Running head: WEST NILE VIRUS

West Nile Virus

HSCI 451: Principles of Epidemiology

Dr. Mshigeni

America Zavala, Dalal Alshammary

Anthony Swanson, Susana Perez

December 7, 2017

West Nile Virus

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Introduction

West Nile Virus is a virus that is most commonly spread throughout the bite of a

mosquito. Since the virus is transmitted from the mosquito, it becomes very common during

mosquito season which is from Summer to Fall (West Nile virus). The CDC explained that in a

total of 47 states in 2017 there has been a total of 1,757 cases of West Nile disease reported. The

West Nile Virus unfortunately affects the entire United States population. This is most common

in the west, central, northern, and southern United States. Until this day the CDC has stated that

there are no vaccines to prevent or any medication to treat the West Nile Virus. Most people who

are affected by the West Niles virus have no symptoms when becoming infected by it. One in

every five people who are affected by the West Nile Virus experience fever, while one in every

one-hundred and fifty people infected by the virus become fatal (West Nile virus). The Centers of

Disease Control and Prevention suggests that the best way that we could prevent mosquito bites

is by applying insect repellent and wearing protective clothing. The following will have a strong

focus on this epidemiological topic such as: a literature review, identification of the problem,

current examples of the importance of this infection, and the 3 main concepts of epi, and

prevention.

Literature Review

West Nile is known as an arbovirus meaning that it is transmitted through blood feeding

arthropods; the most commonly of which are mosquitos. The base source of infection frequently

originates from birds that the mosquitos feed upon which is then spread to humans. The typical

incubation period can range from 2 to 14 days. Although most people infected will experience no

symptoms from the disease, some cases can display Febrile illness, and severe symptoms can

include inflammation of the brain and spinal cord. Persons over the age of 60 are at greater risk
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for these symptoms. There is no current vaccine available to the public . With the lack of a

vaccine, preventing transmission, with awareness through public health initiatives, is the first

line of defense from the disease (CDC.gov). Personal protection from mosquito bites is the most

prevalent measure to be taken. Vector control plays an important role in the monitoring of

mosquito populations. Other methods may focus on preventing transmission to livestock, and

the spread of the virus through blood transfusion. For those infected that show severe symptoms,

supportive treatments is usually all that can be done (WHO.int).

West Nile was first detected in the United States in 1999. Since its detection 1,172 deaths

have been reported from 1999 to 2011. Its first detection in California came in 2003, and the

following two years the state had the highest number of human cases (Carney et al). This trend is

continuing to occur. Data collected from the CDC for 2017 shows California leading in the

number of all our reported cases, the number of neuroinvasive incidences, and the number of

deaths caused by the disease (See Graphs 1 and 2). Variables that most likely contribute to this

phenomena is the state’s warm temperature, its landscape complexity, elevation, and vegetation

water content. (Liu, Weng 1999). Those infected by the virus may feel symptoms such as

headache and fever. A study done by the Red Cross compared a group of infected individuals

with a false positive control group. 61% of the verified infected individuals reported feeling

symptoms such as headache and fever while 21% of the controls reported the same symptoms.

(Orton et al 2005). The pattern pertaining to reported symptoms between positive and negative

controls can be seen in graph 3. Because of its massive spread through the continent since its first

reported case in 1999, the implementation of protective measures for the spread of WNV has

become a significant obligation for community leaders. Personal protection and community

awareness play a vital role on the spread of the disease. Window screens should be installed on
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houses, and mosquito repellents should be used during outdoor activity. On a larger scale, vector

controls are one of the most effective measures in combating the spread of mosquito spread

illnesses. Monitoring, testing and combating mosquito populations fall under the vector control

authority. (Nasci, 2013)

Discussion

According to Kramer, Li & Shi, (2007) the West Nile Virus is an epidemic in the United

States with a total number of cases counted to be 16,196 which has caused 1,549 deaths since

1999. Kramer, Li and Shi reported that there have been more than 780,000 cases of the virus

within the United States with the highest number of increase happening between July and

September in the Midwest. The occurrence of the virus took place in about 25 percent of the

people that have been infected (Kramer, Li & Shi, 2007). However, for those that have been

infected, their cases vary in clinical severity.

Petersen, Marfin and Gubler (2007), wrote that almost all the cases of the West Nile

Virus have been as a result of mosquito bites. Petersen, Marfin and Gubler however noted that in

2002, there was a case where the virus was spread from the mother to the fetus during

pregnancy. The mother was in her second trimester. Many people who have been infected with

the disease also stay asymptomatic (Petersen, Marfin & Gubler, 2007). The authors report that

the rate at which humans get infected is similar by age although the frequency becomes higher as

age increases. The transmission of this virus happens when a mosquito bites a bird that is

infected with the diseases and then the same mosquito goes to bite another person. It is however

important to note that not everyone that experiences mosquito bites get infected with the West

Nile Virus. The West Nile Virus can also be spread to other animals like the horses. A human

being cannot however contract this virus through coming into contact with the infected animal.
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The virus also cannot be spread when a non infected person shares a kiss with an infected

individual. However, the virus can spread through an organ transplant or going through a process

of blood transfusion. In the United States, the spread of the West Nile Virus rarely happens via

blood transfusion as all the blood is usually screened before it is transferred to another

individual.

