A review of the epidemiological and clinical aspects of West Nile virus.
A review of the epidemiological and clinical aspects of West Nile virus.
复制标题
DOI：
10.2147/ijgm.s59902
复制
发表时间：
2014
影响因子：
2.3
通讯作者：
Webb CE
中科院分区：
文献类型：
--
作者：
Gray TJ;Webb CE
近年来，西尼罗河病毒（WNV）在北美和欧洲的死灰复燃引起了地方当局的关注，并强调蚊子传播的疾病不仅限于世界热带地区。西尼罗河病毒维持在地方病循环中，主要涉及库蚊属。蚊子和鸟类宿主，并向包括马和人类在内的哺乳动物流行性传播。人类感染导致约五分之一的病例出现症状性疾病，不到1%的感染者出现神经侵袭性疾病。最一致公认的神经侵袭性疾病的危险因素是年龄较大，尽管糖尿病，酒精过量和癌症史也可能增加风险。尽管越来越多的公共卫生问题，目前西尼罗河病毒的治疗是不够的。目前的证据支持使用利巴韦林，干扰素α，和WNV特异性免疫球蛋白进行审查。核酸检测是一项重要的诊断技术，对于保护捐献的血液供应尤其重要。虽然有效的西尼罗河病毒疫苗可广泛用于马，但没有人用疫苗注册。西尼罗河病毒构成的未来风险大小存在不确定性，预测模型受到环境、病媒和宿主因素（即使是在邻近地区）异质性的限制。然而，最近的历史表明，在存在合适的蚊子媒介和储存宿主的地区，将有发生大流行病的风险。鉴于这些爆发可能包括严重的神经侵袭性疾病，应实施战略以监测和应对爆发风险。虽然大规模的蚊子控制计划将有助于减少蚊子种群的数量，从而降低疾病的风险，但对许多人来说，使用局部驱虫剂和其他个人保护策略仍将是抵御感染的第一道防线。
The resurgence of West Nile virus (WNV) in North America and Europe in recent years has raised the concerns of local authorities and highlighted that mosquito-borne disease is not restricted to tropical regions of the world. WNV is maintained in enzootic cycles involving, primarily, Culex spp. mosquitoes and avian hosts, with epizootic spread to mammals, including horses and humans. Human infection results in symptomatic illness in approximately one-fifth of cases and neuroinvasive disease in less than 1% of infected persons. The most consistently recognized risk factor for neuroinvasive disease is older age, although diabetes mellitus, alcohol excess, and a history of cancer may also increase risk. Despite the increasing public health concern, the current WNV treatments are inadequate. Current evidence supporting the use of ribavirin, interferon α, and WNV-specific immunoglobulin are reviewed. Nucleic acid detection has been an important diagnostic development, which is particularly important for the protection of the donated blood supply. While effective WNV vaccines are widely available for horses, no human vaccine has been registered. Uncertainty surrounds the magnitude of future risk posed by WNV, and predictive models are limited by the heterogeneity of environmental, vector, and host factors, even in neighboring regions. However, recent history has demonstrated that for regions where suitable mosquito vectors and reservoir hosts are present, there will be a risk of major epidemics. Given the potential for these outbreaks to include severe neuroinvasive disease, strategies should be implemented to monitor for, and respond to, outbreak risk. While broadscale mosquito control programs will assist in reducing the abundance of mosquito populations and subsequently reduce the risks of disease, for many individuals, the use of topical insect repellents and other personal protective strategies will remain the first line of defense against infection.