West Nile Virus Questions Answered

1. How do people get infected with West Nile virus (WNV)?

The principle route of human infection with West Nile virus is through the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds, which may circulate the virus in their blood for a few days. The virus eventually finds its way into the mosquito's salivary glands. During subsequent blood meals, the virus may be injected into humans and animals, where it can multiply and possibly cause illness.

Additional routes of infection have become apparent during the 2002 West Nile epidemic. It is important to note that these other methods of transmission represent a very small proportion of cases. A recent investigation has confirmed WNV transmission through transplanted organs. Investigations of other patients who developed WNV infection within several weeks of receiving blood products or organs are ongoing to determine whether WNV was transmitted by transfusion or transplantation in any of these cases.

Based on a recent case in Michigan, it appears that West Nile virus can be transmitted through breast milk. There is one reported case of transplacental (mother-to-child) WNV transmission. Although transmission of WNV and similar viruses to laboratory workers is not a new phenomenon, two recent cases of WNV infection of laboratory workers have been reported.

2. What are the symptoms of West Nile virus infection?

Most people who are infected with the West Nile virus will not have any type of illness. It is estimated that 20% of the people who become infected will develop West Nile fever: mild symptoms, including fever, headache, and body aches, occasionally with a skin rash on the trunk of the body and swollen lymph glands.

The symptoms of severe infection (West Nile encephalitis or meningitis) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. It is estimated that 1 in 150 persons infected with the West Nile virus will develop a more severe form of disease.

3. How is West Nile encephalitis treated?

There is no specific treatment for West Nile virus infection. In more severe cases, intensive supportive therapy is indicated, often involving hospitalization, intravenous fluids, airway management, respiratory support (ventilator), prevention of secondary infections (pneumonia, urinary tract, etc.), and good nursing care.

4. What risk does WNV illness during pregnancy present to a fetus?

Based on the limited number of cases studied so far, it is not yet possible to determine what percentage of WNV infections during pregnancy result in infection of the fetus or medical problems in newborns.

Because of ongoing concerns that mother-to-child WNV transmission can occur with possible adverse health effects, pregnant women should take precautions to reduce their risk for WNV and other mosquito-borne infections by avoiding mosquitoes, using protective clothing, and using repellents containing DEET. Repellents with DEET are safe for pregnant women.