The outbreak of West Nile virus infection in the New York City area in 1999.
The outbreak of West Nile virus infection in the New York City area in 1999.
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DOI：
10.1056/nejm200106143442401
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发表时间：
2001-06-14
影响因子：
158.5
通讯作者：
Smith, P
中科院分区：
文献类型：
--
作者：
Nash, D;Mostashari, F;Smith, P
背景资料：1999年8月下旬，纽约市卫生部收到了一批与肌肉无力有关的脑膜脑炎病例。初步的流行病学和环境调查表明，虫媒病毒cause.Methods：实施主动监测，以确定住院的病毒性脑炎和脑膜炎患者。脑脊液，血清和组织标本从疑似病例患者进行血清学和病毒检测的证据arboviral infection.Results：暴发监测确定了59例西尼罗河病毒感染住院病人在纽约市地区在1999年8月和9月。这些患者的中位年龄为71岁（范围：5 - 90岁）。临床西尼罗河病毒感染的总体发病率至少为每百万人口6.5例，并随年龄增长而急剧增加。大多数患者（63%）有脑炎的临床症状; 7名患者死亡（12%）。27%的患者出现肌无力，10%的患者出现弛缓性麻痹;在所有后者中，神经传导研究表明是轴突性多发性神经病。年龄在75岁或以上是死亡的独立危险因素（经有无糖尿病校正的相对危险度为8.5; 95%可信区间为1.2 ~ 59.1），糖尿病的存在也是如此。（年龄调整的相对危险度为5.1; 95%可信区间为1.5 ~ 17.3）。这次在纽约市大都会地区爆发的西尼罗河脑膜脑炎是西半球首次发现这种病毒。考虑到病毒随后的快速传播，美国东海岸沿着医生在夏季的脑炎和病毒性脑膜炎的鉴别诊断中应考虑西尼罗河病毒感染，特别是在老年患者和肌肉无力的患者中。（新英格兰医学杂志2001;344：1807-14。）版权所有（C）2001马萨诸塞州医学会。
Background: In late August 1999, an unusual cluster of cases of meningoencephalitis associated with muscle weakness was reported to the New York City Department of Health. The initial epidemiologic and environmental investigations suggested an arboviral cause.Methods: Active surveillance was implemented to identify patients hospitalized with viral encephalitis and meningitis. Cerebrospinal fluid, serum, and tissue specimens from patients with suspected cases underwent serologic and viral testing for evidence of arboviral infection.Results: Outbreak surveillance identified 59 patients who were hospitalized with West Nile virus infection in the New York City area during August and September of 1999. The median age of these patients was 71 years (range, 5 to 90). The overall attack rate of clinical West Nile virus infection was at least 6.5 cases per million population, and it increased sharply with age. Most of the patients (63 percent) had clinical signs of encephalitis; seven patients died (12 percent). Muscle weakness was documented in 27 percent of the patients and flaccid paralysis in 10 percent; in all of the latter, nerve conduction studies indicated an axonal polyneuropathy. An age of 75 years or older was an independent risk factor for death (relative risk adjusted for the presence or absence of diabetes mellitus, 8.5; 95 percent confidence interval, 1.2 to 59.1), as was the presence of diabetes mellitus (age-adjusted relative risk, 5.1; 95 percent confidence interval, 1.5 to 17.3).Conclusions: This outbreak of West Nile meningoencephalitis in the New York City metropolitan area represents the first time this virus has been detected in the Western Hemisphere. Given the subsequent rapid spread of the virus, physicians along the eastern seaboard of the United States should consider West Nile virus infection in the differential diagnosis of encephalitis and viral meningitis during the summer months, especially in older patients and in those with muscle weakness. (N Engl J Med 2001;344:1807-14.) Copyright (C) 2001 Massachusetts Medical Society.