Volume 72, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In 2002, the world’s largest outbreak of neuroinvasive West Nile virus (WNV) disease occurred. Illinois reported 21% of the total cases in the United States, the most among all states. The epidemiology of WNV in Illinois in 2002 was examined to determine factors associated with severe disease and death. A total of 884 cases were identified and there were 66 deaths. The overall attack rate of WNV infection was 7.1 per 100,000 population and this increased with age. The median ages of patients and patients who died were 56 and 78 years, respectively. Among patients who died, 91% were diagnosed with encephalitis and the case-fatality rate for patients with encephalitis was 18.6%. Patients more than 50 years old had a significantly higher risk of being reported with encephalitis (relative risk [RR] = 3.3, 95% confidence interval [CI] = 2.6–4.3%) and death (RR = 22.3, 95% CI = 5.5–90.4%). Clinicians evaluating elderly patients with WNV infection should assess patients closely for progression of disease.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Creech W, 1977. St. Louis Encephalitis in the United States, 1975. J Infect Dis 185 : 1014–1016. [Google Scholar]
  2. Nash D, Mostashari F, Fine A, Miller J, O’Leary D, Murray K, Huang A, Rosenberg A, Greenberg A, Sherman M, Wong S, Layton M, 1999. West Nile Outbreak Response Working Group, 2001. The outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med 344 : 1807–1814. [Google Scholar]
  3. Martin DA, Muth DA, Brown T, Johnson AJ, Karabatsos N, Roehrig JT, 2000. Standardization of immunoglobulin M capture enzyme-linked immunosorbent assays for routine diagnosis of arboviral infections. J Clin Microbiol 38 : 1823–1826. [Google Scholar]
  4. Centers for Disease Control and Prevention, 2003. Arboviral Encephalitides. Fort Collins, CO: Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/dvbid/pubs/arbovirus-pubs.htm (date accessed October 21, 2003).
  5. United States Department of Commerce, 2000. United States Census. http://www.census.gov (date accessed October 21, 2003).
  6. Lanciotti RS, Kerst AJ, Nasci RS, Godsey MS, Mitchell CJ, Savage HM, Komar N, Panella NA, Allen BC, Volpe KE, Davis BS, Roehrig JT, 2000. Rapid detection West Nile virus from human clinical specimens, field-collected mosquitoes, and avian samples by TaqMan reverse transcriptase-PCR assay. J Clin Microbiol 38 : 4066–4071. [Google Scholar]
  7. Zweighaft RM, Rasmussen C, Brolnitsky O, Lashof JC, 1979. St. Louis encephalitis: The Chicago experience. Am J Trop Med Hyg 28 : 114–118. [Google Scholar]
  8. Pealer LN, Marfin AA, Petersen LR, Lanciotti RS, Page PL, Stramer SL, Stobierski MG, Signs K, Newman B, Kapoor H, Goodman JL, Chamberland ME, West Nile Virus Transmission Investigation Team, 2003. Transmission of West Nile virus through blood transfusion—United States, 2002. N Engl J Med 349 : 1236–1245. [Google Scholar]
  9. Centers for Disease Control and Prevention, 2002. Provisional surveillance summary of the West Nile virus epidemic—United States, January–November 2002. MMWR Morb Mortal Wkly Rep 51 : 1129–1133. [Google Scholar]
  10. McIntosh BM, Jupp PG, dos Santos I, Meenehan GM, 1976. Epidemics of West Nile and Sindbis viruses in South Africa with Culex (Culex) univittatus Theobald as vector. S Afr J Sci 72 : 296–300. [Google Scholar]
  11. Tsai TF, 1994. Factors in the changing epidemiology of Japanese encephalitis and West Nile fever. Tsai TF, ed. CRC Handbook Series in Zoonoses. Section B: Viral Zoonoses. Boca Raton, FL: CRC Press,.
  12. Mostashari F, Bunning ML, Kitsutani PT, Singer DA, Nash D, Cooper MJ, Katz N, Liljebjelke KA, Biggerstaff BJ, Fine AD, Layton MC, Mullin SM, Johnson AJ, Martin DA, Hayes EB, Campbell GL, 2001. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survery. Lancet 358 : 261–264. [Google Scholar]
  13. Centers for Disease Control and Prevention, 2001. Serosurveys for West Nile virus infection—New York and Connecticut Counties, 2000. MMWR Morb Mortal Wkly Rep 50 : 31–39. [Google Scholar]
  14. Campbell G, Marfin A, Lanciotti R, Gubler D, 2002. West Nile virus. Lancet Infect Dis 2 : 519–529. [Google Scholar]
  15. Chowers MY, Lang R, Nassar F, Ben-David D, Giladi M, Rubinshtein E, Itzhaki A, Mishal J, Siegman-Igra Y, Kitzes R, Pick N, Landau Z, Wolf D, Bin H, Mendelson E, Pitlik SD, Weinberger M, 2001. Clinical characteristics of the West Nile fever outbreak, Israel, 2000. Emerg Infect Dis 7 : 675–678. [Google Scholar]
  16. Peterson LR, Roehrig JT, 2001. West Nile virus: a reemerging global pathogen. Emerg Infect Dis 7 : 611–614. [Google Scholar]
  17. Watson JT, Pertel PE, Jones RC, Siston AM, Paul WS, Austin CA, Gerber SI, 2004. Clinical characteristics and functional outcomes of West Nile fever. Ann Intern Med 141 : 360–365. [Google Scholar]
