It was July in Marion, North Carolina. As was typical for summertime, the small town at the edge of the Blue Ridge Mountains was thriving with activity. Hikers filled the streets for a quick bite to eat. Children were playing in yards.
Rambunctious five-year-old Granger Horney was usually the first out the back door and gone with the wind. But that day, Granger was abnormally tired and weak. His father, Cody, a 32-year-old maintenance technician at IV bag producer Baxter Healthcare, immediately knew something was off.
"All of a sudden, he's basically stuck on the couch," said Cody. "He couldn't even stand up by himself. Couldn't really respond to anything. Then the vomiting and seizure symptoms started."
A Race for a Diagnosis
Cody and his wife, Nikki, took their son to several specialists. But still there was no answer as to what was happening to Granger. As his seizures grew more frequent, the family rushed Granger to Mission Hospital in Asheville - the only hospital in western North Carolina equipped to treat pediatric patients with severe illness.
Granger recovering at Mission Hospital in Asheville, NC. Credit: Cody Horney.
Tipped off by Granger's neurological symptoms, doctors pulled cerebrospinal fluid from Granger's spinal cord. The lumbar puncture procedure revealed two things: that there was an immense amount of fluid around his spine and the presence of antibodies likely against a virus.
At that point, Granger's diagnosis was abundantly clear to the pediatricians overseeing his care. He had contracted La Crosse virus, a relatively uncommon mosquito-borne disease found in western North Carolina.
Unfortunately, there is no treatment or vaccine for the virus. The pediatricians at Mission Hospital did their best to support Granger while they waited for the confirmatory test to come back. Doctors removed some fluid that was applying pressure against his spinal cord and gave him medicine to quell his fever.
All they could do is wait for the virus to run its course. And, much to the delight of his parents, Granger had quickly rebounded.
"Within a few hours of getting that fluid removed, he was up sitting there, talking, eating," said Nikki. "It was kind of crazy how fast he bounced back just after that."
Not all children are able to bounce back, let alone so quickly.
A Lesser-Known Mosquito Borne Disease
La Crosse virus average annual incidence per 100,000 population by county of residence, 2003-2023. Credit: Centers for Disease Control and Prevention.
La Crosse virus is a mosquito-borne disease transmitted by the eastern treehole mosquito (Aedes triseriatus). The virus, which was first identified in La Crosse, Wisconsin in 1960, is isolated to rural regions where these mosquitoes thrive, including densely wooded areas of southeastern Ohio, eastern Tennessee, and western North Carolina.
According to the CDC, the following counties in NC have seen the highest incidence of La Crosse Virus since recording began in 2003: Swain, Transylvania, Jackson, Haywood, Graham, Buncombe, Macon, Yancey, Polk, Henderson, Cherokee, and McDowell.
The first three listed counties-Swain, Transylvania, and Jackson-have the highest incidence rates in the entire United States.
Zooming out from North Carolina, La Crosse virus is the second-most prevalent mosquito-borne virus in the United States and the most common among children. But, despite the virus's discovery many decades ago, the number of cases has stayed the same-likely due to misdiagnosis, lack of awareness, or underreporting.
"Neither one of us had ever heard about this virus," said Cody. "We would have never dreamed that he got mosquito bit and got a virus, and that is what caused all this."
Aedes triseriatus. Note its dark body, white and silver scales on the side of its abdomen, and the lack of banding on its legs. Credit: TC Riley, Observation 283161052.
The eastern treehole mosquito transmits the virus through a bite to the skin. Symptoms can crop up anywhere from a few days to a few weeks after being bitten by the infected mosquito. While adults are often asymptomatic or only have mild symptoms, children under the age of 18 are more likely to have severe, life-altering symptoms.
Severe disease usually takes the form of encephalitis, or brain inflammation, which is often characterized by:
- High fever,
- Seizures,
- Brain swelling,
- Disorientation,
- Vomiting,
- Paralysis
"The doctor told us that if we would have waited 24 more hours, Granger might not be with us, or, you know, he would be in worse shape," said Nikki. "We were thankful we reacted when we did."
While Granger was recovering, doctors and nurses asked the Horney family if they wanted to take part in an ongoing study about the La Crosse virus.
