A species-independent lateral flow microarray immunoassay to detect WNV and USUV NS1-specific antibodies in serum

Arboviruses such as West Nile Virus (WNV) and Usutu Virus (USUV) are emerging pathogens that circulate between mosquitoes and birds, occasionally spilling over into humans and horses. Current serological screening methods require access to a well-equipped laboratory and are not currently available for on-site analysis. As a proof of concept, we propose here a species-independent lateral flow microarray immunoassay (LMIA) able to quickly detect and distinguish between WNV Non-Structural 1 (NS1) and USUV NS1-specific antibodies. A double antigen approach was used to test sera collected from humans, horses, European jackdaws (Corvus monedula), and common blackbirds (Turdus merula). Optimization of the concentration of capture antigen spotted on the LMIA membrane and the amount of detection antigen conjugated to detector particles indicated that maximizing both parameters increased assay sensitivity. Upon screening of a larger serum panel, the optimized LMIA showed significantly higher spot intensity for a homologous binding event. Using a Receiver Operating Characteristics (ROC) curve, WNV NS1 LMIA results in humans, horses, and C. monedula showed good correlation when compared to "gold standard" WNV FRNT90. The most optimal derived sensitivity and specificity of the WNV NS1 LMIA relative to corresponding WNV FRNT90-confirmed sera were determined to be 96% and 86%, respectively. While further optimization is required, this study demonstrates the feasibility of developing a species-independent LMIA for on-site analysis of WNV, USUV, and other arboviruses. Such a tool would be useful for the on-site screening and monitoring of relevant species in more remote or low-income regions.

Automated molecular detection of West Nile Virus in mosquito pools using the Panther Fusion system

West Nile Virus (WNV) is an arthropod-borne virus that is spread through mosquito vectors. WNV emerged in the US in 1999 and has since become endemic in the US, causing the most domestically acquired arboviral disease in the country. Mosquito surveillance for WNV is useful to monitor arboviral disease burden over time and across different locations. RT-qPCR is the preferred method for WNV surveillance, but these methods are labor-intensive. The Panther Fusion System has an Open Access feature that allows for laboratory-developed tests (LDTs) to run on a fully automated system for nucleic acid extraction, RT-qPCR, and result generation. This study demonstrates the successful optimization of a WNV multiplex LDT (assay targets: ENV and NS1 genes) for high-throughput environmental surveillance testing of mosquito pool homogenates on the Panther Fusion System. Analytical sensitivity of the assay was 186 and 744 copies/PCR reaction for the ENV and NS1 targets, respectively. To assess the performance of this assay, a total of 80 mosquito pools were tested, including 60 previously tested pools and 20 spiked negative mosquito pools. Among the 60 previously tested specimens, the Panther Fusion WNV LDT demonstrated 100% positive and negative agreement with the CDC West Nile RT-qPCR assay. The Panther Fusion WNV LDT also detected all 20 spiked specimens. The Panther Fusion WNV LDT assay was successfully developed and optimized for high throughput testing with similar performance to the previously used CDC West Nile RT-qPCR assay.

Long-term trends and spatial patterns of West Nile Virus emergence in California, 2004-2021

AIMS

West Nile Virus (WNV) has remained a persistent source of vector-borne disease risk in California since first being identified in the state in 2003. The geographic distribution of WNV activity is relatively widespread, but varies considerably across different regions within the state. Spatial variation in human WNV infection depends upon social-ecological factors that influence mosquito populations and virus transmission dynamics. Measuring changes in spatial patterns over time is necessary for uncovering the underlying regional drivers of disease risk.

METHODS AND RESULTS

In this study, we utilized statewide surveillance data to quantify temporal changes and spatial patterns of WNV activity in California. We obtained annual WNV mosquito surveillance data from 2004 through 2021 from the California Arbovirus Surveillance Program. Geographic coordinates for mosquito pools were analysed using a suite of spatial statistics to identify and classify patterns in WNV activity over time.

CONCLUSIONS

We detected clear patterns of non-random WNV risk during the study period, including emerging hot spots in the Central Valley and non-random periods of oscillating WNV risk in Southern and Northern California subregions. Our findings offer new insights into 18 years of spatio-temporal variation in WNV activity across California, which may be used for targeted surveillance efforts and public health interventions.

Circulation of West Nile Virus and Usutu Virus in Europe: Overview and Challenges

West Nile Virus (WNV) and Usutu Virus (USUV) are both neurotropic mosquito-borne viruses belonging to the Flaviviridae family. These closely related viruses mainly follow an enzootic cycle involving mosquitoes as vectors and birds as amplifying hosts, but humans and other mammals can also be infected through mosquito bites. WNV was first identified in Uganda in 1937 and has since spread globally, notably in Europe, causing periodic outbreaks associated with severe cases of neuroinvasive diseases such as meningitis and encephalitis. USUV was initially isolated in 1959 in Swaziland and has also spread to Europe, primarily affecting birds and having a limited impact on human health. There has been a recent expansion of these viruses' geographic range in Europe, facilitated by factors such as climate change, leading to increased human exposure. While sharing similar biological traits, ecology, and epidemiology, there are significant distinctions in their pathogenicity and their impact on both human and animal health. While WNV has been more extensively studied and is a significant public health concern in many regions, USUV has recently been gaining attention due to its emergence in Europe and the diversity of its circulating lineages. Understanding the pathophysiology, ecology, and transmission dynamics of these viruses is important to the implementation of effective surveillance and control measures. This perspective provides a brief overview of the current situation of these two viruses in Europe and outlines the significant challenges that need to be addressed in the coming years.

Characterizing the West Nile Virus's polyprotein from nucleotide sequence to protein structure - Computational tools

Objectives

West Nile virus (WNV) belongs to the Flaviviridae family and causes West Nile fever. The mechanism of transmission involves the culex mosquito species. Infected individuals are primarily asymptomatic, and few exhibit common symptoms. Moreover, 10 % of neuronal infection caused by this virus cause death. The proteins encoded by these genes had been uncharacterized, although understanding their function and structure is important for formulating antiviral drugs.

Methods

Herein, we used in silico approaches, including various bioinformatic tools and databases, to analyse the proteins from the WNV polyprotein individually. The characterization included GC content, physicochemical properties, conserved domains, soluble and transmembrane regions, signal localization, protein disorder, and secondary structure features and their respective 3D protein structures.

Results

Among 11 proteins, eight had >50 % GC content, eight proteins had basic pI values, three proteins were unstable under in vitro conditions, four were thermostable according to >100 AI values and some had negative GRAVY values in physicochemical analyses. All protein-conserved domains were shared among Flaviviridae family members. Five proteins were soluble and lacked transmembrane regions. Two proteins had signals for localization in the host endoplasmic reticulum. Non-structural (NS) 2A showed low protein disorder. The secondary structural features and tertiary structure models provide a valuable biochemical resource for designing selective substrates and synthetic inhibitors.

Conclusions

WNV proteins NS2A, NS2B, PM, NS3 and NS5 can be used as drug targets for the pharmacological design of lead antiviral compounds.

