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West Nile fever-a reemerging mosquito-borne viral disease in Europe.


West Nile virus West Nile virus, microorganism and the infection resulting from it, which typically produces no symptoms or a flulike condition. The virus is a flavivirus and is related to a number of viruses that cause encephalitis.  causes sporadic cases and outbreaks of human and equine disease in Europe (western Mediterranean and southern Russia in 1962-64, Belarus and Ukraine in the 1970s and 1980s, Romania in 1996-97, Czechland in 1997, and Italy in 1998). Environmental factors, including human activities, that enhance population densities of vector mosquitoes (heavy rains followed by floods, irrigation irrigation, in agriculture, artificial watering of the land. Although used chiefly in regions with annual rainfall of less than 20 in. (51 cm), it is also used in wetter areas to grow certain crops, e.g., rice. , higher than usual temperature, or formation of ecologic niches that enable mass breeding of mosquitoes) could increase the incidence of West Nile fever West Nile fever West Nile meningoencephalitis Infectious disease An acute, mosquito-borne flaviviral infection endemic–rarely, epidemic–in the Near East, Africa, former Soviet Union, India Clinical After a 3-6 day incubation, children present with a .

The 1996-97 outbreak of West Nile fever in and near Bucharest, Romania, with more than 500 clinical cases and a case-fatality rate approaching 10% (1-3), was the largest outbreak of arboviral illness in Europe since the Ockelbo-Pogosta-Karelian fever epidemic caused by Sindbis virus Sindbis virus
n.
An alphavirus that is the causative agent of Sindbis fever.
 in northern Europe in the 1980s. This latest outbreak reaffirmed that mosquito-borne viral diseases viral diseases

Diseases caused by viruses. Long-term immunity usually follows viral childhood diseases (see chickenpox). The common cold recurs into adulthood because many different viruses cause its symptoms, and immunity against one does not protect against others.
 may occur on a mass scale, even in temperate climates.

West Nile virus is a member of the Japanese encephalitis Japanese Encephalitis Definition

Japanese encephalitis is an infection of the brain caused by a virus. The virus is transmitted to humans by mosquitoes.
 antigenic complex of the genus Flavivirus, family Flaviviridae (4). All known members of this complex (Alfuy, Japanese encephalitis, Kokobera, Koutango, Kunjin, Murray Valley encephalitis Murray Valley encephalitis

see Murray Valley encephalitis.
, St. Louis encephalitis St. Louis encephalitis

see St. Louis encephalitis.
, Stratford, Usutu, and West Nile viruses) are transmissible transmissible /trans·mis·si·ble/ (trans-mis´i-b'l) capable of being transmitted.

trans·mis·si·ble
adj.
Capable of being conveyed from one person to another.
 by mosquitoes and many of them can cause febrile febrile /feb·rile/ (feb´ril) pertaining to or characterized by fever.

feb·rile
adj.
Of, relating to, or characterized by fever; feverish.
, sometimes fatal, illnesses in humans.

West Nile virus was first isolated from the blood of a febrile woman in the West Nile West Nile may refer to:
  • West Nile virus
  • West Nile region in Uganda
 district of Uganda in 1937 (5) and was subsequently isolated from patients, birds, and mosquitoes in Egypt in the early 1950s (6-7). The virus was soon recognized as the most widespread of the flaviviruses, with geographic distribution including Africa and Eurasia. Outside Europe (Figure), the virus has been reported from Algeria, Asian Russia Noun 1. Asian Russia - the Russia that is part of Asia
Asia - the largest continent with 60% of the earth's population; it is joined to Europe on the west to form Eurasia; it is the site of some of the world's earliest civilizations
, Azerbaijan, Botswana, Central African Republic Central African Republic, republic (2005 est. pop. 3,800,000), 240,534 sq mi (622,983 sq km), central Africa. The landlocked nation is bordered by Chad (N), Sudan (E), Congo (Kinshasa) and Congo (Brazzaville) (S), and Cameroon (W). , Cote d'Ivoire, Cyprus, Democratic Republic of Congo (former Zaire), Egypt, Ethiopia, India, Israel, Kazakhstan, Madagascar, Morocco, Mozambique, Nigeria, Pakistan, Senegal, South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. , Tajikistan, Turkmenia, Uganda, and Uzbekistan. Furthermore, West Nile virus antibodies have been detected in human sera from Armenia, Borneo, China, Georgia, Iraq, Kenya, Lebanon, Malaysia, the Philippines, Sri Lanka Sri Lanka (srē läng`kə) [Sinhalese,=resplendent land], formerly Ceylon, ancient Taprobane, officially Democratic Socialist Republic of Sri Lanka, island republic (2005 est. pop. , Sudan, Syria, Thailand, Tunisia, and Turkey (8-10). Kunjin virus Kunjin virus

a strain of West Nile virus, generally considered apathogenic but has been isolated from horses with encephalomyelitis. See also encephalitis.
 is closely related to West Nile virus (11,12), representing a counterpart or subtype (programming) subtype - If S is a subtype of T then an expression of type S may be used anywhere that one of type T can and an implicit type conversion will be applied to convert it to type T.  for Australia and Southeast Asia Southeast Asia, region of Asia (1990 est. pop. 442,500,000), c.1,740,000 sq mi (4,506,600 sq km), bounded roughly by the Indian subcontinent on the west, China on the north, and the Pacific Ocean on the east. ; some West Nile virus seroreactions in Southeast Asia may, in fact, represent antibodies to Kunjin virus.

