What do you need to know about West Nile virus?

With the arrival of mosquito season in North America, health authorities have started issuing warnings about prevention of potentially fatal West Nile virus. My latest coauthored publication reviews the epidemiological and clinical aspects of this mosquito-borne pathogen.

West Nile virus is a pathogen generally spread by mosquitoes from birds to humans. While only about one in five people infected develop symptoms (inc fever, headache, body aches, nausea, vomiting, swollen lymph glands or a skin rash.), for those over 50, there can be more serious implications and the illness may be fatal. There is currently no vaccine, avoiding mosquito bites is the only way to prevent disease.

The virus was first detected in North America in 1999 and has since spread from coast to coast, having a significant impact on the health of both people (resulting in an economic burden of around $56 million per year) and wildlife (particularly birds). Interestingly, from 2007 there was a steady decline in the activity of the virus and many thought that major outbreaks would be a thing of the past but 2012 saw a one of the largest outbreaks in almost a decade. During this time, Texas was particularly hard hit with 1,868 cases and estimated costs of around US$47.6 million.

The activity of the virus in 2013 wasn’t insignificant either.


Annual total numbers of West Nile virus disease cases and deaths reported by CDC 1999-2013.

It hasn’t only been North America that has been impacted by West Nile virus. Outbreaks of human and animal illness have also been reported in Europe. In fact, cases of West Nile virus were reported from France in the 1960s. However, there wasn’t a major outbreak until 1996-1997; prompting warnings from health authorities about the future risks associated with this pathogen in Europe. The activity of the virus in North American, Europe and Africa provides interesting opportunities to research the genetic differences between regions and potential implications for surveillance and disease control. Europe has developed an extensive surveillance program to assess activity of endemic and exotic mosquitoes and activity of the virus.

Human illness in Europe resulting from West Nile virus infection during 2012 (European Centre for Disease Prevention and Control)

It is interesting to note that one of the key factors linking outbreaks of West Nile virus in both North America and Europe is the presence of closely related mosquitoes. Unlike dengue, chikungunya or yellow fever viruses that are spread by Aedes mosquitoes, and malaria parasites by Anopheles mosquitoes, West Nile virus is primarily spread by Culex mosquitoes. In particular, the bird-feeding mosquitoes within the Culex pipiens group.

The Culex pipiens group, particularly Culex pipiens, Culex quinquefasciatus and Culex molestus, are closely associated with urban environments. With mosquitoes found in close contact with humans, there is greater risk associated with potential outbreaks.

Our recent review article in the International Journal of General Medicine provides an overview of the clinical and epidemiological aspects of West Nile virus and is a good starting point for anyone interested in this pathogen and the factors that drive outbreaks in North America and Europe.

The abstract of our paper is here:

The reurgence of West Nile virus (WNV) in North America and Europe in recent years has raised the concerns of local authorities and highlighted that mosquito-borne disease is not restricted to tropical regions of the world. WNV is maintained in enzootic cycles involving, primarily, Culex spp. mosquitoes and avian hosts, with epizootic spread to mammals, including horses and humans. Human infection results in symptomatic illness in approximately one-fifth of cases and neuroinvasive disease in less than 1% of infected persons. The most consistently recognized risk factor for neuroinvasive disease is older age, although diabetes mellitus, alcohol excess, and a history of cancer may also increase risk. Despite the increasing public health concern, the current WNV treatments are inadequate. Current evidence supporting the use of ribavirin, interferon α, and WNV-specific immunoglobulin are reviewed. Nucleic acid detection has been an important diagnostic development, which is particularly important for the protection of the donated blood supply. While effective WNV vaccines are widely available for horses, no human vaccine has been registered. Uncertainty surrounds the magnitude of future risk posed by WNV, and predictive models are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. However, recent history has demonstrated that for regions where suitable mosquito vectors and reservoir hosts are present, there will be a risk of major epidemics. Given the potential for these outbreaks to include severe neuroinvasive disease, strategies should be implemented to monitor for, and respond to, outbreak risk. While broadscale mosquito control programs will assist in reducing the abundance of mosquito populations and subsequently reduce the risks of disease, for many individuals, the use of topical insect repellents and other personal protective strategies will remain the first line of defense against infection.

The full paper can be downloaded for free here.

You can also read more background to West Nile virus and the 2012 outbreak in my piece for The Conversation. For a comprehensive look at how the pathogen is managed in North America, download the CDC publication “West Nile Virus in the United States: Guidelines for Surveillance, Prevention, and Control“.

Why not join the conversation on Twitter by following me at @mozziebites?

The image at the top of this piece is taken from Mother Jones.