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Simple Summary: Insect-borne viruses, such as those of the Flaviviridae family, pose a serious risk to global health. WNV, a mosquito-borne flavivirus, is transmitted primarily by the Culex mosquito. Despite the increasing exposure of populations to mosquito-borne flaviviruses and the expanding range of the vector mosquito, there are limited resources available to prevent or treat flavivirus infections. Using the model organism Drosophila melanogaster, commonly known as the fruit fly, we previously found that insulin signaling reduces WNV infection. We translated these finding to mosquitoes and human cells and showed similar mechanisms of insulin-mediated antiviral activity. However, insect and mammalian hormones can regulate insulin signaling. Specifically, decretin hormones suppress insulin secretion, especially during periods of starvation and low glucose intake. In this study, we show that the insect decretin, Limostatin, and its mammalian ortholog, Neuromedin U, can promote WNV infection. These results suggest that the inhibition of decretin signaling may be a novel therapeutic target to control WNV infection. The arbovirus West Nile virus (WNV) is a danger to global health. Spread primarily by mosquitoes, WNV causes about 2000 cases per year in the United States. The natural mosquito immune response controls viral replication so that the host survives but can still transmit the virus. Using the genetically malleable Drosophila melanogaster model, we previously dissected innate immune pathways used to control WNV infection. Specifically, we showed that insulin/IGF-1 signaling (IIS) activates a JAK/STAT-mediated immune response that reduces WNV. However, how factors that regulate IIS in insects control infection has not been identified. D. melanogaster Limostatin (Lst) encodes a peptide hormone that suppresses insulin secretion. Its mammalian ortholog, Neuromedin U (NMU), is a peptide that regulates the production and secretion of insulin from pancreatic beta cells. In this study, we used D. melanogaster and human cell culture models to investigate the roles of these insulin regulators in immune signaling. We found that D. melanogaster Lst mutants, which have elevated insulin-like peptide expression, are less susceptible to WNV infection. Increased levels of insulin-like peptides in these flies result in upregulated JAK/STAT activity, leading to protection from infection. Treatment of human cells with the insulin regulator NMU results in increased WNV replication. Further investigation of methods to target Lst in mosquitoes or NMU in mammals can improve vector control methods and may lead to improved therapeutics for human and animal infection. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) is the most prevalent mosquito-borne virus in the United States with approximately 2,000 cases each year. There are currently no approved human vaccines and a lack of prophylactic and therapeutic treatments. Understanding host responses to infection may reveal potential intervention targets to reduce virus replication and disease progression. The use of Drosophila melanogaster as a model organism to understand innate immunity and host antiviral responses is well-established. Previous studies revealed that insulin-mediated signaling regulates WNV infection in invertebrates by regulating canonical antiviral pathways. Because insulin signaling is well-conserved across insect and mammalian species, we sought to determine if results using D. melanogaster can be extrapolated for the analysis of orthologous pathways in humans. Here, we identify insulin-mediated endothelin signaling using the D. melanogaster model and evaluate an orthologous pathway in human cells during WNV infection. We demonstrate that endothelin signaling reduces WNV replication through the activation of canonical antiviral signaling. Taken together, our findings show that endothelin-mediated antiviral immunity is broadly conserved across species and reduces replication of viruses that can cause severe human disease. IMPORTANCE Arboviruses, particularly those transmitted by mosquitoes, pose a significant threat to humans and are an increasing concern because of climate change, human activity, and expanding vector-competent populations. West Nile virus is of significant concern as the most frequent mosquito-borne disease transmitted annually within the continental United States. Here, we identify a previously uncharacterized signaling pathway that impacts West Nile virus infection, namely endothelin signaling. Additionally, we demonstrate that we can successfully translate results obtained from D. melanogaster into the more relevant human system. Our results add to the growing field of insulin-mediated antiviral immunity and identify potential biomarkers or intervention targets to better address West Nile virus infection and severe disease. [ABSTRACT FROM AUTHOR]

Arboviruses (arthropod-borne-viruses) are an emerging global health threat that are rapidly spreading as climate change, international business transport, and landscape fragmentation impact local ecologies. Since its initial detection in 1999, West Nile virus has shifted from being a novel to an established arbovirus in the United States of America. Subsequently, more than 25,000 cases of West Nile neuro-invasive disease have been diagnosed, cementing West Nile virus as an arbovirus of public health importance. Given its novelty in the United States of America, high-risk ecologies are largely underdefined making targeted population-level public health interventions challenging. Using the Centers for Disease Control and Prevention ArboNET neuroinvasive West Nile virus data from 2000–2021, this study aimed to predict neuroinvasive West Nile virus human cases at the county level for the contiguous USA using a spatio-temporal Bayesian negative binomial regression model. The model includes environmental, climatic, and demographic factors, as well as the distribution of host species. An integrated nested Laplace approximation approach was used to fit our model. To assess model prediction accuracy, annual counts were withheld, forecasted, and compared to observed values. The validated models were then fit to the entire dataset for 2022 predictions. This proof-of-concept mathematical, geospatial modelling approach has proven utility for national health agencies seeking to allocate funding and other resources for local vector control agencies tackling West Nile virus and other notifiable arboviral agents. [ABSTRACT FROM AUTHOR]