When the virus strikes, between 70 to 80 percent of those infected show no symptoms.

However, in about 20 percent of the cases there is usually some form of febrile illness. Certain

individuals develop a fever which come with other symptoms those are: vomiting, headaches,

diarrhea, joint pain and rashes. Infected individuals usually go through a complete recovery

although they are left with weakness and fatigue for some more days before the effects of the

virus completely disappear. There have been instances of severe symptoms in certain group of

the population which the CDC reports to be less than 1 percent of those who get affected. Within

this category, individuals develop neurologic illnesses like meningitis and encephalitis. The

symptoms of such illnesses include high fever, disorientation, headaches, seizures, neck stiffness

and tremors.

As stated above, the west nile virus is a serious viral infection that should be a concern to

everyone, in particular those who reside in the state of California. The following are current

examples as to why this topic is serious and important. The primary reason is due to its negative

impact it can have in the health of an individual and its surrounding population. Becoming aware

of this type of virus will help keep a person healthy and possibly avoid any deaths. The

seriousness to this virus incidence rate should be a concern mainly during the mosquito season,

but being aware at all times is best. In addition, it’s important to become aware of the WNV

outbreak because this year it’s been recorded to be the largest seen in the US in a long time. With
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such a drastic change, it’s imperative that we acknowledge those who are more vulnerable to this

virus, the region or regions affected and the time of its occurrence.

The following will describe the three main concepts of epidemiology which are people,

place and time. Once again any individual in the US may be affected with the virus, but

primarily those who are 60 years and above. This is true because the elderly’s immune system is

too weak which causes a vulnerable attack towards the virus. The locations where this virus took

place where; west, central, northern and southern US. These regions became our central focus in

this assignment. According to the CDC 1,757 cases were reported about the transmission of the

WNV in 2017. Although it’s still unknown how the virus started in the US, we should be

attentive to the time of this viral infectious species. In epi, time includes the change over time.

From the first detection of this virus in 1999 there was thousands and thousands of cases

reported, but over time there has been a huge decrease of cases reported. According to the

statistics we have fewer cases and that is due to prevention and awareness of the virus.

Awareness and prevention of the West Nile Virus should be important to the residents of

the United States. In epidemiology, public health awareness is being informed about the WNV.

Educating the public about this virus can bring about awareness and help prevent the

transmission of the mosquito bites. In the US awareness week has been an ongoing trend that

helps educate people on how to avoid mosquitos, what to do if they bite you and the

consequences. Also educating the public about how to take preventative measures is strictly

necessary to help fight the virus. During mosquito season it is important to eliminate standing

water around the home. If out in public, avoiding these areas is crucial. Residents are highly

encouraged to stay inside as much as possible and make sure that their doors and windows have

screens. If outdoors, it's important to use the proper protection against this virus such as
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protective gear and mosquito repellant. Overall, through education and awareness the residents

will be empowered to take control of the virus and its effects.

Conclusion

With the early detection of the West Nile Virus in the late 1990s in the United States and

the detection of the first case in the early 2000s in California, there have been many many health

organizations providing the public with information and resources to decrease death rates. With

that being said many different prevalence measures have been given such as wearing clothes

thats covers the body from bites and mosquito repellent. Since there is yet to be a vaccine for

West Nile it's suggested to educate yourself and your family how to stay protected and continue

living West Nile virus free.

Reference

Kramer, L. D., Li, J., & Shi, P. Y. (2007). West Nile virus. The Lancet Neurology, 6(2), 171-181.

Petersen, L. R., Marfin, A. A., & Gubler, D. J. (2003). West nile virus. Jama, 290(4), 524-528.

The West Nile Virus. (2017). Retrieved from Center for Disease Control and Treatment:

https://www.cdc.gov/westnile/faq/genQuestions.html

Trevejo, R. T., & Eidson, M. (2008). West Nile virus. Journal of the American Veterinary

Medical Association, 232(9), 1302-1309.

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“West Nile virus.” Centers for Disease Control and Prevention, Centers for Disease Control and

Prevention, 7 Nov. 2017, www.cdc.gov/westnile/index.html.

Carney, R. (2011). Early Warning System for West Nile Virus Risk Areas, California, USA.

Emerging Infectious Diseases. doi:10.3201/eid1708.10041

Liu, H., & Weng, Q. (2011). Environmental Factors and Risk Areas of West Nile Virus in

Southern California, 2007–2009. Environmental Modeling & Assessment, 17(4), 441-

452. doi:10.1007/s10666-011-9304-0

Orton, S., Stramer, S., & Dodd, R. (2006). Self-reported symptoms associated with West Nile

virus infection in RNA-positive blood donors. Transfusion, 46(2), 272-277.

doi:10.1111/j.1537-2995.2006.00710.x N., & S., R. (2013, April 1). Monitoring and

Controlling West Nile Virus: Are Your Prevention Practices in Place? Journal of Environmental

Health.

West Nile virus. (2015, February 12). Retrieved November 14, 2017, from

https://www.cdc.gov/westnile/faq/index.html

West Nile virus. (n.d.). Retrieved November 14, 2017, from

http://www.who.int/mediacentre/factsheets/fs354/en/
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Appendix- Graph 1

Appendix- Graph 2
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Appendix- Graph 3
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