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West Nile encephalitis epidemic in southeastern Romania
T F Tsai1, F Popovici, C Cernescu
1Division of Vectorborne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80522, USA.
Lancet (London, England)
|September 16, 1998
Summary
The 1996 West Nile fever epidemic in Romania, primarily affecting older adults, highlighted increased regional transmission. This mosquito-borne flavivirus outbreak in Europe underscores potential risks for other cities.
Area of Science:
- Epidemiology
- Virology
- Public Health
Background:
- West Nile fever (WNF) is a mosquito-borne flavivirus infection endemic in Africa and Asia.
- The first major WNF epidemic in Europe occurred in Romania in 1996, characterized by a high rate of neurological infections.
- Investigation aimed to characterize transmission patterns and determine the origin of this novel European epidemic.
Purpose of the Study:
- To investigate the 1996 West Nile fever epidemic in Romania.
- To characterize transmission patterns of West Nile virus (WNV) in a European setting.
- To determine the origin of the WNF outbreak.
Main Methods:
- Hospital-based surveillance for acute aseptic meningitis and encephalitis in 40 Romanian districts.
- Serological confirmation of WNF infection using IgM capture and indirect IgG ELISAs.
- Outpatient surveys for seroprevalence and entomological/ornithological sampling for WNV detection.
Main Results:
- 393 patients with confirmed or probable WNF infection identified; 352 had acute central-nervous-system infections.
- Fatality and incidence increased with age; 17 deaths in patients over 50.
- Outbreak confined to 14 districts and Bucharest; WN virus isolated from Culex pipiens mosquitoes; 41% seropositivity in domestic fowl.
Conclusions:
- The Bucharest epidemic reflected increased regional WNF transmission in 1996.
- Culex pipiens mosquitoes were identified as the likely vector.
- Potential for future WNF epidemics in other European cities with suitable transmission conditions.