West Nile Virus Ecology

Arthropod arthropod

Any member of the largest phylum, Arthropoda, in the animal kingdom. Arthropoda consists of more than one million known invertebrate species in four subphyla: Uniramia (five classes, including insects), Chelicerata (three classes, including arachnids and horseshoe
 Vectors

Mosquitoes, largely bird-feeding species, are the principal vectors of West Nile virus. The virus has been isolated from 43 mosquito species, predominantly of the genus Culex Culex /Cu·lex/ (ku´leks) a genus of mosquitoes found throughout the world, many species of which are vectors of disease-producing organisms.

Cu·lex
n.
 (Table 1). In Africa and the Middle East, the main vector is Cx. univittatus (although Cx. poicilipes, Cx. neavei, Cx. decens, Aedes albocephalus, or Mimomyia spp. play an important role in certain areas). In Europe, the principal vectors are Cx. pipiens, Cx. modestus, and Coquillettidia richiardii, and in Asia, Cx. quinquefasciatus, Cx. tritaeniorhynchus, and Cx. vishnui predominate. Successful experimental transmission of the virus has been described in Culiseta longiareolata, Cx. bitaeniorhynchus, and Ae. albopictus (8,13). Transovarial transmission Transovarial transmission occurs in certain arthropod vectors as they transmit disease-causing bacteria from parent arthropod to offspring arthropod. For instance, Rickettsia rickettsii  of the virus has been demonstrated in Cx. tritaeniorhynchus, Ae. aegypti, and Ae. albopictus, though at low rates.

Table 1. Isolations of West Nile virus from hematophagous hematophagous

subsisting on blood, e.g. hematophagous flies.
 arthropods (7-10)
Species                    No.   Countries

Mosquitoes
Culex antennatus(a)          6   Egypt, Madagascar
 decens group                8   Madagascar
 ethiopicus                  1   Ethiopia
 guiarti                     1   Cote d"Ivoire
 modestus                    3   France, Russia
 neavei                      4   Senegal, South Africa
 nigripes                    1   Central African Republic
 perexiguus                  1   Israel
 perfuscus group             3   Central African Republic, Senegal
 pipiens(a)                  7   South Africa, Egypt, Israel,
                                  Romania, Czechland, Bulgaria(b)
 poicilipes                 29   Senegal
 pruina                      1   Central African Republic
 quinquefasciatus(a)         7   India, Pakistan, Madagascar
 scottii                     1   Madagascar
 theileri(a)                 4   South Africa
 tritaeniorhynchus(a)        3   Pakistan, India, Madagascar
 univittatus(a)             51   Egypt, Israel, South Africa,
                                  Madagascar
 vishnui(a) group            6   India, Pakistan
 weschei                     1   Central African Republic
 sp.                         3   Egypt, Algeria, Central African
                                  Republic
Coquillettidia metallica     1   Uganda
 microannulata               1   South Africa
 richiardii                  5   South Russia, Bulgaria(b)
Mansonia uniformis           1   Ethiopia
Aedes aegypti(a)             1   Madagascar
 africanus                   1   Central African Republic
 albocephalus               35   Madagascar
 albothorax                  1   Kenya
 cantans                     7   Slovakia, Ukraine, Bulgaria(b)
 caspius(a)                  1   Ukraine
 circumluteolus              2   South Africa, Madagascar
 excrucians                  1   Ukraine
 juppi+caballus              1   South Africa
 madagascarensis             1   Madagascar
 vexans                      3   Senegal, Russia
Anopheles brunnipes          1   Madagascar
 coustani                    1   Israel
 maculipalpis                1   Madagascar
 maculipennis                3   Portugal, Ukraine
 subpictus                   1   India
 sp.                         1   Madagascar
Mimomyia hispida             8   Senegal
 lacustris                   4   Senegal
 splendens                   6   Senegal
 sp.                         2   Senegal
Aedeomyia africana           1   Senegal
Soft ticks
Argas hermanni(a)            3   Egypt
Ornithodoros capensis(a)     5   Azerbaijan
Hard ticks
Hyalomma marginatum          5   Astrakhan, Azerbaijan
 detritum                    1   Turkmenistan
Rhipicephalus turanicus      1   Azerbaijan
 muhsamae                    1   Central African Republic
Amblyomma variegatum         1   Central African Republic
Dermacentor marginatus(a)    1   Moldavia


(a) Experimental transmission of the virus also demonstrated.

(b) Detected in mosquitoes by immunofluorescence Immunofluorescence

A technique that uses a fluorochrome to indicate the occurrence of a specific antigen-antibody reaction. The fluorochrome labels either an antigen or an antibody.
 assay.

Virus isolations have occasionally been reported from other hematophagous arthropods (e.g., bird-feeding argasid [soft] or amblyommine [hard] ticks) (Table 1), and experimental transmission has been observed in Ornithodoros savignyi, O. moubata, O. maritimus, O. erraticus, Rhipicephalus sanguineus, R. rossicus, Dermacentor reticulatus, and Haemaphysalis leachii (8,13).

Vertebrate Hosts

Wild birds are the principal hosts of West Nile virus. The virus has been isolated from a number of wetland and terrestrial avian species in diverse areas (7-10,14-16). High, long-term viremia viremia /vi·re·mia/ (vi-re´me-ah) the presence of viruses in the blood.

vi·re·mi·a
n.
The presence of viruses in the bloodstream.
, sufficient to infect vector mosquitoes, has been observed in infected birds (7,17,18). The virus persists in the organs of inoculated ducks and pigeons for 20 to 100 days (18). Migratory birds are therefore instrumental in the introduction of the virus to temperate areas of Eurasia during spring migrations (12,14-16,19).