Seasonality in infectious disease prevalence is predominantly attributed to changes in exogenous risk factors. For vectored pathogens, high abundance, activity, and/or diversity of vectors can exacerbate disease risk for hosts. Conversely, many host defenses, particularly immune responses, are seasonally variable. Seasonality in host defenses has been attributed, in part, to the proximate (i.e., metabolic) and ultimate (i.e., reproductive fitness) costs of defense. In this study, our goal was to discern whether any seasonality is observable in how a common avian host, the house sparrow (Passer domesticus), copes with a common zoonotic arbovirus, the West Nile virus (WNV), when hosts are studied under controlled conditions. We hypothesized that if host biorhythms play a role in vector-borne disease seasonality, birds would be most vulnerable to WNV when breeding and/or molting (i.e., when other costly physiological activities are underway) and thus most transmissive of WNV at these times of year (unless birds died from infection). Overall, the results only partly supported our hypothesis. Birds were most transmissive of WNV in fall (after their molt is complete and when WNV is most prevalent in the environment), but WNV resistance, WNV tolerance, and WNV-dependent mortality did not vary among seasons. These results collectively imply that natural arboviral cycles could be partially underpinned by endogenous physiological changes in hosts. However, other disease systems warrant study, as this result could be specific to the nonnative and highly commensal nature of the house sparrow or a consequence of the relative recency of the arrival of WNV to the United States. [ABSTRACT FROM AUTHOR]

West Nile virus (WNv) is a major cause of viral encephalitis in the United States. WNv infection is usually asymptomatic or a limited febrile illness in the immunocompetent hosts, although a small percentage can develop neuroinvasive disease. Neuroinvasive disease due to WNv in solid organ transplant recipients occurs at higher rates than observed in the general population and can have long term neurological sequalae. Methods: We retrospectively reviewed medical records of all solid organ transplant recipients at our institution who tested positive for WNv from 2010 to 2018. Two reviewers performed electronic searches of Medline, Embase, Cochrane Library of literature of WNv infections in SOT. Descriptive statistics were performed on key variables. Results: Eight recipients (mean age 54, five males) were diagnosed with neuroinvasive WNv infection at our institution. Distribution of infection was as follows: five kidney transplants, one in each kidney‐pancreas, liver, and lung. Diagnoses included meningitis (3), encephalitis (1), meningo‐encephalitis (4). Median time from transplant to infection was 49.8 months (2.7–175.4). No infections were considered donor‐derived. Five patients received treatment with IVIG. Six patients were alive at median follow‐up of 49.5 months (21.7–116.8). We identified 29 studies published from 2002 to 2019. Median time from transplant to infection was 14.2 months, with similar allograft distribution; 53% were donor‐derived infections. Conclusion: WNv infections in solid organ transplant recipients can be a consequence of organ donation or can be acquired via the community. Infections can be more severe in SOT recipients and lead to neuroinvasive disease. [ABSTRACT FROM AUTHOR]

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A rise in adiposity in the United States has resulted in more than 70% of adults being overweight or obese, and global obesity rates have tripled since 1975. Following the 2009 H1N1 pandemic, obesity was characterized as a risk factor that could predict severe infection outcomes to viral infection. Amidst the SARS-CoV-2 pandemic, obesity has remained a significant risk factor for severe viral disease as obese patients have a higher likelihood for developing severe symptoms and requiring hospitalization. However, the mechanism by which obesity enhances viral disease is unknown. In this study, we utilized a diet-induced obesity mouse model of West Nile virus (WNV) infection, a flavivirus that cycles between birds and mosquitoes and incidentally infects both humans and mice. Likelihood for severe WNV disease is associated with risk factors such as diabetes that are comorbidities also linked to obesity. Utilizing this model, we showed that obesity-associated chronic inflammation increased viral disease severity as obese female mice displayed higher mortality rates and elevated viral titers in the central nervous system. In addition, our studies highlighted that obesity also dysregulates host acute adaptive immune responses, as obese female mice displayed significant dysfunction in neutralizing antibody function. These studies highlight that obesity-induced immunological dysfunction begins at early time points post infection and is sustained through memory phase, thus illuminating a potential for obesity to alter the differentiation landscape of adaptive immune cells. [ABSTRACT FROM AUTHOR]

Acute flaccid myelitis, defined by acute flaccid limb weakness in the setting of grey matter lesions of the spinal cord, became increasingly recognised in 2014 following outbreaks in Colorado and California, temporally associated with an outbreak of enterovirus D68 respiratory disease. Since then, there have been biennial increases in late summer/early fall. A viral infectious aetiology, most likely enteroviral, is strongly suspected, but a definitive connection has yet to be established. Patients typically present with asymmetric weakness, maximal proximally, in the setting of a febrile illness. MRI demonstrates T2/FLAIR abnormalities in the central grey matter of the spinal cord, and cerebrospinal fluid typically shows a lymphocytic pleocytosis with variable elevation in protein. The weakness may be progressive over several days and involve respiratory muscles, making early recognition and close monitoring essential. Other complications in the acute period may include autonomic instability and bowel/bladder involvement. There is no clear recommended treatment at this time, although intravenous immunoglobulin, steroids and plasma exchange have been used. Intensive therapies and rehab services have shown benefit in maximising function, and surgical interventions may be considered in cases without optimal response to therapies. Close attention should also be paid to psychosocial factors. Prognosis is generally guarded, and additional factors that predict final outcome, including host factors and treatment effects, have yet to be elucidated. Multicentre collaborative efforts will be required to provide answers about this rare but serious disorder. [ABSTRACT FROM AUTHOR]

Insecticides are broadly applied in many urban areas of the western United States to control mosquito populations and reduce the prevalence of diseases such as West Nile and Zika Virus. We assessed the extent to which incidental exposure to the insecticide Permethrin affected drifting and benthic invertebrates in Spring Creek, Laramie, WY, USA. We collected drift samples before, immediately after (~ 3–6 h), and 1 day after (~ 28 h) insecticide application. We collected benthic invertebrates with a Hess sampler twice before and twice after spraying began. We measured an 11 × increase in the density of drifting aquatic insects immediately after pesticide application. Additionally, we observed an increase in drifting aquatic invertebrates 2.25 km downstream from treatment. A decrease in the biomass of benthic invertebrates and an increase in taxa richness at the end of the summer suggested that invertebrates are colonizing the stream but may be unable to persist. Fewer aquatic invertebrates in the stream may have cascading effects on the ecosystem by altering resources available to fish and riparian insectivores (e.g., bats, spiders, and amphibians). Understanding the unintended ecological impacts of current pest control practices could lead to more effective and less detrimental management strategies. [ABSTRACT FROM AUTHOR]

Describes some mosquito- and tick-borne arboviral infections related to community and athletic settings. Measures that can help prevent the transmission caused by arthropod pests; Need for continuous screening for skin infections; Prevalence of West Nile virus in the U.S.

