Investigation of an outbreak of encephalomyelitis caused by West Nile virus in 136 horses

Comparison of West Nile Virus Disease in Humans and Horses: Exploiting Similarities for Enhancing Syndromic Surveillance

West Nile virus (WNV) neuroinvasive disease threatens the health and well-being of horses and humans worldwide. Disease in horses and humans is remarkably similar. The occurrence of WNV disease in these mammalian hosts has geographic overlap with shared macroscale and microscale drivers of risk. Importantly, intrahost virus dynamics, the evolution of the antibody response, and clinicopathology are similar. The goal of this review is to provide a comparison of WNV infection in humans and horses and to identify similarities that can be exploited to enhance surveillance methods for the early detection of WNV neuroinvasive disease.

Eastern, Western, and Venezuelan Equine Encephalitis and West Nile Viruses: Clinical and Public Health Considerations

The continued recognition and emergence of alphavirus and flavivirus diseases is a growing veterinary and public health concern. As the global environment continues to change, mosquito-borne diseases will continue to evolve and expand. Continued development of readily available vaccines for the prevention of these diseases in humans and animals is essential to controlling epizootics of these diseases. Further research into effective antiviral treatments is also sorely needed. This article describes equine encephalitis viruses with a focus on clinical and public health considerations.

West-Nil-Virus-Infektion bei 12 Pferden in Mitteldeutschland

Gegenstand und Ziel Die Vorstellungsgründe, klinische Symptomatik, Diagnostik, Therapie und Ergebnis der Therapie von 12 Pferden mit klinisch apparenter West-Nil-Virus (WNV)-Infektion werden beschrieben.

Material und Methoden Fallserie

Ergebnisse Die adulten Pferde (Alter 6–18 Jahre, 7 Stuten, 5 Wallache) aus Sachsen oder Sachsen-Anhalt wurden zwischen September 2018 und September 2020 mit unterschiedlichen Vorberichten vorgestellt. Alle Pferde wurden im August oder September vorgestellt und keines der Pferde war gegen das WNV geimpft. Fieber war das häufigste Allgemeinsymptom und trat bei 8/12 Pferden auf. An neurologischen Symptomen traten Muskelfaszikulationen (11/12 Pferde), Ataxie (8/12 Pferde) sowie Hyperästhesie und Kopfschiefhaltung (je 6/12 Pferde) am häufigsten auf. Bei allen Pferden wurde die Infektion mittels Nachweises von IgM sowie neutralisierenden Antikörpern gegen das WNV diagnostiziert, zwei euthanasierte Pferde waren zudem PCR-positiv. Die symptomatische Therapie beinhaltete vor allem nicht-steroidale Antiphlogistika oder Dexamethason sowie Infusionstherapie. Die Dauer des Klinikaufenthaltes betrug im Durchschnitt 7,5 Tage. Sieben Pferde erholten sich laut Besitzerangaben vollständig, für 2 Pferde war keine Information erhältlich.

Schlussfolgerungen und klinische Relevanz Die WNV-Enzephalomyelitis muss in Mitteldeutschland seit 2018 als Differentialdiagnose von im Sommer und Spätsommer auftretenden akuten neurologischen Erkrankungen ungeimpfter Pferdes in Betracht gezogen werden. Die beschriebenen Symptome sowie das Ergebnis der Therapie sind weitgehend deckungsgleich mit Berichten aus Nordamerika und anderen europäischen Ländern.

Arboviral Equine Encephalitides

A number of viruses transmitted by biological vectors or through direct contact, air, or ingestion cause neurologic disease in equids. Of interest are viruses of the Togaviridae, Flaviviridae, Rhabdoviridae, Herpesviridae, Bornaviridae, and Bunyaviridae families. Many are classified as arboviruses because they use arthropod vectors, whereas others are transmitted directly via ingestion, inhalation, or integument damage. The goal of this article is to provide an overview on pathophysiologic and clinical aspects of arboviruses of equine importance, including alphaviruses (Togaviridae) and flaviviruses (Flaviviridae).