Modeling West Nile Virus transmission in birds and humans: Advantages of using a cellular automata approach

In Canada, the periodic circulation of West Nile Virus (WNV) is difficult to predict and, beyond climatic factors, appears to be related to the migratory movements of infected birds from the southern United States. This hypothesis has not yet been explored in a spatially distributed model. The main objective of this work was to develop a spatially explicit dynamic model for the transmission of WNV in Canada, that allows us to explore non-climate related hypotheses associated with WNV transmission. A Cellular Automata (CA) approach for multiple hosts (birds and humans) is used for a test region in eastern Ontario, Canada. The tool is designed to explore the role of host and vector spatial heterogeneity, host migration, and vector feeding preferences. We developed a spatialized compartmental SEIRDS-SEI model for WNV transmission with a study region divided into 4 k m 2 rectangular cells. We used 2010-2021 bird data from the eBird project and 2010-2019 mosquito data collected by Ontario Public Health to mimic bird and mosquito seasonal variation. We considered heterogeneous bird densities (high and low suitability areas) and homogeneous mosquito and human densities. In high suitability areas for birds, we identified 5 entry points for WNV-infected birds. We compared our simulations with pools of WNV-infected field collected mosquitoes. Simulations and sensitivity analyses were performed using MATLAB software. The results showed good correspondence between simulated and observed epidemics, supporting the validity of our model assumptions and calibration. Sensitivity analysis showed that a 5% increase or decrease in each parameter of our model except for the biting rate of bird by mosquito (c ( B , M ) ) and mosquito natural mortality rate (d M ), had a very limited effect on the total number of cases (newly infected birds and humans), prevalence peak, or date of occurrence. We demonstrate the utility of the CA approach for studying WNV transmission in a heterogeneous landscape with multiple hosts.

A Case Report of NMO Transverse Myelitis

BACKGROUND

Transverse myelitis is considered one of the cardinal features of neuromyelitis optica spectrum disorder (NMOSD), an immune-mediated inflammatory condition of the CNS characterized by severe, immune-mediated demyelination and axonal damage predominantly targeting optic nerves and spinal cord. We describe a case in which a diagnosis of NMOSD was established, associated with West Nile Virus (WNV) infection.

CASE PRESENTATION

A healthy 18-year-old female presented with intractable hiccups and rapidly progressing paraparesis. MRI demonstrated T2 edema extending from the medulla to the conus, consistent with longitudinally extensive transverse myelitis. Serum and CSF Aquaporin-4 IgG (AQP4) were both positive with high titers. In conjunction with antiviral therapy, immunomodulatory treatment was initiated using pulse methylprednisolone, plasmapheresis and Rituximab. A month and a half after admission, the patient was fully ambulatory with no residual symptoms. On her rheumatology follow-up visit, West Nile Virus-specific IgM in CSF was found to be positive from the patient's initial presentation.

CONCLUSION

We propose that West Nile Virus may have been the autoimmune trigger to the patient's development of NMOSD, highlighting the importance of evaluating viral triggers in autoimmune diseases.

Probable West Nile Virus hepatitis: Case report

West Nile Virus infections has become endemic in various locations around the world. Symptomatic cases manifest as an acute febrile illness and in less than 1% with neuroinvasive manifestations. We report one of the very few cases of probable WNV-mediated isolated hepatitis to shed light on a possibly underestimated clinical picture.

Novel tools to study West Nile virus NS3 protease activity

West Nile Virus (WNV) belongs to a group of pathogenic viruses called flaviviruses. West Nile virus infection can be mild, causing so-called West Nile Fever (WNF) or severe neuroinvasive form of the disease (WNND), and ultimately even death. There are currently no known medications to prevent West Nile virus infection. Only symptomatic treatment is used. To date, there are no unequivocal tests enabling a quick and unambiguous assessment of WN virus infection. The aim of the research was to obtain specific and selective tools for determining the activity of the West Nile virus serine proteinase. Using the methods of combinatorial chemistry with iterative deconvolution, the substrate specificity of the enzyme in non-primed and primed positions was determined. The FRET ABZ-Ala-Lys-Gln-Arg-Gly-Gly-Thr-Tyr(3-NO₂)-NH₂ substrate was obtained, characterized by kinetic parameters (KM = 4.20 ± 0.32 × 10^-5 M) as for the majority of proteolytic enzymes. The obtained sequence was used to develop and synthesize highly sensitive functionalized quantum dot-based protease probes (QD). A QD WNV NS3 protease probe was obtained to detect an increase in fluorescence of 0.05 nmol enzyme in the assay system. This value was at least 20 times lower than that observed with the optimized substrate. The obtained result may be the basis for further research on the potential use of the WNV NS3 protease in the diagnosis of West Nile virus infection.

Delivery of small molecule mast cell activators for West Nile Virus vaccination using acetalated dextran microparticles

Recently, there has been increasing interest in the activation of mast cells to promote vaccine efficacy. Several mast cell activating (MCA) compounds have been reported such as M7 and Compound 48/80 (C48/80). While these MCAs have been proven to be efficacious vaccine adjuvants, their translatability is limited by batch-to-batch variability, challenging large-scale manufacturing, and poor in vivo stability for the M7 peptide. Due to this, high throughput screening was performed to identify small molecule MCAs. Several potent MCAs were identified via this screening, but the in vivo translatability of the compounds was limited due to their poor aqueous solubility. To enhance the delivery of these MCAs we encapsulated them in acetalated dextran (Ace-DEX) microparticles (MPs). We have previously utilized Ace-DEX MPs for vaccine delivery due to their passive targeting to phagocytic cells, acid sensitivity, and tunable degradation. Four different MCA loaded MPs were combined with West Nile Virus Envelope III protein (EDIII) and their vaccine adjuvant activities were compared in vivo. MPs containing the small molecule MCA ST101036 produced the highest anti-EDIII IgG titers of all the MCAs tested. Further, ST101036 MPs produced higher titers than ST101036 formulated with PEG as a cosolvent which highlights the benefit of Ace-DEX MPs over a conventional formulation technique. Finally, in a mouse model of West Nile Virus infection ST101036 MPs produced similar survival to soluble M7 (80-90%). Overall, these data show that ST101036 MPs produce a robust antibody response against EDIII and survival emphasizing the benefits of using Ace-DEX as a delivery platform for the poorly soluble ST101036.

A West Nile Virus infection expressed as unilateral limb paralysis and complicated by Parsonage-Turner syndrome: a case report

BACKGROUND

West Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage-Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus.

CLINICAL PRESENTATION

In late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage-Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.

CONCLUSIONS

West Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage-Turner syndrome diagnosis. We diagnosed Parsonage-Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.

Specific Recognition of the 5'-Untranslated Region of West Nile Virus Genome by Human Innate Immune System

In the last few years, the sudden outbreak of COVID-19 caused by SARS-CoV-2 proved the crucial importance of understanding how emerging viruses work and proliferate, in order to avoid the repetition of such a dramatic sanitary situation with unprecedented social and economic costs. West Nile Virus is a mosquito-borne pathogen that can spread to humans and induce severe neurological problems. This RNA virus caused recent remarkable outbreaks, notably in Europe, highlighting the need to investigate the molecular mechanisms of its infection process in order to design and propose efficient antivirals. Here, we resort to all-atom Molecular Dynamics simulations to characterize the structure of the 5′-untranslated region of the West Nile Virus genome and its specific recognition by the human innate immune system via oligoadenylate synthetase. Our simulations allowed us to map the interaction network between the viral RNA and the host protein, which drives its specific recognition and triggers the host immune response. These results may provide fundamental knowledge that can assist further antivirals’ design, including therapeutic RNA strategies.

Taking the Bite out of Mosquito Bites: The Role of Perceived Risk

The present study examined how dimensions of perceived risk contributed to mosquito avoidance behaviors in a flood-prone area. Mosquito avoidance behaviors were classified into proactive (i.e. used repellant sources) and withdrawal/reactive (i.e. reduced outside activities) behaviors. After controlling for level of mosquito bites, increased scores for above normal perceived risk were associated with withdrawal/reactive avoidance behaviors; whereas, increased scores for normal perceived risk were associated with proactive avoidance behaviors. Efforts to improve mosquito avoidance behaviors should distinguish the type of perceived risk and the type of avoidance behavior. Greater congruence between perceived risk (i.e. normal risk of mosquito-borne illnesses) and avoidance behaviors (i.e. planning avoidance behaviors) will increase the effectiveness of education programs for disease prevention.