West Nile virus (WNV) is a neurotropic flavivirus and the leading cause of mosquito-borne encephalitis in the United States. Recent studies in humans have found that dysfunctional T cell responses strongly correlate with development of severe WNV neuroinvasive disease. However, the contributions of human dendritic cells (DCs) in priming WNV-specific T cell immunity remains poorly understood. Here, we demonstrate that human monocyte derived DCs (moDCs) support productive viral replication following infection with a pathogenic strain of WNV. Antiviral effector gene transcription was strongly induced during the log phase of viral growth, while secretion of type I interferons (IFN) occurred with delayed kinetics. Activation of RIG-I like receptor (RLR) or type I IFN signaling prior to log phase viral growth significantly diminished viral replication, suggesting that early activation of antiviral programs can block WNV infection. In contrast to the induction of antiviral responses, WNV infection did not promote transcription or secretion of proinflammatory (interleukin-6 [IL-6], granulocyte-macrophage colony-stimulating factor [GM-CSF], CCL3, CCL5, and CXCL9) or T cell modulatory (IL-4, IL-12, and IL-15) cytokines. There was also minimal induction of molecules associated with antigen presentation and T cell priming, including the costimulatory molecules CD80, CD86, and CD40. Functionally, WNV-infected moDCs dampened allogenic CD4 and CD8 T cell activation and proliferation. Combining these observations, we propose a model whereby WNV subverts human DC activation to compromise priming of WNV-specific T cell immunity. IMPORTANCE West Nile virus (WNV) is an encephalitic flavivirus that remains endemic in the United States. Previous studies have found dysfunctional T cell responses correlate to severe disease outcomes during human WNV infection. Here, we sought to better understand the ability of WNV to program human dendritic cells (DCs) to prime WNV-specific T cell responses. While productive infection of monocyte-derived DCs activated antiviral and type I interferon responses, molecules associated with inflammation and programming of T cells were minimally induced. Functionally, WNV-infected DCs dampened T cell activation and proliferation during an allogeneic response. Combined, our data support a model whereby WNV infection of human DCs compromises WNV-specific T cell immunity. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV), a neurotropic flavivirus, is the leading cause of viral encephalitis in the United States. Recently, Zika virus (ZIKV) infections have caused serious neurological diseases and birth defects, specifically Guillain-Barrè syndrome and microcephaly. Z-DNA binding protein 1 (ZBP1) is a cytoplasmic sensor that that has been shown to play a significant role in initiating a robust immune response. We previously reported that WNV and ZIKV infections induce dramatic up-regulation of ZBP1 in mouse brains as well as in infected primary mouse cells. Herein, we show the critical role of ZBP1 in restricting the pathogenesis of WNV and ZIKV infections. Deletion of ZBP1 resulted in significantly higher morbidity and mortality after infection with a pathogenic WNV NY99 strain in mice. No mortality was observed in wild-type (WT) mice infected with the non-pathogenic WNV strain, Eg101. Interestingly, infection of ZBP1−/− mice with WNV Eg101 was lethal resulting in 100% mortality, suggesting that ZBP1 is required for survival after WNV infection. Viremia and brain viral load were significantly higher in ZBP1−/− mice compared to WT mice. In addition, protein levels of interferon (IFN)-α, and inflammatory cytokines and chemokines were significantly higher in the serum and brains of infected ZBP1−/− mice compared to the WT mice. Primary mouse cortical neurons and mouse embryonic fibroblasts (MEFs) derived from ZBP1−/− mice produced higher virus titers compared to WT cells after infection with WNV NY99 and WNV Eg101. Similarly, neurons and MEFs lacking ZBP1 exhibited significantly enhanced replication of PRVABC59 (Asian) and MR766 (African) ZIKV compared to WT cells. The knockout of ZBP1 function in MEFs inhibited ZBP1-dependent virus-induced cell death. In conclusion, these data reveal that ZBP1 restricts WNV and ZIKV production in mouse cells and is required for survival of a peripheral WNV infection in mice. [ABSTRACT FROM AUTHOR]

West Nile Virus (WNV), an emerging and re-emerging RNA virus, is the leading source of arboviral encephalitic morbidity and mortality in the United States. WNV infections are acutely controlled by innate immunity in peripheral tissues outside of the central nervous system (CNS) but WNV can evade the actions of interferon (IFN) to facilitate CNS invasion, causing encephalitis, encephalomyelitis, and death. Recent studies indicate that STimulator of INterferon Gene (STING), canonically known for initiating a type I IFN production and innate immune response to cytosolic DNA, is required for host defense against neurotropic RNA viruses. We evaluated the role of STING in host defense to control WNV infection and pathology in a murine model of infection. When challenged with WNV, STING knock out (-/-) mice displayed increased morbidity and mortality compared to wild type (WT) mice. Virologic analysis and assessment of STING activation revealed that STING signaling was not required for control of WNV in the spleen nor was WNV sufficient to mediate canonical STING activation in vitro. However, STING-/- mice exhibited a clear trend of increased viral load and virus dissemination in the CNS. We found that STING-/- mice exhibited increased and prolonged neurological signs compared to WT mice. Pathological examination revealed increased lesions, mononuclear cellular infiltration and neuronal death in the CNS of STING-/- mice, with sustained pathology after viral clearance. We found that STING was required in bone marrow derived macrophages for early control of WNV replication and innate immune activation. In vivo, STING-/- mice developed an aberrant T cell response in both the spleen and brain during WNV infection that linked with increased and sustained CNS pathology compared to WT mice. Our findings demonstrate that STING plays a critical role in immune programming for the control of neurotropic WNV infection and CNS disease. [ABSTRACT FROM AUTHOR]