Phylogenetic analysis of West Nile virus: first report of lineage 1 in donkey in Turkey

West Nile virus (WNV), a member of the Flaviviridae, is a major arbovirus that causes West Nile fever. Previous data showed the prevalence of the WNV serologically and molecular in Turkey, and the presence of lineage 1 in horses and humans has been reported. This is the first notification of partial phylogeny of WNV detected in donkeys in the northeast of Turkey (on the Iranian border). Blood serum samples collected from 25 donkeys without clinical symptoms were tested by RT-PCR. Sequence analysis of the sample detected as positive was performed. Multiple sequence alignments of reference sequences taken from GenBank were performed using the ClustalW method using the MEGA6 program. Partial nucleotide sequences of the capsid gene coding region revealed that the strains are closely related to viruses of lineage 1, clade 1a. According to the phylogenetic tree, the TUR/Igdir/donkey strain was included in the same cluster as the strain (KJ958922) previously obtained from horses in Turkey and the strain (GQ851658) from the Central African Republic. This study is the first report to show the circulation of WNV lineage 1 in donkeys in Turkey.

West Nile Virus Lineage 2 in Horses and Other Animals with Neurologic Disease, South Africa, 2008-2015

During 2008–2015 in South Africa, we conducted West Nile virus surveillance in 1,407 animals with neurologic disease and identified mostly lineage 2 cases in horses (7.4%, 79/1,069), livestock (1.5%, 2/132), and wildlife (0.5%, 1/206); 35% were fatal. Geographic correlation of horse cases with seropositive veterinarians suggests disease in horses can predict risk in humans.

Detection of Antibodies to West Nile Virus in Equine Sera Using Microsphere Immunoassay

One hundred and ninety-one sera from horses that recently were exposed to West Nile virus (WNV) by either vaccination or natural infection or that were not vaccinated and remained free of infection were used to evaluate fluorescent microsphere immunoassays (MIAs) incorporating recombinant WNV envelope protein (rE) and recombinant nonstructural proteins (rNS1, rNS3, and rNS5) for detection of equine antibodies to WNV. The rE MIA had a diagnostic sensitivity and specificity, respectively, of 99.3% and 97.4% for detection of WNV antibodies in the serum of horses that were recently vaccinated or naturally infected with WNV, as compared to the plaque reduction neutralization test (PRNT). The positive rE MIA results were assumed to be WNV-specific because of the close agreement between this assay and the PRNT and the fact that unvaccinated control horses included in this study were confirmed to be free of exposure to the related St Louis encephalitis virus. The NS protein–based MIA were all less sensitive than either the rE MIA or PRNT (sensitivity 0–48.0), although the rNS1 MIA distinguished horses vaccinated with the recombinant WNV vaccine from those that were immunized with the inactivated WNV vaccine ( P < 0.0001) or naturally infected with WNV ( P < 0.0001). The rE MIA would appear to provide a rapid, convenient, inexpensive, and accurate test for the screening of equine sera for the presence of antibodies to WNV.

Emergence of Equine West Nile Encephalitis in Central Macedonia, Greece, 2010

During the summer of 2010, an outbreak of West Nile virus (WNV) infections attributed to a lineage 2 WNV strain was reported among humans and horses in Central Macedonia, Northern Greece. Here, the clinical and laboratory investigation of horses that showed severe neurological signs due to WNV infection is being described. Specifically, between August and September 2010, 17 horses with neurological signs were detected. WNV infection was confirmed in all 17 clinical cases by applying laboratory testing. The duration of WNV-specific IgM antibodies in sera obtained from seven of the clinically affected horses was relatively short (10-60 days; mean 44 days). In the regional unit of Thessaloniki, (i) seroprevalence of WNV and fatality rate in horses were high (33% and 30%, respectively), and (ii) the ratio of neurological manifestations-to-infections for this virus strain was high (19%). These observations indicate that the strain responsible for the massive human epidemic of 2010 in Greece was also highly pathogenic for horses. This is the first time that WNV infection has been documented in horses with clinical manifestations in Greece. WNV infection should be included in the differential diagnosis of horses with encephalitis in Greece.