Process evaluation of integrated West Nile virus surveillance in northern Italy: an example of a One Health approach in public health policy

West Nile virus (WNV) is endemic in the Po valley area in northern Italy. Regional health authorities have implemented integrated WNV surveillance following a One Health approach, based on collaboration between human, animal and environmental health institutions. We evaluated this integrated WNV surveillance system in Emilia-Romagna, Lombardy and Piedmont regions by means of a process evaluation. We examined the system's implementation fidelity, dose delivered and received, reach, and we identified strengths and weaknesses in the system. Qualitative and semi-quantitative data were obtained from three regional focus groups. Data were discussed in a follow up focus group, where participants suggested recommendations for improving the surveillance system. Inter-institutional and interdisciplinary integration and the creation of a 'community of practice' were identified as key elements for effective surveillance. We identified differences in the degree of interdisciplinary integration in the three regions, likely due to different epidemiological situations and years of experience in surveillance implementation. Greater collaboration and sharing of information, public engagement and economic assessments of the integrated surveillance approach would facilitate its social recognition and guarantee its sustainability through dedicated funding. We demonstrate that a transdisciplinary research approach based on process evaluation has value for designing and fine-tuning integrated health surveillance systems.

Perceived Risk of Mosquito-Borne Arboviruses in the Continental United States

The United States experienced local transmission of West Nile Virus (WNV) for the first time in 1999, and Zika Virus (ZIKV) in 2016. These introductions captured the public's attention in varying degrees. The research presented here analyzes the disproportional perception of ZIKV risk compared to WNV transmission risk, by the public and vector control personnel. The risk perception of vector control was measured through purposive sampled interviews (24 interviews in 13 states; May 2020-June 2021), while the public's perception was estimated from news publications (January 2000-December 2020), and Google searches (January 2004-December 2020). Over time, we observed a decrease in the frequency of press reporting and Google searches of both viruses with decreasing annual peaks in the summer. The highest peak of ZIKV news, and searches, surpassed that of WNV. We observed clear differences in the contents of the headlines for both viruses. We propose that the main reason in risk perception differences between the viruses were psychological. Zika infections (mosquito-borne and sexually transmitted) can result in devastating symptoms in fetuses and newborns, observations that frequently appeared in ZIKV-related headlines. Our results highlight the likely influence the news media has on risk perception and the need for public health agencies to play active roles in the conversation, helping disseminate timely and accurate information. Understanding the factors that shape risk perceptions of vector-borne diseases will hopefully lead to better use of resources by providing better guidance.

An unusual neurologic presentation of pediatric neuroinvasive West Nile virus infection: ophthalmoplegia

BACKGROUND

West Nile virus (WNV) is an uncommon arbovirus infection and is usually asymptomatic in pediatric patients and due to its rarity is not very well known by clinicians.

CASE

We present a 5-year-old girl admitted to the Pediatric Emergency Service with fever, vomiting, neck stiffness, walking difficulty and sudden deviation of eyes who was diagnosed with a neuroinvasive WNV infection.

CONCLUSIONS

Ophthalmoplegia is an unusual presentation of neuroinvasive WNV and there are no published pediatric cases with ophthalmoplegia in the literature.

A climate-dependent spatial epidemiological model for the transmission risk of West Nile virus at local scale

In this study, initial elements of a modelling framework aimed to become a spatial forecasting model for the transmission risk of West Nile virus (WNV) are presented. The model describes the dynamics of a WNV epidemic in population health states of mosquitoes, birds and humans and was applied to the case of Greece for the period 2010–2019. Calibration was performed with the available epidemiological data from the Hellenic Centre for Disease Control and Prevention and the environmental data from the European Union's earth observation program, Copernicus. Numerical results of the model for each municipality were evaluated against observations. Specifically, the occurrence of WNV, the number of infected humans and the week of incidence predicted from the model were compared to the corresponding numbers from observations. The results suggest that dynamic downscaling of a climate-dependent epidemiological model is feasible down-to roughly 80km². This below nomenclature of territorial units for statistics (NUTS) 3 level represents the municipalities being the lowest level of administrative units, able to cope with WNV and take actions. The average detection probability in hindcast mode was 72%, improving strongly as the number of infected humans increased. Using the developed model, we were also able to show the fundamental importance of the May temperatures in shaping the WNV dynamics. The modeling framework couples epidemiological and environmental dynamical variables with surveillance data producing risk maps downscaled at a local level. The approach can be expanded to provide targeted early warning probabilistic forecasts that can be used to inform public health policy decision making.

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Downscaling of a climate-dependent epidemiological model feasible to roughly 80 km².

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The model demonstrates competence in reproducing WNV event occurrence spatially at the municipality scale.

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The average detection probability is 72%, improving with increasing human infections.

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The hardest to model WNV events occurred at municipalities and years with only one human infection annually.

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Temperatures in May are found most critical in shaping the WNV dynamics.

West Nile Neuroinvasive Disease With Atypical CSF Findings: A Case Report

West Nile Neuroinvasive Disease (WNND) is a rare complication of West Nile Virus infection with the capability of mimicking other neurologic diseases. This infection should be considered in the differential diagnosis for patients presenting in the late summer months with altered mentation, fever, and focal neurologic deficits without an otherwise clear etiology. A 63-year-old male presented with acute onset fever, confusion, falls, ataxia, vertical nystagmus, and right leg weakness. Although magnetic resonance imaging of the brain and cervical spine were unremarkable, the lumbar spine revealed enhancement of ventral nerve roots in the cauda equina. Cerebrospinal fluid (CSF) analysis was significant for elevated protein without pleocytosis, which was more suggestive of albuminocytologic dissociation. Both serum and CSF IgM labs testing for West Nile Virus were positive. Despite a 5 day course of immunoglobulin therapy, his symptoms did not significantly improve. He eventually was transferred to inpatient rehabilitation for several days prior to returning home. This case highlights the variable presentations of acute West Nile Virus infection in the rare setting of neuroinvasive disease, which can make diagnosis difficult. The CSF analysis may also not always show results consistent with an acute viral infection, which can make determining the underlying etiology more challenging.

Rehabilitation Outcomes in Subjects with West Nile Neuro-Invasive Disease

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

Influence of Biological Model on the Formation of the Pathogenic Properties of the West Nile Virus Isolate

Various biological models are used to isolate West Nile virus, but their role as a selection factor that facilitates selection of isolates with certain properties is usually not evaluated. We compared pathogenic properties of three strains of the West Nile virus obtained from one sample of virus-containing material using different models: WNV Volgograd 900m/18 (on the model of suckling mice), WNV Volgograd 900a/18 (on C6/36 cells) and WNV Volgograd 900v/18 (on Vero cells). WNV Volgograd 900m/18 strain demonstrated virulent (LD₅₀ 5×10³±0.005×10⁴ PFU, p≤0.05) and neuroinvasive properties, induced viremia and pathomorphological changes in the liver, lymph nodes, and brain of nonlinear white mice. WNV Volgograd 900v/18 strain had similar characteristics except for neuroinvasiveness. WNV Volgograd 900a/18 variant demonstrated minimum virulence (LD₅₀ 5×10⁴±0.005×10⁴ PFU, p≤0.05), did not cause neurological symptoms, and was not isolated from the blood of infected animals.

