The weather is getting hot and mosquitoes are getting nasty. It's time for everybody to learn to protect against West Nile virus, which infects thousands of people, killing hundreds of them, each year in the United States.
The following is cited from the CDC and should be considered authoritative.
What Is West Nile Virus?
West Nile Virus is a flavivirus commonly found in Africa, West Asia, and the Middle East. It is closely related to St. Louis encephalitis virus which is also found in the United States. The virus can infect humans, birds, mosquitoes, horses and some other mammals.
West Nile virus (WNV) is a potentially serious illness. Experts believe WNV is established as a seasonal epidemic in North America that flares up in the summer and continues into the fall. This fact sheet contains important information that can help you recognize and prevent West Nile virus.
How long has West Nile virus been in the U.S.?
It is not known how long it has been in the U.S., but CDC scientists believe the virus has probably been in the eastern U.S. since the early summer of 1999, possibly longer.
How many cases of West Nile disease in humans have occurred in the U.S.?
In 2004, there were 2539 human cases of WNV disease reported, including 100 deaths. For a report of cases by clinical syndrome and by state, please see the 2004 human disease cases.
In 2003, there were 9862 human cases of WNV disease, including 264 deaths. Cases were reported throughout much of the US; for a report of cases by each state please refer to the 2002 human case count. In 2001, there were 66 human cases of severe disease and 9 deaths. In 2000, 21 cases were reported, including 2 deaths in the New York City area. In 1999, 62 cases of severe disease, including 7 deaths, occurred in the New York area.
No reliable estimates are available for the number of cases of West Nile encephalitis that occur worldwide.
What proportion of people with severe illness due to West Nile virus die?
Among those with severe illness due to West Nile virus, case-fatality rates range from 3% to 15% and are highest among the elderly. Less than 1% of people who become infected with West Nile virus will develop severe illness -- most people who get infected do not develop any disease at all.
Who is at risk for getting West Nile encephalitis?
All residents of areas where virus activity has been identified are at risk of getting West Nile encephalitis; persons over 50 years of age have the highest risk of severe disease. It is unknown if immunocompromised persons are at increased risk for WNV disease.
How do people get infected with West Nile virus (WNV)?
The main route of human infection with West Nile virus is through the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds, which may circulate the virus in their blood for a few days. The virus eventually gets into the mosquito's salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness.
Additional routes of human infection became apparent during the 2002 West Nile epidemic. It is important to note that these other methods of transmission represent a very small proportion of cases. Investigations have identified WNV transmission through transplanted organs and through blood transfusions. See Blood Transfusions and Transmission: Questions and Answers.
There is one reported case of transplacental (mother-to-child) WNV transmission. This case is detailed in MMWR Dec 20, 2002. There is also one reported case of transmission of WNV through breast-milk. See Questions and Answers concerning WNV and breastfeeding for more information on this topic.
Although transmission of WNV and similar viruses to laboratory workers is not a new phenomenon, two recent cases of WNV infection of laboratory workers have been reported. These cases are detailed in MMWR Dec 20, 2002.
What is the basic transmission cycle of West Nile virus?
Mosquitoes become infected when they feed on infected birds, which may circulate the virus in their blood for a few days. Infected mosquitoes can then transmit West Nile virus to humans and animals while biting to take blood. The virus is located in the mosquito's salivary glands. During blood feeding, the virus may be injected into the animal or human, where it may multiply, possibly causing illness.
What are the symptoms of West Nile virus (WNV) infection?
Infection with WNV can be asymptomtic (no symptoms), or can lead to West Nile fever or severe West Nile disease.
It is estimated that about 20% of people who become infected with WNV will develop West Nile fever. Symptoms include fever, headache, tiredness, and body aches, occasionally with a skin rash (on the trunk of the body) and swollen lymph glands. While the illness can be as short as a few days, even healthy people have reported being sick for several weeks.
The symptoms of severe disease (also called neuroinvasive disease, such as West Nile encephalitis or meningitis or West Nile poliomyelitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. It is estimated that approximately 1 in 150 persons infected with the West Nile virus will develop a more severe form of disease. Serious illness can occur in people of any age, however people over age 50 and some immunocompromised persons (for example, transplant patients) are at the highest risk for getting severely ill when infected with WNV.
Most people (about 4 out of 5) who are infected with West Nile virus will not develop any type of illness (an asymptomatic infection), however you cannot know ahead of time if you'll get sick or not when infected.
What is the incubation period in humans (i.e., time from infection to onset of disease symptoms) for West Nile disease?
Usually 2 to 15 days.
How long do symptoms last?
Symptoms of West Nile fever will generally last a few days, although even some healthy people report having the illness last for several weeks. The symptoms of severe disease (encephalitis or meningitis) may last several weeks, although neurological effects may be permanent.
What is meant by West Nile encephalitis, West Nile meningitis, West Nile poliomyelitis, “neuroinvasive disease” and West Nile fever?