Rarely, West Nile virus has been isolated from mammals (Arvicanthis niloticus, Apodemus flavicollis, Clethrionomys glareolus, sentinel mice and hamsters, Lepus europaeus, Rousettus leschenaulti Leschenault's Rousette Rousettus leschenaulti (Desmarest, 1820) is a species of fruit bat found in South and Southeast Asia. Distribution
The distribution range includes Pakistan, India, Nepal, Assam, Myanmar, Indochina, and Java (Lekagul and McNeely, 1977).
, camels, cattle, horses, dogs, Galago galago: see bush baby.
galago

Any of six species of small, tree-dwelling primates (genus Galago) found in forests of sub-Saharan Africa. Galagos are gray, brown, or reddish or yellowish brown animals with large eyes and ears, long hind legs, soft
 senegalensis, humans) in enzootic en·zo·ot·ic
adj.
Prevalent among or restricted to animals of a specific geographic area. Used of a disease.

n.
An enzootic disease.



enzootic

peculiar to or present constantly in a location. See also endemic.
 foci (8-10). Mammals are less important than birds in maintaining transmission cycles of the virus in ecosystems. Only horses and lemurs (20) have moderate viremia and seem to support West Nile virus circulation locally. Frogs (Rana ridibunda) also can harbor the virus, and their donor ability for Cx. pipiens has been confirmed (21).

Transmission Cycles

Although Palearctic natural foci of West Nile virus infections are mainly situated in wetland ecosystems (river deltas or flood plains) and are characterized by the bird-mosquito cycle, argasid and amblyommine ticks may serve as substitute vectors and form a bird-tick cycle in certain dry and warm habitats lacking mosquitoes. Even a frog-mosquito cycle (21) may function under certain circumstances.

In Europe, West Nile virus circulation is confined to two basic types of cycles and ecosystems: rural (sylvatic sylvatic /syl·vat·ic/ (sil-vat´ik) sylvan; pertaining to, located in, or living in the woods.

sylvatic

found in the woods; occurring in animals of the forest.
) cycle (wild, usually wetland birds and ornithophilic mosquitoes) and urban cycle (synanthropic or domestic birds and mosquitoes feeding on both birds and humans, mainly Cx. pipiens/molestus). The principal cycle is rural, but the urban cycle predominated in Bucharest during the 1996-97 outbreak (2,3). Circulation of West Nile fever in Europe is similar to that of St. Louis encephalitis in North America North America, third largest continent (1990 est. pop. 365,000,000), c.9,400,000 sq mi (24,346,000 sq km), the northern of the two continents of the Western Hemisphere. , where the rural cycle of exoanthropic birds--Cx, tarsalis alternates with the urban cycle of synanthropic birds--Cx, pipiens/ quinquefasciatus.

West Nile Fever in Humans and Other Vertebrates

Humans

West Nile fever in humans usually is a febrile, influenzalike illness, characterized by an abrupt onset (incubation period incubation period
n.
1. See latent period.

2. See incubative stage.


Incubation period 
 is 3 to 6 days) of moderate to high fever (3 to 5 days, infrequently biphasic bi·pha·sic  
adj.
Having two distinct phases: a biphasic waveform; a biphasic response to a stimulus. 
, sometimes with chills), headache (often frontal), sore throat Sore Throat Definition

Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza.
, backache back·ache
n.
Discomfort or a pain in the region of the back or spine.
, myalgia myalgia /my·al·gia/ (mi-al´jah) muscular pain.myal´gic

epidemic myalgia  see under pleurodynia.


my·al·gia
n.
, arthralgia arthralgia /ar·thral·gia/ (ahr-thral´jah) pain in a joint.

ar·thral·gia
n.
Severe pain in a joint. Also called arthrodynia.
, fatigue, conjunctivitis conjunctivitis (kənjəngtəvī`təs), inflammation or infection of the mucosal membrane that covers the eyeball and lines the eyelid, usually acute, caused by a virus or, less often, by a bacillus, an allergic reaction, or an , retrobulbar retrobulbar /ret·ro·bul·bar/ (-bul´bar)
1. behind the medulla oblongata.

2. behind the eyeball.


retrobulbar

1. behind the pons.

2. behind the eyeball.
 pain, maculopapular or roseolar rash (in approximately half the cases, spreading from the trunk to the extremities and head), lymphadenopathy lymphadenopathy /lym·phad·e·nop·a·thy/ (-op´ah-the) disease of the lymph nodes.

angioimmunoblastic lymphadenopathy , angioimmunoblastic lymphadenopathy with dysproteinemia
, anorexia, nausea, abdominal pain Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. , diarrhea, and respiratory symptoms (9). Occasionally ([is less than] 15% of cases), acute aseptic meningitis aseptic meningitis Infectious disease Nonpurulent meningeal inflammation, which is more common in those < age 30 Etiology Viruses, especially Coxsackievirus and echovirus, circumscribed bacterial infections, hemorrhage, neoplasia–eg leukemia and lymphoma,  or encephalitis encephalitis (ĕnsĕf'əlī`təs), general term used to describe a diffuse inflammation of the brain and spinal cord, usually of viral origin, often transmitted by mosquitoes, in contrast to a bacterial infection of the meninges  (associated with neck stiffness, vomiting, confusion, disturbed consciousness, somnolence somnolence /som·no·lence/ (som´no-lens) drowsiness or sleepiness, particularly in excess.

som·no·lence
n.
1. A state of drowsiness; sleepiness.

