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In August 1999, in the midst of a hot, dry summer in New York City, a series of very ill, elderly patients appear at a small hospital in Queens. Their symptoms are unusual, combining aspects of deadly viral encephalitis with a form of muscle weakness bordering on paralysis. This case tells the story of the treatment and reporting of these cases at Flushing Hospital and how it led, slowly and with significant difficulty, to the understanding that a significant new illness known as West Nile Virus had come to the United States for the first time. The case describes the crucially important operation of the US public health system, including local public health officials and the federal Center for Disease Control, and examines the ways in which the appearance of a new illness created a difficult challenge for it. Notably, the case details the crucial role played by alert individuals, including those of physicians, health officials and, surprisingly, an animal pathologist at the world famous Bronx Zoo, whose observations about dead birds proved crucial to cracking the West Nile mystery. The (A) case allows for discussion of the design and management of the public health system, including discussion of the factors that made identification of West Nile a difficult process. The (B) case tells the story of New York City''s response once West Nile had been identified. Specifically, it describes the daunting logistics of mounting an effective mosquito control program on short notice. These cases are meant to help shed light on the problems public agencies have in responding to any hereto-fore unknown problem. More specifically, however, the West Nile story provides a parallel for those considering the nature and structure of a public health response to a so-called bio-terrorism attack which, like West Nile, might well not be announced and only make itself known quietly, if inexorably. These cases were commissioned by the Kennedy School''s Domestic Preparedness project, with funding support from the US Department of Justice.