Serum neutralising antibody response of seronegative horses against lineage 1 and lineage 2 West Nile virus following vaccination with an inactivated lineage 1 West Nile virus vaccine

Lineage 2 West Nile virus (WNV) strains are endemic in South Africa and cause severe neurological disease in horses. An inactivated lineage 1 vaccine, Duvaxyn WNV, protects mice against challenge with a neuroinvasive South African lineage 2 strain of WNV. To evaluate the potential of Duvaxyn WNV to protect horses against lineage 2 strains of WNV, serum neutralising antibody responses of horses against lineage 1 WNV strain NY385/99 and lineage 2 WNV strain SPU93/01, isolated from a human with meningo-encephalitis in South Africa, were compared following vaccination with two doses of Duvaxyn WNV, 28 days apart, and a third dose one year later. Twenty-two seronegative horses were randomly assigned to two treatment groups: 16 to a vaccinated group and six retained as unvaccinated controls. Blood samples were taken from all horses on study days 0, 28, 35, 42, 49, 91, 141, 182, 231, 274, 322, 364 and 413. Primovaccination with Duvaxyn WNV resulted in high titres of serum neutralising antibodies against both strains. Following a single dose of Duvaxyn WNV on day 399, one year after primovaccination, there was a strong anamnestic response with a log25-fold rise in the titres of neutralising antibodies against strains NY385/99 and SPU93/01. These results provide further evidence that Duvaxyn WNV is likely to protect horses against infection with lineage 2 strains of WNV and that a single annual booster may be sufficient to maintain immunity against lineage 2 WNV infection in horses.

Inactivated West Nile Virus (WNV) vaccine, Duvaxyn WNV, protects against a highly neuroinvasive lineage 2 WNV strain in mice

BACKGROUND

Lineage 2 West Nile Virus (WNV) is endemic to southern Africa and Madagascar, and has recently been associated with encephalitis outbreaks in humans and horses in South Africa, central Europe, Italy and Greece. Commercial vaccines have mostly been evaluated against WNV lineage 1 strains and their efficacy against lineage 2 strains rarely reported.

METHODS

To evaluate protection of Duvaxyn WNV vaccine against lineage 2 strains associated with encephalitis in South Africa, mice were vaccinated twice intramuscularly three weeks apart, and challenged four weeks later with highly neuroinvasive lineage 1 strain NY385/99 or lineage 2 strain SPU93/01. Neutralising antibody titres were measured at the time of challenge and three weeks later. Immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) were conducted on brains of mice that succumbed during the trial, on controls and on vaccinated mice that survived.

RESULTS

Serum neutralising antibodies in vaccinated mice were detected but low three weeks after primovaccination. Three weeks post-challenge, vaccinated mice had significantly higher serum neutralising antibody titres against both lineages than unvaccinated controls. After challenge, all vaccinated mice remained healthy but all unvaccinated mice demonstrated severe neurological signs with 75% mortality rate. WNV was not detected in brains of vaccinated mice whereas virus replicated in most unvaccinated mice challenged with either lineage. Gross and microscopic lesions were found only in unvaccinated mice challenged with both lineages.

CONCLUSION

Duvaxyn WNV vaccine provided complete protection against challenge with lineage 2 WNV and stimulated significant cross protective neutralising antibodies in mice against lineage 2.

Concurrent occurrence of human and equine West Nile virus infections in Central Anatolia, Turkey: the first evidence for circulation of lineage 1 viruses

BACKGROUND

West Nile fever is an important zoonotic infection caused by West Nile virus (WNV), a member of the Flaviviridae. Previous serological data from Turkey suggest widespread WNV circulation. This report includes cases of human and equine WNV infections occurring concurrently, and manifesting as central nervous system infections, in two neighboring provinces of Central Anatolia, Turkey. A partial phylogenetic analysis of the causative virus is given for the first time.

METHODS

The cases were reported in February (horses) and March (human). Symptoms of the disease were similar in the two species, characterized by neurological manifestations suggesting meningoencephalitis. Real-time/nested PCRs and commercial immunoassays and a plaque reduction neutralization assay were employed for the detection of viral RNA and specific antibodies, respectively.