Sensitivity of Quails (Coturnix coturnix), Siskins (Carduelis spinus), and Frogs (Rana ridibunda) to West Nile Virus

The level of viremia and features of the course of experimental infection caused by West Nile virus were studied in two species of migratory birds, siskins Сarduelis spinus and quails Coturnix coturnix, and in one species of amphibians, frogs Rana ridibunda. In quails, the virus caused a fatal disease; histological analysis revealed pathological changes in the heart, kidneys, liver, and brain stem. In siskins and frogs, virus antigen was detected in cloacal smears despite the absence of clinical manifestations, the level of viremia was sufficient to infect insect vectors during bloodsucking. These findings suggest that siskins and frogs can be potential reservoirs of West Nile virus and play a role in its circulation.

First neuroinvasive human case of West Nile Disease in Southern Italy: Results of the 'One Health' approach

Background

West Nile Disease (WND) is a zoonotic mosquito‐borne infection involving viral pathogens, human and animal hosts, vectors and environment. Cooperation among medical, veterinary and entomological fields has been promoted by the Italian Public Health Authorities, and an integrated West Nile Virus (WNV) Surveillance Plan has been in force in Italy since 2016 to prevent the transmission risk of WND to humans through an early detection of viral circulation by animal and entomological surveillance. This managing model is unique in Europe.

Objectives

This survey aimed at presenting the ‘One Health’ approach applied in 2016 to the first autochthonous human case of West Nile Neuroinvasive Disease (WNND) in Sicily (Southern Italy).

Methods

Serological (anti‐WNV IgM and IgG ELISA, anti‐WNV neutralizing antibodies) and molecular tests were conducted on blood, liquor and urine of a 38‐year‐old man with encephalitis and meningitis. Overall, 2704 adult culicides from 160 mosquito catches were morphologically identified. Female mosquitoes were analysed in pools for WNV RNA detection. Serological (anti‐WNV IgM and IgG ELISA) and molecular analyses for WNV were carried out in 11 horses, 271 chickens and two dogs sampled in farms around the man's residence.

Results and conclusions

WNND was confirmed by serological analysis on patient's liquor and serum. Collected mosquito species included Culex pipiens (93.56%, CI_95% 92.64%–94.49%), Aedes albopictus (5.25%, CI_95% 4.41%–6.09%), Culex hortensis (0.59%, CI_95% 0.30%–0.88%), Culiseta longiareolata (0.55%, CI_95% 0.27%–0.83%) and Anopheles maculipennis s.l. (0.04%, CI_95% –0.04% to 0.11%). Mosquito pools were negative for WNV RNA. Two dogs (100%) and two horses (18.18%, CI_95% –4.61 to 40.97%) resulted positive for anti‐WNV specific antibodies.

The ‘One Health’ approach allowed to report the first human neuroinvasive WND in Sicily and to confirm the local circulation of WNV in animals of the same area where the clinical case occurred, defining the autochthonous origin of the infection.

Rational design of West Nile virus vaccine through large replacement of 3' UTR with internal poly(A)

The genus Flavivirus comprises numerous emerging and re-emerging arboviruses causing human illness. Vaccines are the best approach to prevent flavivirus diseases. But pathogen diversities are always one of the major hindrances for timely development of new vaccines when confronting unpredicted flavivirus outbreaks. We used West Nile virus (WNV) as a model to develop a new live-attenuated vaccine (LAV), WNV-poly(A), by replacing 5' portion (corresponding to SL and DB domains in WNV) of 3'-UTR with internal poly(A) tract. WNV-poly(A) not only propagated efficiently in Vero cells, but also was highly attenuated in mouse model. A single-dose vaccination elicited robust and long-lasting immune responses, conferring full protection against WNV challenge. Such "poly(A)" vaccine strategy may be promising for wide application in the development of flavivirus LAVs because of its general target regions in flaviviruses.

Public Perceptions on Non-Pharmaceutical Interventions for West Nile Virus Infections: A Survey from an Endemic Area in Northern Italy

During the last decade, cases of West Nile Virus (WNV) have occurred in the Emilia Romagna Region (ERR). Even though the notification rates remain relatively low, ranging from 0.06 to 1.83 cases/100,000 inhabitants, the persistent pathogen's circulation in settings characterized by favorable environmental characteristics suggests that WNV is becoming endemic to the Po River Valley. This study assesses knowledge, attitudes, and preventive practices toward WNV prevention among residents from 10 high-risk municipalities from the provinces of Parma and Reggio Emilia (total population: 82,317 inhabitants, census 2020). A web-based survey, based on the health belief model, was performed during the month of January 2021, with a convenience sampling of 469 participants from a series of closed discussion groups on social media (i.e., 2.1% of the potential responders). A total of 243 participants knew the meaning of WNV: Of them, 61.3% were aware of previous WNV infections in ERR, 76.5% acknowledged WNV infection as a severe one, but only 31.3% expressed any worry about WNV. Our results irregularly report preventive practices, either collective (e.g., draining standing water from items and the environment, 50.7%; spraying pesticides around the home, 33.0%) or individual (e.g., use of skin repellants when going outdoors, 42.6%). In a multivariate analysis, performed through binary logistic regression, participants reporting any worry towards WNV were more likely to characterize WNV as a severe disease (adjusted odds ratio [aOR] = 20.288, 95% confidence interval [CI] = 5.083-80.972). On the contrary, respondents supporting community mosquito control programs were more likely among people working with animals/livestock (aOR = 13.948, 95%CI = 2.793-69.653), and supporting tax exemptions for mosquito control programs (aOR = 4.069, 95%CI 2.098-7.893). In conclusion, our results suggest that future interventions promoting WNV prevention among residents in ERR should focus on perceptions of vulnerability to WNV, emphasizing the benefits of personal protective behaviors.

Hypergraph models of biological networks to identify genes critical to pathogenic viral response

Background

Representing biological networks as graphs is a powerful approach to reveal underlying patterns, signatures, and critical components from high-throughput biomolecular data. However, graphs do not natively capture the multi-way relationships present among genes and proteins in biological systems. Hypergraphs are generalizations of graphs that naturally model multi-way relationships and have shown promise in modeling systems such as protein complexes and metabolic reactions. In this paper we seek to understand how hypergraphs can more faithfully identify, and potentially predict, important genes based on complex relationships inferred from genomic expression data sets.

Results

We compiled a novel data set of transcriptional host response to pathogenic viral infections and formulated relationships between genes as a hypergraph where hyperedges represent significantly perturbed genes, and vertices represent individual biological samples with specific experimental conditions. We find that hypergraph betweenness centrality is a superior method for identification of genes important to viral response when compared with graph centrality.

Conclusions

Our results demonstrate the utility of using hypergraphs to represent complex biological systems and highlight central important responses in common to a variety of highly pathogenic viruses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12859-021-04197-2.

Variations in West Nile Virus neuroinvasive infection: A case series of three patients in West Phoenix

West Nile Virus (WNV) is the most common mosquito-borne virus in the United States and North America. Although WNV disease occurs on a spectrum ranging from a relatively benign febrile illness to life-threatening neuroinvasive disease, the clinical presentations can vary widely and thus necessitates a high degree of suspicion. Here we describe three such cases where each individual presented with a unique constellation of symptoms that made the diagnosis challenging. It is essential for physicians to be well informed on the differing symptomology so early diagnosis and supportive management can mitigate poor prognosis.

