspan="1"/></tr><tr><td align="left" rowspan="1" colspan="1">NE</td><td align="center" rowspan="1" colspan="1">46</td><td align="right" rowspan="1" colspan="1">16.52</td><td align="left" rowspan="1" colspan="1">1.83<xref ref-type="table-fn" rid="TFN7">*</xref></td><td align="left" rowspan="1" colspan="1">1.19</td><td align="left" rowspan="1" colspan="1">2.80</td></tr><tr><td align="left" rowspan="1" colspan="1">SW</td><td align="center" rowspan="1" colspan="1">24</td><td align="right" rowspan="1" colspan="1">9.23</td><td align="left" rowspan="1" colspan="1">1.02</td><td align="left" rowspan="1" colspan="1">0.61</td><td align="left" rowspan="1" colspan="1">1.70</td></tr><tr><td align="left" rowspan="1" colspan="1">SE</td><td align="center" rowspan="1" colspan="1">71</td><td align="right" rowspan="1" colspan="1">19.22</td><td align="left" rowspan="1" colspan="1">2.13<xref ref-type="table-fn" rid="TFN7">*</xref></td><td align="left" rowspan="1" colspan="1">1.44</td><td align="left" rowspan="1" colspan="1">3.14</td></tr></tbody></table><table-wrap-foot><fn id="TFN7"><label>*</label><p id="P34">Denotes statistical significance. 95% confidence intervals that do not span 1 (reference zone risk) are considered statistically significant.</p></fn><fn id="TFN8"><p id="P35">NW zone&#x02014;reference</p></fn></table-wrap-foot></table-wrap></floats-group></article>