2.
, tremor of extremities, abnormal reflexes, convulsions Convulsions
Also termed seizures; a sudden violent contraction of a group of muscles.

Mentioned in: Heat Disorders
, pareses, and coma), anterior myelitis myelitis /my·eli·tis/ (mi?e-li´tis)
1. inflammation of the spinal cord; often expanded to include noninflammatory spinal cord lesions.

2. inflammation of the bone marrow (osteomyelitis).
, hepatosplenomegaly, hepatitis, pancreatitis, and myocarditis Myocarditis Definition

Myocarditis is an inflammatory disease of the heart muscle (myocardium) that can result from a variety of causes. While most cases are produced by a viral infection, an inflammation of the heart muscle may also be instigated by
 occur. Laboratory findings involve a slightly increased sedimentation rate sedimentation rate
n.
The degree of rapidity with which red blood cells sink in a specimen of drawn blood, which when elevated may indicate anemia or inflammation. Also called erythrocyte sedimentation rate, sed rate.
 and a mild leukocytosis Leukocytosis Definition

Leukocytosis is a condition characterized by an elevated number of white cells in the blood.
Description

Leukocytosis is a condition that affects all types of white blood cells.
; cerebrospinal fluid cerebrospinal fluid (CSF)

Clear, colourless liquid that surrounds the brain and spinal cord and fills the spaces in them. It helps support the brain, acts as a lubricant, maintains pressure in the skull, and cushions shocks.
 in patients with central nervous system involvement is clear, with moderate pleocytosis pleocytosis /pleo·cy·to·sis/ (ple?o-si-to´sis) presence of a greater than normal number of cells in cerebrospinal fluid.

ple·o·cy·to·sis
n.
 and elevated protein. The virus can be recovered from the blood for up to 10 days in immunocompetent im·mu·no·com·pe·tent
adj.
Having the normal bodily capacity to develop an immune response following exposure to an antigen.



im
 febrile patients, as late as 22 to 28 days after infection in immunocompromised immunocompromised /im·mu·no·com·pro·mised/ (-kom´pro-mizd) having the immune response attenuated by administration of immunosuppressive drugs, by irradiation, by malnutrition, or by certain disease processes (e.g., cancer).  patients; peak viremia occurs 4 to 8 days postinfection. Recovery is complete (less rapid in adults than in children, often accompanied by long-term myalgias and weakness), and permanent sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention  have not been reported. Most fatal cases have been recorded in patients older than 50 years. Many of the West Nile fever symptoms have been reproduced in volunteers with underlying neoplastic neoplastic /neo·plas·tic/ (ne?o-plas´tik)
1. pertaining to a neoplasm.

2. pertaining to neoplasia.


neoplastic

pertaining to neoplasia or a neoplasm.
 disease who had been inoculated with virus to achieve pyrexia pyrexia /py·rex·ia/ (pi-rek´se-ah) pl. pyrex´iae   fever.pyrex´ial

py·rex·i·a
n.
See fever.



py·rex
 and oncolysis (22).

Hundreds of West Nile fever cases have been described in Israel and South Africa. The largest African epidemic, with approximately 3,000 clinical cases, occurred in an arid region of the Cape Province Cape Province, former province, S South Africa. Under the South African constitution of 1994 it was divided into Eastern Cape, Western Cape, Northern Cape, and part of a fourth province, North West.  after heavy rains in 1974 (23). An outbreak with approximately 50 patients, eight of whom died, was described in Algeria in 1994 (1). Other cases or outbreaks have been observed in Azerbaijan, Central African Republic, Democratic Republic of Congo (former Zaire), Egypt, Ethiopia, India, Madagascar, Nigeria, Pakistan, Senegal, Sudan, and in a few European countries.

Horses

Equine disease, called Near Eastern equine encephalitis Eastern equine encephalitis A rare, sporadic, and aggressive enzootic infection by a single-stranded RNA Togavirus that primarily affects birds Vector Ornithophilic mosquito, Culiseta melanura  in Egypt and lourdige in France, was observed and experimentally reproduced as fever and diffuse encephalomyelitis encephalomyelitis /en·ceph·a·lo·my·eli·tis/ (en-sef?ah-lo-mi?e-li´tis) inflammation of the brain and spinal cord.

acute disseminated encephalomyelitis
 with a moderate to high fatality rate fa·tal·i·ty rate
n.
See death rate.



fatality rate

see case fatality rate.
 in Egypt (24), France (c. 50 cases in 1962-65) (25), Italy (14 cases in 1998, six died or were euthanised) (R. Lelli, G. Ferrari, pers. comm.), Portugal (26) and Morocco (42 of 94 affected horses died) (27). In the 1960s, the biphasic, encephalomyelitic form, which causes staggering gait and weakness to paralysis of the hind legs, was apparent among infected semiferal horses in Camargue (25).

Other Mammals

Inoculation inoculation, in medicine, introduction of a preparation into the tissues or fluids of the body for the purpose of preventing or curing certain diseases. The preparation is usually a weakened culture of the agent causing the disease, as in vaccination against  of sheep with West Nile virus results in fever, abortion in pregnant ewes, and rare encephalitis, in contrast to the asymptomatic infection seen in pigs and dogs (9,28). Rabbits, adult albino albino (ălbī`nō) [Port.,=white], animal or plant lacking normal pigmentation. The absence of pigment is observed in the body covering (skin, hair, and feathers) and in the iris of the eye.  rats, and guinea pigs are resistant to West Nile virus infection, but laboratory mice and Syrian hamsters are markedly susceptible; they often become ill with fatal encephalitis, even when inoculated peripherally (8). Adult rodents stressed or immunosuppressed Immunosuppressed
A state in which the immune system is suppressed by medications during the treatment of other disorders, like cancer, or following an organ transplantation.

