Quantitative Risk Assessment of the Pathways by Which West Nile Virus Could Reach Hawaii

The introduction of West Nile virus (WNV) to Hawaii could have severe impacts on human health, wildlife health and, as a result, Hawaii’s tourism-based economy. To provide guidance for management agencies seeking to prevent the introduction of WNV, we performed a quantitative assessment of the pathways by which WNV could reach Hawaii from North America. We estimated the rate of infectious individuals reaching Hawaii by the following means (1) humans on aircraft, (2) wind-transported mosquitoes, (3) human-transported mosquitoes, (4) human-transported birds or other vertebrates, and (5) migratory birds. We found that pathways 3 and 4 represented the highest risk. We estimated that each year, 7–70 WNV infectious mosquitoes will reach Hawaii by airplane when WNV becomes well established in the Western U.S. Exemptions in current quarantine regulations will also result in the import of birds that will be infectious with WNV for 0.3–2.2 bird-days each year. We propose actions that would substantially reduce the risk of WNV reaching Hawaii by these means, including reinstating aircraft disinsection in cargo holds and altering bird quarantine rules. Finally, research is urgently needed to determine whether a migratory bird can survive the migration from North America to Hawaii with a viremic WNV infection.