title: A review of the epidemiological and clinical aspects of West Nile virus.
abstract: The resurgence 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.
authors.affiliation: Department of Infectious Diseases, St Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Gray
authors.affiliation: Department of Medical Entomology, Centre for Infectious Diseases and Microbiology and Pathology West - Institute of Clinical Pathology and Medical Research, Westmead, NSW, Australia ; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia.
authors.forename: Cameron E
authors.initials: CE
authors.lastname: Webb
keywords: flavivirus; mosquitoes; public health threat
references.citation: Science. 1999 Dec 17;286(5448):2333-7
references.pmid: 10600742
references.citation: J Virol. 2005 Nov;79(21):13350-61
references.pmid: 16227257
references.citation: J Infect Dis. 2003 Jul 1;188(1):1-4
references.pmid: 12825164
references.citation: Int J Environ Res Public Health. 2013 Aug 09;10(8):3543-62
references.pmid: 23939389
references.citation: Clin Microbiol Infect. 2012 Dec;18(12):E545-7
references.pmid: 23020657
references.citation: Emerg Infect Dis. 2001 Jul-Aug;7(4):692-6
references.pmid: 11585534
references.citation: Emerg Infect Dis. 2002 Jan;8(1):107-8
references.pmid: 11749765
references.citation: Acta Virol. 1998 Apr;42(2):119-20
references.pmid: 9770080
references.citation: Transpl Infect Dis. 2012 Jun;14(3):268-77
references.pmid: 22606990
references.citation: Pediatrics. 2006 Mar;117(3):e537-45
references.pmid: 16510632
references.citation: Euro Surveill. 2011 Aug 25;16(34):
references.pmid: 21903037
references.citation: Science. 2012 Aug 31;337(6098):1030
references.pmid: 22936749
references.citation: Antivir Chem Chemother. 2004 Mar;15(2):101-9
references.pmid: 15185728
references.citation: Case Rep Infect Dis. 2013;2013:351872
references.pmid: 23533851
references.citation: Emerg Infect Dis. 2006 Apr;12(4):618-23
references.pmid: 16704810
references.citation: Emerg Infect Dis. 1999 Sep-Oct;5(5):643-50
references.pmid: 10511520
references.citation: Can J Neurol Sci. 2013 Jul;40(4):580-4
references.pmid: 23786744
references.citation: Proc Soc Exp Biol Med. 1951 Aug;77(4):661-5
references.pmid: 14891830
references.citation: Vaccine. 2013 Nov 19;31(48):5772-7
references.pmid: 23968769
references.citation: Ann N Y Acad Sci. 2001 Dec;951:153-60
references.pmid: 11797773
references.citation: PLoS One. 2012;7(6):e39549
references.pmid: 22745781
references.citation: J Med Entomol. 2005 Jan;42(1):57-62
references.pmid: 15691009
references.citation: Clin Microbiol Rev. 2012 Oct;25(4):635-48
references.pmid: 23034323
references.citation: Ann N Y Acad Sci. 2001 Dec;951:58-73
references.pmid: 11797805
references.citation: J Infect Dis. 1974 Dec;130(6):634-41
references.pmid: 4372273
references.citation: Eur J Clin Microbiol Infect Dis. 2004 Mar;23(3):147-56
references.pmid: 14986160
references.citation: Ann Inst Pasteur (Paris). 1970 Feb;118(2):239-47
references.pmid: 5461277
references.citation: J Gen Virol. 1974 Apr;23(1):91-6
references.pmid: 4833603
references.citation: J Infect Dis. 2006 May 15;193(10):1361-4
references.pmid: 16619182
references.citation: Pharmacotherapy. 2007 Mar;27(3):455-8
references.pmid: 17316156
references.citation: Antiviral Res. 2013 Jul;99(1):1-5
references.pmid: 23624155
references.citation: J Leukoc Biol. 2002 Apr;71(4):565-81
references.pmid: 11927642
references.citation: Can J Neurol Sci. 2004 May;31(2):131-4
references.pmid: 15198433
references.citation: JAMA. 2013 Jul 17;310(3):308-15
references.pmid: 23860989
references.citation: Am J Trop Med Hyg. 1998 Aug;59(2):323-4
references.pmid: 9715955
references.citation: Rev Sci Tech. 2012 Dec;31(3):829-44
