Epidemic West Nile virus encephalomyelitis: a temperature-dependent, spatial model of disease dynamics

West Nile virus infections are here! Are we prepared to face another flavivirus epidemic?

Emerging arthropod-borne viruses (arboviruses), such as chikungunya and Zika viruses, are a major threat to public health in countries like Brazil where biodiversity is high and medical care is sometimes precarious. West Nile fever is a disease caused by the West Nile Virus (WNV), an RNA virus belonging to the Flaviviridae family. It is transmitted by infected mosquitoes to numerous animals like birds, reptiles and mammals, including human and non-human primates. In the last decade, the number of reported cases of WNV infection in humans and animals has increased in the Americas. Circulation of WNV in forests and rural areas in Brazil has been detected based on serological surveys and, in 2014, the first case of West Nile fever was confirmed in a patient from Piauí State. In 2018, the virus was isolated for the first time from a horse from a rural area in the state of Espírito Santo presenting with a neurological disorder; this raises the possibility that other cases of WNV encephalitis may have occurred without clinical recognition and without laboratory diagnosis by specific assays. The imminent WNV outbreak poses a challenge for Brazilian clinicians and researchers. In this review, we summarize the basic biological and ecological characteristics of this virus and the clinical presentation and treatment of febrile illnesses caused by WNV. We also discuss the epidemiological aspects, prophylaxis of WNV infections, and monitoring strategies that could be applied in the possibility of a WNV outbreak in Brazil.

An Integrative Eco-Epidemiological Analysis of West Nile Virus Transmission

West Nile disease, caused by the West Nile virus (WNV), is a mosquito-borne zoonotic disease affecting humans and horses that involves wild birds as amplifying hosts. The mechanisms of WNV transmission remain unclear in Europe where the occurrence of outbreaks has dramatically increased in recent years. We used a dataset on the competence, distribution, abundance, diversity and dispersal of wild bird hosts and mosquito vectors to test alternative hypotheses concerning the transmission of WNV in Southern France. We modelled the successive processes of introduction, amplification, dispersal and spillover of WNV to incidental hosts based on host-vector contact rates on various land cover types and over four seasons. We evaluated the relative importance of the mechanisms tested using two independent serological datasets of WNV antibodies collected in wild birds and horses. We found that the same transmission processes (seasonal virus introduction by migratory birds, Culex modestus mosquitoes as amplifying vectors, heterogeneity in avian host competence, absence of 'dilution effect') best explain the spatial variations in WNV seroprevalence in the two serological datasets. Our results provide new insights on the pathways of WNV introduction, amplification and spillover and the contribution of bird and mosquito species to WNV transmission in Southern France.

Risk mapping of West Nile virus circulation in Spain, 2015

West Nile fever is an emergent disease in Europe. The objective of this study was to conduct a predictive risk mapping of West Nile Virus (WNV) circulation in Spain based on historical data of WNV circulation. Areas of Spain with evidence of WNV circulation were mapped based on data from notifications to the surveillance systems and a literature review. A logistic regression-based spatial model was used to assess the probability of WNV circulation. Data were analyzed at municipality level. Mean temperatures of the period from June to October, presence of wetlands and presence of Special Protection Areas for birds were considered as potential predictors. Two predictors of WNV circulation were identified: higher temperature [adjusted odds ratio (AOR) 2.07, 95% CI 1.82-2.35, p<0.01] and presence of wetlands (3.37, 95% CI 1.89-5.99, p<0.01). Model validations indicated good predictions: area under the ROC curve was 0.895 (95% CI 0.870-0.919) for internal validation and 0.895 (95% CI 0.840-0.951) for external validation. This model could support improvements of WNV risk- based surveillance in Spain. The importance of a comprehensive surveillance for WNF, including human, animal and potential vectors is highlighted, which could additionally result in model refinements.

Serological evidence of widespread circulation of West Nile virus and other flaviviruses in equines of the Pantanal, Brazil

A recent study reported neutralizing antibodies to West Nile virus (WNV) in horses from four ranches of southern Pantanal. To extend that study, a serosurvey for WNV and 11 Brazilian flaviviruses was conducted with 760 equines, 238 sheep and 61 caimans from 17 local cattle ranches. Among the tested equines, 32 were collected from a ranch where a neurologic disorder outbreak had been recently reported. The sera were initially screened by using a blocking ELISA and then titrated by 90% plaque-reduction neutralization test (PRNT90) for 12 flaviviruses. Employing the criterion of 4-fold greater titer, 78 (10.3%) equines were seropositive for Ilheus virus, 59 (7.8%) for Saint Louis encephalitis virus, 24 (3.2%) for WNV, two (0.3%) for Cacipacore virus and one (0.1%) for Rocio virus. No serological evidence was found linking the neurological disease that affected local equines to WNV. All caimans and sheep were negative by blocking ELISA for flaviviruses. There were no seropositive equines for Bussuquara, Iguape, Yellow fever and all four Dengue virus serotypes. The detection of WNV-seropositive equines in ten ranches and ILHV and SLEV-seropositive equines in fourteen ranches of two different sub-regions of Pantanal is strong evidence of widespread circulation of these flaviviruses in the region.

