Epidemiology of West Nile virus in Africa: An underestimated threat

Background West Nile virus is a mosquito-borne flavivirus which has been posing continuous challenges to public health worldwide due to the identification of new lineages and clades and its ability to invade and establish in an increasing number of countries. Its current distribution, genetic variability, ecology, and epidemiological pattern in the African continent are only partially known despite the general consensus on the urgency to obtain such information for quantifying the actual disease burden in Africa other than to predict future threats at global scale. Methodology and principal findings References were searched in PubMed and Google Scholar electronic databases on January 21, 2020, using selected keywords, without language and date restriction. Additional manual searches of reference list were carried out. Further references have been later added accordingly to experts’ opinion. We included 153 scientific papers published between 1940 and 2021. This review highlights: (i) the co-circulation of WNV-lineages 1, 2, and 8 in the African continent; (ii) the presence of diverse WNV competent vectors in Africa, mainly belonging to the Culex genus; (iii) the lack of vector competence studies for several other mosquito species found naturally infected with WNV in Africa; (iv) the need of more competence studies to be addressed on ticks; (iv) evidence of circulation of WNV among humans, animals and vectors in at least 28 Countries; (v) the lack of knowledge on the epidemiological situation of WNV for 19 Countries and (vii) the importance of carrying out specific serological surveys in order to avoid possible bias on WNV circulation in Africa. Conclusions This study provides the state of art on WNV investigation carried out in Africa, highlighting several knowledge gaps regarding i) the current WNV distribution and genetic diversity, ii) its ecology and transmission chains including the role of different arthropods and vertebrate species as competent reservoirs, and iii) the real disease burden for humans and animals. This review highlights the needs for further research and coordinated surveillance efforts on WNV in Africa.

West Nile virus transmission potential in Portugal

It is unclear whether West Nile virus (WNV) circulates endemically in Portugal. Despite the country’s adequate climate for transmission, Portugal has only reported four human WNV infections so far. We performed a review of WNV-related data (1966–2020), explored mosquito (2016–2019) and land type distributions (1992–2019), and used climate data (1981–2019) to estimate WNV transmission suitability in Portugal. Serological and molecular evidence of WNV circulation from animals and vectors was largely restricted to the south. Land type and climate-driven transmission suitability distributions, but not the distribution of WNV-capable vectors, were compatible with the North-South divide present in serological and molecular evidence of WNV circulation. Our study offers a comprehensive, data-informed perspective and review on the past epidemiology, surveillance and climate-driven transmission suitability of WNV in Portugal, highlighting the south as a subregion of importance. Given the recent WNV outbreaks across Europe, our results support a timely change towards local, active surveillance.

Selection of Monitoring points for the Number and Infectivity of the Main Vectors of West Nile Virus in the Volgograd Region

