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West Nile Virus Eight Years Later—A Mosquito-borne Menace
Sensitive and specific nucleic acid amplification tests were rapidly developed adulticide application, and public education) has been adopted to reduce
for screening the blood supply after transfusion transmission of WNV was mosquito populations. Debate continues over the health and environmental
recognized in 2002.
63
Implementation of the assay in 2003 detected 1.49 effects of pesticides used to control mosquitoes.
42
RNA-positive blood samples per 10,000 donations, at a calculated cost of
$1.7 million per quality-adjusted life year saved.
64
High-throughput assays Four WNV vaccines have been licensed successfully for prevention of
based on Taqman
®
reverse transcription quantitative polymerase chain disease in equines, and trials are under way for human vaccines.
reaction (RT-PCR) were developed in response to intensive testing of Approaches include the use of inactivated vaccines, DNA expression
mosquitoes and dead birds for WNV RNA.
65,66
Rapid diagnostic assays based vector-based and recombinant protein-based immunizations, chimeric
on antigen capture using dipsticks
67
or fluorescence
68
were developed for use virus, and attenuated virus.
42
Treatment using antivirals may be a more
by less sophisticated laboratories than large state-run health departments. reasonable approach taking into account the population most affected
by WN disease and the unpredictable nature of the outbreaks. Potentially
Control effective therapeutics include ribavirin,
69
intravenous immunoglobulin
After eight years of WNV activity in the US, the number of cases is low in the derived from donor plasma with high levels of WNV antibodies,
70
eastern US, while the overall number of cases in the US appears to have humanized monoclonal antibodies directed against the WNV envelope
stabilized (see Table 1). However, a significant increase in the number of cases protein,
71
interferon therapy,
72
and oligomers with complementary
was observed in western Canada in 2007. The virus is now endemic in North sequence to portions of the WNV genome (antisense therapies).
73
America, and changes in activity will most likely be related to weather
conditions. The intensity of transmission of WNV in the US and the epidemic In summary, WNV is a major public health problem, and is likely to remain
proportion of the outbreaks have stimulated the development of effective so for the foreseeable future. The introduction of this virus into the western
methods of limiting viral transmission and preventing and/or treating WN hemisphere in 1999 precipitated intensive research, which has increased our
disease. Efforts have focused on reducing mosquito vector populations and understanding of the ecology, pathogenesis, and epidemiology of this virus
encouraging use of personal protective measures (long sleeves, insect greatly. The event heightened awareness of the consequences of naturally
repellents) to limit exposure to mosquito bites. A multifaceted approach introduced pathogens. It is clear that we will face similar challenges from
(mosquito population monitoring, mosquito source reduction, larvicide and newly introduced zoonotic pathogens in the future. ■
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