West Nile Virus


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Public Health aspects:

1. Article Title: Surveillance of Above- and Below-Ground Mosquito Breeding Habitats in a Rural Midwestern Community: Baseline Data for Larvicidal Control Measures Against West Nile Virus Vectors
Authors: Kronenwetter-Koepel TA, Meece JK, Miller CA, Reed KD.

Clinical Research Center, Marshfield Clinic Research Foundation, 1000 N. Oak Avenue, Marshfield, Wisconsin 54449

BACKGROUND: Mosquitoes in the genus Culex are thought to play a major role as vectors in the transmission cycle of West Nile virus (WNV) and other arboviruses in the United States. Effective control of mosquitoes through larviciding and adulticiding is expensive for communities and should be guided by reliable surveillance data on the distribution of mosquito breeding habitats. However, few small to medium sized cities in rural areas of the midwestern United States have this type of baseline information available. OBJECTIVE: During the summer of 2004, we investigated the characteristics of Culex and other mosquito-breeding habitats in a rural central Wisconsin community with a population of approximately 19,000. Such baseline information will aid in the development of rational strategies to control mosquito populations and prevent human exposure to WNV and other mosquito-transmitted viruses. METHODS: Mosquito larvae were collected and identified weekly from 14 below-ground storm water catch basins and 10 above-ground standing water sites distributed throughout the community. Collection began June 4, 2004 and continued through September 24, 2004. For each collection site the primary and adjacent land use patterns were determined. RESULTS: Over the study period, 1,244 larvae were collected from catch basins; 94% were Culex species. Breeding activity was first detected in early July. Peak breeding was observed during a period of several weeks when average daily temperatures were at the maximum observed and rainfall had declined. Organically enriched catch basins in low intensity urban sites adjacent to forests and wetlands were found to be more productive breeding habitats compared to catch basins having little organic debris located in isolated high intensity urban sites. Above-ground standing water sites produced 1,504 larvae; 66% of which were Culex species. Flood control ditches and permanent wetlands with stagnant water were most productive, while ditches with moving water were least productive habitats. Larvae were produced earlier in the season by above-ground sites than were produced by catch basins. However, larvae production was more variable in above-ground sites since half the sites became dry at some point during the study period. CONCLUSION: The observed differences in Culex larvae production based on the variables of habitat-type, temperature, and precipitation support the need for ongoing surveillance in communities to guide public health officials in planning for and prioritizing mosquito control efforts.
Citation: Clin Med Res. 2005 Feb;3(1):3-12.
For the fulltext of the journal article is available on PubMedCentral at:

2. Epidemic Epizootic West Nile Virus in the United States: Guidedlines for Surveillance, Prevention, and Control

Information for Clinicans:

1. Article Title: The epidemiology and early clinical features of West Nile virus infection.
Authors: Mazurek JM, Winpisinger K, Mattson BJ, Duffy R, Moolenaar RL.

Abstract We studied early clinical features of the West Nile virus (WNV) infection. Case patients were Ohio residents who reported to the Ohio Department of Health from August 14 to December 31, 2002, with a positive serum or cerebrospinal fluid for anti-WNV IgM. Of 441 WNV cases, medical records of 224 (85.5%) hospitalized patients were available for review. Most frequent symptoms were fever at a temperature of 38.0 degrees C or higher (n = 155; 69.2%), headache (n = 114; 50.9%), and mental status changes (n = 113; 50.4%). At least one neurological symptom, one gastrointestinal symptom, and one respiratory symptom was present in 186 (83.0%), 119 (53.1%), and 46 (20.5%) patients, respectively. Using multivariate logistic regression and controlling for age, we found that the initial diagnosis of encephalitis ( P = .001) or reporting abdominal pain ( P < .001) was associated with death. Because initial symptoms of WNV infection are not specific, physicians should maintain a high index of suspicion during the epidemic season, particularly in elderly patients with compatible symptoms.
Citation: Am J Emerg Med. 2005 Jul;23(4):536-43

2. Article Title: West Nile virus. Primer for family physicians
Authors: MacDonald RD, Krym VF.

Research Program, Ontario Air Ambulance, Toronto.

OBJECTIVE: To provide primary care physicians with an understanding of West Nile virus in North America. This article focuses on epidemiology, clinical features, diagnosis, and prevention of infection. QUALITY OF EVIDENCE: MEDLINE and EMBASE searches revealed epidemiologic, surveillance, cohort, and outcome studies providing level II evidence. There were no randomized controlled trials of treatment. Recommended prevention and treatment strategies are based on level II and III evidence. MAIN MESSAGE: The mosquito-borne virus that first appeared on this continent in 1999 is now prevalent throughout North America. Most infections are asymptomatic. Fewer than 1% of those infected develop severe illness; 3% to 15% of those with severe illness die. While methods for controlling the mosquito population are available, we lack evidence that they reduce infection in the general human population. Family physicians have an important role in advising their patients on ways to prevent infection and in identifying patients who might be infected with West Nile virus. CONCLUSION: The general population is at low risk of West Nile virus infection. Prevention of infection rests on controlling the mosquito population and educating people on how to protect themselves against mosquito bites.
Citation: Can Fam Physician. 2005 Jun;51:833-7

3. West Nile Virus (WNV) Infection: Information for Clinicians

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