Global climate change, driven by anthropogenic greenhouse gas emissions, is being particularly felt in Canada, with warming generally greater than in the rest of the world. Continued warming will be accompanied by changes in precipitation, which will vary across the country and seasons, and by increasing climate variability and extreme weather events. Climate change will likely drive the emergence of infectious diseases in Canada by northward spread from the United States and introduction from elsewhere in the world via air and sea transport. Diseases endemic to Canada are also likely to re-emerge. This special issue describes key infectious disease risks associated with climate change. These include emergence of tick-borne diseases in addition to Lyme disease, the possible introduction of exotic mosquito-borne diseases such as malaria and dengue, more epidemics of Canada-endemic vector-borne diseases such as West Nile virus, and increased incidence of foodborne illnesses. Risk is likely to be compounded by an aging population affected by chronic diseases, which results in greater sensitivity to infectious diseases. Identifying emerging disease risks is essential to assess our vulnerability, and a starting point to identify where public health effort is required to reduce the vulnerability and exposure of the Canadian population. [ABSTRACT FROM AUTHOR]

Over the past two decades, West Nile virus has become the most common arbovirus in North America, leading to several outbreaks and infecting thousands of people. Mosquitos help transmit the virus in the majority of cases, but transmission occurs via blood transfusions, organ transplantation, and possibly pregnancy and breastfeeding. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases have been reported in the United States, with over 700 cases occurring in children from 2003 to 2016. Neuroinvasive disease presents as meningitis, encephalitis, or acute flaccid paralysis, and carries a high likelihood of poor outcome, including severe neurological disability or death. To date, no pharmacologic treatment has proven effective. Therapeutic clinical trials have not been successfully completed due to the sporadic nature of viral outbreaks and resultant poor study enrollment. Although older age and chronic disease are risk factors for neuroinvasive West Nile virus disease in adults, the specific factors that influence the risk in pediatric populations have not been fully elucidated. This review summarizes the most recent literature regarding West Nile virus-associated neuroinvasive disease, especially as it pertains to the pediatric population. Moreover, the review describes the epidemiology, clinical, laboratory, and radiographic findings, and outlines the various therapies that have been trialed and potential future research directions. [ABSTRACT FROM AUTHOR]

Infection with West Nile virus (WNV) has a well-characterized acute disease process. However, long-term consequences are less understood. We searched death records for 4,142 residents of Texas, USA, infected with WNV during 2002-2012 and identified 557 (13%) deaths. We analyzed all-cause and cause-specific deaths after WNV infection by calculating standardized mortality ratios and using statewide mortality data. Acute-phase deaths (<90 days after symptom onset) occurred in 289 (7%) of case-patients; of those deaths, 289 (92%) were cases of West Nile neuroinvasive disease (WNND). Convalescent-phase deaths (>90 days after symptom onset) occurred in 268 (7%) of the remaining 3,853 case-patients; 210 (78%) of these deaths occurred in patients with WNND. Convalescent-phase WNND case-patients showed excess deaths from infectious and renal causes; case-patients <60 years of age had increased risk for all-cause death, specifically from renal, infectious, digestive, and circulatory causes. We provide population-level evidence of increased risk for death after WNV infection resulting in WNND. [ABSTRACT FROM AUTHOR]

Abstract The second largest outbreak of West Nile encephalitis and West Nile fever ever recorded occurred in the United States (U.S) in the summer of 2012. The outbreak was related to the widespread circulation of closely related clades, or groups, of West Nile virus (WNV) into multiple states where they were not previously found. Whether the invading 2012 strains were able to circulate and overwinter in states with their own endemic population of WNV is unknown and the effect of viral genetics on adaptation and persistence in a new ecological niche is unclear. In this study, we sequenced 70 mosquito isolates from multiple counties throughout Texas in 2012–2015. We identified isolates representative of previously described 2012 WNV groups (Groups 8–10) and discovered a novel group which we called Group 11. Although we identified isolates representative of WNV endemic (2/70) to Texas, most isolates (68/70) were related to the invading 2012 strains, and of these Group 10 (45/68) was predominant. We also observed differences among the 2012 WNV groups correlating to their genotype. Group 10 WNV in Texas, which carry two putative positively selected variants, had limited introductions into Texas, wide circulation, and strong evidence of continued persistence perhaps indicative of overwintering. In contrast, Groups 8 and 11, without positively selected variants, had multiple introductions into Texas, limited circulation, and limited persistence. Lastly, we identified a potential transmission source in New York for incoming Group 8 WNV into Texas. Altogether our study suggests that mutations in the WNV genome may influence the range and dynamics of WNV circulation, and the ability of different strains to persist in new ecological niches. Highlights • Determined the circulation and persistence of WNV clades, or groups, introduced into Texas during a major outbreak in 2012. • Determined that newly introduced NA/WN02 strains are the predominant genotype in Texas. • Observed that Group 10 WNV had limited introductions into Texas, wide circulation, and continued persistence. • Group 8 and 11 WNV had multiple introductions into Texas, limited circulation, and limited evidence of persistence. • Identified the most recent source in New York for Group 8 WNV introduced into Texas. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) is the most important causative agent of viral encephalitis worldwide and an important public health concern in the United States due to its high prevalence, severe disease, and the absence of effective treatments. Infection with WNV is mainly asymptomatic, but some individuals develop severe, possibly fatal, neurological disease. Individual host factors play a role in susceptibility to WNV infection, including genetic polymorphisms in key anti-viral immune genes, but age is the most well-defined risk factor for susceptibility to severe disease. Ageing is associated with distinct changes in immune cells and a decline in immune function leading to increased susceptibility to infection and reduced responses to vaccination. WNV is detected by pathogen recognition receptors including Toll-like receptors (TLRs), which show reduced expression and function in ageing. Neutrophils, monocyte/macrophages and dendritic cells, which first recognize and respond to infection, show age-related impairment of many functions relevant to anti-viral responses. Natural killer cells control many viral infections and show age-related changes in phenotype and functional responses. A role for the regulatory receptors Mertk and Axl in blood-brain barrier permeability and in facilitating viral uptake through phospholipid binding may be relevant for susceptibility to WNV, and age-related up-regulation of Axl has been noted previously in human dendritic cells. Understanding the specific immune parameters and mechanisms that influence susceptibility to symptomatic WNV may lead to a better understanding of increased susceptibility in elderly individuals and identify potential avenues for therapeutic approaches: an especially relevant goal, as the world's populating is ageing. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) is the primary mosquito-borne disease in the United States and has had case reports every year since its introduction in 1999. As such, it is critical that we characterize the distribution of WNV vectors. Estimates of Culex tarsalis Coquillett species distribution, a major WNV vector, are scarce. We used ensemble distribution modeling to estimate habitat suitability for this species across the contiguous United States by consolidating presence data from four publicly available mosquito trapping data servers. The central plains region and much of the western US were estimated to have high habitat suitability. We identified multiple metrics of temperature and precipitation to be important in predicting the occurrence of Cx. tarsalis in a given geographic area. Furthermore, we observed habitat suitability for Cx. tarsalis to be significantly higher in areas with a high incidence of West Nile neuroinvasive disease compared to areas with low WN disease incidence, suggesting that Cx. tarsalis is present in regions with a high incidence of disease., (© The Author(s) 2023. Published by Oxford University Press on behalf of Entomological Society of America.)

