title: First outbreak of West Nile virus neuroinvasive disease in humans, Croatia, 2012.
abstract: Between September 6 and 21, 2012, seven human cases of West Nile virus (WNV) neuroinvasive infection were laboratory confirmed in Croatia. The median patient age was 62 years (range 48-77). Five patients presented with meningoencephalitis and two patients with meningoencephalitis followed by acute flaccid paralysis. Four of them had an underlying disease (hypertension). Using enzyme-linked immunosorbent assay (ELISA), WNV-specific immunoglobulin M (IgM) and IgG antibodies of low avidity were detected in six patients, whereas one showed only IgM antibodies. All samples were confirmed using plaque-reduction neutralization and microneutralization tests. Five patients recovered fully. Before human cases were reported, acute asymptomatic WNV infection was demonstrated by detection of IgM antibodies in sentinel horses. Moreover, an increased WNV IgG seropositivity in horses was detected in counties where human cases occurred. Adulticidal and larvicidal treatments were administered immediately in the respective places of residence. The end of the warm season contributed to the fact that there were no new cases of WNV disease recorded.
authors.affiliation: 1 Communicable Diseases Epidemiology Service, Croatian National Institute of Public Health , Zagreb, Croatia .
authors.forename: Iva
authors.initials: I
authors.lastname: Pem-Novosel
authors.forename: Tatjana
authors.initials: T
authors.lastname: Vilibic-Cavlek
authors.forename: Ira
authors.initials: I
authors.lastname: Gjenero-Margan
authors.forename: Nenad
authors.initials: N
authors.lastname: Pandak
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Peric
authors.forename: Ljubo
authors.initials: L
authors.lastname: Barbic
authors.forename: Eddy
authors.initials: E
authors.lastname: Listes
authors.forename: Ante
authors.initials: A
authors.lastname: Cvitkovic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Stevanovic
authors.forename: Giovanni
authors.initials: G
authors.lastname: Savini
mesh_terms: D000368:Aged; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood*; D017523:Croatia / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006734:Horse Diseases / Q000453:epidemiology / Q000821:virology; D006736:Horses; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008590:Meningoencephalitis / Q000150:complications*; D008875:Middle Aged; D009500:Neutralization Tests; D010243:Paralysis / Q000150:complications*; D012621:Seasons; D014901:West Nile Fever / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D014902:West Nile virus / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M