Thanks largely to systematic larviciding by the State's 39 municipalities, and aided by the public's destruction of "backyard" mosquito habitats and adoption of personal protective measures (clothing, repellant), Rhode Island minimized the potential human burden of WNV during the 2003 mosquito season (six serious WNV cases, one death, and no reports of WNV-tainted blood donations). The potential burden of WNV on domestic animals was also reduced through immunization. Nonetheless, the State's first WNV death reminds us of the danger this disease poses for the very young, for elders, and for people of all ages who are immune-compromised. Similarly, the widespread location of birds positive for WNV signifies the ubiquity of risk. All mosquitoes must be avoided. Based on its experience with WNV control over the past few years, the State will continue and enhance its surveillance and control efforts in 2004. Once again, systematic larviciding by municipalities and continuing public education through multiple channels will form the backbone of control, supported by active surveillance for the virus in the wild, in domestic animals, and in humans. For the latter effort, the vigilance of the health care community is of signal importance to the protection of the public. Every human case is investigated thoroughly, to establish as accurately as possible the time and place of exposure. DEM and HEALTH use this information to assess potential weaknesses in WNV control efforts, and to take corrective action, as necessary. Health care providers also play an essential role in public education, reminding patients (all patients, but especially the very young, elders, and the immune-compromised) to avoid mosquito bites. Discussing the avoidance of mosquito bites with patients who engage in regular outdoor activity is especially important. School physicians and the medical directors of nursing homes are well-positioned to keep mosquito control and avoidance on the agenda of their respective institutions. Together, we can control the burden of this disease among domestic animals and humans, if we continue to pursue mosquito control and personal protection aggressively. If we don't, the potential for tragedy is tremendous, as evidenced by the recent experience of other regions of the country.