Mentioned in: Fifth Disease
 by cold, isolation, cyclophosphamide cyclophosphamide /cy·clo·phos·pha·mide/ (-fos´fah-mid) a cytotoxic alkylating agent of the nitrogen mustard group; used as an antineoplastic, as an immunosuppressant to prevent transplant rejection, and to treat some diseases , corticosterone corticosterone (kôr'təkōstĕr`ōn), steroid hormone secreted by the outer layer, or cortex, of the adrenal gland. Classed as a glucocorticoid, corticosterone helps regulate the conversion of amino acids into carbohydrates and , or bacterial endotoxin Endotoxin

A biologically active substance produced by bacteria and consisting of lipopolysaccharide, a complex macromolecule containing a polysaccharide covalently linked to a unique lipid structure, termed lipid A.
 contract fatal encephalitis, even when an attenuated Attenuated
Alive but weakened; an attenuated microorganism can no longer produce disease.

Mentioned in: Tuberculin Skin Test


attenuated

having undergone a process of attenuation.
 viral strain is given (29). Inoculation of rhesus and bonnet monkeys (but not cynomolgus monkeys or chimpanzees) causes fever, ataxia ataxia (ətăk`sēə), lack of coordination of the voluntary muscles resulting in irregular movements of the body. Ataxia can be brought on by an injury, infection, or degenerative disease of the central nervous system, e.g. , and prostration prostration /pros·tra·tion/ (pros-tra´shun) extreme exhaustion or lack of energy or power.

heat prostration  see under exhaustion.


pros·tra·tion
n.
 with occasional encephalitis, tremor of extremities, pareses, or paralysis. Infection may be fatal or cause long-term virus persistence in survivors (5,6,30).

Birds

Birds usually do not show any symptoms when infected with West Nile virus. However, natural disease due to the virus has been observed in a pigeon in Egypt (7), and inoculation of certain avian species (e.g., pigeons, chickens, ducks, gulls, and corvids) causes occasional encephalitis and death or long-term virus persistence (7,10,17,18). Chick embryos may be killed by the virus (8).

West Nile Virus and Fever in Europe

In Europe, the presence of West Nile virus was indicated in 1958, when two Albanians had specific West Nile virus antibodies (31). The first European isolations of the virus were recorded in 1963 from patients and mosquitoes in the Rhone Delta (32) and from patients and Hyalomma marginatum ticks in the Volga Delta The Volga Delta is the largest inland river delta in Europe, and occurs where Europe's largest river system, the Volga River, drains into the Caspian Sea in Russia's Astrakhan Oblast, north-east of the republic of Kalmykia.  (33,34). West Nile virus was subsequently isolated in Portugal (35), Slovakia (36), Moldavia (37), Ukraine (38), Hungary (39), Romania (2), Czechland (40), and Italy (V. Deubel, G. Ferrari, pers. comm.).

The incidence of West Nile fever in Europe is largely unknown. In the 1960s, cases were observed in southern France Southern France (or the South of France), colloquially known as Le Midi, is a loosely defined geographical area consisting of the regions of France that border the Atlantic Ocean south of the Gironde, Spain, the Mediterranean Sea, Italy, and Switzerland south of the  (25), southern Russia (41), Spain (26), southwestern Romania (42), in the 1970s, 1980s, and 1990s in Belarus (43), western Ukraine Western Ukraine may refer to:
  • Generally, the territories in the West of Ukraine
  • West Ukrainian National Republic
  • West Ukraine, the Ukrainian part of Kresy
 (44), southeastern Romania (1,2), and Czechland (45). West Nile fever in Europe occurs during the period of maximum annual activity of mosquito vectors (July to September) (Table 2).
Table 2. West Nile Virus in Europe, 1960-1998

