Treatment and prevention of West Nile virus infection
- Lyle R Petersen, MD, MPH
Lyle R Petersen, MD, MPH
- Division of Vector-borne Infectious Diseases
- Centers for Disease Control and Prevention
West Nile virus, a member of the Japanese encephalitis virus antigenic complex, can lead to a wide range of clinical symptoms from asymptomatic disease to severe meningitis and encephalitis.
Management and prevention of West Nile virus is discussed below. The clinical manifestations and epidemiology of the infection are discussed elsewhere. (See "Epidemiology and pathogenesis of West Nile virus infection" and "Clinical manifestations and diagnosis of West Nile virus infection".)
Treatment of WN virus infection is primarily supportive. The potential use of several different therapeutic agents has been described [1-11]. However, only one controlled study to evaluate specific therapies for WN virus infection has been completed . Uncontrolled studies or case reports suggesting treatment efficacy should be cautiously interpreted, since the clinical course and outcomes with WN virus neuroinvasive disease are highly variable [1,2].
Agents that have been considered include:
Interferon — The rationale for the use of alfa interferon is based upon evidence of efficacy against WN virus in vitro and in animal models [3-5].
- Sejvar JJ, Haddad MB, Tierney BC, et al. Neurologic manifestations and outcome of West Nile virus infection. JAMA 2003; 290:511.
- Gea-Banacloche J, Johnson RT, Bagic A, et al. West Nile virus: pathogenesis and therapeutic options. Ann Intern Med 2004; 140:545.
- Morrey JD, Day CW, Julander JG, et al. Effect of interferon-alpha and interferon-inducers on West Nile virus in mouse and hamster animal models. Antivir Chem Chemother 2004; 15:101.
- Anderson JF, Rahal JJ. Efficacy of interferon alpha-2b and ribavirin against West Nile virus in vitro. Emerg Infect Dis 2002; 8:107.
- Sayao AL, Suchowersky O, Al-Khathaami A, et al. Calgary experience with West Nile virus neurological syndrome during the late summer of 2003. Can J Neurol Sci 2004; 31:194.
- Kalil AC, Devetten MP, Singh S, et al. Use of interferon-alpha in patients with West Nile encephalitis: report of 2 cases. Clin Infect Dis 2005; 40:764.
- Hrnicek MJ, Mailliard ME. Acute west nile virus in two patients receiving interferon and ribavirin for chronic hepatitis C. Am J Gastroenterol 2004; 99:957.
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- Agrawal AG, Petersen LR. Human immunoglobulin as a treatment for West Nile virus infection. J Infect Dis 2003; 188:1.
- Hart J Jr, Tillman G, Kraut MA, et al. West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes. BMC Infect Dis 2014; 14:248.
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- O'Leary DR, Marfin AA, Montgomery SP, et al. The epidemic of West Nile virus in the United States, 2002. Vector Borne Zoonotic Dis 2004; 4:61.
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- Carson PJ, Konewko P, Wold KS, et al. Long-term clinical and neuropsychological outcomes of West Nile virus infection. Clin Infect Dis 2006; 43:723.
- Loeb M, Hanna S, Nicolle L, et al. Prognosis after West Nile virus infection. Ann Intern Med 2008; 149:232.
- Murray KO, Garcia MN, Rahbar MH, et al. Survival analysis, long-term outcomes, and percentage of recovery up to 8 years post-infection among the Houston West Nile virus cohort. PLoS One 2014; 9:e102953.
- Burton JM, Kern RZ, Halliday W, et al. Neurological manifestations of West Nile virus infection. Can J Neurol Sci 2004; 31:185.
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- Sejvar JJ, Bode AV, Marfin AA, et al. West Nile Virus-associated flaccid paralysis outcome. Emerg Infect Dis 2006; 12:514.
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- Chung WM, Buseman CM, Joyner SN, et al. The 2012 West Nile encephalitis epidemic in Dallas, Texas. JAMA 2013; 310:297.
- Busch MP, Caglioti S, Robertson EF, et al. Screening the blood supply for West Nile virus RNA by nucleic acid amplification testing. N Engl J Med 2005; 353:460.
- Petersen LR, Epstein JS. Problem solved? West Nile virus and transfusion safety. N Engl J Med 2005; 353:516.
- Stramer SL, Fang CT, Foster GA, et al. West Nile virus among blood donors in the United States, 2003 and 2004. N Engl J Med 2005; 353:451.
- Montgomery SP, Brown JA, Kuehnert M, et al. Transfusion-associated transmission of West Nile virus, United States 2003 through 2005. Transfusion 2006; 46:2038.
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- Pletnev AG, Claire MS, Elkins R, et al. Molecularly engineered live-attenuated chimeric West Nile/dengue virus vaccines protect rhesus monkeys from West Nile virus. Virology 2003; 314:190.
- Qiao M, Ashok M, Bernard KA, et al. Induction of sterilizing immunity against West Nile Virus (WNV), by immunization with WNV-like particles produced in insect cells. J Infect Dis 2004; 190:2104.
- Monath TP, Liu J, Kanesa-Thasan N, et al. A live, attenuated recombinant West Nile virus vaccine. Proc Natl Acad Sci U S A 2006; 103:6694.
- Biedenbender R, Bevilacqua J, Gregg AM, et al. Phase II, randomized, double-blind, placebo-controlled, multicenter study to investigate the immunogenicity and safety of a West Nile virus vaccine in healthy adults. J Infect Dis 2011; 203:75.
- Dayan GH, Bevilacqua J, Coleman D, et al. Phase II, dose ranging study of the safety and immunogenicity of single dose West Nile vaccine in healthy adults ≥ 50 years of age. Vaccine 2012; 30:6656.
- Martin JE, Pierson TC, Hubka S, et al. A West Nile virus DNA vaccine induces neutralizing antibody in healthy adults during a phase 1 clinical trial. J Infect Dis 2007; 196:1732.
- U.S. Centers for Disease Control. Interim Guidelines for the Evaluation of Infants Born to Mothers Infected With West Nile Virus During Pregnancy. www.cdc.gov/ncidod/dvbid/westnile/congenitalinterimguidelines.htm (Accessed on March 07, 2005).
- Centers for Disease Control and Prevention (CDC). Interim guidelines for the evaluation of infants born to mothers infected with West Nile virus during pregnancy. MMWR Morb Mortal Wkly Rep 2004; 53:154.
- Intravenous immunoglobulin
- Personal protection measures
- Mosquito control programs
- Blood donor screening programs
- Vaccine development
- MANAGEMENT AND PREVENTION OF INFECTION DURING PREGNANCY
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