references.pmid: 23520737
references.citation: N Engl J Med. 2004 Jul 22;351(4):370-8
references.pmid: 15269317
references.citation: Emerg Infect Dis. 2001 Jul-Aug;7(4):675-8
references.pmid: 11585531
references.citation: Clin Infect Dis. 2003 Sep 15;37(6):e88-90
references.pmid: 12955669
references.citation: Emerg Infect Dis. 2011 May;17(5):920-2
references.pmid: 21529413
references.citation: Emerg Infect Dis. 2011 Oct;17(10):1868-72
references.pmid: 22000357
references.citation: J Infect Dis. 2000 Oct;182(4):1214-7
references.pmid: 10979920
references.citation: Am J Trop Med Hyg. 1974 Nov;23(6):1150-2
references.pmid: 4429184
references.citation: Immunotherapy. 2011 Feb;3(2):269-85
references.pmid: 21322763
references.citation: Int J Environ Res Public Health. 2013 Dec 20;11(1):67-90
references.pmid: 24362544
references.citation: N Engl J Med. 2009 Mar 19;360(12):1260-2
references.pmid: 19297584
references.citation: Antibiot Khimioter. 2009;54(11-12):17-20
references.pmid: 20583562
references.citation: Surv Ophthalmol. 2005 Jan-Feb;50(1):3-13
references.pmid: 15621074
references.citation: Clin Infect Dis. 2006 May 1;42(9):1234-40
references.pmid: 16586381
references.citation: Emerg Infect Dis. 2005 Feb;11(2):225-31
references.pmid: 15752439
references.citation: Arch Virol Suppl. 2004;(18):35-41
references.pmid: 15119761
references.citation: Am J Epidemiol. 2013 Sep 1;178(5):829-35
references.pmid: 23825164
references.citation: J Infect Dis. 1953 Nov-Dec;93(3):207-18
references.pmid: 13109233
references.citation: PLoS One. 2012;7(11):e49494
references.pmid: 23166685
references.citation: Hepatology. 2011 Oct;54(4):1433-44
references.pmid: 21898493
references.citation: Science. 1999 Dec 17;286(5448):2331-3
references.pmid: 10600741
references.citation: Scand J Infect Dis. 2005;37(11-12):944-6
references.pmid: 16308241
references.citation: J Med Entomol. 2002 Jan;39(1):221-5
references.pmid: 11931261
references.citation: Emerg Infect Dis. 2012 May;18(5):792-800
references.pmid: 22516173
references.citation: J Infect Dis. 2011 May 15;203(10):1396-404
references.pmid: 21398392
references.citation: J Infect Dis. 2008 Oct 1;198(7):984-93
references.pmid: 18729783
references.citation: Am J Trop Med Hyg. 2013 Nov;89(5):996-1000
references.pmid: 24062481
references.citation: Genome Announc. 2013 May 16;1(3):
references.pmid: 23682140
references.citation: J Med Entomol. 2006 Sep;43(5):936-46
references.pmid: 17017231
references.citation: Clin Infect Dis. 2010 Aug 15;51(4):e34-7
references.pmid: 20597692
references.citation: Transfusion. 2005 Apr;45(4):492-9
references.pmid: 15819668
references.citation: Lancet. 1998 Sep 5;352(9130):767-71
references.pmid: 9737281
references.citation: Ochsner J. 2003 Summer;5(3):6-10
references.pmid: 21765761
references.citation: J Med Virol. 2011 Oct;83(10):1857-60
references.pmid: 21837805
references.citation: Proc Natl Acad Sci U S A. 2013 Sep 24;110(39):15620-5
references.pmid: 24019459
references.citation: Infect Genet Evol. 2012 Mar;12(2):181-90
references.pmid: 22226703
references.citation: Can J Neurol Sci. 2004 May;31(2):194-203
references.pmid: 15198443
references.citation: N Engl J Med. 2003 Sep 25;349(13):1236-45
references.pmid: 14500806
references.citation: Am J Trop Med Hyg. 2006 Dec;75(6):1232-3
references.pmid: 17172398
references.citation: Am J Trop Med Hyg. 1956 Jul;5(4):579-620
references.pmid: 13354882
references.citation: Curr Pharm Des. 2014;20(21):3428-44
references.pmid: 24001228
references.citation: Oecologia. 2009 Jan;158(4):699-708
references.pmid: 18941794
references.citation: Emerg Infect Dis. 2012 Apr;18(4):684-6
references.pmid: 22469465
references.citation: J Virol. 2011 Mar;85(6):2964-74
references.pmid: 21159871