Predictive modeling of West Nile virus transmission risk in the Mediterranean Basin: how far from landing?

The impact on human and horse health of West Nile fever (WNF) recently and dramatically increased in Europe and neighboring countries. Involving several mosquito and wild bird species, WNF epidemiology is complex. Despite the implementation of surveillance systems in several countries of concern, and due to a lack of knowledge, outbreak occurrence remains unpredictable. Statistical models may help identifying transmission risk factors. When spatialized, they provide tools to identify areas that are suitable for West Nile virus transmission. Mathematical models may be used to improve our understanding of epidemiological process involved, to evaluate the impact of environmental changes or test the efficiency of control measures. We propose a systematic literature review of publications aiming at modeling the processes involved in WNF transmission in the Mediterranean Basin. The relevance of the corresponding models as predictive tools for risk mapping, early warning and for the design of surveillance systems in a changing environment is analyzed.

Exploring the spatio-temporal dynamics of reservoir hosts, vectors, and human hosts of West Nile virus: a review of the recent literature

Over the last two decades West Nile Virus (WNV) has been responsible for significant disease outbreaks in humans and animals in many parts of the World. Its extremely rapid global diffusion argues for a better understanding of its geographic extent. The purpose of this inquiry was to explore spatio-temporal patterns of WNV using geospatial technologies to study populations of the reservoir hosts, vectors, and human hosts, in addition to the spatio-temporal interactions among these populations. Review of the recent literature on spatial WNV disease risk modeling led to the conclusion that numerous environmental factors might be critical for its dissemination. New Geographic Information Systems (GIS)-based studies are monitoring occurrence at the macro-level, and helping pinpoint areas of occurrence at the micro-level, where geographically-targeted, species-specific control measures are sometimes taken and more sophisticated methods of surveillance have been used.

Analysis of climatic and environmental variables associated with the occurrence of West Nile virus in Morocco

West Nile disease (WND) is one of the most widespread mosquito-borne infectious diseases in the World. In Morocco the first WND cases were reported in equines in 1996. After an apparent epidemiological silence, WND re-occurred in 2003 and in 2010, when the disease was reported in equines living in the central and north-western part of the country. Eco-climatic variables are known to influence the mosquito presence and abundance and, therefore, the probability of occurrence of mosquito-borne infections. The remote sensed values of Land Surface Temperature (LST), Normalised Difference Vegetation Index (NDVI) and rainfall registered from 2001 to 2010 were evaluated for a possible association with the occurrence of WND cases in 2003 and in 2010. In the zones where WND cases occurred, NDVI values recorded in 2003 and 2010, from June to November, were significantly higher than those registered during the same months in the rest of the decade. Rainfall data showed higher peaks in 2003 and 2010, when the number of days with extreme rainfall was significantly higher during 1-2 months before the occurrence of WND cases. Temperature does not seem to play an important role in Moroccan epidemiological conditions.

Spatial-temporal model of haemorrhagic disease in white-tailed deer in south-east USA, 1983 to 2000

The present study constructed a spatial-temporal statistical model to identify the risk and protective factors for haemorrhagic disease (HD) in white-tailed deer in the five states of Alabama, Georgia, South Carolina, North Carolina and Tennessee. The response variable was binary, indicating the presence or absence of HD in an individual county, measured annually from 1983 to 2000. Predictor variables included climatic factors of temperature, rainfall, wind speed and dew point, remotely sensed data of normalised difference vegetation index (NDVI) and land surface temperature derived from archived remotely sensed advanced very-high-resolution radiometer (AVHRR) satellite data, elevation, a spatial autocorrelation (SA) term and a temporal autocorrelation term. This study first applied principal component factor analysis to reduce the volume of climatic data and remotely sensed data. Then, a generalised linear mixed model framework (GLMM) was used to develop a spatial-temporal statistical model. The results showed that the area under receiver operating characteristic curve (ROC) was 0.728, indicating a good overall fit of the model. The total prediction accuracy over the 18 year period with optimal cut-off probability was 67 per cent. The prediction accuracy for individual years ranged from 48 to 75 per cent.

