Evaluating Associations Between Drought and West Nile Virus Epidemics: A Systematic Review

Human West Nile virus (WNV) infections can have severe neurological health effects, especially among those over 50 years of age. As changes in weather patterns lead to more frequent and intense droughts, there is a public health need for improved understanding of drought associated WNV risks. While multiple studies have reported an association between drought conditions and human WNV cases, this information has not yet been synthesized systematically across studies. Our review aims to evaluate the existing evidence of an association between drought and human WNV cases while considering the impacts of different study regions, methodological approaches, drought metrics, and WNV case definitions. We conducted a systematic literature search of peer-reviewed epidemiological studies that examined a potential association between drought and human WNV cases. Our inclusion criteria targeted studies that employed measures of drought beyond precipitation and reported effect estimates along with measures of error. The literature search and screening process resulted in the inclusion of nine papers with study periods spanning from 1999 to 2018. The included peer-reviewed publications employed a wide variety of study designs and methods, such as linear mixed-effects models, generalized linear models using simultaneous autoregression, generalized additive models, Bayesian model averaging, and a case-crossover design using conditional logistic regression models. We summarize the key findings and provide study quality evaluations for each of the nine included studies. Studies that analyzed drought indices averaged over a seasonal period of three to four months reported positive associations between drought and WNV. However, studies that analyzed drought indicator variables averaged over weekly periods of time had less consistent results. We discuss potential mechanisms underlying the observed associations between drought and human WNV cases.