Current developments in understanding of West Nile virus central nervous system disease.
Current developments in understanding of West Nile virus central nervous system disease.
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DOI：
10.1097/wco.0000000000000088
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发表时间：
2014-06
影响因子：
4.8
通讯作者：
Tyler KL
中科院分区：
文献类型：
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作者：
Tyler KL
西尼罗河病毒（WNV）是美国流行性脑炎的最重要原因。我们回顾了过去18个月内发表的与该病的流行病学、免疫学、临床特征和治疗相关的文章。2012年，西尼罗河病毒在美国死灰复燃。目前在美国占主导地位的WNV毒株（NA/WN 02）与1999年最初出现的分离株（NY 99）不同。然而，目前流行的美国西尼罗河病毒株的遗传学差异并不能解释流行程度或疾病严重程度的变化。先天性和获得性免疫是控制西尼罗河病毒的关键，在某些情况下，途径是中枢神经系统特异性的。感染的临床特征现在已经很清楚了，尽管尿中慢性病毒排泄的未经证实的观察结果仍然存在争议。目前还没有针对西尼罗河病毒的特异性抗病毒治疗，但针对其他黄病毒的抗病毒药物的研究可能会发现有希望对抗西尼罗河病毒的药物。I期和II期人类WNV疫苗临床试验已经确定可以开发耐受性良好且具有免疫原性的WNV疫苗。西尼罗河病毒仍然是一个重要的公共卫生问题。虽然最近的研究已经大大增加了我们对控制西尼罗河病毒感染的宿主免疫和遗传因素的了解，但还没有特异性的治疗方法。开发一种耐受性好、免疫原性强、有效的西尼罗河病毒疫苗几乎肯定是可行的，但经济因素和缺乏对爆发规模和地点的可预测性，对于设计III期试验和最终许可证是有问题的。
West Nile virus (WNV) is the most important cause of epidemic encephalitis in the United States. We review articles published in the last 18 months related to the epidemiology, immunology, clinical features, and treatment of this disease. There was a resurgence in WNV disease in the United States in 2012. The WNV strain now predominant in the United States (NA/WN02) differs from the initial emergent isolate in 1999 (NY99). However, differences in the genetics of currently circulating United States WNV strains do not explain variations in epidemic magnitude or disease severity. Innate and acquired immunity are critical in control of WNV, and in some cases pathways are central nervous system specific. The clinical features of infection are now well understood, although nonconfirmed observations of chronic viral excretion in urine remain controversial. There is no specific antiviral therapy for WNV, but studies of antivirals specific for other flaviviruses may identify agents with promise against WNV. Phase I and II human WNV vaccine clinical trials have established that well tolerated and immunogenic WNV vaccines can be developed. WNV remains an important public health problem. Although recent studies have significantly increased our understanding of host immune and genetic factors involved in control of WNV infection, no specific therapy is yet available. Development of a well tolerated, immunogenic, and effective vaccine against WNV is almost certainly feasible, but economic factors and the lack of predictability of the magnitude and location of outbreaks are problematic for designing phase III trials and ultimate licensure.