Using reported case data from ArboNET and previous seroprevalence data stratified by age and sex, we conservatively estimate that ≈7 million persons in the United States have been infected with West Nile virus since its introduction in 1999. Our data support the need for public health interventions and improved surveillance. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) is the most widespread arbovirus in the world and endemic to much of the United States. Its range continues to expand as land use patterns change, creating more habitable environments for the mosquito vector. Though WNV is endemic, the year-to-year risk is highly variable, thus making it difficult to understand the risk for human spillover events. Abatement districts monitor for infected mosquitoes to help understand these potential risks and to help guide our understanding of the risk posed by these observed infected mosquitoes. Creating optimal monitoring networks will provide more informed decision-making tools for abatement districts and policy makers. Investment in these monitoring networks that capture robust observations on mosquito infection rates will allow for environmentally informed inference systems to help guide decision-making and WNV risk. In turn, enhanced decision-making tools allow for faster response times of more targeted and economical surveillance and mosquito population reduction efforts and the overall reduction of WNV transmission. Here we discuss the data streams, their processing, and specifically three ways to calculate WNV infection rates in mosquitoes., (© 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Before 1999, the United States had no appropriated funding for arboviral surveillance, and many states conducted no such surveillance. After emergence of West Nile virus (WNV), federal funding was distributed to state and selected local health departments to build WNV surveillance systems. The Council of State and Territorial Epidemiologists conducted assessments of surveillance capacity of resulting systems in 2004 and in 2012; the assessment in 2012 was conducted after a 61% decrease in federal funding. In 2004, nearly all states and assessed local health departments had well-developed animal, mosquito, and human surveillance systems to monitor WNV activity and anticipate outbreaks. In 2012, many health departments had decreased mosquito surveillance and laboratory testing capacity and had no systematic disease-based surveillance for other arboviruses. Arboviral surveillance in many states might no longer be sufficient to rapidly detect and provide information needed to fully respond to WNV outbreaks and other arboviral threats (e.g., dengue, chikungunya). [ABSTRACT FROM AUTHOR]

West Nile encephalitis emerged in 1999 in the United States, then rapidly spread through the North American continent causing severe disease in human and horses. Since then, outbreaks appeared in Europe, and in 2012, the United States experienced a new severe outbreak reporting a total of 5,387 cases of West Nile virus (WNV) disease in humans, including 243 deaths. So far, no human vaccine is available to control new WNV outbreaks and to avoid worldwide spreading. In this review, we discuss the state-of-the-art of West Nile vaccine development and the potential of a novel safe and effective approach based on recombinant live attenuated measles virus (MV) vaccine. MV vaccine is a live attenuated negative-stranded RNA virus proven as one of the safest, most stable and effective human vaccines. We previously described a vector derived from the Schwarz MV vaccine strain that stably expresses antigens from emerging arboviruses, such as dengue, West Nile or chikungunya viruses, and is strongly immunogenic in animal models, even in the presence of MV pre-existing immunity. A single administration of a recombinant MV vaccine expressing the secreted form of WNV envelope glycoprotein elicited protective immunity in mice and non-human primates as early as two weeks after immunization, indicating its potential as a human vaccine. [ABSTRACT FROM AUTHOR]

Highlights: [•] In 2012, West Nile virus disease was at the highest level in a decade. [•] Precise locations and intensity of WNV outbreaks remain difficult to predict. [•] Large outbreaks like those in 2002–03 and 2012 can be expected in the future. [•] Reductions in funding for surveillance and research hinder responses to outbreaks. [Copyright &y& Elsevier]

Abstract: Confirmed clinical and veterinary cases of West Nile virus (WNV) infection in Mexico remain restricted to northern Mexico, supporting a unidirectional transmission model from the US into Mexico. Full-length genomic sequencing of nine WNV isolates obtained from Culex spp. mosquito pools in El Paso, Texas (n=7) and Cuidad Juarez, Mexico (n=2) from 2005 to 2010 demonstrates the co-circulation of three independent genetic groups, two of which belong to the southwestern (SW/WN03) genotype and the other to the North American (NA/WN02) genotype. These results indicate ongoing dynamic circulation of WNV between the United States and Mexico. [Copyright &y& Elsevier]

The article offers information on West Nile virus. It describes the prevalence of West Nile virus disease in the U.S., along with the mortality rate associated with neuroinvasive disease. The authors explain the challenges associated with West Nile virus outbreak. They note the need to have timely surveillance in order to prevent outbreaks.