The most severe type of disease due to a person being infected with West Nile virus is sometimes called “neuroinvasive disease,” because it affects a person's nervous system. Specific types of neuroinvasive disease include: West Nile encephalitis, West Nile meningitis, West Nile meningoencephalitis and West Nile poliomyelitis. Encephalitis refers to an inflammation of the brain, meningitis is an inflammation of the membrane around the brain and the spinal cord, meningoencephalitis refers to inflammation of the brain and the membrane surrounding it, and poliomyelitis refers to an inflammation of the spinal cord.
West Nile Fever is another type of illness that can occur in people who become infected with the virus. It is characterized by fever, headache, tiredness, aches and sometimes rash. Although the illness can be as short as a few days, even healthy people have been sick for several weeks.
If I have West Nile Fever, can it turn into West Nile encephalitis?
When someone is infected with West Nile virus (WNV) they will typically have one of three outcomes: No symptoms (most likely), West Nile fever (WNF in about 20% of people) or severe West Nile disease, such as meningitis or encephalitis (less than 1% of those who get infected). If you develop a high fever with severe headache, consult your health care provider.
West Nile fever is characterized by symptoms such as fever, body aches, headache and sometimes swollen lymph glands and rash. West Nile fever generally lasts only a few days, though in some cases symptoms have been reported to last longer, even up to several weeks. West Nile fever does not appear to cause any permanent health effects. There is no specific treatment for WNV infection. People with West Nile fever recover on their own, though symptoms can be relieved through various treatments (such as medication for headache and body aches, etc.).
Some people may develop a brief, WNF-like illness (early symptoms) before they develop more severe disease, though the percentage of patients in whom this occurs is not known.
Occasionally, an infected person may develop more severe disease such as “West Nile encephalitis,” “West Nile meningitis” or “West Nile meningoencephalitis.” Encephalitis refers to an inflammation of the brain, meningitis is an inflammation of the membrane around the brain and the spinal cord, and meningoencephalitis refers to inflammation of the brain and the membrane surrounding it. Although there is no treatment for WNV infection itself, the person with severe disease often needs to be hospitalized. Care may involve nursing IV fluids, respiratory support, and prevention of secondary infections.
What Can I Do to Prevent WNV?
The easiest and best way to avoid WNV is to prevent mosquito bites.
When you are outdoors, use insect repellent containing an EPA-registered active ingredient. Follow the directions on the package.
Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.
Make sure you have good screens on your windows and doors to keep mosquitoes out.
Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.
What Are the Symptoms of WNV?
Serious Symptoms in a Few People. About one in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.
Milder Symptoms in Some People. Up to 20 percent of the people who become infected have symptoms such as fever, headache, and body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even healthy people have become sick for several weeks.
No Symptoms in Most People. Approximately 80 percent of people (about 4 out of 5) who are infected with WNV will not show any symptoms at all.
How Does West Nile Virus Spread?
Infected Mosquitoes. Most often, WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite.
Transfusions, Transplants, and Mother-to-Child. In a very small number of cases, WNV also has been spread through blood transfusions, organ transplants, breastfeeding and even during pregnancy from mother to baby.
Not through touching. WNV is not spread through casual contact such as touching or kissing a person with the virus.
How Soon Do Infected People Get Sick?
People typically develop symptoms between 3 and 14 days after they are bitten by the infected mosquito.
How Is WNV Infection Treated?
There is no specific treatment for WNV infection. In cases with milder symptoms, people experience symptoms such as fever and aches that pass on their own, although even healthy people have become sick for several weeks. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment including intravenous fluids, help with breathing and nursing care.
What Should I Do if I Think I Have WNV?
Milder WNV illness improves on its own, and people do not necessarily need to seek medical attention for this infection though they may choose to do so. If you develop symptoms of severe WNV illness, such as unusually severe headaches or confusion, seek medical attention immediately. Severe WNV illness usually requires hospitalization. Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WNV.
What Is the Risk of Getting Sick from WNV?
People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites.
Being outside means you're at risk. The more time you're outdoors, the more time you could be bitten by an infected mosquito. Pay attention to avoiding mosquito bites if you spend a lot of time outside, either working or playing.
Risk through medical procedures is very low. All donated blood is checked for WNV before being used. The risk of getting WNV through blood transfusions and organ transplants is very small, and should not prevent people who need surgery from having it. If you have concerns, talk to your doctor.
Pregnancy and nursing do not increase risk of becoming infected with WNV. The risk that WNV may present to a fetus or an infant infected through breastmilk is still being evaluated. Talk with your care provider if you have concerns.
What Else Should I Know?
If you find a dead bird: Don't handle the body with your bare hands. Contact your local health department for instructions on reporting and disposing of the body. They may tell you to dispose of the bird after they log your report.
For more information call the CDC public response hotline
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646 (TTY)
