West Nile Virus (WNV)

West Nile Virus (WNV) infection is spread by mosquitoes that have the virus. Most people who are infected with the virus don't have any symptoms or only have a mild illness. However, in a small number of cases, WNV can cause severe, life-threatening meningitis (inflammation of the spinal cord) or encephalitis (inflammation of the brain). These neurological complications have made the West Nile virus a cause of concern across the globe.

This article discusses the symptoms, causes, and diagnosis of West Nile virus, as well as treatment and ways to prevent it.

West Nile Virus Symptoms

It is estimated that 60% to 80% of people who get infected with the West Nile virus have no signs or symptoms of any disease. Roughly 20% will develop what is called West Nile fever.

Symptoms of West Nile fever may include:

• Fever
• Muscle aches
• Headache
• Sore throat
• Nausea and vomiting
• Fatigue 
• Skin rash 

These typical viral symptoms usually improve after a few days and are usually considered to be just a “summer cold.” Most people and their healthcare providers never knew they had a West Nile virus infection.

Meningitis/Encephalitis

In a small number of infected people—thought to be well under 1%—a serious neurological infection can occur.

People who develop West Nile meningitis or encephalitis may experience:

• Very high fever
• Headache
• Stiff neck
• Disorientation or confusion
• Tremors
• Paralysis
• Seizures
• Coma 

West Nile meningitis or encephalitis can be fatal, even with comprehensive medical care. Many who recover have lingering neurological symptoms for a year or longer, and some may be left with permanent neurological deficits.

The neurological complications from West Nile virus are more likely in:

• People over 60
• Those with cancer
• People who have received an organ transplant from a donor who was infected with West Nile Virus
• People with certain medical conditions, such as hypertension, diabetes, cancer, and kidney disease

What Causes West Nile Virus?

West Nile virus is an RNA virus that is found all over the world, including Europe, Africa, Asia, Australia, and North and South America. While the virus itself is not new, it was far more localized to Africa and the Middle East until a few decades ago. Scientists first associated it with severe neurological illness only during the 1990s.

The primary hosts for the West Nile virus are birds. Mosquitoes pass the virus from bird to bird, allowing the virus to multiply and spread. When a mosquito carrying the virus bites a person, the virus can enter the bloodstream and cause an infection.

The virus isn't contagious, so it can't spread from person to person through coughing, sneezing, or touching. However, it can spread through blood transfusion and organ transplant if donated from an infected person. Mothers with West Nile infection can pass it to the baby during pregnancy, delivery, or breastfeeding.

In the northern hemisphere, infections with the West Nile virus are seen from late May or early June through September, when mosquitoes are active. The risk of infection tends to peak in late summer.

How Is West Nile Virus Diagnosed?

Two tests may be used to identify West Nile virus infection:

• Polymerase chain reaction (PCR) test: This is a blood test that can identify the virus itself. However, this has limited usefulness because of the virus's short lifespan in humans. It's possible to have been infected with West Nile and test negative.
• ELISA testing: This blood test (which is done in two parts) can detect IgM antibodies—proteins your body generates in reaction to the virus. This test can detect evidence of immunity to the virus even if the virus is no longer present in your body.

The PCR and ELISA tests are costly. These tests are usually only performed if a doctor feels it's imperative to formally diagnose West Nile infection, such as in cases when an individual is seriously ill.

Most people with the infection don't experience symptoms or only have mild flu-like symptoms that resolve on their own. While those with mild cases might want to officially know if it's West Nile that is affecting them, a test-confirmed diagnosis won't affect treatment recommendations.

West Nile Virus Treatment

There is no specific therapy for West Nile virus, so treatment is primarily focused on reducing symptoms. Those with typical West Nile fever (the vast majority of whom never learn they are infected with the West Nile virus) generally treat themselves with usual comfort measures—rest, fluid, and pain relievers—and their illnesses resolve in a few days.

West Nile Virus Doctor Discussion Guide

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People who are hospitalized with a serious illness from West Nile virus are treated to manage the fever and to keep vital signs (pulse, temperature, breathing rate, and blood pressure) stable.

While antiviral medication and intravenous immunoglobulin are often used to treat West Nile infection in hospitalized patients, real evidence that these treatments help with recovery is lacking.

Mortality with serious neurological West Nile infection, even with optimal medical care, has been reported as 4.6% in the United States between 1999 to 2019.

How to Prevent West Nile Virus

Because there are no good treatments for this infection, prevention is very important. Ways to prevent or reduce the risk of infection, include:

• Avoid mosquito-infested areas
• Clear living spaces of any standing water where mosquito larvae may develop
• Use insect repellant

Screening donated blood for West Nile virus has significantly reduced the risk of transmission by blood transfusion.

Vaccines against West Nile virus are being developed. While vaccines for horses have been licensed for use in the United States, no vaccines for human use have yet entered clinical trials.

Summary

West Nile virus is a mosquito-borne infection that is widespread across the United States and the world. While most people infected with West Nile virus have relatively mild illnesses and recover completely, those who develop neurological infections can become seriously ill and may have a prolonged recovery, as well as a risk of death.

Because there is no specific treatment for West Nile virus, it's important that you take measures to avoid getting infected by protecting yourself and your loved ones from mosquitos whenever possible.