Phylogenetic Analysis of the 2020 West Nile Virus (WNV) Outbreak in Andalusia (Spain)

During recent decades West Nile Virus (WNV) outbreaks have continuously occurred in the Mediterranean area. In August 2020 a new WNV outbreak affected 71 people with meningoencephalitis in Andalusia and six more cases were detected in Extremadura (south-west of Spain), causing a total of eight deaths. The whole genomes of four viruses were obtained and phylogenetically analyzed in the context of recent outbreaks. The Andalusian viral samples belonged to lineage 1 and were relatively similar to those of previous outbreaks which occurred in the Mediterranean region. Here we present a detailed analysis of the outbreak, including an extensive phylogenetic study. As part on this effort, we implemented a local Nextstrain server, which has become a constituent piece of regional epidemiological surveillance, wherein forthcoming genomes of environmental samples or, eventually, future outbreaks, will be included.

Expanding the Differential During the COVID-19 Pandemic: Fatal West Nile Virus Neuroinvasive Disease

The ever-evolving pandemic of Coronavirus disease 2019 (COVID-19) has the potential to drown out other viruses continuing to infect communities. To highlight this, we present 2 cases of fatal West Nile virus neuroinvasive disease that occurred within 2 weeks of each other. Since the first positive case of West Nile virus in the United States, there have been 2 epidemics in the past 2 decades, most often occurring in regions of North Texas and Southern California, which have been areas of high-incidence for COVID-19. It is important for the health care provider to recognize diagnostic biases and maintain broad differentials for the patient presenting with fever and other symptoms associated with COVID-19.

Epidemiology of West Nile Virus Infections in Humans, Italy, 2012-2020: A Summary of Available Evidences

In Italy, human cases of West Nile virus (WNV) infection have been recorded since 2008, and seasonal outbreaks have occurred almost annually. In this study, we summarize available evidences on the epidemiology of WNV and West Nile neuro-invasive disease (WNND) in humans reported between 2012 and 2020. In total, 1145 WNV infection cases were diagnosed; of them 487 (42.5%) had WNND. A significant circulation of the pathogen was suggested by studies on blood donors, with annual incidence rates ranging from 1.353 (95% confidence intervals (95% CI) 0.279-3.953) to 19.069 cases per 100,000 specimens (95% CI 13.494-26.174). The annual incidence rates of WNND increased during the study period from 0.047 cases per 100,000 (95% CI 0.031-0.068) in 2012, to 0.074 cases per 100,000 (95% CI 0.054-0.099) in 2020, peaking to 0.377 cases per 100,000 (95% CI 0.330-0.429) in 2018. There were 60 deaths. Cases of WNND were clustered in Northern Italy, particularly in the Po River Valley, during the months of August (56.7%) and September (27.5%). Higher risk for WNND was reported in subjects of male sex (risk ratio (RR) 1.545, 95% CI 1.392-1.673 compared to females), and in older age groups (RR 24.46, 95% CI 15.61-38.32 for 65-74 y.o.; RR 43.7, 95% CI 28.33-67.41 for subjects older than 75 years), while main effectors were identified in average air temperatures (incidence rate ratio (IRR) 1.3219, 95% CI 1.0053-1.7383), population density (IRR 1.0004, 95% CI 1.0001-1.0008), and occurrence of cases in the nearby provinces (IRR 1.0442, 95% CI 1.0340-1.0545). In summary, an enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

Acute transverse myelitis in West Nile Virus, a rare neurological presentation

Introduction

West Nile Virus varies in presentation from asymptomatic to a febrile illness often associated with malaise, weakness and maculopapular rash. West Nile neuro-invasive disease often manifests as meningitis, encephalitis, and less commonly acute flaccid paralysis in a "polio-like" presentation. Acute transverse myelitis (ATM) is a rare manifestation. We present a case of neuro-invasive West Nile Virus infection with radiographic evidence of longitudinally extensive transverse myelitis (LETM), a subset of ATM.

Case narration

A 42-year-old male from Massachusetts presented with progressive asymmetric paralysis of 4 days duration after developing a prodrome of fever, neck stiffness and urinary retention. Physical examination demonstrated asymmetric lower extremity weakness Lumbar puncture revealed lymphocytic pleocytosis with normal protein and glucose and a positive West Nile IgM in CSF (4.89, reference <0.90), and West Nile Virus detected by PCR in CSF. His West Nile serum IgM was 3.03 (reference range <0.90) and IgG was <1.30 (reference range <1.30). MRI of the lumbar spine showed findings consistent with the diagnosis of ATM.

Conclusion

With our patient's presentation of acute onset asymmetrical weakness following a viral illness, we ruled out differentials including demyelinating syndrome such as GBS, inflammation of the meninges through meningitis or meningoencephalitis, or traumatic/ischemic involvement of the spinal cord directly. Due to the MRI findings, his motor weakness and urinary retention, supporting CSF findings and WNV positive serologies, ATM due to WNV infection was the main suspect for his presentation. Although ATM is an uncommon manifestation of WNV, it is imperative to consider this in the differential for patients presenting with acute onset flaccid paralysis in regions where WNV is endemic.

Insight the data: Wikipedia's researches and real cases of arboviruses in Italy

OBJECTIVES

The primary aim of this study was to evaluate the temporal correlation between Wikitrends and conventional surveillance data generated for Chikungunya, Dengue, Zika, and West Nile Virus infection reported by bulletin of Italian National Institute of Health (Istituto Superiore di Sanità in italian, ISS).

STUDY DESIGN

A cross-sectional study design was used.

METHODS

The reported cases of Dengue and Chikungunya were selected from July 2015 to December 2019. For West Nile Virus, the bulletins are issued in the period June-November (6 months) of the years 2015-2019, and for Zika virus, the data reported in the ISS bulletin start from January 2016. From Wikipedia Trends, we extracted the number of monthly views by users from the July 2015 to December 2019 of the pages Chikungunya, Dengue, Zika virus, and West Nile Virus.

RESULTS

A correlation was observed between the bulletin of ISS and Wikipedia Wikitrends, the correlation was strong for Chikungunya and West Nile Virus (r = 0.9605; r = 0.9556, respectively), and highly statistically significant with P-values <0.001. The correlation was moderate for Dengue and Zika virus (r = 0.6053; r = 0.5888, respectively), but highly statistically significant with P-values <0.001.

CONCLUSIONS

Classical surveillance system should be integrated with the tools of digital epidemiology that have potential role in public health for the dynamic information and provide near real-time indicators of the spread of infectious disease.

The abundance of Culex mosquito vectors for West Nile Virus and other flaviviruses: A time-series analysis of rainfall and temperature dependence in Singapore

Culex mosquitoes are important vectors of West Nile Virus (WNV), St. Louis Encephalitis Virus (SLEV) and Japanese Encephalitis Virus (JEV). Climate change is expected to alter their ability to spread diseases in human populations. Studies examining the influence of climate variability on Culex mosquitoes in South East Asia are scarce. We examined the influence of climate variability on reported Culex mosquito larval habitats from 2009 to 2018 in Singapore. We analysed the non-linear immediate and lagged weather dependence of Culex habitats over 5 weeks in negative binomial regression models using nationally representative data. We adjusted for the effects of long-term trend, seasonality, public holidays and autocorrelation. There were 41,170 reported Culex larval habitats over the study period. Non-residential premises were associated with more reports of habitats compared to residential premises [Rate Ratio (RR): 113.9, 95% CI: 110.9, 116.9]. Larvae in more than 90% of these habitats were entomologically identified as Culex quinquefasciatus. In residences, every 10 mm increase in rainfall above a 90 mm threshold was associated with a 10.1% [Incidence Rate Ratio (IRR): 0.899, 95% CI: 0.836, 0.968] cumulative decline in larval habitats. Public holidays were not significantly included in the model analysing larval habitats in residences. In non-residences, a 1 °C increase in the ambient air temperature with respect to the mean was associated with a 36.0% (IRR: 1.360, 95% CI: 1.057, 1.749) cumulative increase in Culex larval habitats. Public holidays were associated with a decline in Culex larval habitats in the same week. Our study provides evidence of how ambient air temperature and rainfall variability influences the abundance of Culex mosquito larval habitats. Our findings support the utility of using weather data in predictive models to inform the timing of vector control measures aimed at reducing the risk of WNV and other Culex-borne flavivirus transmission in urban areas.