RESULTS

WNV RNAs were detected in buffy coat (horses) and cerebrospinal fluid (human) samples. Partial nucleotide sequences of the E-gene coding region revealed that the strains are closely related to viruses of lineage 1, clade 1a. Accompanying equine serosurveillance demonstrated WNV-specific antibodies in 31.6% of the samples.

CONCLUSIONS

This is the first report of acute WNV infections caused by lineage 1 strains from Turkey, in concordance with previous reports from some European and North African countries.

Kunjin flaviviral encephalomyelitis in an Arabian gelding in New South Wales, Australia

Flaviviruses, including Kunjin virus, are arboviruses that cause encephalomyelitis in humans and horses. This case report describes an Arabian gelding exhibiting neurological signs of flavivirus encephalomyelitis, the diagnostic investigation and confirmation of an unreported case of Kunjin virus equine encephalomyelitis in Australia.

Fatal neurologic disease and abortion in mare infected with lineage 1 West Nile virus, South Africa

In 2010, lineage 1 West Nile virus was detected in South Africa in the brain of a pregnant mare that succumbed to neurologic disease and in her aborted fetus, suggesting an association with abortion in horses. All West Nile virus strains previously detected in horses and humans in South Africa were lineage 2.

West Nile virus lineage 2 as a cause of zoonotic neurological disease in humans and horses in southern Africa

West Nile virus (WNV) is widely distributed in South Africa, but since a few cases of neurological disease have been reported from this region, endemic lineage 2 strains were postulated to be of low virulence. Several cases of nonfatal encephalitis in humans as well as fatal cases in a foal, dog, and ostrich chicks have, however, been associated with lineage 2 WNV in South Africa. The pathogenesis of lineage 2 WNV strains was investigated using mouse neuroinvasive experiments, gene expression experiments, and genome sequence comparisons which indicated that lineage 2 strains that are highly pathogenic exist. To determine whether cases of WNV were being missed in South Africa, horses with fever and neurological disease were investigated. Several cases of WNV were identified, all associated with severe neurological disease, 85% of which had to be euthanized or died. All cases positive by RT-PCR were shown to belong to lineage 2 WNV by DNA sequencing and phylogenetic analysis. Two cases of occupational infection were investigated, including a case of zoonotic transmission to a veterinarian who performed an autopsy on one of the horses as well as a laboratory infection after a needle stick injury with a neuroinvasive lineage 2 strain. Both resulted in neurological disease. Cytokine expression was investigated in the second case to assess the immunopathogenesis of WNV. Collectively, these studies suggest that lineage 2 WNV may be significantly under estimated as a cause of neurological disease in South Africa.

Lineage 2 west nile virus as cause of fatal neurologic disease in horses, South Africa

Serologic evidence suggests that West Nile virus (WNV) is widely distributed in horses in southern Africa. However, because few neurologic cases have been reported, endemic lineage 2 strains were postulated to be nonpathogenic in horses. Recent evidence suggests that highly neuroinvasive lineage 2 strains exist in humans and mice. To determine whether neurologic cases are being missed in South Africa, we tested 80 serum or brain specimens from horses with unexplained fever (n = 48) and/or neurologic signs (n = 32) for WNV. From March 2007 through June 2008, using reverse transcription-PCR (RT-PCR) and immunoglobulin (Ig) M ELISA, we found WNV RNA or IgM in 7/32 horses with acute neurologic disease; 5 horses died or were euthanized. In 5/7 horses, no other pathogen was detected. DNA sequencing for all 5 RT-PCR-positive cases showed the virus belonged to lineage 2. WNV lineage 2 may cause neurologic disease in horses in South Africa.

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.

Serum antibodies to West Nile virus in naturally exposed and vaccinated horses

A polyvalent ELISA and plaque reduction neutralization tests (PRNTs) were used to measure serum antibodies to West Nile virus (WNV) in horses naturally exposed to or vaccinated against this flavivirus in Connecticut and New York State, USA. Relying on a PRNT as a 'gold standard', the main objective was to validate a modified ELISA containing a recombinant WNV envelope protein antigen. It was also important to assess specificity by testing sera from horses that had other, undiagnosed illnesses. Sera for the latter study were obtained from 43 privately owned horses during 1995-1996. Analyses by an ELISA and a PRNT confirmed the presence of WNV antibodies in 21 (91%) of 23 sera from naturally exposed horses and in 85% of the 20 vaccinated subjects; overall results for both study groups were highly concordant (91% agreement). Humoral responses of naturally exposed and immunized horses were similar. Both serological tests were useful in confirming past infections with WNV, but there was no evidence that horses with undiagnosed illnesses were exposed to WNV prior to a 1999 outbreak in Connecticut, USA.