Relevance. Since 1999, the incidence of West Nile fever has been recorded in the Volgograd region. The main vectors of West Nile virus in Russia are Cx mosquitoes. pipiens L. and Cx. modestus Fic. An objective assessment of the entomological situation and infection rate of these species within the framework of epidemiological surveillance of West Nile fever is possible only in biotopes with sufficiently high numbers of mosquitoes; therefore, the choice of sampling points is an urgent task. Purpose of the study. Analysis of the West Nile virus main vectors - mosquitoes Cx. pipiens L. and Cx. modestus Fic. average number, occurrence and infection rate at the various open biotopes of the Volgograd region to justify the choice of optimal points for entomological monitoring. Materials and methods. The catching and accounting of the mosquitoes’ number was carried out in 2015–2019 from May to August in the third decade of each month in a floodplain forest, at a personal plot, a summer cottage and on bank of water body. To catch mosquitoes, automatic traps Mosquito Magnet Executive and LovKom-1 were used. The accounting unit was the number of mosquitoes collected in both traps per trap-night. The average number, the index of occurrence and infection rate were determined by generally accepted methods. Detection of West Nile virus RNA in samples of mosquito pool suspensions was performed by RT-PCR using the AmpliSense WNV-FL reagent kit. The results were statistically processed using Microsoft Excel 2016 (Microsoft Corporation, USA). Results. In the 2015-2019 period, 17468 mosquitoes of the genus Culex: 8258 species – Cx. pipiens L., 9210 species – Cx. modestus Fic. were collected in over than 80 trap nights at the selected stationary points of the Volgograd region. Average number of Cx. pipiens L. was: in the floodplain forest – 4.6 individuals per 1 trap-night; at the personal plot – 183.9; at the summer cottage – 30.2; on the bank of water body – 194.3. Average number of Cx. modestus Fic. was: in the floodplain forest – 5.2 individuals per 1 trapnight; at the personal plot – 8.3; at the summer cottage – 2.5;on the bank of water body – 444.6. Occurrence index Cx. pipiens L. was highon the bank of water body and at the personal plot (47.1% and 44.5%, respectively), much lower – at the summer cottage (7.3%) and in the floodplain forest (1.1%). Level of WNV infection among Cx. pipiens L.on a personal plot was 5.4%, on a summer cottage – 3.6%,on the bank of water body – 2.2%. No infected samples were found among Cx. pipiens L. collected from the floodplain forest. WNV RNA in samples from mosquitoes Cx. modestus Fic. found only in individuals caughton the bank of water body. Their infection rate was 1.2%. Discussion. Ecological plasticity of Cx. pipiens L. mosquitoes allows them to live in settlements and near water bodies. Mosquitoes of the species Cx. modestus Fic. do not fly away from ponds, breeding places. Conclusion. High numbers and occurrence of the Cx. pipiens L. mosquitoes were observed at a personal plot within the city andon the bank of water body, Cx. modestus Fic. –on the bank of water body. WNV RNA positive samples were detected from mosquitoes collected at the personal plot, the summer cottage andon the bank of water body. To monitor the number and infection rate among Cx. pipiens L., points of registration and sampling should be placed in open stationson personal plots in settlements, banks of water bodies and summer cottages. We recommend to carry entomological monitoring for Cx. modestus Fic. out onlyon the banks of water bodies along the water's edge in reed thickets. The placement of the main WNV vectors number and infection rate monitoring points in the floodplain forest is not advisable.

Immunological Cross-Reactivity to Dengue Virus among Persons with Neuroinvasive West Nile Virus Infection

Antibody dependent enhancement has been well described between Zika and dengue viruses, but is poorly characterized between West Nile and dengue viruses. We demonstrate that neuroinvasive West Nile virus infection leads to the development of non-neutralizing, cross-reactive IgG antibodies to dengue and Zika viruses capable of causing antibody dependent enhancement in vitro of dengue virus and leads to the formation of flavivirus cross-reactive memory B cells in some patients.

Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes

West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013–2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33–84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5–73), and the median hospital LOS was 34 days (range 7–97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3–5, 6 (26.0%) had slight disability/mRS 2–1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6–69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3–5, one (4.3%) had slight disability/mRS 2–1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.

West Nile Virus Lineage 1 in Italy: Newly Introduced or a Re-Occurrence of a Previously Circulating Strain?

In Italy, West Nile virus (WNV) appeared for the first time in the Tuscany region in 1998. After 10 years of absence, it re-appeared in the areas surrounding the Po River delta, affecting eight provinces in three regions. Thereafter, WNV epidemics caused by genetically divergent isolates have been documented every year in the country. Since 2018, only WNV Lineage 2 has been reported in the Italian territory. In October 2020, WNV Lineage 1 (WNV-L1) re-emerged in Italy, in the Campania region. This is the first occurrence of WNV-L1 detection in the Italian territory since 2017. WNV was detected in the internal organs of a goshawk (Accipiter gentilis) and a kestrel (Falco tinnunculus). The RNA extracted in the goshawk tissue samples was sequenced, and a Bayesian phylogenetic analysis was performed by a maximum-likelihood tree. Genome analysis, conducted on the goshawk WNV complete genome sequence, indicates that the strain belongs to the WNV-L1 Western-Mediterranean (WMed) cluster. Moreover, a close phylogenetic similarity is observed between the goshawk strain, the 2008–2011 group of Italian sequences, and European strains belonging to the Wmed cluster. Our results evidence the possibility of both a new re-introduction or unnoticed silent circulation in Italy, and the strong importance of keeping the WNV surveillance system in the Italian territory active.