  18. Sejvar JJ, Haddad MB, Tierney BC, Campbell GL, Marfin AA, van Gerpen JA, Fleischauer A, Leis AA, Stokic DS, Petersen LR, 2003. Neurologic manifestations and outcome of West Nile virus infection. JAMA 290 : 511–515. [Google Scholar]
  19. Tsai TF, Popovici F, Cernescu C, Campbell GL, Nedelcu NI, 1998. West Nile encephalitis epidemic in southeastern Romania. Lancet 352 : 767–771. [Google Scholar]
  20. Marberg K, Goldblum N, Sterk VV, Jasinska-Klingberg W, Klingberg MA, 1956. The natural history of West Nile fever. I. Clinical observations during an epidemic in Israel. Am J Hyg 64 : 259–269. [Google Scholar]
  21. Goldblum N, Sterk VM, Paderski B, 1954. The clinical features of the disease and the isolation of West Nile virus from the blood of nine human cases. Am J Hyg 59 : 89–103. [Google Scholar]
  22. Spigland I, Jasinska-Klinberg W, Hofshi E, Goldblum N, 1958. Clincial and laboratory observations in an outbreak of West Nile fever in Israel in 1957. Harefuah 54 : 275–281. [Google Scholar]
  23. Goldblum N, Sterk VM, Jasinka-Klingberg W, 1957. The natural history of West Nile fever. II. Virological findings and the development of homologous and heterologous antibodies in West Nile infections in man. Am J Hyg 66 : 363–380. [Google Scholar]
  24. Platonov AE, 2001. West Nile encephalitis in Russia 1999–2001: were we ready? Are we ready? Ann N Y Acad Sci 951 : 102–116. [Google Scholar]
  25. Weiss D, Carr D, Kellachan J, Tan C, Phillips M, Bresnitz E, Layton M, West Nile Virus Outbreak Response Working Group, 2001. Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000. Emerg Infect Dis 7 : 654–658. [Google Scholar]
  26. Ceausu E, Erscoiu S, Calistru P, Ispas D, Dorobat O, Homos M, Barbulescu C, Cojocaru I, Simion CV, Cristea C, Oprea C, Dumitrescu C, Duiculescu D, Marcu I, Mociornita C, Stoicev T, Zolotusca I, Calomfirescu C, Rusu R, Hodrea R, Geamai S, Paun L, 1997. Clinical manifestations in the West Nile virus outbreak. Rom J Virol 48 : 3–11. [Google Scholar]
  27. Komar N, Langevin S, Hinten S, Nemeth N, Edwards E, Hettler D, Davis B, Bowen R, Bunning M, 2003. Experimental infection of North American birds with the New York 1999 strain of West Nile virus. Emerg Infect Dis 9 : 311–322. [Google Scholar]
  28. Day JF, 2001. Predicting St. Louis encephalitis virus epidemics: lessons from recent, and not so recent, outbreaks. Annu Rev Entomol 46 : 111–138. [Google Scholar]
  29. Calisher CH, 2000. West Nile virus in the new world: appearance, persistence, and adaptation to a new econiche - an opportunity taken. Viral Immunol 13 : 411–414. [Google Scholar]
  30. Gubler DJ, Campbell GL, Nasci R, Komar N, Petersen L, Roehrig JT, 2000. West Nile virus in the United States: guidelines for detection, prevention, and control. Viral Immunol 13 : 469–475. [Google Scholar]
  31. Monath TP, 1980. Epidemiology. Monath TP, ed. St. Louis Encephalitis. Washington, DC: American Public Health Association, 239–312.
  32. Moore CG, McLean RG, Mitchell CJ, Nasci RS, Tsai TF, Calisher CH, Marfin AA, Moore PS, Gubler DJ, 1993. Guidelines for Arbovirus Surveillance Programs in the United States. Volume 18. Fort Collins, CO: Centers for Disease Control and Prevention.
  33. Ross HH, Horsfall WR, 1965. A synopsis of the mosquitoes of Illinois. Ill. Ill Nat Hist Surv Bull 52 : 1–50. [Google Scholar]
  34. Centers for Disease Controls and Prevention, 2003. West Nile Virus: Entomology. Atlanta, GA: Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/dvbid/westnile/mosquitoSpecies.htm.
  35. Lampman RL, Novak RJ, 1996. Oviposition preference of Culex pipiens and Culex restuans for infusion-baited traps. J Am Mosq Control Assoc 12 : 23–32. [Google Scholar]
  36. Illinois State Water Survey, 2002. Illinois State Climatologist Data. Champaign, IL: Illinois Department of Natural Resources.
  37. Nasci RS, Komar N, Marfin AA, Ludwig GV, Kramer LD, Daniels TJ, Falco RC, Campbell SR, Brookes K, Gottfried KL, Burkhalter KL, Aspen SE, Kerst AJ, Lanciotti RS, Moore CG, 2002. Detection of West Nile virus-infected mosquitoes and seropositive juvenile birds in the vicinity of virus-positive dead birds. Am J Trop Med Hyg 67 : 492–496. [Google Scholar]
  38. Graber JW, Graber RR, Kirk EL, 1987. Illinois Birds: Corvidae. Champaign, IL: Illinois Natural History Survey. Biological Notes 126.
  39. Peterson LR, Marfin AA, Gubler DJ, 2003. West Nile virus. JAMA 290 : 524–528. [Google Scholar]
  40. Fradin MS, Day JF, 2002. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med 347 : 13–18. [Google Scholar]

Data & Media loading...

  • Received : 01 May 2004
  • Accepted : 07 Oct 2004

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error