Potential Dual Role of West Nile Virus NS2B in Orchestrating NS3 Enzymatic Activity in Viral Replication

West Nile virus (WNV) nonstructural protein 3 (NS3) harbors the viral triphosphatase and helicase for viral RNA synthesis and, together with NS2B, constitutes the protease responsible for polyprotein processing. NS3 is a soluble protein, but it is localized to specialized compartments at the rough endoplasmic reticulum (RER), where its enzymatic functions are essential for virus replication. However, the mechanistic details behind the recruitment of NS3 from the cytoplasm to the RER have not yet been fully elucidated. In this study, we employed immunofluorescence and biochemical assays to demonstrate that NS3, when expressed individually and when cleaved from the viral polyprotein, is localized exclusively to the cytoplasm. Furthermore, NS3 appeared to be peripherally recruited to the RER and proteolytically active when NS2B was provided in trans. Thus, we provide evidence for a potential additional role for NS2B in not only serving as the cofactor for the NS3 protease, but also in recruiting NS3 from the cytoplasm to the RER for proper enzymatic activity. Results from our study suggest that targeting the interaction between NS2B and NS3 in disrupting the NS3 ER localization may be an attractive avenue for antiviral drug discovery.

Detection of West Nile virus in a common whitethroat (Curruca communis) and Culex mosquitoes in the Netherlands, 2020

On 22 August, a common whitethroat in the Netherlands tested positive for West Nile virus lineage 2. The same bird had tested negative in spring. Subsequent testing of Culex mosquitoes collected in August and early September in the same location generated two of 44 positive mosquito pools, providing first evidence for enzootic transmission in the Netherlands. Sequences generated from the positive mosquito pools clustered with sequences that originate from Germany, Austria and the Czech Republic.

West Nile virus in humans, Greece, 2018: the largest seasonal number of cases, 9 years after its emergence in the country

Background

Human cases of West Nile virus (WNV) infection are recorded since 2010 in Greece, with seasonal outbreaks occurring almost annually. Enhanced surveillance has been implemented since 2010, to promptly characterise cases’ temporal and geographical distribution and inform authorities for implementation of appropriate measures (mosquito control, health education, blood safety).

Aim

We describe the epidemiology of WNV human infections in Greece focusing on the 2018 season.

Methods

The National Public Health Organization advised physicians to test all suspect WNV infection cases and refer samples to reference laboratories. Laboratories notified diagnosed cases on a daily basis. Treating physicians, patients, and infected blood donors were interviewed within 48 hours after diagnosis and the probable infection location was identified. Hospitalised cases were followed up until discharge.

Results

A total of 317 autochthonous WNV infection cases were diagnosed in 2018. Among them, 243 cases had neuroinvasive disease (WNND), representing a 23% increase of WNND cases compared with 2010, the previous most intense season. There were 51 deaths. Cases started occurring from week 22, earlier than usual. Both rural and urban areas were affected, with 86 (26% of the total) municipalities belonging to seven (54% of the total) regions recording cases. Two major epicentres were identified in Attica and Central Macedonia regions.

Conclusions

The largest number of human cases of WNV infection ever recorded in Greece occurred in 2018, with a wide geographical distribution, suggesting intense virus circulation. Enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

First record of West Nile Virus detection inside wild mosquitoes in Khartoum capital of Sudan using PCR

This study aimed to explore the presence of West Nile Virus (WNV) inside four species of mosquitoes: Culex univittatus (Theobald), Culex quinquefasciatus (Say) Aedes vittatus (Bigot) and Aedes vexans (Meigen). Adult wild mosquitoes were collected from different sites: Soba West, Hellat Kuku, Shambat, and Khartoum North Central Live Stock Market (KCLM). Surveys were carried out at Khartoum State during two phases: pre to the rainy season and post to the rainy season. Mosquito specimens were identified using classical keys then preserved at -80 °C freezer for two weeks till the virus examination using polymerase chain reaction (PCR) were carried out. WNV has been detected inside the three species of mosquitoes: A. vexans, C. univittatus, and C. quinquefasciatus. The species were collected from Hellat Kuku, (Shambat and Hellat Kuku), and (Shambat and KCLM) respectively. Two species of mosquitoes were positive for the virus: C. quinquefasciatus and C. univittatus. Positive results for the virus during the first phase of the study; males of C. quinquefasciatus and C. univittatus collected during the second phase of the study were also tested for the existence of the virus and they were positive. For our knowledge this study represents first record of WNV inside wild mosquitoes in Sudan. PCR technique provided reliable information because specific primer-probe sets were used for the detection of the virus. Extra studies are required to incriminate these species of mosquitoes as potential vectors of WNV.

Genetic characterization of West Nile Virus strains during neuroinvasives infection outbreak in Tunisia, 2018

West Nile Virus (WNV) is an arbovirus transmitted by mosquito bite involving birds as reservoirs, humans and equines as accidental hosts. Eight distinct lineages (WNV-1 to WNV-8) have been identified: WNV-1 and WNV-2 infect humans and animals, and WNV-3 to WNV-8 have been identified only in vectors. WNV has been implicated in neuroinvasives infections, especially meningitis and encephalitis. Tunisia experienced three epidemics in 1997, 2003 and 2012. Serological studies on humans, equines and birds as well as the detection of the virus in the vector favour a fairly frequent circulation in the country. A new epidemic has been observed in Tunisia between August and November 2018. The obtained sequences of the VWN from Tunisia 2018 grouped in a distinct monophyletic group within the Mediterranean subtype in Cluster 1, with a maximum of 2% nucleotide divergence. These sequences were clearly distinct from the Tunisia 1997, which grouped with sequences mainly from USA in Cluster 2. This work reports the genetic characterization of the Tunisia 2018 strain in comparison with the previously identified strains in Tunisia and worldwide. The epidemic virus Tunisia 2018 was genetically close to the Mediterranean basin and Eastern Europe sequences but distinct from the Tunisia 1997 closely related to the American sequences.

A Cell-Based Capture Assay for Rapid Virus Detection

Routine methods for virus detection in clinical specimens rely on a variety of sensitive methods, such as genetic, cell culture and immuno-based assays. It is imperative that the detection assays would be reliable, reproducible, sensitive and rapid. Isolation of viruses from clinical samples is crucial for deeper virus identification and analysis. Here we introduce a rapid cell-based assay for isolation and detection of viruses. As a proof of concept several model viruses including West Nile Virus (WNV), Modified Vaccinia Ankara (MVA) and Adenovirus were chosen. Suspended Vero cells were employed to capture the viruses following specific antibody labeling which enables their detection by flow cytometry and immuno-fluorescence microscopy assays. Using flow cytometry, a dose response analysis was performed in which 3.6e4 pfu/mL and 1e6 pfu/mL of MVA and WNV could be detected within two hours, respectively. When spiked to commercial pooled human serum, detection sensitivity was slightly reduced to 3e6 pfu/mL for WNV, but remained essentially the same for MVA. In conclusion, the study demonstrates a robust and rapid methodology for virus detection using flow cytometry and fluorescence microscopy. We propose that this proof of concept may prove useful in identifying future pathogens.

