Volume 83, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Prognosis varies among persons with West Nile virus (WNV) infection, but the most important factors associated with persistent symptoms are not clear. In this cross-sectional study, 265 persons with symptomatic WNV infection during 2006–2008 completed a survey a mean of 7.7 months after diagnosis. We determined the association of demographic and clinical characteristics to the most common symptoms. Of 214 persons infected ≥ 6 months, 53% reported one or more persistent symptoms, including fatigue, muscle aches, decreased activity, difficulty with memory, and difficulty concentrating. Persons with neuroinvasive disease, hypertension, or diabetes were significantly more likely to report persistent symptoms, whereas age, sex, and time since infection were not associated with persistent symptoms. In conclusion, persistent symptoms persisted in most persons for more than six months after symptomatic WNV infection. Improved strategies for prevention and treatment are needed.


Article metrics loading...

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

Full text loading...



  1. Campbell GL, Marfin AA, Lanciotti RS, Gubler DJ, , 2002. West Nile virus. Lancet Infect Dis 2: 519529.[Crossref] [Google Scholar]
  2. Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Epidemic/Epizootic West Nile Virus in the United States: Guidelines for Surveillance, Prevention and Control. Available at: http://www.cdc.gov/ncidod/dvbid/westnile/resources/wnv-guidelines-aug-2003.pdf. Accessed March 28, 2010. [Google Scholar]
  3. 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 survey. Lancet 358: 261264.[Crossref] [Google Scholar]
  4. Berner YN, Lang R, Chowers MY, , 2002. Outcome of West Nile fever in older adults. J Am Geriatr Soc 50: 18441846.[Crossref] [Google Scholar]
  5. 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: 511515.[Crossref] [Google Scholar]
  6. Klee AL, Maidin B, Edwin B, Poshni I, Mostashari F, Fine A, Layton M, Nash D, , 2004. Long-term prognosis for clinical West Nile virus infection. Emerg Infect Dis 10: 14051411.[Crossref] [Google Scholar]
  7. Watson JT, Pertel PE, Jones RC, Siston AM, Paul WS, Austin CC, Gerber SI, , 2004. Clinical characteristics and functional outcomes of West Nile fever. Ann Intern Med 141: 360365.[Crossref] [Google Scholar]
  8. Gottfried K, Quinn R, Jones T, , 2005. Clinical description and follow-up investigation of human West Nile virus cases. South Med J 98: 603606.[Crossref] [Google Scholar]
  9. Ou AC, Ratard RC, , 2005. One-year sequelae in patients with West Nile virus encephalitis and meningitis in Louisiana. J La State Med Soc 157: 4246. [Google Scholar]
  10. Carson PJ, Konewko P, Wold KS, Mariani P, Goli S, Bergloff P, Crosby RD, , 2006. Long-term clinical and neuropsychological outcomes of West Nile virus infection. Clin Infect Dis 43: 723730.[Crossref] [Google Scholar]
  11. Patnaik JL, Harmon H, Vogt RL, , 2006. Follow-up of 2003 human West Nile virus infections, Denver, Colorado. Emerg Infect Dis 12: 11291131.[Crossref] [Google Scholar]
  12. Sejvar JJ, , 2007. The long-term outcomes of human West Nile virus infection. Clin Infect Dis 44: 16171624.[Crossref] [Google Scholar]
  13. Loeb M, Hanna S, Nicolle L, Eyles J, Elliott S, Rathbone M, Drebot M, Neupane B, Fearon M, Mahony J, , 2008. Prognosis after West Nile virus infection. Ann Intern Med 149: 232241.[Crossref] [Google Scholar]
  14. Murray KO, Resnick M, Miller V, , 2007. Depression after infection with West Nile virus. Emerg Infect Dis 13: 479481.[Crossref] [Google Scholar]
  15. Centers for Disease Control and Prevention, 2007. West Nile virus activity—United States, 2006. MMWR Morb Mortal Wkly Rep 56: 556559. [Google Scholar]
  16. McMurtrey CP, Lelic A, Piazza P, Chakrabarti AK, Yablonsky EJ, Wahl A, Bardet W, Eckerd A, Cook RL, Hess R, Buchli R, Loeb M, Rinaldo CR, Bramson J, Hildebrand WH, , 2008. Epitope discovery in West Nile virus infection: identification and immune recognition of viral epitopes. Proc Natl Acad Sci USA 105: 29812986.[Crossref] [Google Scholar]
  17. Custer B, Kamel H, Kiely NE, Murphy EL, Busch MP, , 2009. Associations between West Nile virus infection and symptoms reported by blood donors identified through nucleic acid test screening. Transfusion 49: 278288.[Crossref] [Google Scholar]
  18. Middleton J, Lee BE, Fox JD, Tilley PA, Robinson JL, , 2008. Comparison between the clinical and laboratory features of enterovirus and West Nile virus infections. J Med Virol 80: 12521259.[Crossref] [Google Scholar]
  19. Murphy TD, Grandpre J, Novick SL, Seys SA, Harris RW, Musgrave K, , 2005. West Nile virus infection among health-fair participants, Wyoming 2003: assessment of symptoms and risk factors. Vector Borne Zoonotic Dis 5: 246251.[Crossref] [Google Scholar]
  20. Orton SL, Stramer SL, Dodd RY, , 2006. Self-reported symptoms associated with West Nile virus infection in RNA-positive blood donors. Transfusion 46: 272277.[Crossref] [Google Scholar]
  21. Haaland KY, Sadek J, Pergam S, Echevarria LA, Davis LE, Goade D, Harnar J, Nofchissey RA, Sewel CM, Ettestad P, , 2006. Mental status after West Nile virus infection. Emerg Infect Dis 12: 12601262.[Crossref] [Google Scholar]
  22. Murray KO, Koers E, Baraniuk S, Herrington E, Carter H, Sierra M, Kilborn C, Arafat R, , 2009. Risk factors for encephalitis from West Nile virus: a matched case-control study using hospitalized controls. Zoonoses Public Health 56: 370375.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 01 Dec 2009
  • Accepted : 07 Jul 2010
  • Published online : 05 Nov 2010

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