Country                       Year            Species infected

Portugal, southern          1967-1970   Cattle, sheep
                                        Horses
                                        Humans
                                        Mosquitoes (1 isolate)
                                        Wild birds
Spain, northern             1979        Rodents
   Northwestern             1960s       Humans
   Donana National Park                 Humans
   Ebro Delta               1979        Epidemic of influenza-like
                                         illness
France, southern            1962        Humans, 10 severe cases (2
                                         isolates)
                                        Horses, 50 encephalomyelitis
                                         cases (1 isolate)
   Camargue                 1962-1965   Mosquitoes (2 isolates)
                                        Wild birds
                            1975-1980   Humans
                                        Horses
   Corsica                  1965        Humans
Italy, Tuscany              1998        Horses, 14 cases, 2 fatal
                                         (1 isolate)
   Northeastern             1967-1969   Migrating birds
                                        Humans
   Northwestern                         Humans
   Central                              Humans
                                        Domestic mammals
                                        Rodents
                                        Chickens
   Southern                             Humans
                                        Goats
                            1981        Rodents
Former Yugoslavia
   Serbia                               Humans
   Croatia                              Humans
   Montenegro                           Humans
   Bosnia, Kosovo                       Humans
Albania                     1958        Humans
                                        Domestic animals
Greece                      1970-1978   Humans
                                        Domestic animals
                                        Rabbits
                                        Birds
Bulgaria                    1960-1970   Humans
   Eastern                              Wetland birds
                                        Domestic animals
                            1978        Mosquitoes (virus detected)
Romania
   Bucharest, SE lowlands   1996        Humans, 453 clin. cases, 9%
                                         fatality rate (1 isolate)
                            1997        Human, 14 cases, 2 fatal
                                        Domestic & wild mammals
                                        Dogs
                                        Wild birds
                            1966-70     Mosquitoes (1 isolate)
   Banat (SW)                           Humans (cases)
   Southern                 1980-1995   Humans
Hungary                     1970s       Rodents (2 isolates)
                                        Cattle
                                        Humans
Slovakia                    1972        Mosquitoes (1 isolate)
                            1970-1973   Migrating birds (4 isolates)
                                        Game animals
                                        Cattle, dogs
                                        Sheep
                                        Pigeons
                                        Humans
Austria                     1964-1977   Wetland passerines
                                        Reptiles
                                        Wild mammals
                                        Domestic animals
                                        Humans
Czechland                   1978        Domestic animals
   Southern Bohemia         1978        Hares
   Southern Moravia         1980s       Game animals
                            1985        Wetland birds
                            1990        Cormorants
                            1997        Mosquitoes (1 isolate)
                                        Humans (5 cases)
Poland near Warsaw          1996        Sparrows
Belarus                     1977        Humans (cases in Brest area)
                            1972-1973   Wild birds
Ukraine
   Southern, western                    Birds (7 isolates),
                                         mosquitoes (3 isolates)
   Southern                 1970s       Human cases (4 isolates)
   Western                  1985        Humans 38 cases,
                                         encephalitis in 16
Moldavia                    1970s       Ticks, mosquitoes (several
                                         isolates)
                                        Humans
Russia,
   Volga Delta              1963-1968   Humans (>10 cases, 3
                                         isolates)
                                        Ticks (4 isolates)
                                        Water birds (2 isolates)
                                        Mosquitoes (2 isolates)

Country                           Species infected         HI(a) (%)

Portugal, southern          Cattle, sheep                     15
                            Horses                            29
                            Humans                             3
                            Mosquitoes (1 isolate)
                            Wild birds                         5
Spain, northern             Rodents                            3
   Northwestern             Humans                            17
   Donana National Park     Humans                             +
   Ebro Delta               Epidemic of influenza-like       8-30
                             illness
France, southern            Humans, 10 severe cases (2         19
                              isolates)
                            Horses, 50 encephalomyelitis        9
                             cases (1 isolate)
   Camargue                 Mosquitoes (2 isolates)
                            Wild birds                          6
                            Humans                              5
                            Horses                              2
   Corsica                  Humans                             30
Italy, Tuscany              Horses, 14 cases, 2 fatal
                             (1 isolate)
   Northeastern             Migrating birds                    10
                            Humans                              5
   Northwestern             Humans                             23
   Central                  Humans                             2-8
                            Domestic mammals                    8
                            Rodents                             8
                            Chickens                           20
   Southern                 Humans                             2-5
                            Goats                              2-13
                            Rodents                             1
Former Yugoslavia
   Serbia                   Humans                             1-8
   Croatia                  Humans                             1-3
   Montenegro               Humans                              1
   Bosnia, Kosovo           Humans                              1
Albania                     Humans
                            Domestic animals
Greece                      Humans                             1-27
                            Domestic animals                    7
                            Rabbits                             4
                            Birds                              22
Bulgaria                    Humans                              3
   Eastern                  Wetland birds                       2
                            Domestic animals                    1
                            Mosquitoes (virus detected)
Romania
   Bucharest, SE lowlands   Humans, 453 clin. cases, 9%        17
                             fatality rate (1 isolate)
                            Human, 14 cases, 2 fatal
                            Domestic & wild mammals            2-23
                            Dogs                               19-45
                            Wild birds                         22
                            Mosquitoes (1 isolate)
   Banat (SW)               Humans (cases)                     17
   Southern                 Humans                             2-12
   Hungary                  Rodents (2 isolates)
                            Cattle                             4-9
                            Humans                             4-6
Slovakia                    Mosquitoes (1 isolate)
                            Migrating birds (4 isolates)
                            Game animals
                            Cattle, dogs                        8
                            Sheep                               1
                            Pigeons                             5
                            Humans                             1-4
Austria                     Wetland passerines                 1-3
                            Reptiles
                            Wild mammals
                            Domestic animals                   7-33
                            Humans                             1-6
Czechland                   Domestic animals                    2
   Southern Bohemia         Hares                               5
   Southern Moravia         Game animals                        8
                            Wetland birds                      4-10
                            Cormorants                         10
                            Mosquitoes (1 isolate)
                            Humans (5 cases)
Poland near Warsaw          Sparrows                           3-12
Belarus                     Humans (cases in Brest area)        1
                            Wild birds                          3
Ukraine
   Southern, western        Birds (7 isolates),
                             mosquitoes (3 isolates)
   Southern                 Human cases (4 isolates)
   Western                  Humans 38 cases,
                             encephalitis in 16
Moldavia                    Ticks, mosquitoes (several
                             isolates)
                            Humans                              3
Russia,
   Volga Delta              Humans (>10 cases, 3               7-31
                             isolates)
                            Ticks (4 isolates)
                            Water birds (2 isolates)           4-59
                            Mosquitoes (2 isolates)

