title: Neuroinvasive arboviral disease in the United States: 2003 to 2012.
abstract: OBJECTIVE
  To describe the epidemiologic and clinical syndromes associated with pediatric neuroinvasive arboviral infections among children in the United States from 2003 through 2012.
  
  
  METHODS
  We reviewed data reported by state health departments to ArboNET, the national arboviral surveillance system, for 2003 through 2012. Children (<18 years) with neuroinvasive arboviral infections (eg, meningitis, encephalitis, or acute flaccid paralysis) were included. Demographic, clinical syndrome, outcome, geographic, and temporal data were analyzed for all cases.
  
  
  RESULTS
  During the study period, 1217 cases and 22 deaths due to pediatric neuroinvasive arboviral infection were reported from the 48 contiguous states. La Crosse virus (665 cases; 55%) and West Nile virus (505 cases; 41%) were the most common etiologies identified. Although less common, Eastern equine encephalitis virus (30 cases; 2%) resulted in 10 pediatric deaths. La Crosse virus primarily affected younger children, whereas West Nile virus was more common in older children and adolescents. West Nile virus disease cases occurred throughout the country, whereas La Crosse and the other arboviruses were more focally distributed.
  
  
  CONCLUSIONS
  Neuroinvasive arboviral infections were an important cause of pediatric disease from 2003 through 2012. Differences in the epidemiology and clinical disease result from complex interactions among virus, vector, host, and the environment. Decreasing the morbidity and mortality from these agents depends on vector control, personal protection to reduce mosquito and tick bites, and blood donor screening. Effective surveillance is critical to inform clinicians and public health officials about the epidemiologic features of these diseases and to direct prevention efforts.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and.
authors.forename: James T
authors.initials: JT
authors.lastname: Gaensbauer
authors.affiliation: Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Lindsey
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and.
authors.forename: Kevin
authors.initials: K
authors.lastname: Messacar
authors.affiliation: Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado.
authors.forename: J Erin
authors.initials: JE
authors.lastname: Staples
authors.affiliation: Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado mfischer@cdc.gov.
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
mesh_terms: D001102:Arbovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D002648:Child; D004670:Encephalitis, California / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D018062:La Crosse virus / Q000472:pathogenicity; D011159:Population Surveillance / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014901:West Nile Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology
keywords: United States; arboviruses; child; epidemiology
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