Morbidity, mortality and long-term sequelae of West Nile virus disease in Québec

AbstractWe aimed to describe the clinical characteristics of West Nile patients reported in Québec in 2012 and 2013 and to document physical, mental and functional status 24 months after symptom onset according to illness severity. The cases were recruited by a public health professional. Data were collected from public health files, medical records and two standardised phone questionnaires: the Short Form-36 and the Instrumental Activities of Daily Living. In all, 92 persons participated in the study (25 had West Nile fever (WNF), 18 had meningitis and 49 had encephalitis). Encephalitis participants were older, had more underlying medical conditions, more neurological symptoms, worse hospital course and higher lethality than meningitis or WNF participants. Nearly half of the surviving hospitalised encephalitis patients required extra support upon discharge. At 24-month follow-up, encephalitis and meningitis patients had a lower score in two domains of the mental component: mental health and social functioning (P = 0.0025 and 0.0297, respectively) compared with the norms based on age- and sex-matched Canadians. Physical status was not affected by West Nile virus (WNV) infection. In addition, 5/36 (15%) of encephalitis, 1/17 (6%) of meningitis and 1/23 (5%) of WNF participants had new functional limitations 24 months after symptom onset. In summary, mental and functional sequelae in encephalitis patients are likely to represent a source of long-term morbidity. Preventive measures should target patients at higher risk of severe illness after WNV infection.

Download Full-text

Up-to-date knowledge of West Nile virus infection

Medicinski pregled ◽

10.2298/mpns0906231h ◽

2009 ◽

Vol 62 (5-6) ◽

pp. 231-235

Author(s):

Ivana Hrnjakovic-Cvjetkovic ◽

Dejan Cvjetkovic ◽

Dusan Petric ◽

Vesna Milosevic ◽

Vera Jerant-Patic ◽

...

Keyword(s):

West Nile Virus ◽

Virus Infection ◽

Mosquito Control ◽

Virus Disease ◽

West Nile Virus Infection ◽

The United States ◽

Flaccid Paralysis ◽

Adult Mosquito ◽

West Nile Fever ◽

West Nile

Virus West Nile virus is a single-stranded RNA virus of the family Flaviviridae, genus Flavivirus. Epidemiology West Nile virus is maintained in the cycle involving culicine mosquitoes and birds .Humans typically acquire West Nile infection through a bite from infected adult mosquito. Person to person transmission can occur through organ transplantation, blood and blood product transfusions, transplacentally and via brest milk. Human cases of West Nile infections were recorded in Africa, Israel, Russia, India, Pakistan. In Romania in 1996 West Nile fever occurred with hundreds of neurologic cases and 17 fatalities. First human cases in the United States were in New York City where 59 persons were infected and had fever, meningitis, encephalitis and flaccid paralysis. Clinical manifestation Most human cases are asymptomatic. The majority of symptomatic patients have a self limited febrile illness. Fatigue, nausea, vomiting, eye pain, headache, myalgias, artralgias, lymphadenopathy and rash are common complaints. Less than 1% of all infected persons develop more severe neurologic illness including meningitis, encefalitis and flaccid paralysis. Laboratory diagnosis Diagnosis of West Nile virus infection is based on serologic testing, isolation of virus from patient samples and detection of viral antigen or viral genom. ELISA test and indirect immunofluorescenceassay are used for detecting IgM and IgG antibodies in serum and cerebrospinal fluid. Treatment In vitro studies have suggested that ribavirin and interferon alfa -2b may be useful in the treatment of West Nile virus disease. Prevention The most important measures are mosquito control program and personal protective measures. .

Download Full-text

Characteristics of Chimeric West Nile Virus Based on the Japanese Encephalitis Virus SA14-14-2 Backbone

Viruses ◽

10.3390/v13071262 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1262

Author(s):

Guohua Li ◽

Xianyong Meng ◽

Zhiguang Ren ◽

Entao Li ◽

Feihu Yan ◽

...

Keyword(s):

Public Health ◽

West Nile Virus ◽

Health Risk ◽

Japanese Encephalitis Virus ◽

Animal Study ◽

Japanese Encephalitis ◽

Virus Disease ◽

The West ◽

West Nile ◽

Significant Public Health

West Nile virus disease (WND) is an arthropod-borne zoonosis responsible for nonspecific fever or severe encephalitis. The pathogen is West Nile virus belonging to the genus Flavivirus, family Flaviviridae. Every year, thousands of cases were reported, which poses significant public health risk. Here, we constructed a West Nile virus chimera, ChiVax-WN01, by replacing the prMΔE gene of JEV SA14-14-2 with that of the West Nile virus NY99. The ChiVax-WN01 chimera showed clear, different characters compared with that of JEV SA14-14-2 and WNV NY99 strain. An animal study indicated that the ChiVax-WN01 chimera presented moderate safety and immunogenicity for 4-week female BALB/c mice.

Download Full-text

Initial and Long-Term Costs of Patients Hospitalized with West Nile Virus Disease

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.13-0206 ◽

2014 ◽

Vol 90 (3) ◽

pp. 402-409 ◽

Cited By ~ 36

Author(s):

J. Erin Staples ◽

Manjunath B. Shankar ◽

Marc Fischer ◽

Martin I. Meltzer ◽

James J. Sejvar

Keyword(s):

West Nile Virus ◽

Virus Disease ◽

West Nile

Download Full-text

West Nile virus in Portugal

10.1101/2021.02.02.21251021 ◽

2021 ◽

Author(s):

José Lourenço ◽

Sílvia C Barros ◽

Líbia Zé-Zé ◽

Daniel SC Damineli ◽

Marta Giovanetti ◽

...