Abstract: Human cases of West Nile virus (WNV) infection have spread across the continental United States since the disease’s first appearance in the United States in 1999. However, most WNV spatial studies to date have focused on relatively small scale urban areas. This study examines spatial autocorrelation and clustering of WNV cases from 1999 to 2008 throughout the continental United States. The data, collected by the Centers for Disease Control and Prevention (CDC) at the county level, were normalized by population, then a global Moran’s I test for spatial autocorrelation was performed on both the non-normalized and normalized datasets for each year during the study period. Both datasets exhibited strong positive spatial autocorrelation for every year (p < 0.01). There was also a geographic pattern of high-value clustering in the northern Midwest that was unexpected. These results indicate significant clustering of human WNV cases throughout the United States, as well as an interesting unexplained regional pattern in the northern Midwest that deserves further investigation. [Copyright &y& Elsevier]

West Nile virus (WNV), a category B pathogen endemic in parts of Africa, Asia and Europe, emerged in North America in 1999, and spread rapidly across the continental U.S. Outcomes of infection with WNV range from asymptomatic to severe neuroinvasive disease manifested as encephalitis, paralysis, and/or death. Neuroinvasive WNV disease occurs in less than one percent of cases, and although host genetic factors are thought to influence risk for symptomatic disease, the identity of these factors remains largely unknown. We tested 360 common haplotype tagging and/or functional SNPs in 86 genes that encode key regulators of immune function in 753 individuals infected with WNV including: 422 symptomatic WNV cases and 331 cases with asymptomatic infections. After applying a Bonferroni correction for multiple tests and controlling for population stratification, SNPs in IRF3 (OR 0.54, p = 0.035) and MX1, (OR 0.19, p = 0.014) were associated with symptomatic WNV infection and a single SNP in OAS1 (OR 9.79, p = 0.003) was associated with increased risk for West Nile encephalitis and paralysis (WNE/P). Together, these results suggest that genetic variation in the interferon response pathway is associated with both risk for symptomatic WNV infection and WNV disease progression. [ABSTRACT FROM AUTHOR]

The article presents surveillance data for West Nile virus (WNV) disease and other arboviral diseases in the U.S. in 2010 reported to the Centers for Disease Control and Prevention (CDC). The highest incidence of WNV disease were reported by the states of Arizona, New Mexico, Nebraska and Colorado. Other neuroinvasive arboviral disease reported during the year include California serogroup viruses (CALV), eastern equine encephalitis virus (EEEV) and Powassan virus (POWV). It outlines the total number of human cases of WNV disease in 2010.

West Nile virus, first identified within the United States in 1999, has since spread across the continental states and infected birds, humans and domestic animals, resulting in numerous deaths. Previous studies in mice identified the Oas1b gene, a member of the OAS/RNASEL innate immune system, as a determining factor for resistance to West Nile virus (WNV) infection. A recent case-control association study described mutations of human OAS1 associated with clinical susceptibility to WNV infection. Similar studies in horses, a particularly susceptible species, have been lacking, in part, because of the difficulty in collecting populations sufficiently homogenous in their infection and disease states. The equine OAS gene cluster most closely resembles the human cluster, with single copies of OAS1, OAS3 and OAS2 in the same orientation. With naturally occurring susceptible and resistant sub-populations to lethal West Nile encephalitis, we undertook a case-control association study to investigate whether, similar to humans (OAS1) and mice (Oas1b), equine OAS1 plays a role in resistance to severe WNV infection. We identified naturally occurring single nucleotide mutations in equine (Equus caballus) OAS1 and RNASEL genes and, using Fisher's Exact test, we provide evidence that mutations in equine OAS1 contribute to host susceptibility. Virtually all of the associated OAS1 polymorphisms were located within the interferon-inducible promoter, suggesting that differences in OAS1 gene expression may determine the host's ability to resist clinical manifestations associated with WNV infection. [ABSTRACT FROM AUTHOR]

A.G. Freifeld, J. Meza, B. Schweitzer, L. Shafer, A.C. Kalil. A.R. Sambol. Seroprevalence of West Nile virus infection in solid organ transplant recipients. Transpl Infect Dis 2010: 12: 120–126. All rights reserved Background. Of people infected with mosquito-borne West Nile virus (WNV), <1% develop neuroinvasive disease (NID). Population studies suggest that people older than 65 years may be at higher risk for neurologic symptoms. It has been suggested that solid organ transplant (SOT) recipients are also at higher risk for WNV NID, but definitive serologic and epidemiologic data are lacking. Methods. A serologic screening survey, using a US Food & Drug Administration-approved enzyme-linked immunosorbant assay to detect WNV immunoglobulin-G (IgG) antibody responses in cohorts of SOT recipients and non-immunocompromised controls, was undertaken at a large Midwestern university organ transplant center in the aftermath of the summer 2003 WNV regional outbreak. Hemagglutination-inhibition testing was used to confirm WNV IgG-positive results and differentiate them from positive results caused by Saint Louis encephalitis virus, another flavivirus that is endemic in the Midwestern US. Findings. The rate of WNV IgG-seropositive responses did not differ between SOT recipients and non-immunocompromised controls, and were 12% and 10%, respectively. Retrospective chart review showed no documented WNV NID in the seropositive SOT recipients, suggesting an incidence of WNV NID may be as low as 0.7% in this population. Interpretation. Asymptomatic WNV infection is common among immunocompromised SOT patients, occurring as often as it does in non-immunocompromised controls. Our data indicated that severe WNV NID is less frequent in SOT patients, contrary to what has been suggested in other studies. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated the performance of a new Food and Drug Administration-approved lateral-flow diagnostic screening test for qualitative detection of West Nile Virus (WNV) immunoglobulin M (IgM) in serum or plasma. Five public health laboratories across the United States performed retrospective testing on blinded serum samples from patients with physician reported diagnoses of WNV infection. The results of the RapidWN™ WNV IgM assay were compared with two commercially available WNV IgM enzyme-linked immunosorbent assays (EIA) and two public health-developed WNV-IgM tests. After discrepancies were resolved, the RapidWN™ WNV IgM EIA demonstrated a 98.8% sensitivity (range: 96.0–100%), a 95.3% specificity (range: 90.9–100%), a positive predictive value of 96.3% (range: 94.7–100%), and a negative predictive value of 98.4% (range: 95.5–100%), as compared to the predicate assays. The study results suggest that the RapidWN™ WNV IgM EIA is an effective, qualitative screening test that produces results comparable to that of predicate assays and can be employed rapidly to detect WNV IgM in patients suspected of having WNV infection. [Copyright &y& Elsevier]