Identification of suitable areas for West Nile virus outbreaks in equid populations for application in surveillance plans: the example of the Castile and Leon region of Spain

The introduction and rapid spread of West Nile virus (WNV) into new areas such as the American continent, associated also with the severity of the disease in humans and equids has increased concerns regarding the need to better prevent and control future WNV incursions. WNV outbreaks in equids usually occur under specific climatic and environmental conditions and, typically, before detection of WNV cases in humans. Targeting surveillance strategies in areas and time periods identified as suitable for WNV outbreaks in equids may act as an early-warning system to prevent disease in both equids and humans. This study used a GIS-based framework to identify suitable areas and time periods for WNV outbreak occurrence in one of the most important areas of equid production in Spain, i.e. Castile and Leon. Methods and results presented here may help to improve the early detection and control of future WNV outbreaks in Spain and other regions.

A metapopulation model to simulate West Nile virus circulation in Western Africa, Southern Europe and the Mediterranean basin

In Europe, virological and epidemiological data collected in wild birds and horses suggest that a recurrent circulation of West Nile virus (WNV) could exist in some areas. Whether this circulation is permanent (due to overwintering mechanisms) or not remains unknown. The current conception of WNV epidemiology suggests that it is not: this conception combines an enzootic WNV circulation in tropical Africa with seasonal introductions of the virus in Europe by migratory birds. The objectives of this work were to (i) model this conception of WNV global circulation; and (ii) evaluate whether the model could reproduce data and patterns observed in Europe and Africa in vectors, horses, and birds. The model was calibrated using published seroprevalence data obtained from African (Senegal) and European (Spain) wild birds, and validated using independent, published data: seroprevalence rates in migratory and resident wild birds, minimal infection rates in vectors, as well as seroprevalence and incidence rates in horses. According to this model, overwintering mechanisms are not needed to reproduce the observed data. However, the existence of such mechanisms cannot be ruled out.

Equine West Nile virus disease occurrence and the Normalized Difference Vegetation Index

The association between the Normalized Difference Vegetation Index (NDVI) and periods of above- or below-average reported cases of equine West Nile virus encephalomyelitis, reported in Texas between 2002 and 2004, was investigated. A time-series of case reports, using a biweekly window, was constructed. Because of the disparity in number of cases reported (1698, 672 and 101 in 2002, 2003 and 2004, respectively), data were standardized by calculating the number of cases reported during each biweekly period as a ratio of the annual average number of cases reported. The mean NDVI (0.439) in Texas in biweekly periods in which cases were reported was significantly higher (P<0.001) than the mean NDVI (0.396) in periods in which cases were not reported. The best-fitting model of standardized case ratios included the mean NDVI in the preceding 4-week period. This association was further investigated in the two ecological regions of Texas in which most cases were reported during the study period--Prairies and Lakes, and the Panhandle Plains. Standardized case ratios in the Prairies and Lakes ecoregion were best predicted by NDVI estimated 19-20 weeks previously, whereas standardized case ratios in the Panhandle Plains region were most strongly associated with NDVI estimated 1-4 weeks previously, indicating that the temporal lag between appropriate environmental conditions and resulting increased risk of WNV transmission can vary in different regions. The associations identified could be useful in an early-warning system of increased disease risk.

Environmental risk factors for equine West Nile virus disease cases in Texas

West Nile Virus (WNV) was first detected in the Texas equine population during June 2002. Infection has since spread rapidly across the state and become endemic in the equine population. Environmental risk factors associated with equine WNV attack rates in Texas counties during the period 2002 to 2004 were investigated. Equine WNV attack rates were smoothed using an empirical Bayesian model, because of the variability among county equine populations (range 46-9,517). Risk factors investigated included hydrological features (lakes, rivers, swamps, canals and river basins), land cover (tree, mosaic, shrub, herbaceous, cultivated and artificial), elevation, climate (rainfall and temperature), and reports of WNV-positive mosquito and wild bird samples. Estimated county equine WNV attack rate was best described by the number of lakes, presence of broadleaf deciduous forest, presence of cultivated areas, location within the Brazos River watershed, WNV-positive mosquito status and average temperature. An understanding of environmental factors that increase equine WNV disease risk can be used to design and target disease control programs.

Aspectos epidemiológicos da Febre do Oeste do Nilo

Desde sua introdução na América do Norte em 1999, mais de 27.500 casos humanos da infecção por West Nile virus (WNV) foram reportados nos Estados Unidos da América (EUA), resultando em mais de 1000 casos fatais. Recentemente, a disseminação do vírus para o hemisfério sul foi confirmada com a detecção de animais infectados pelo WNV em território sul-americano. A soropositividade para WNV em eqüídeos na Colômbia e Venezuela e o isolamento do vírus nestes animais na Argentina, reiteram a necessidade da manutenção do sistema de vigilância enzoótica para WNV em território brasileiro. Aspectos pertinentes à infecção, patogenia e epidemiologia do WNV são discutidos neste artigo.