references.citation: PLoS One. 2013 Sep 18;8(9):e74575
references.pmid: 24058590
references.citation: Arch Virol Suppl. 2004;(18):85-96
references.pmid: 15119764
references.citation: Infect Genet Evol. 2011 Oct;11(7):1577-85
references.pmid: 21875691
references.citation: Emerg Infect Dis. 2010 Mar;16(3):549-52
references.pmid: 20202444
references.citation: Hum Pathol. 2004 Feb;35(2):254-8
references.pmid: 14991545
references.citation: Transpl Infect Dis. 2011 Jun;13(3):312-7
references.pmid: 21235711
references.citation: J Infect Dis. 2006 Nov 1;194(9):1300-8
references.pmid: 17041857
references.citation: Front Neurol. 2012 Mar 21;3:37
references.pmid: 22461779
references.citation: J Travel Med. 2010 May-Jun;17(3):182-92
references.pmid: 20536888
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Jun 28;62(25):513-7
references.pmid: 23803959
references.citation: N Engl J Med. 2001 Jun 14;344(24):1807-14
references.pmid: 11407341
references.citation: J Infect Dis. 2010 Nov 1;202(9):1354-61
references.pmid: 20874087
references.citation: Viruses. 2013 Sep 24;5(9):2311-9
references.pmid: 24064795
references.citation: Clin Transplant. 2010 Mar-Apr;24(2):223-8
references.pmid: 19659514
references.citation: J Gen Virol. 2007 Mar;88(Pt 3):875-884
references.pmid: 17325360
references.citation: Antiviral Res. 2002 Jul;55(1):107-16
references.pmid: 12076755
references.citation: Vector Borne Zoonotic Dis. 2007 Summer;7(2):173-80
references.pmid: 17627435
references.citation: J Gen Virol. 2013 Feb;94(Pt 2):318-325
references.pmid: 23136360
references.citation: Vector Borne Zoonotic Dis. 2005 Fall;5(3):252-7
references.pmid: 16187894
references.citation: Transbound Emerg Dis. 2013 Nov;60 Suppl 2:40-4
references.pmid: 24589100
references.citation: Med Vet Entomol. 2013 Mar;27(1):1-9
references.pmid: 22624654
references.citation: Clin Infect Dis. 2013 Dec;57(12):1731-41
references.pmid: 24065324
references.citation: Ann N Y Acad Sci. 2001 Dec;951:195-206
references.pmid: 11797777
references.citation: Nat Rev Drug Discov. 2007 Dec;6(12):975-90
references.pmid: 18049472
references.citation: Emerg Infect Dis. 2011 Aug;17(8):1445-54
references.pmid: 21801622
references.citation: BMC Infect Dis. 2009 Feb 17;9:18
references.pmid: 19222853
references.citation: Lancet. 2001 Jul 28;358(9278):254-5
references.pmid: 11498205
references.citation: Ann N Y Acad Sci. 2001 Dec;951:332-5
references.pmid: 11797791
references.citation: S Afr Med J. 1986 Aug 16;70(4):218-20
references.pmid: 3016922
references.citation: J Hepatol. 2011 Aug;55(2):245-64
references.pmid: 21371579
references.citation: Clin Infect Dis. 2008 Aug 1;47(3):303-27
references.pmid: 18582201
references.citation: Crit Care Clin. 2013 Jul;29(3):621-49
references.pmid: 23830656
references.citation: Lancet Neurol. 2007 Feb;6(2):171-81
references.pmid: 17239804
references.citation: PLoS One. 2012;7(6):e39387
references.pmid: 22724010
references.citation: Lancet. 2001 Jul 28;358(9278):261-4
references.pmid: 11498211
references.citation: J Med Entomol. 2001 Mar;38(2):130-4
references.pmid: 11296813
references.citation: Vaccine. 2012 Oct 19;30(47):6656-64
references.pmid: 22959989
references.citation: Am J Trop Med Hyg. 2012 May;86(5):895-901
references.pmid: 22556093
references.citation: Antiviral Res. 2009 Sep;83(3):214-27
references.pmid: 19501622
references.citation: Emerg Infect Dis. 2003 Mar;9(3):311-22
references.pmid: 12643825
references.citation: Ophthalmology. 2004 Nov;111(11):2065-70
references.pmid: 15522373
references.citation: Clin Infect Dis. 2005 Mar 1;40(5):764-6
references.pmid: 15714427
references.citation: Am J Trop Med Hyg. 2011 Nov;85(5):952-6
references.pmid: 22049056
references.citation: Antiviral Res. 1999 Feb;41(1):57-64
references.pmid: 10321579