St. Louis Encephalitis Virus Disease in the United States, 2003–2017

Emily J. Curren Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado;
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia

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Nicole P. Lindsey Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado;

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Marc Fischer Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado;

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Susan L. Hills Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado;

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St. Louis encephalitis virus (SLEV), an arthropod-borne flavivirus, can cause disease presentations ranging from mild febrile illness through severe encephalitis. We reviewed U.S. national SLEV surveillance data for 2003 through 2017, including human disease cases and nonhuman infections. Over the 15-year period, 198 counties from 33 states and the District of Columbia reported SLEV activity; 94 (47%) of those counties reported SLEV activity only in nonhuman species. A total of 193 human cases of SLEV disease were reported, including 148 cases of neuroinvasive disease. A median of 10 cases were reported per year. The national average annual incidence of reported neuroinvasive disease cases was 0.03 per million. States with the highest average annual incidence of reported neuroinvasive disease cases were Arkansas, Arizona, and Mississippi. No large outbreaks occurred during the reporting period. The most commonly reported clinical syndromes were encephalitis (N = 116, 60%), febrile illness (N = 35, 18%), and meningitis (N = 25, 13%). Median age of cases was 57 years (range 2–89 years). The case fatality rate was 6% (11/193) and all deaths were among patients aged > 45 years with neuroinvasive disease. Nonhuman surveillance data indicated wider SLEV activity in California, Nevada, and Florida than the human data alone suggested. Prevention depends on community efforts to reduce mosquito populations and personal protective measures to decrease exposure to mosquitoes.

Author Notes

Address correspondence to Susan L. Hills, Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 3156 Rampart Rd., Fort Collins, CO 80521. E-mail: shills@cdc.gov

Authors’ addresses: Emily J. Curren, Nicole P. Lindsey, Marc Fischer, and Susan L. Hills, Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, E-mails: ecurren@cdc.gov, nplindsey@cdc.gov, mfischer@cdc.gov, and shills@cdc.gov.

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