Keyword(s):

Public Health ◽

West Nile Virus ◽

European Countries ◽

Serological Evidence ◽

The South ◽

West Nile ◽

Transmission Potential ◽

The Past ◽

The North

AbstractBackgroundWest Nile virus (WNV) is a mosquito-borne pathogen with a globally expanding geographical range. Many European countries regularly report outbreaks affecting both human and equine populations, with an increase in epidemic activity in the past decade. Portugal, on the far west of Europe, has not yet experienced large outbreaks of WNV, despite its suitable Mediterranean climate.ObjectivesTo provide a comprehensive, data-driven perspective on the past epidemiology, surveillance and transmission suitability of WNV in Portugal.MethodsLiterature and database reviews were performed, covering the period between 1966 and 2020 on existing evidence for WNV circulation. Climatic data was used to estimate the theoretical transmission potential of WNV, and to analyse long-term climate trends between 1981 and 2019.ResultsExisting data show that WNV-capable mosquito species are spread across the country, while WNV molecular and serological evidence is vastly concentrated in the south. Our analyses suggest that two different climate types, characteristic of the north and south of Portugal, contribute to quantitative differences in WNV theoretical transmission potential. This supports the north-south divide observed from previous molecular and serological evidence. Due to long-term changes in local climate, suitability for WNV transmission is shown to have been slowly increasing in the country.DiscussionData and theoretical analyses support the notion that the south of Portugal is more suitable for WNV transmission, while not rejecting the possibility of transmission in the north. Mosquito monitoring has been effective, but surveillance of key sentinel species remains passive, creating important knowledge gaps for epidemic control and public health. To date, evidence supports WNV circulation, but it remains unclear whether it is endemic or sporadically transmitted. This study supports a timely change towards WNV active surveillance, to avoid and mitigate potential public health emergencies as those recently observed in other European countries.

Download Full-text

AI for Early Warning of Seasonal Infectious Disease: Shapely Additive Explanations Improves Prediction of Extraordinary West Nile virus Events in Europe

10.1101/2020.08.27.20183327 ◽

2020 ◽

Author(s):

Albert A Gayle

Keyword(s):

Machine Learning ◽

West Nile Virus ◽

Early Warning ◽

Complex Disease ◽

Virus Disease ◽

Resource Planning ◽

Model Complexity ◽

Maximum Temperature ◽

West Nile

West Nile virus disease is a growing issue with devastating outbreaks and linkage to climate. It's a complex disease with many factors contributing to emergence and spread. High-performance machine learning models, such as XGBoost, hold potential for development of predictive models which performs well with complex diseases like West Nile virus disease. Such models furthermore allow for expanded ability to discover biological, ecological, social and clinical associations as well as interaction effects. In 1951, a deductive method based on cooperative game theory was introduced: Shapley values. The Shapley method has since been shown to be the only way to derive "true" effect estimations from complex systems. Up till recently, however, wide-scale application has been computationally prohibitive. Herein, we present a novel implementation of the Shapley method applied to machine learning to derive high-quality effect estimations. We set out to apply this method to study the drivers of and predict West Nile virus in Europe. Model validity was furthermore tested using observed information in the time periods following the prospective prediction window. We furthermore benchmarked results of XGBoost models against equivalently specified logistic regression models. High predictive performance was consistently observed. All models were statistically equivalent in terms of AUC performance (96.3% average). The top features across models were found to be vapor pressure, the autoregressive past year's feature, maximum temperature, wind speed, and local GNP. Moreover, when aggregated across quarters, we found that the effect of these features are broadly consistent across model configurations. We furthermore confirmed that for an equivalent level of model sophistication, XGBoost and logistic regressions performed similarly, with an advantage to XGBoost as model complexity increased. Our findings highlight the importance of ecological factors, such as climate, in determining outbreak risk of West Nile virus in Europe. We conclude by demonstrating the feasibility of same-year prospective early warning models that combine same-year observed climate with autoregressive geospatial covariates and long-term bioclimatic features. Scenario-based forecasts could likely be developed using similar methods, to provide for long-term intervention and resource planning, therefore increasing public health preparedness and resilience.

Download Full-text

Faculty Opinions recommendation of Long-term clinical and neuropsychological outcomes of West Nile virus infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1040429.489397 ◽

2006 ◽

Author(s):

Phillip Peterson

Keyword(s):

West Nile Virus ◽

Virus Infection ◽

West Nile Virus Infection ◽

West Nile ◽

Neuropsychological Outcomes

Download Full-text

Long-term Outcome of Patients With West Nile Virus Infection

Infectious Diseases in Clinical Practice ◽

10.1097/01.idc.0000166958.44764.39 ◽

2005 ◽

Vol 13 (3) ◽

pp. 101-103 ◽

Cited By ~ 3

Author(s):

Lara E. Jeha ◽

Gregory P. Hanes ◽

Cathy A. Sila ◽

Richard J. Lederman ◽

Carlos M. Isada ◽

...

Keyword(s):

West Nile Virus ◽

Virus Infection ◽

West Nile Virus Infection ◽

West Nile ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1650 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S658-S658

Author(s):

Andrew H Karaba ◽

Paul W Blair ◽

Kevin M Martin ◽

Mustapha O Saheed ◽

Karen C Carroll ◽

...

Keyword(s):

West Nile Virus ◽

Virus Disease ◽

Case Fatality ◽

Cost Savings ◽

Primary Objective ◽

Neurological Deficits ◽

West Nile ◽

Hospital System ◽

Elisa Testing ◽

Before And After

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.

Download Full-text