Transmission dynamics and changing epidemiology of West Nile virus

West Nile virus (WNV) is a flavivirus that is maintained in a bird-mosquito transmission cycle. Humans, horses and other non-avian vertebrates are usually incidental hosts, but evidence is accumulating that this might not always be the case. Historically, WNV has been associated with asymptomatic infections and sporadic disease outbreaks in humans and horses in Africa, Europe, Asia and Australia. However, since 1994, the virus has caused frequent outbreaks of severe neuroinvasive disease in humans and horses in Europe and the Mediterranean Basin. In 1999, WNV underwent a dramatic expansion of its geographic range, and was reported for the first time in the Western Hemisphere during an outbreak of human and equine encephalitis in New York City. The outbreak was accompanied by extensive and unprecedented avian mortality. Since then, WNV has dispersed across the Western Hemisphere and is now found throughout the USA, Canada, Mexico and the Caribbean, and parts of Central and South America. WNV has been responsible for >27,000 human cases, >25,000 equine cases and hundreds of thousands of avian deaths in the USA but, surprisingly, there have been only sparse reports of WNV disease in vertebrates in the Caribbean and Latin America. This review summarizes our current understanding of WNV with particular emphasis on its transmission dynamics and changing epidemiology.

Comparative efficacies of three commercially available vaccines against West Nile Virus (WNV) in a short-duration challenge trial involving an equine WNV encephalitis model

We used a severe challenge model that produces clinical West Nile virus (WNV) disease to test the efficacy of three commercially available equine WNV vaccines in horses. Twenty-four healthy, WNV-seronegative horses of varying ages and genders were placed, in random and blind manner, into three trial groups consisting of eight horses each; two horses in each group received (i) an inactivated WNV vaccine (K-WN), (ii) a modified-live vaccine (CP-WN) containing the WNV prM and E proteins expressed by a canarypox vector, (iii) a live-chimera vaccine (WN-FV) containing WNV prM and E proteins expressed in a YF17D vector, or (iv) a diluent control. Challenge by this model caused grave neurological signs, viremia, moderate to severe histopathologic lesions in the brain and spinal cord, and an outcome of 0% survivorship in all six control horses. In contrast, challenge in horses at between 28 days postvaccination with the chimera vaccine and 56 days postvaccination with the commercial inactivated or modified-live vaccine resulted in 100% survivorship (protection from the onset of WNV encephalitis and viremia). Horses vaccinated with the live-chimera vaccine showed significantly fewer clinical signs than did the control horses (P </= 0.01) and the horses vaccinated with inactivated vaccine (P = 0.035). Mild residual inflammatory lesions were seen in a few of the vaccinated horses.

Incidence and effects of West Nile virus infection in vaccinated and unvaccinated horses in California

A prospective cohort study was used to estimate the incidence of West Nile virus (WNV) infection in a group of unvaccinated horses (n = 37) in California and compare the effects of natural WNV infection in these unvaccinated horses to a group of co-mingled vaccinated horses (n = 155). Horses initially were vaccinated with either inactivated whole virus (n = 87) or canarypox recombinant (n = 68) WNV vaccines during 2003 or 2004, prior to emergence of WNV in the region. Unvaccinated horses were serologically tested for antibodies to WNV by microsphere immunoassay incorporating recombinant WNV E protein (rE MIA) in December 2003, December 2004, and every two months thereafter until November 2005. Clinical neurologic disease attributable to WNV infection (West Nile disease (WND)) developed in 2 (5.4%) of 37 unvaccinated horses and in 0 of 155 vaccinated horses. One affected horse died. Twenty one (67.7%) of 31 unvaccinated horses that were seronegative to WNV in December, 2004 seroconverted to WNV before the end of the study in November, 2005. Findings from the study indicate that currently-available commercial vaccines are effective in preventing WND and their use is financially justified because clinical disease only occurred in unvaccinated horses and the mean cost of each clinical case of WND was approximately 45 times the cost of a 2-dose WNV vaccination program.