                                                           Neutra-
Country                           Species infected         lization
                                                             (%)
Portugal, southern          Cattle, sheep
                            Horses
                            Humans
                            Mosquitoes (1 isolate)
                            Wild birds
Spain, northern             Rodents
   Northwestern             Humans                            17
   Donana National Park     Humans
   Ebro Delta               Epidemic of influenza-like
                             illness
France, southern            Humans, 10 severe cases (2
                              isolates)
                            Horses, 50 encephalomyelitis      30
                             cases (1 isolate)
   Camargue                 Mosquitoes (2 isolates)
                            Wild birds
                            Humans
                            Horses
   Corsica                  Humans                            55
Italy, Tuscany              Horses, 14 cases, 2 fatal         40
                             (1 isolate)
   Northeastern             Migrating birds
                            Humans
   Northwestern             Humans
   Central                  Humans
                            Domestic mammals
                            Rodents
                            Chickens
   Southern                 Humans
                            Goats
                            Rodents
Former Yugoslavia
   Serbia                   Humans
   Croatia                  Humans
   Montenegro               Humans
   Bosnia, Kosovo           Humans
Albania                     Humans                             2
                            Domestic animals
Greece                      Humans                             1
                            Domestic animals
                            Rabbits
                            Birds
Bulgaria                    Humans
   Eastern                  Wetland birds                     10
                            Domestic animals
                            Mosquitoes (virus detected)
Romania
   Bucharest, SE lowlands   Humans, 453 clin. cases, 9%
                             fatality rate (1 isolate)
                            Human, 14 cases, 2 fatal
                            Domestic & wild mammals
                            Dogs
                            Wild birds
                            Mosquitoes (1 isolate)
   Banat (SW)               Humans (cases)
   Southern                 Humans
   Hungary                  Rodents (2 isolates)
                            Cattle
                            Humans
Slovakia                    Mosquitoes (1 isolate)
                            Migrating birds (4 isolates)      1-13
                            Game animals                      1-8
                            Cattle, dogs
                            Sheep
                            Pigeons
                            Humans
Austria                     Wetland passerines
                            Reptiles
                            Wild mammals
                            Domestic animals
                            Humans
Czechland                   Domestic animals
   Southern Bohemia         Hares
   Southern Moravia         Game animals
                            Wetland birds
                            Cormorants
                            Mosquitoes (1 isolate)
                            Humans (5 cases)                   2
Poland near Warsaw          Sparrows
Belarus                     Humans (cases in Brest area)
                            Wild birds
Ukraine
   Southern, western        Birds (7 isolates),
                             mosquitoes (3 isolates)
   Southern                 Human cases (4 isolates)
   Western                  Humans 38 cases,
                             encephalitis in 16
Moldavia                    Ticks, mosquitoes (several
                             isolates)
                            Humans
Russia,
   Volga Delta              Humans (>10 cases, 3
                             isolates)
                            Ticks (4 isolates)
                            Water birds (2 isolates)          2-11
                            Mosquitoes (2 isolates)

Country                           Species infected          Ref.

Portugal, southern          Cattle, sheep                  26, 35
                            Horses
                            Humans
                            Mosquitoes (1 isolate)
                            Wild birds
Spain, northern             Rodents
   Northwestern             Humans                         26
   Donana National Park     Humans
   Ebro Delta               Epidemic of influenza-like
                             illness
France, southern            Humans, 10 severe cases (2     25,32,46
                              isolates)
                            Horses, 50 encephalomyelitis
                             cases (1 isolate)
   Camargue                 Mosquitoes (2 isolates)
                            Wild birds
                            Humans
                            Horses
   Corsica                  Humans
Italy, Tuscany              Horses, 14 cases, 2 fatal      47
                             (1 isolate)
   Northeastern             Migrating birds
                            Humans                         (b)
   Northwestern             Humans
   Central                  Humans
                            Domestic mammals
                            Rodents
                            Chickens
   Southern                 Humans
                            Goats
                            Rodents
Former Yugoslavia
   Serbia                   Humans                         48
   Croatia                  Humans
   Montenegro               Humans
   Bosnia, Kosovo           Humans
Albania                     Humans                         31,49
                            Domestic animals
Greece                      Humans                         50.51
                            Domestic animals
                            Rabbits
                            Birds
Bulgaria                    Humans                         52,53
   Eastern                  Wetland birds
                            Domestic animals
                            Mosquitoes (virus detected)
Romania                                                    1-3,42
                                                            54,55
   Bucharest, SE lowlands   Humans, 453 clin. cases, 9%
                             fatality rate (1 isolate)
                            Human, 14 cases, 2 fatal
                            Domestic & wild mammals        (c)
                            Dogs
                            Wild birds
                            Mosquitoes (1 isolate)
   Banat (SW)               Humans (cases)
   Southern                 Humans
   Hungary                  Rodents (2 isolates)           39,56
                            Cattle
                            Humans
Slovakia                    Mosquitoes (1 isolate)         16, 36,
                                                            57-60
                            Migrating birds (4 isolates)
                            Game animals
                            Cattle, dogs
                            Sheep
                            Pigeons
                            Humans
Austria                     Wetland passerines             61,62
                            Reptiles
                            Wild mammals
                            Domestic animals
                            Humans
Czechland                   Domestic animals               40,45,
                                                           63-67
   Southern Bohemia         Hares
   Southern Moravia         Game animals
                            Wetland birds
                            Cormorants
                            Mosquitoes (1 isolate)
                            Humans (5 cases)
Poland near Warsaw          Sparrows                       68
Belarus                     Humans (cases in Brest area)   43
                            Wild birds
Ukraine                                                    34,44,69
   Southern, western        Birds (7 isolates),
                             mosquitoes (3 isolates)
   Southern                 Human cases (4 isolates)
   Western                  Humans 38 cases,
                             encephalitis in 16
Moldavia                    Ticks, mosquitoes (several     37, 70
                             isolates)
                            Humans
Russia,                                                   33,344,155
   Volga Delta              Humans (>10 cases, 3
                             isolates)
                            Ticks (4 isolates)
                            Water birds (2 isolates)
                            Mosquitoes (2 isolates)


