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Completeness of West Nile virus testing in patients with meningitis and encephalitis during an outbreak in Arizona, USA

  • I. B. WEBER (a1), N. P. LINDSEY (a1), A. M. BUNKO-PATTERSON (a2), G. BRIGGS (a3), T. J. WADLEIGH (a2), T. L. SYLVESTER (a2), C. LEVY (a4), K. K. KOMATSU (a4), J. A. LEHMAN (a1), M. FISCHER (a1) and J. E. STAPLES (a1)...

Accurate data on West Nile virus (WNV) cases help guide public health education and control activities, and impact regional WNV blood product screening procedures. During an outbreak of WNV disease in Arizona, records from patients with meningitis or encephalitis were reviewed to determine the proportion tested for WNV. Of 60 patients identified with meningitis or encephalitis, 24 (40%) were tested for WNV. Only 12 (28%) of 43 patients aged <50 years were tested for WNV compared to 12 (71%) of 17 patients aged ⩾50 years (P<0·01). Patients with clinical signs of weakness or paralysis, elevated CSF protein, admitted to an inpatient facility, or discharged to a rehabilitation facility were also more likely to have WNV testing performed. The lack of testing in younger age groups and in those with less severe disease probably resulted in substantial underestimates of WNV neuroinvasive disease burden.

Corresponding author
*Author for correspondence: Dr I. B. Weber, CDC/DVBD, 3150 Rampart Road, Fort Collins, Colorado 80521, USA. (Email:
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1. Reimann CA, et al. Epidemiology of neuroinvasive arboviral disease in the United States, 1999–2007. American Journal of Tropical Medicine and Hygiene 2008; 79: 974979.
2. Mostashari F, et al. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet 2001; 358: 261264.
3. Sejvar JJ, Marfin AA. Manifestations of West Nile neuroinvasive disease. Reviews in Medical Virology 2006; 16: 209224.
4. Lindsey NP, et al. Surveillance for human West Nile virus disease – United States, 1999–2008. Morbidity and Mortality Weekly Report . Surveillance Summaries 2010; 59: 117.
5. Custer B, et al. The cost-effectiveness of screening the U.S. blood supply for West Nile virus. Annals of Internal Medicine 2005; 143: 486492.
6. Boehmer TK, et al. Use of hospital discharge data to evaluate notifiable disease reporting to Colorado's Electronic Disease Reporting System. Public Health Reports 2011; 126: 100106.
7. Silk BJ, et al. Differential West Nile fever ascertainment in the United States: a multilevel analysis. American Journal of Tropical Medicine and Hygiene 2010; 83: 795802.
8. Patnaik JL, Harmon H, Vogt RL. Follow-up of 2003 human West Nile virus infections, Denver, Colorado. Emerging Infectious Diseases 2006; 12: 11291131.
9. Lindsey NP, et al. West Nile virus disease in children, United States, 1999–2007. Pediatrics 2009; 123: e1084–1089.
10. Jean CM, et al. Risk factors for West Nile virus neuro-invasive disease, California, 2005. Emerging Infectious Diseases 2007; 13: 19181920.
11. Sejvar JJ. The long-term outcomes of human West Nile virus infection. Clinical Infectious Diseases 2007; 44: 16171624.
12. Unlu I, et al. Evaluation of surveillance methods for detection of West Nile virus activity in East Baton Rouge Parish, Louisiana, 2004–2006. Journal of the American Mosquito Control Association 2009; 25: 126133.
13. Stramer SL, et al. Strategies for testing blood donors for West Nile virus. Transfusion 2006; 46: 20362037.
14. Centers for Disease Control and Prevention. Epidemic/epizootic West Nile virus in the United States: guidelines for surveillance, prevention, and control. Atlanta: CDC, 2003.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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