This region of NJ USA has had a few cases. In composing an index of suspicion when dealing with elderly with head and back aches, motor weakness and episodic fever, what hints to us that this elderly patient will do badly and we must aggressively intervene? What might be a rational approach?
Just a comment:
First WNV case (in a horse) in Germany in September 2018.
Very interesting! But do you mean first isolated case? In humans it was long diagnosed since 1927 in Uganda but more persistently in the Middle East, traced to a certain very hardy Culex mosquito species. It has been a major burden to NYC since the turn of the century. One useful sign for Newyorkers has been spotting an unusually frequent dead bird on the ground. It is not clear if the NYC Board of Health, a laudatory infection control organization, that responds quickly with intense spraying when so alerted. NYCBH has done as well with the virus as had been done with other CNS diseases. But can that be said for other places?
Viral brain infection in humans is very hard to study. But from what we knew after the 1999 burst of WND, the hardy mosquito-lady vector has a much longer biting season than most. So it is a severe threat to the elderly for many months of the year, particularly in basements and garages of urban/suburban homes. However, the spotting and management of WN Fever through infection control over the last two decades has not been very satisfactory. It is very interesting that the geriatric profile of infection is distinguishable from that for children and for adults. I would have expected far more research, even a vaccine, by now. More interesting, I feel would be the evolutionary biology of this virus and its vectors in modern urban settings as opposed to the rural ones where first typed in Africa. While virology has ceased to be a research interest, from a clinical perspective, I find myself the beneficiary of little progress, at least, since 1999, as was my feeling with all encephalitic viral phenomena. Indeed, here the big seeming chasm between basic science and epidemiology seems sparsely filled in. Yet, it never got the white hot attention that Lyme Disease got at the translational level. If someone can contradict me and attribute it to my lack of focus on it, pointing me to very reliable translational research I would be most grateful. Lastly, it seems to me that for the methodical clinician, a process of differential diagnosis must be developed that PRECEDES virological and immunological testing as one or two blood tests to nail down the symptoms are provoked only by exclusionary thinking. So, I would most appreciate direction to solid thinking about the educated philosophy of anyone dealing with this mosquito that might bite you all year round. Amongst the complexities of geriatric medicine, is this a source of contribution to the pathologic picture's index of suspicion around a patient's vague cephalic chief complaint, or does it tend to be something considered for lab studies only out of frustration with the posterior circulation insufficiency-like symptomatology (both rather hard to nail down) that doesn't obtain radiological confirmation? How is this processed in today's high volume cafetria-like general medicine practice?
Weekly updates: 2018 West Nile fever transmission season
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Situation update
Between 28 September and 4 October 2018, EU Member States reported 50 human West Nile virus infections in Greece (22), Romania (19), Hungary (7), Bulgaria (1) and the Czech Republic (1). EU neighbouring countries reported 30 cases, all in Serbia. In three areas, human cases were reported for the first time: Bulgaria (1), the Czech Republic (1) and Serbia (1). All other human cases were reported from areas that have been affected during previous transmission seasons. This week, 18 deaths were reported by Greece (8), Romania (6), Serbia (3) and the Czech Republic (1).
In the same week, 21 outbreaks among equids were reported by Italy (13), Greece (3), France (3), Hungary (1) and Slovenia (1).
In 2018 and as of 4 October 2018, EU Member States have reported 1 317 human cases in Italy (495), Greece (283), Romania (256), Hungary (197), Croatia (45), France (16), Austria (15), Bulgaria (6), Slovenia (3) and the Czech Republic (1). EU neighbouring countries reported 434 human cases in Serbia (350), Israel (81) and Kosovo* (3). To date, 142 deaths due to West Nile virus infection have been reported by Italy (36), Romania (36), Greece (34), Serbia (32), Bulgaria (1), the Czech Republic (1), Hungary (1) and Kosovo* (1).
During the current transmission season, 222 outbreaks among equids have been reported by Italy (120), Hungary (79), Greece (13), France (5), Romania (2), Austria (1), Germany (1) and Slovenia (1).
In accordance with European Commission Directive 2014/110/EU, prospective blood donors should defer for 28 days after leaving an area with evidence of West Nile virus circulation among humans unless the results of an individual nucleic acid test are negative.
as you see above the numbers are "FAT"
big numbers unfortunately
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