(a) Hemagglutination hemagglutination /he·mag·glu·ti·na·tion/ (he?mah-gloo-ti-na´shun) agglutination of erythrocytes.

he·mag·glu·ti·na·tion
n.
 inhibition.

(b) Q. Ferrari, R. Lelli, pets. comm.

(c) C. Ceianu, pers. comm.

The Future

West Nile virus can cause sporadic human cases, clusters, or outbreaks of West Nile fever, even in temperate Europe. Environmental factors, including human activities that enhance vector population densities (irrigation, heavy rains followed by floods, higher than usual temperatures, and formation of ecologic niches enabling the mass breeding of mosquitoes) allow the reemergence of this mosquito-borne disease. For instance, global warming global warming, the gradual increase of the temperature of the earth's lower atmosphere as a result of the increase in greenhouse gases since the Industrial Revolution.  scenarios hypothesize hy·poth·e·size  
v. hy·poth·e·sized, hy·poth·e·siz·ing, hy·poth·e·siz·es

v.tr.
To assert as a hypothesis.

v.intr.
To form a hypothesis.
 warmer, more humid weather that may produce an increase in the distribution and abundance of mosquito vectors (71). Surveillance for West Nile fever (monitoring population densities and infection rates of principal vectors, serosurveys on vertebrates and exposed human groups, and routine diagnosis of human infections) should therefore be carried out in affected areas.

The mechanism of West Nile virus persistence in disease-endemic foci of temperate Europe presents a challenge for further research. General hypotheses of how an arbovirus arbovirus

Any of a large group of viruses that develop in arthropods (chiefly mosquitoes and ticks). The name derives from “arthropod-borne virus.” The spheroidal virus particle is encased in a fatty membrane and contains RNA; it causes no apparent harm to the
 could overwinter o·ver·win·ter  
intr.v. o·ver·win·tered, o·ver·win·ter·ing, o·ver·win·ters
1. To remain alive through the winter: sheep that overwintered on the steppe.

2.
 under adverse climatic conditions have already been postulated (72). The virus could persist in Verb 1. persist in - do something repeatedly and showing no intention to stop; "We continued our research into the cause of the illness"; "The landlord persists in asking us to move"
continue
 hibernating female Culex spp.; transovarially infected Culex spp. progeny; or chronically infected vertebrate hosts, perhaps birds or frogs. Alternatively, the virus may be reintroduced by chronically infected migratory birds from tropical or subtropical sub·trop·i·cal  
adj.
Of, relating to, or being the geographic areas adjacent to the Tropics.


subtropical
Adjective

of the region lying between the tropics and temperate lands

 foci at irregular intervals. These issues have to be addressed, because present data substantiate all particular mechanisms and their combinations. For instance, the hibernating vector idea has been supported by a few field and experimental data on female Cx. univittatus (7,73). On the other hand, if the reintroduction scheme is correct, a greatly increased activity of West Nile virus in Africa should be followed by an epidemic occurrence of West Nile fever in Europe in the next few years.

References

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n.
The scientific study of insects.



ento·mo·log
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n. pl. se·rol·o·gies
1. The science that deals with the properties and reactions of serums, especially blood serum.

2.
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1. derived from different cells.

2. pertaining to several clones.


polyclonal

derived from different cells; pertaining to several clones.
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pertaining to or emanating from neurotrophy, e.g. neurotropic osteopathy.
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JSM Just Shoot Me (sitcom)
JSM Journal of Sport Management
JSM Journal of Software Maintenance
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JSM John Sidney McCain
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Danziger Goldwasser (German: Gold water of Danzig
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n.
A parasite that lives on the surface or exterior of the host organism, such as an ectophyte or an ectozoon.



ec
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SSSR Society for the Scientific Study of Reading
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blind antiquarian wrapped up in his scholarly annotations of the classics. [Br. Lit.: George Eliot Romola]

See : Scholarliness
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BJH Bethel Junior High
BJH Bopp-Jancso-Heinzinger (potential function)
BJH Brookhurst Junior High (Anaheim, CA) 
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pertaining to or emanating from serology.


serological test
one involving examination of blood serum usually for antibody.
 and virological virological

pertaining to viruses.
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(72.) Reeves WC. Overwintering o·ver·win·ter·ing
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Zdenek Hubalek and Jiri Halouzka are scientists at the Academy of Sciences of the Czech Republic The Academy of Sciences of the Czech Republic Czech: Akademie věd České republiky, abbr. AV ČR . They are interested in the ecology of arthropodborne human pathogenic viruses and bacteria.

Address for correspondence: Z. Hubalek, Institute of Vertebrate Biology, Academy of Sciences, Klasterni 2, CZ-69142 Valtice, Czech Republic; fax: 420-627-352-387; e-mail: zhubalek@brno.cas.cz.
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Author:Halouzka, Jiri
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Date:Sep 1, 1999
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