Using Climate to Explain and Predict West Nile Virus Risk in Nebraska

We used monthly precipitation and temperature data to give early warning of years with higher West Nile Virus (WNV) risk in Nebraska. We used generalized additive models with a negative binomial distribution and smoothing curves to identify combinations of extremes and timing that had the most influence, experimenting with all combinations of temperature and drought data, lagged by 12, 18, 24, 30, and 36 months. We fit models on data from 2002 through 2011, used Akaike's Information Criterion (AIC) to select the best-fitting model, and used 2012 as out-of-sample data for prediction, and repeated this process for each successive year, ending with fitting models on 2002-2017 data and using 2018 for out-of-sample prediction. We found that warm temperatures and a dry year preceded by a wet year were the strongest predictors of cases of WNV. Our models did significantly better than random chance and better than an annual persistence naïve model at predicting which counties would have cases. Exploring different scenarios, the model predicted that without drought, there would have been 26% fewer cases of WNV in Nebraska through 2018; without warm temperatures, 29% fewer; and with neither drought nor warmth, 45% fewer. This method for assessing the influence of different combinations of extremes at different time intervals is likely applicable to diseases other than West Nile, and to other annual outcome variables such as crop yield.

Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series

The 2018 West Nile Virus (WNV) season in Europe was characterized by an extremely high infection rate and an exceptionally higher burden when compared to previous seasons. Overall, there was a 10.9-fold increase in incidence in Italy, with 577 human cases, 230 WNV neuroinvasive diseases (WNNV) and 42 WNV-attributed deaths. Methods: in this paper we retrospectively reported the neurological presentation of 7 patients admitted to University Hospital of Udine with a diagnosis of WNNV, especially focusing on two patients who presented with atypical severe brain stem involvement. Conclusions: the atypical features of some of these forms highlight the necessity to stay vigilant and suspect the diagnosis when confronted with neurological symptoms. We strongly encourage clinicians to consider WNNV in patients presenting with unexplained neurological symptoms in mild climate-areas at risk.

The Role of Microglia during West Nile Virus Infection of the Central Nervous System

Encephalitis resulting from viral infections is a major cause of hospitalization and death worldwide. West Nile Virus (WNV) is a substantial health concern as it is one of the leading causes of viral encephalitis in the United States today. WNV infiltrates the central nervous system (CNS), where it directly infects neurons and induces neuronal cell death, in part, via activation of caspase 3-mediated apoptosis. WNV infection also induces neuroinflammation characterized by activation of innate immune cells, including microglia and astrocytes, production of inflammatory cytokines, breakdown of the blood-brain barrier, and infiltration of peripheral leukocytes. Microglia are the resident immune cells of the brain and monitor the CNS for signs of injury or pathogens. Following infection with WNV, microglia exhibit a change in morphology consistent with activation and are associated with increased expression of proinflammatory cytokines. Recent research has focused on deciphering the role of microglia during WNV encephalitis. Microglia play a protective role during infections by limiting viral growth and reducing mortality in mice. However, it also appears that activated microglia are triggered by T cells to mediate synaptic elimination at late times during infection, which may contribute to long-term neurological deficits following a neuroinvasive WNV infection. This review will discuss the important role of microglia in the pathogenesis of a neuroinvasive WNV infection. Knowledge of the precise role of microglia during a WNV infection may lead to a greater ability to treat and manage WNV encephalitis.

Clinical and virological findings in patients with Usutu virus infection, northern Italy, 2018

BackgroundUsutu virus (USUV) is a mosquito-borne flavivirus, which shares its transmission cycle with the phylogenetically related West Nile virus (WNV). USUV circulates in several European countries and its activity has increased over the last 5 years.AimTo describe human cases of USUV infection identified by surveillance for WNV and USUV infection in the Veneto Region of northern Italy in 2018.MethodsFrom 1 June to 30 November 2018, all cases of suspected autochthonous arbovirus infection and blood donors who had a reactive WNV nucleic acid test were investigated for both WNV and USUV infection by in-house molecular methods. Anti-WNV and anti-USUV IgM and IgG antibodies were detected by ELISA and in-house immunofluorescence assay, respectively; positive serum samples were further tested by WNV and USUV neutralisation assays run in parallel.ResultsEight cases of USUV infection (one with neuroinvasive disease, six with fever and one viraemic blood donor who developed arthralgia and myalgia) and 427 cases of WNV infection were identified. A remarkable finding of this study was the persistence of USUV RNA in the blood and urine of three patients during follow-up. USUV genome sequences from two patients shared over 99% nt identity with USUV sequences detected in mosquito pools from the same area and clustered within lineage Europe 2.ConclusionsClinical presentation and laboratory findings in patients with USUV infection were similar to those found in patients with WNV infection. Cross-reactivity of serology and molecular tests challenged the differential diagnosis.

Exploring the socio-economic and environmental components of infectious diseases using multivariate geovisualization: West Nile Virus

Background

This study postulates that underlying environmental conditions and a susceptible population's socio-economic status should be explored simultaneously to adequately understand a vector borne disease infection risk. Here we focus on West Nile Virus (WNV), a mosquito borne pathogen, as a case study for spatial data visualization of environmental characteristics of a vector's habitat alongside human demographic composition for understanding potential public health risks of infectious disease. Multiple efforts have attempted to predict WNV environmental risk, while others have documented factors related to human vulnerability to the disease. However, analytical modeling that combines the two is difficult due to the number of potential explanatory variables, varying spatial resolutions of available data, and differing research questions that drove the initial data collection. We propose that the use of geovisualization may provide a glimpse into the large number of potential variables influencing the disease and help distill them into a smaller number that might reveal hidden and unknown patterns. This geovisual look at the data might then guide development of analytical models that can combine environmental and socio-economic data.

Methods

Geovisualization was used to integrate an environmental model of the disease vector's habitat alongside human risk factors derived from socio-economic variables. County level WNV incidence rates from California, USA, were used to define a geographically constrained study area where environmental and socio-economic data were extracted from 1,133 census tracts. A previously developed mosquito habitat model that was significantly related to WNV infected dead birds was used to describe the environmental components of the study area. Self-organizing maps found 49 clusters, each of which contained census tracts that were more similar to each other in terms of WNV environmental and socio-economic data. Parallel coordinate plots permitted visualization of each cluster's data, uncovering patterns that allowed final census tract mapping exposing complex spatial patterns contained within the clusters.

Results

Our results suggest that simultaneously visualizing environmental and socio-economic data supports a fuller understanding of the underlying spatial processes for risks to vector-borne disease. Unexpected patterns were revealed in our study that would be useful for developing future multilevel analytical models. For example, when the cluster that contained census tracts with the highest median age was examined, it was determined that those census tracts only contained moderate mosquito habitat risk. Likewise, the cluster that contained census tracts with the highest mosquito habitat risk had populations with moderate median age. Finally, the cluster that contained census tracts with the highest WNV human incidence rates had unexpectedly low mosquito habitat risk.

Serum neutralising antibody titres against a lineage 2 neuroinvasive West Nile Virus strain in response to vaccination with an inactivated lineage 1 vaccine in a European endemic area

In the last decade in Hungary and the neighbouring countries, West Nile Neuroinvasive Disease (WNND) has been caused in dramatically increasing numbers by lineage 2 West Nile Virus (WNV) strains both in horses and in humans. The disease in this geographical region is seasonal, so vaccination of horses should be carefully scheduled to maintain the highest antibody titres during outbreak periods. The objective of this study was to characterise the serum neutralising (SN) antibody titres against a lineage 2 WNV strain in response to vaccination with an inactivated lineage 1 vaccine (Equip® WNV). Thirty-two seronegative horses were enrolled in the study, 22 horses were allocated to the vaccinated group and 10 retained as unvaccinated controls. Horses were vaccinated according to the product's vaccination guidelines. A primary vaccination of two doses administered 28 days apart was initiated approximately 5 months before the WNV outbreak season, followed by a booster vaccination one year later. Blood samples were collected during a 2-year period to monitor production of SN antibodies against lineage 1 and the enzootic lineage 2 WNV strain. Mean antibody titres against lineage 1 WNV were significantly higher (P ≤ 0.05) in the vaccinated group compared to the control group at all-time points after the primary dose of vaccination. Similarly, mean antibody titres against lineage 2 WNV were significantly higher (P ≤ 0.05) in the vaccinated group compared to the control group at all time-points except at 6 months after the primary vaccination. SN antibody titres were significantly higher against lineage 1 than lineage 2 at all-time points. According to the results, vaccination with an inactivated lineage 1 vaccine induces antibodies against both WNV lineages 1 and 2 strains up to 2 years after booster vaccination, but in those geographical regions where lineage 2 strains are responsible for seasonal outbreaks, a booster vaccination should be considered earlier than 12 months after primary vaccination.