Fundamental issues in mosquito surveillance for arboviral transmission

Marked spatiotemporal variabilities in mosquito infection of arboviruses, exemplified by the transmission of West Nile virus (WNV) in America, require adaptive strategies for mosquito sampling, pool screening and data analyses. Currently there is a lack of reliable and consistent measures of risk exposure, which may compromise comparison of surveillance data. Based on quantitative reasoning, we critically examined fundamental issues regarding mosquito sampling design and estimation of transmission intensity. Two surveillance strategies were proposed, each with a distinct focus, i.e. targeted surveillance for detection of low rates of mosquito infection and extensive surveillance for evaluation of risk exposure with high levels of mosquito infection. We strongly recommend the use of indicators embodying both mosquito abundance and infection rates as measures of risk exposure. Aggregation of surveillance data over long periods of time and across broad areas obscures patterns of focal arboviral transmission. We believe that these quantitative issues, once addressed by mosquito surveillance programs, can improve the epidemiological intelligence of arbovirus transmission.

Explaining Usutu virus dynamics in Austria: model development and calibration

Usutu virus (USUV), a flavivirus of the Japanese encephalitis virus complex, was for the first time detected outside Africa in the region around Vienna (Austria) in 2001 by Weissenböck et al. [Weissenböck, H., Kolodziejek, J., Url, A., Lussy, H., Rebel-Bauder, B., Nowotny, N., 2002. Emergence of Usutu virus, an African mosquito-borne flavivirus of the Japanese encephalitis virus group, central Europe. Emerg. Infect. Dis. 8, 652-656]. USUV is an arthropod-borne virus (arbovirus) circulating between arthropod vectors (mainly mosquitoes of the Culex pipiens complex) and avian amplification hosts. Infections of mammalian hosts or humans, as observed for the related West Nile virus (WNV), are rare. However, USUV infection leads to a high mortality in birds, especially blackbirds (Turdus merula), and has similar dynamics with the WNV in North America, which, amongst others, caused mortality in American robins (Turdus migratorius). We hypothesized that the transmission of USUV is determined by an interaction of developing proportion of the avian hosts immune and climatic factors affecting the mosquito population. This mechanism is implemented into the present model that simulates the seasonal cycles of mosquito and bird populations as well as USUV cross-infections. Observed monthly climate data are specified for the temperature-dependent development rates of the mosquitoes as well as the temperature-dependent extrinsic-incubation period. Our model reproduced the observed number of dead birds in Austria between 2001 and 2005, including the peaks in the relevant years. The high number of USUV cases in 2003 seems to be a response to the early beginning of the extraordinary hot summer in that year. The predictions indicate that >70% of the bird population acquired immunity, but also that the percentage would drop rapidly within only a couple of years. We estimated annually averaged basic reproduction numbers between R (0)=0.54 (2004) and 1.35 (2003). Finally, extrapolation from our model suggests that only 0.2% of the blackbirds killed by USUV were detected by the Austrian USUV monitoring program [Chvala, S., Bakonyi, T., Bukovsky, C., Meister, T., Brugger, K., Rubel, F., Nowotny, N., Weissenböck, H., 2007. Monitoring of Usutu virus activity and spread by using dead bird surveillance in Austria, 2003-2005. Vet. Microbiol. 122, 237-245]. These results suggest that the model presented is able to quantitatively describe the process of USUV dynamics.

West Nile virus-infected dead corvids increase the risk of infection in Culex mosquitoes (Diptera: Culicidae) in domestic landscapes

A comparative study of West Nile virus (family Flaviviridae, genus Flavivirus, WNV) infection rates in Culex mosquitoes collected at 13 sites, seven reporting WNV-positive dead corvids (case sites) and six without reported dead birds (control sites) was conducted in Davis, CA, from 14 to 21 July at the beginning of the 2006 WNV outbreak. In total, 3051 Culex mosquitoes were collected using gravid traps and CO2-baited traps; WNV-infected mosquitoes were only collected with CO2-baited traps. WNV-infected Culex pipiens L. were collected at one of the seven case sites. Six of seven case sites yielded WNV-infected Culex tarsalis Coquillett, whereas only one of six control sites had WNV-infected Cx. tarsalis. Overall, the odds of finding WNV-positive mosquitoes were 19.75 times greater at sites reporting a WNV-infected dead corvid than sites without a WNV-infected dead corvid. Maximum likelihood estimates of the overall infection rates at the case sites were 3.48/1000 for Cx. tarsalis and 8.69/1000 for Cx. pipiens compared with 1.02/1000 in Cx. tarsalis collected at the control sites. Results indicate that Cx. tarsalis was important in early season enzootic transmission within Davis and that sites reporting WNV-infected dead corvids are areas to focus control and surveillance efforts.