This section presents a continuing education (CE) quiz from the National Environmental Health Association (NEHA) on topics including horse owner practices, the West Nile neuroinvasive disease, and the human eastern equine encephalitis.

BACKGROUND: The cobas TaqScreen West Nile virus (WNV) test (Roche Molecular Systems) was licensed by the Food and Drug Administration (FDA) in August 2007 for detecting WNV RNA in pools of six or in individual donations (IDs). A series of studies established the performance characteristics of the assay and test system before FDA licensure. STUDY DESIGN AND METHODS: Analytic sensitivity was determined by probit analysis using multiple source materials. Clinical sensitivity was determined by testing a panel of 315 known WNV RNA–positive specimens. A large clinical specificity study was conducted by five laboratories during months when WNV activity was not expected. RESULTS: The 95 percent limit of detection for ID testing using the Lineage 1 Health Canada WNV reference standard was 40.3 copies per mL (95% individual donation, 35.1-47.8 copies per mL). Clinical sensitivity was 100 percent (95% confidence interval [CI], 98.8%-100%) for ID testing and 97.5 percent (95% CI, 95.1-98.9%) for minipool (MP) testing. Clinical specificity, when resolved to the ID, was 100 percent for both formats and was 99.986 percent at the MP level. CONCLUSION: The cobas TaqScreen WNV test performed on the cobas s 201 system is a fully automated test system with excellent clinical sensitivity and specificity that offers the benefits of automated sample preparation and a secure environment for donor testing information. [ABSTRACT FROM AUTHOR]

Since 1999, West Nile virus (WNV) disease has affected the northeastern United States. To describe the spatial epidemiology and identify risk factors for disease incidence, we analyzed 8 years (1999-2006) of county-based human WNV disease surveillance data. Among the 56.6 million residents in 8 northeastern states sharing primary enzootic vectors, we found 977 cases. We controlled for population density and potential bias from surveillance and spatial proximity. Analyses demonstrated significant spatial spreading from 1999 through 2004 (p<0.01, r² = 0.16). A significant trend was apparent among increasingly urban counties; county quartiles with the least (<38%) forest cover had 4.4-fold greater odds (95% confidence interval [CI] 1.4-13.2, p = 0.01) of having above-median disease incidence (>0.75 cases/100,000 residents) than counties with the most (>70%) forest cover. These results quantify urbanization as a risk factor for WNV disease incidence and are consistent with knowledge of vector species in this area. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) was first detected in the Western Hemisphere in 1999 in New York City. From 1999 through 2004, >16,600 cases of WNV-related illnesses were reported in the United States, of which >7,000 were neuroinvasive disease and >600 were fatal. Several approaches are under way to develop a human vaccine. Through simulations and sensitivity analysis that incorporated uncertainties regarding future transmission patterns of WNV and costs of health outcomes, we estimated that the range of values for the cost per case of WNV illness prevented by vaccination was US 20,000 dollars-59,000 dollars(mean 36,000 dollars). Cost-effectiveness was most sensitive to changes in the risk for infection, probability of symptomatic illness, and vaccination cost. Analysis indicated that universal vaccination against WNV disease would be unlikely to result in societal monetary savings unless disease incidence increases substantially over what has been seen in the past 6 years. [ABSTRACT FROM AUTHOR]

The article presents an update on the detection, transmission and control of the West Nile virus (WNV) in the U.S. as of December 2005. The number of cases of WNV disease in humans reportedly increased in the U.S. Statistical data from the U.S. Centers for Disease Control and Prevention regarding WNV human infection are presented. Surveillance data on WNV-infected animals are provided.

Presents the results of the West Nile virus surveillance data reported to the U.S. Centers for Disease Control and Prevention through ArboNET as of August 30, 2005. Number of human cases of West Nile virus illness reported by states in the U.S. in 2005; Comparison of human cases and deaths from West Nile virus from 2002 to 2005; Animals affected by West Nile virus in the country.

objective—To characterize an outbreak of West Nile virus (WNV)infection in horses in North Dakota in 2002, evaluate vaccine effectiveness, and determine horse characteristics and clinical signs associated with infection. Design—Retrospective study. Animals—569 horses. Procedure—Data were obtained from veterinary laboratory records, and a questionnaire was mailed to veterinarians of affected horses. Results—Affected horses were defined as horses with typical clinical signs and seroconversion or positive results of virus isolation; affected horses were detected in 52 of the 53 counties and concentrated in the eastern and northeastern regions of the state. Among affected horses, 27% (n = 152) were vaccinated against WNV, 54% (309) were not, and 19% (108) had unknown vaccination status; 61% (345)recovered, 22% (126) died, and 17% (98) had unknown outcome. The odds of death among nonvaccinated horses were 3 and 16 times the odds among horses that received only 1 or 2 doses of vaccine and horses that were vaccinated according to manufacturer's recommendations, respectively. Horses with recumbency, caudal paresis, and age > 5 years had higher odds of death, whereas horses with incoordination had lower odds of death, compared with affected horses without these characteristics. Conclusions and Clinical Relevance—Vaccination appears to have beneficial effects regarding infection and death caused by WNV. [ABSTRACT FROM AUTHOR]