West Nile virus: recent trends in diagnosis and vaccine development

West Nile virus (WNV) is a mosquito-borne flavivirus, native to Africa, Europe, and Western Asia. In many respects, WNV is an outstanding example of a zoonotic pathogen that has leaped geographical barriers and can cause severe disease in human and horse. Before the emergence of WNV in the USA, only few methods of diagnosis were available. Recently, many changes in the fields of WN diagnosis and prevention have happened. This paper will review all these new tools. After a description of the main concerns in WNV and West Nile (WN) disease in humans and animals, this review will present the main available tests for serology and virology detection, from gold standard tests to more recently developed methods. Finally, licensed vaccines and candidate vaccines developed in humans, horses and birds will also been described.

Meningitis and Encephalomyelitis in Horses

This article provides an overview of meningitis and encephalomyelitis in horses, including diagnostic tests, treatment developments, and preventative measures reported in the equine and human medical literature of the past few years.

Characteristics of an outbreak of West Nile virus encephalomyelitis in a previously uninfected population of horses

Equine West Nile virus (WNV) encephalomyelitis cases - based on clinical signs and ELISA serology test results - reported to Texas disease control authorities during 2002 were analyzed to provide insights into the epidemiology of the disease within a previously disease-free population. The epidemic occurred between June 27 and December 17 (peaking in early October) and 1,698 cases were reported. Three distinct epidemic phases were identified, occurring mostly in southeast, northwest and then central Texas. Significant (P<0.05) disease clusters were identified in northwest and northern Texas. Most (91.1%) cases had no recent travel history, and most (68.9%) cases had not been vaccinated within the previous 12 months. One-third of cases did not survive, 71.2% of which were euthanatized. The most commonly reported presenting signs included ataxia (69%), abnormal gait (52%), muscle fasciculations (49%), depression (32%) and recumbency (28%). Vaccination status, ataxia, falling down, recumbency and lip droop best explained the risk of not surviving WNV disease. Results suggest that the peak risk period for encephalomyelitis caused by WNV may vary substantially among regions within Texas. Recumbent horses have a poor prognosis for survival. Vaccines, even if not administered sufficiently in advance of WNV infection within a district, may reduce the risk of death by at least 44%.

Environmental and ecological determinants of West Nile virus occurrence in horses in North Dakota, 2002

West Nile virus (WNV) outbreak in North Dakota in 2002 included over 569 horse cases, clustered mainly in the eastern and northeastern parts of the state. The pattern of occurrence observed suggested existence of specific environmental and ecological factors that increased the risk for infection and illness in those locations. We developed a predictive model with factors that explained the pattern of WNV occurrence observed. Results indicated that surface elevation, temperature, precipitation, reported WNV-positive birds, reported WNV-positive humans, and reported WNV-positive mosquitoes were important predictors of occurrence in horses. However, case distance from water bodies was not significant in the model. Future predictive models of WNV occurrence in horses should take into account these factors in order to improve accuracy and reliability. Research into other potential determinants such as horse management factors are required to determine more differential risk factors associated with WNV occurrence in horses.

Evaluation of factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with West Nile virus infection: 1,017 cases (2003)

OBJECTIVE

To describe the prevalence of West Nile virus (WNV) infection and evaluate factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with WNV infection.

DESIGN

Retrospective case series.

SAMPLE POPULATION

Laboratory submission forms from 1,104 equids tested for WNV in Colorado in 2003.

PROCEDURES

Submission forms accompanying samples submitted for detection of WNV via IgM capture ELISA were obtained from the Colorado state veterinarian and diagnostic laboratories performing the tests. Data on signalment, clinical signs, history of vaccination against WNV, and assay results were collected from laboratory submission forms. Equids with clinical signs compatible with WNV infection in which IgM capture ELISA results were positive were considered as case equids.