Recruiting the innate immune system with GM-CSF to fight viral diseases, including West Nile Virus encephalitis and COVID-19

As the coronavirus disease 2019 (COVID-19) pandemic grows throughout the world, it is imperative that all approaches to ameliorating its effects be investigated, including repurposing drugs that show promise in other diseases. We have been investigating an approach to multiple disorders that involves recruiting the innate immune system to aid the body's healing and regenerative mechanism(s). In the case of West Nile Virus encephalitis and potentially COVID-19, the proposed intervention to stimulate the innate immune system may give the adaptive immune response the necessary time to develop, finish clearing the virus, and provide future immunity. Furthermore, we have found that GM-CSF-induced recruitment of the innate immune system is also able to reverse brain pathology, neuroinflammation and cognitive deficits in mouse models of Alzheimer's disease and Down syndrome, as well as improving cognition in normal aging and in human patients with cognitive deficits due to chemotherapy, both of which exhibit neuroinflammation. Others have shown that GM-CSF is an effective treatment for both bacterial and viral pneumonias, and their associated inflammation, in animals and that it has successfully treated pneumonia-associated Acute Respiratory Distress Syndrome in humans. These and other data strongly suggest that GM-CSF may be an effective treatment for many viral infections, including COVID-19.

Epidemic West Nile Virus Infection Rates and Endemic Population Dynamics Among South Dakota Mosquitoes: A 15-yr Study from the United States Northern Great Plains

Mosquito surveillance has been conducted across South Dakota (SD) to record and track potential West Nile virus (WNV) vectors since 2004. During this time, communities from 29 counties collected nearly 5.5 million mosquitoes, providing data from over 60,000 unique trapping nights. The nuisance mosquito, Aedes vexans (Meigen) was the most abundant species in the state (39.9%), and most abundant in most regions. The WNV vector, Culex tarsalis Coquillett (Diptera: Culicidae), was the second most abundant species (20.5%), and 26 times more abundant than the other Culex species that also transmit WNV. However, geographic variation did exist between WNV vector species, as well as relative abundance of vector and nuisance mosquitoes. The abundance of Ae. vexans decreased from east to west in South Dakota, resulting in an increase in the relative abundance of Cx. tarsalis. Other species are reported in this study, with various relative abundances throughout the different regions of South Dakota. WNV infection rates of mosquitoes showed that Cx. tarsalis had the most positive sampling pools and the highest vector index of all the species tested. This study addressed the need for an updated summary of the predominant mosquito species present in the United States Northern Great Plain and provides infection rate data for WNV among these predominant species.

Introduction, Spread, and Establishment of West Nile Virus in the Americas

The introduction of West Nile virus (WNV) to North America in 1999 and its subsequent rapid spread across the Americas demonstrated the potential impact of arboviral introductions to new regions, and this was reinforced by the subsequent introductions of chikungunya and Zika viruses. Extensive studies of host-pathogen-vector-environment interactions over the past two decades have illuminated many aspects of the ecology and evolution of WNV and other arboviruses, including the potential for pathogen adaptation to hosts and vectors, the influence of climate, land use and host immunity on transmission ecology, and the difficulty in preventing the establishment of a zoonotic pathogen with abundant wildlife reservoirs. Here, we focus on outstanding questions concerning the introduction, spread, and establishment of WNV in the Americas, and what it can teach us about the future of arboviral introductions. Key gaps in our knowledge include the following: viral adaptation and coevolution of hosts, vectors and the virus; the mechanisms and species involved in the large-scale spatial spread of WNV; how weather modulates WNV transmission; the drivers of large-scale variation in enzootic transmission; the ecology of WNV transmission in Latin America; and the relative roles of each component of host-virus-vector interactions in spatial and temporal variation in WNV transmission. Integrative studies that examine multiple factors and mechanisms simultaneously are needed to advance our knowledge of mechanisms driving transmission.

Recent rapid changes in the spatio-temporal distribution of West Nile Neuro-invasive Disease in Italy

In Italy, the first human case of West Nile Virus (WNV) infection was reported in 2008 and, since then, the number of cases has been steadily increasing. In this study, we describe the temporal and spatial pattern of WNV infection risk among humans in Italy, focusing on the human cases of West Nile Neuro-invasive Disease (WNND) observed between 2008 and 2017. Incidence rates are estimated for each year and province under study. The incidence temporal trend is estimated using Poisson regression, and a spatio-temporal cluster detection analysis is performed to detect high-risk areas. In total, 231 WNND cases were notified in Italy between 2008 and 2017. The annual incidence rates increased during the study period (annual percentage change: 11.7%; 95%CI: -0.9%; 26.1%). A geographical spread of the disease was observed during the study period throughout Northern Italy, with an increasing number of affected provinces. Provinces close to the Po River (the main river in the north of Italy) and the Oristano province (in the Sardinia Island) experienced the highest incidence rates during the study period. Our study shows a gradual, but rapid spread of WNND across Northern Italy from east to west and suggests the hypothesis that provinces close to Po River might present ecological and climatic conditions favourable to the virus circulation.

An early start of West Nile virus seasonal transmission: the added value of One Heath surveillance in detecting early circulation and triggering timely response in Italy, June to July 2018

In Italy, the 2018 West Nile virus transmission season started early with a high number of cases reported. One-Health surveillance, within the Italian West Nile national preparedness and response plan, detected viral circulation 9 days before symptom-onset of the first confirmed human case; triggering timely implementation of blood and transplant safety measures. This is an example of how functional coordination allows health authorities to use early warning triggers from surveillance systems to implement preventive measures.

Role of NS1 and TLR3 in Pathogenesis and Immunity of WNV

West Nile Virus (WNV) is a mosquito-transmitted flavivirus which causes encephalitis especially in elderly and immunocompromised individuals. Previous studies have suggested the protective role of the Toll-like receptor 3 (TLR3) pathway against WNV entry into the brain, while the WNV non-structural protein 1 (NS1) interferes with the TLR3 signaling pathway, besides being a component of viral genome replication machinery. In this study, we investigated whether immunization with NS1 could protect against WNV neuroinvasion in the context of TLR3 deficiency. We immunized mice with either an intact or deleted TLR3 system (TLR3KO) with WNV envelope glycoprotein (gE) protein, NS1, or a combination of gE and NS1. Immunization with gE or gE/NS1, but not with NS1 alone, induced WNV neutralizing antibodies and protected against WNV brain invasion and inflammation. The presence of intact TLR3 signaling had no apparent effect on WNV brain invasion. However, mock-immunized TLR3KO mice had higher inflammatory cell invasion upon WNV brain infection than NS1-immunized TLR3KO mice and wild type mice. Thus, immunization against NS1 may reduce brain inflammation in a context of TLR3 signaling deficiency.