Background: West Nile fever, considered a nonsevere manifestation of West Nile virus infection, has not been clinically well described in the United States. In 2002, Illinois had 884 documented cases of West Nile virus infection with 66 associated deaths. Objective: To describe the symptoms and functional outcomes of West Nile fever. Design: Case series. Setting: Illinois. Patients: 98 community-dwelling patients with laboratory evidence of West Nile virus infection but no history of clinical evidence of meningitis, encephalitis, or acute flaccid paralysis. Intervention: Outpatient interviews. Measurements: Presence and duration of patient-reported symptoms of infection, symptom-associated absenteeism, health care use, and impact on daily activities. Results: Of 98 patients, 96% had fatigue for a median of 36 days, 81 % had fever for a median of 5 days, 71 % had headache for a median of 10 days, 61% had muscle weakness for a median of 28 days, and 53% had difficulty concentrating for a median of 14 days. Thirty respondents reported hospitalization, with a median stay of 5 days. At 30 days after onset, 63% of respondents continued to have symptoms. Duration did not vary significantly with increased age. Among the 72 patients who normally attended work or school, 57 (79%) could not attend because of illness (median absence, 10 days). Limitations: Recall bias could have been introduced by the delay between illness onset and interview and by self-reporting of illness information. Conclusions: West Nile fever is a more severe illness than has previously been documented. Mandatory reporting of West Nile fever cases in addition to West Nile meningoencephalitis cases could allow more accurate and timely recognition of the geographic distribution of West Nile virus infections and could inform public health interventions. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) was first isolated in California during July 2003 from a pool of Culex tarsalis collected near El Centro, Imperial County. WNV transmission then increased and spread in Imperial and Coachella Valleys, where it was tracked by isolation from pools of Cx. tarsalis, seroconversions in sentinel chickens, and seroprevalence in free-ranging birds. WNV then dispersed to the city of Riverside, Riverside County, and to the Whittier Dam area of Los Angeles County, where it was detected in dead birds and pools of Cx. pipiens quinquefasciatus. By October, WNV was detected in dead birds collected from riparian corridors in Los Angeles, west to Long Beach, and through inland valleys south from Riverside to San Diego County. WNV was reported concurrently from Arizona in mid-August and from Baja, Mexico, in mid-November. Possible mechanisms for virus introduction, amplification, and dispersal are discussed. [ABSTRACT FROM AUTHOR]

Relatively little is known about the long-term prognosis for patients with clinical West Nile virus (WNV) infection. We conducted a study to describe the recovery of New York City residents infected during the 1999 WNV encephalitis outbreak. Patients were interviewed by telephone on self-perceived health outcomes 6, 12, and 18 months after WNV illness onset. At 12 months, the prevalence of physical, functional, and cognitive symptoms was significantly higher than that at baseline, including muscle weakness, loss of concentration, confusion, and lightheadedness. Only 37% achieved a full recovery by 1 year. Younger age at infection was the only significant predictor of recovery. Efforts aimed at preventing WNV infection should focus on elderly populations who are at increased risk for neurologic manifestations and more likely to experience long-term sequelae of WNV illness. More studies are needed to document the long-term sequelae of this increasingly common infection. [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) infection is a mosquito-borne infection that has caused outbreaks of central nervous system (CNS) disease in Africa, Europe, Asia, and, now, the United States. The virus is a zoogenic, single-strand RNA virus. Outbreaks of WNV have also been reported in Israel and Ro- mania. Meningitis and encephalitis are the complications that are often seen with WNV infection, although encephalitis is the more common CNS complication. The risk of developing CNS complications appears to be directly related to the age of the infected patient. Diagnosis of CNS infections caused by the WNV is based on clinical suspicion and results of laboratory studies. Treatment of WNV-related CNS disease remains supportive and the prognosis of patient with CNS involvement is generally poor. [ABSTRACT FROM AUTHOR]

Increasing travel has lead to an emergence of new diseases and a re-emergence of old diseases. West Nile Virus (WNV) is a disease from the past. Originally introduced in the early 1930's WNV was not as major of a threat as it is today. With increasing travel WNV was able to span the globe in a few years and was officially identified in the United States in 1999. Migratory birds are thought to be the principle carrier host of the virus, leading to a cycling of the disease. This also might explain the increased incidence of dead birds in the endemic areas. The virus is then transmitted from birds to humans and other animals by a vector. Mosquitoes have been identified as the primary vector for WNV. In order for mosquitoes to prosper and transmit the virus they live in areas with standing water. WNVis a member of the Flaviviridae family, which is part of the Japanese encephalitis virus. It is related to other viruses such as St. Louis encephalitis, yellow fever, and dengue. The only hosts able to sustain naturally occurring infection are birds, all other hosts serve as “deadend” hosts. Although humans are “dead-end” hosts, West Nile IgG and IgM have been found to be transmitted through breast-feeding, blood transfusions, and organ transplants. Most cases of WNV are mild, asymptomatic infections that are usually self-limiting. Incubation lasts about 3-14 days. About 1 out of 150 infections results in severe neurologic disease. Symptoms of the disease include fever, severe muscle weakness, gastrointestinal symptoms, seizures, and more. Diagnosis is usually based on a high level of suspicion. Blood or cerebrospinal fluid tests can be performed but results take several days. Treatment is mainly supportive but some agents, interferon alfa-2b and ribavirin, have been tried but have not shown a great benefit in treatment. Prevention is achieved through reduction in mosquito numbers and avoidance of mosquito-human transmission. A vaccine is currently being studied. However the primary method the spread of WNV is proper education about the virus. [ABSTRACT FROM PUBLISHER]

West Nile virus (WNV) antibodies were detected in horses from five Mexican states, and WNV was isolated from a Common Raven in the state of Tabasco. Phylogenetic studies indicate that this isolate, the first from Mexico, is related to strains from the central United States but has a relatively high degree of sequence divergence. [ABSTRACT FROM AUTHOR]