Ross Boyce, MD
The "La Crosse Virus (LACV) Study" is co-led by Ross Boyce, MD, MSc, an expert on epidemiology and vector-borne disease at the UNC School of Medicine and funded by the State of North Carolina through the N.C. Collaboratory. The study, which is done in coordination with researchers across the UNC Institute for Global Health and Infectious Disease, Western Carolina University, and National Institutes of Health, involves collecting patient blood samples and testing mosquito samples to learn more about the virus. Their ultimate goal is to develop new diagnostic tools and potentially vaccines that can reduce the severity of the virus in children.
Cody and Nikki immediately said yes.
Tracking a Neglected Disease
The study officially begins at the Department of Pediatrics at Mission Hospital. Medical professionals there perform diagnoses and provide important health data about the participants with the La Crosse virus. After the study team gathers patient health information, researchers must then track down and identify the vectors, or carriers, that gave study participants the virus.
Brian Byrd, PhD, an environmental health professor at Western Carolina University and leader of the study, travels all over North Carolina to collect and study infected mosquitoes. But it is no easy task. Why? It's all in the name. Eastern treehole mosquitoes breed in stagnant water that collects in cavities at the base of the tree or holes that form after limbs break off the trunk. Oftentimes, breeding sites can be far above eye level.
Madeleine Craig, a vector biologist at
Western Carolina University Mosquito-borne Infectious Disease Laboratory, sampling mosquitoes from a mosquito trap. Credit: Brian Byrd
A week after Granger's hospitalization, it was time for Byrd and his team to pay the Horney family a visit. They arrived at the Horney household in the afternoon to search for breeding sites, collect infected mosquitoes, and set up multiple types of mosquito traps. But Byrd wasn't alone. Granger and his older brother, Gunner, trailed behind him, closely monitoring his work.
Nearing supper time, Cody and Nikki insisted that Byrd stay a while longer to enjoy some delicious fried squash. Once back in the lab, Byrd and his team confirmed that the types of mosquitoes responsible for carrying the virus were around the property. From there, it was time for Boyce to coordinate the next phase of the trial at Chapel Hill.
Boyce grew up outside of Winston-Salem and spent his teenage years as a Boy Scout around Mount Airy, NC. Although his research primarily focuses on mosquito-borne disease that plague Africa, Boyce is passionate about helping the Appalachian region and its people as they struggle with this little-known virus.
"Western North Carolina is particularly affected by this neglected virus," said Boyce. "Nationally, there's probably been 60 to 70 cases per year over the past 40 years that we know of. It's shameful because these are kids we're talking about here. Kids who are often left with long-term disability. And it feels like, we, as a country should have the knowledge and resources to solve this problem."
The Final Stretch
In late January, the Horney's completed the final stretch of the study. They traveled three hours to Chapel Hill, North Carolina, to provide special blood samples, giving researchers the chance to isolate and study the antibodies that helped Granger fight the infection. The study compensated for the family's gas and reserved room and board for them at the Carolina Inn. Citing the rarity of study participants and kindness of the family, Boyce said he wanted them to make it "a weekend out of it."
The Burnett-Womack Building at UNC-Chapel Hill.
At the Clinical Trial Research Center in Burnett-Womack, phlebotomists collected five tubes worth of blood from Granger. He took it like a champ. Cody and Nikki also had their blood drawn to see if they were also exposed to-and had antibodies for-La Crosse virus. The samples were then processed and sent off to the National Institutes of Health for further analysis and testing.
With more samples from courageous children like Granger, researchers studying the La Crosse virus will have the opportunity to develop new diagnostic tools, disease control methods, and potentially vaccines that can reduce the severity of the virus in children.
"Important infectious diseases transmitted by insects often go unrecognized," said Myron Cohen, MD, director of the Institute for Global Health and Infectious Diseases at the UNC School of Medicine. "The collaboration between UNC-Chapel Hill and Western Carolina University offers an opportunity to improve our understanding of these diseases in North Carolina, develop prevention and treatment strategies, and help patients and their families."
The Horney family. Credit: Cody Horney.
The Horney's settled back in their quaint hometown of Marion that Sunday. Granger is healthy and is back to enjoying his time outside. He even had his first baseball practice in early March.
Parents Cody and Nikki may never forget their "three weeks from hell" last summer, but they are thankful for the opportunity to contribute to new research, raise awareness for the vector-borne disease, and help prevent another parent from experiencing the fear and worry that they went through.
"You know your own kids better than anybody else," said Cody. "Keep advocating for them when something isn't right. And use plenty of bug spray."
