West Nile Virus: An Emerging Threat in Transplant Population

Abstract

West Nile virus (WNV) has become one of the new challenges for transplant programs. In addition to transmission by mosquito bite, interhuman transmission is possible through blood products or organ transplantation. Majority of WNV infections present as asymptomatic or mild febrile illness, with less than 1% of infected developing neuroinvasive disease. Many studies report naturally acquired or donor-derived WNV infections in solid-organ transplant recipients, mainly kidney, but also liver, heart, lungs and pancreas. Given the much higher risk of neuroinvasive disease (40% and even higher) based on serologic and clinical studies and increased mortality in transplant population, WNV infection should be considered in all patients presented with fever and neurological symptoms after transplantation, especially during the arbovirus transmission season.

Prevention of infection and optimizing vaccination in the solid organ transplant candidate and recipient

“…Cardiac transplantation should be avoided in the setting of a seropositive donor but kidney and liver donors can be considered with the recipient's informed consent and preemptive monitoring with treatment if disease develops [32 & ,44]. Lastly, West Nile Virus (WNV) has been documented to cause transmission via SOT [45,46]. Thus, testing of all living donors with WNV NAT close to the time of transplant and avoiding donors with confirmed WNV or unexplained encephalitis is recommended [47].…”

“…Lastly, West Nile Virus (WNV) has been documented to cause transmission via SOT [45,46]. Thus, testing of all living donors with WNV NAT close to the time of transplant and avoiding donors with confirmed WNV or unexplained encephalitis is recommended [47].…”

Additive Compendium Map of Outbreak Risk Determinants of West Nile Virus in Europe at NUTS3

“…The endemic potential of WNV is not to be underestimated: seropositivity is reportedly as high as 90% in the sub-Saharan regions where WNV has long been endemic 4 . Reports of human-to-human transmission routes – via blood transfusion 5 , organ transplants 6 , aerosol 7,8 , birthing and breast feeding 9 , and possibly even sexual contact 10 - have added to the concern 11,12 . Response options are limited to symptomatic treatment and no human vaccine is available 10 .…”

Emerging Trends in the West Nile Virus Epidemiology in Croatia in the ‘One Health’ Context, 2011–2020

“…Although the majority of human WNV infections are asymptomatic (80%) or present as a self-limited febrile disease (WNV fever; 20%), some patients develop neuroinvasive infection (WNV neuroinvasive disease-WNND; meningitis, encephalitis, poliomyelitis) [18]. Risk factors associated with developing WNND include older age, a history of organ transplantation and possibly other immunosuppressive conditions [19,20]. Mortality in patients with WNND is 10% and the case-fatality ratio increases considerably with increasing age [21].…”