title: Outbreak of West Nile virus infection among humans in Serbia, August to October 2012.
abstract: We describe the first reported outbreak of West Nile virus (WNV) infection in humans in Serbia in August to October 2012 and examine the association of various variables with encephalitis and fatal outcome. Enzyme-linked immunosorbent assay (ELISA) was used for detection of WNV-specific IgM and IgG antibodies in sera and cerebrospinal fluid. A total of 58 patients (mean age: 61 years; standard deviation: 15) were analysed: 44 were from Belgrade and its suburbs; 52 had neuroinvasive disease, of whom 8 had meningitis, while 44 had encephalitis. Acute flaccid paralysis developed in 13 of the patients with encephalitis. Age over 60 years and immunosuppression (including diabetes) were independently associated with the development of encephalitis in a multivariate analysis: odds ratio (OR): 44.8 (95% confidence interval (CI): 4.93–408.59); p=0.001 (age over 60 years); OR: 10.76 (95% CI: 1.06–109.65); p=0.045 (immunosuppression including diabetes). Respiratory failure requiring mechanical ventilation developed in 13 patients with encephalitis. A total of 35 patients had completely recovered by the time they were discharged; nine patients died. The presence of acute flaccid paralysis, consciousness impairment, respiratory failure and immunosuppression (without diabetes) were found to be associated with death in hospital in a univariate analysis (p<0.001, p=0.007, p<0.001 and p=0.010, respectively).
authors.affiliation: Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Belgrade, Serbia.
authors.forename: N
authors.initials: N
authors.lastname: Popović
authors.forename: B
authors.initials: B
authors.lastname: Milošević
authors.forename: A
authors.initials: A
authors.lastname: Urošević
authors.forename: J
authors.initials: J
authors.lastname: Poluga
authors.forename: L
authors.initials: L
authors.lastname: Lavadinović
authors.forename: J
authors.initials: J
authors.lastname: Nedelijković
authors.forename: D
authors.initials: D
authors.lastname: Jevtović
authors.forename: O
authors.initials: O
authors.lastname: Dulović
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D004196:Disease Outbreaks; D004660:Encephalitis / Q000150:complications / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D018177:Flavivirus Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood* / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000097:blood* / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010243:Paralysis / Q000150:complications / Q000453:epidemiology; D011159:Population Surveillance; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055771:Serbia / Q000453:epidemiology; D017678:Sex Distribution; D014901:West Nile Fever / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D014902:West Nile virus / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M