RESULTS

1,104 equids were tested for WNV; 1,017 (92.1%) had clinical signs compatible with WNV infection. Among equids with clinical signs compatible with WNV infection, the odds of testing positive for WNV via IgM capture ELISA were lower in males and in vaccinated equids and higher in equids with moderate and severe illness, compared with females, unvaccinated equids, and equids with mild illness.

CONCLUSIONS AND CLINICAL RELEVANCE

Among equids with clinical signs compatible with WNV infection, vaccination against WNV, severity of clinical signs, duration of illness, and region in Colorado were associated with increased risk of having a positive IgM capture ELISA result.

Rural cases of equine West Nile virus encephalomyelitis and the normalized difference vegetation index

Data from an outbreak (August to October, 2002) of West Nile virus (WNV) encephalomyelitis in a population of horses located in northern Indiana was scanned for clusters in time and space. One significant (p = 0.04) cluster of case premises was detected, occurring between September 4 and 10 in the south-west part of the study area (85.70 degrees N, 45.50 degrees W). It included 10 case premises (3.67 case premises expected) within a radius of 2264 m. Image data were acquired by the Advanced Very High Resolution Radiometer (AVHRR) sensor onboard a National Oceanic and Atmospheric Administration polar-orbiting satellite. The Normalized Difference Vegetation Index (NDVI) was calculated from visible and near-infrared data of daily observations, which were composited to produce a weekly-1km(2) resolution raster image product. During the epidemic, a significant (p < 0.01) decrease (0.025 per week) in estimated NDVI was observed at all case and control premise sites. The median estimated NDVI (0.659) for case premises within the cluster identified was significantly (p < 0.01) greater than the median estimated NDVI for other case (0.571) and control (0.596) premises during the same period. The difference in median estimated NDVI for case premises within this cluster, compared to cases not included in this cluster, was greatest (5.3% and 5.1%, respectively) at 1 and 5 weeks preceding occurrence of the cluster. The NDVI may be useful for identifying foci of WNV transmission.

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

Since first being detected in New York in 1999, West Nile virus (WNV) has spread throughout the United States and more than 20,000 cases of equine WNV encephalomyelitis have been reported. A spatial model of disease occurrence was developed, using data from an outbreak of serologically confirmed disease in an unvaccinated population of horses at 108 locations in northern Indiana between 3 August and 17 October 2002. Daily maximum temperature data were recorded at meteorological stations surrounding the study area. The distribution of the total number of degree-days elapsing between July 4 and the date of diagnosis of each case was best described by a normal distribution (mean=5243 degrees F, S.D.=1047). The days on which the average risk was >25, >50 and >75% were predicted (versus observed) to occur on August 23 (August 9), August 31 (September 2) and September 9 (September 9). The epidemic was predicted to occur 3 days earlier, or 4 days later, than observed if temperatures in the study area were uniformly increased, or decreased, by 5 degrees F, respectively. Maps indicated that WNV encephalomyelitis risk always remained greater in the northwest quadrant of the study area. Since WNV might exist at a hypoendemic level of infection, and occasionally re-emerge as a cause of epidemics in equine populations, by identifying factors that contributed to this epidemic, the potential impact of future epidemics can be reduced. Such studies rely on a GIS framework, availability of meteorological and possibly remotely sensed data and information on host and landscape factors. An early-warning system for WNV transmission in equine populations could be developed.

A recombinant envelope protein vaccine against West Nile virus

West Nile (WN) virus is a flavivirus that first appeared in North America in 1999. Since then, more than 600 human deaths and 22,000 equine infections have been attributed to the virus in the United States. We expressed a truncated form of WN virus envelope (E) protein in Drosophila S2 cells. This soluble recombinant E protein was recognized by antibodies from naturally infected horses, indicating that it contains native epitopes. Mice and horses produced high-titer antibodies when immunized with recombinant E protein combined with aluminum hydroxide. Immunized mice were resistant to challenge with a lethal viral dose. Sera from immunized horses, administered to naive mice, conferred resistance against a lethal WN viral challenge. In addition, sera of immunized horses neutralized West Nile virus in vitro, as demonstrated by plaque reduction assays. This recombinant form of E protein, combined with aluminum hydroxide, is a candidate vaccine that may protect humans and horses against WN virus infections.