West Nile Virus Infection in the Pediatric Population

BackgroundClinical syndromes associated with West Nile virus (WNV) infection range from fever to neuroinvasive disease. Understanding WNV epidemiology and disease history is important for guiding patient care and healthcare decision-making. The objective of this review was to characterize the existing body of peer-reviewed and surveillance literature on WNV syndromes and summarize epidemiologic and clinical parameters.MethodsWe followed scoping review methodology described by the Joanna Briggs Institute. Terms related to WNV epidemiology, hospitalization, and surveillance were searched in four bibliographic databases (MEDLINE, EMBASE, Scopus, and CINAHL) for literature published from January 1999 to December 2015.ResultsIn total, 2334 non-duplicated titles and abstracts were screened; 92 primary studies were included in the review. Publications included one randomized controlled trial and 91 observational studies. Sample sizes ranged from under 25 patients (n = 19) to over 400 patients (n = 28). Eight studies were from Canada, seven from Israel, and the remaining (n = 77) from the United States. N = 17 studies were classified as outbreak case investigations following epidemics; n = 37 with results of regional/national surveillance and monitoring programs.Mean patient ages were > 40 years old; three studies (3%) focused on the pediatric population. Patients with encephalitis fared worse than patients with meningitis and fever, considering hospitalization, length of stay, discharge, recovery, and case-fatality. Several studies examined risk factors; however, age was the only risk factor for neuroinvasive disease/death consistently identified. Overall, patients with acute flaccid paralysis or encephalitis fared worse than patients with meningitis and West Nile fever in terms of hospitalization and mortality. Among the included studies, proportion hospitalized, length of stay, proportion discharged home and case-fatality ranged considerably.ConclusionOur review highlights the heterogeneity among reporting clinical WNV syndromes and epidemiologic parameters of WNV-related illness. Presently, there is potential for further synthesis of the risk factors of WNV-illness and mortality; undertaking further analysis through a systematic review and meta-analysis may benefit our understanding of risk factors for emerging mosquito-borne diseases. Future research on the burden of WNV can build on existing evidence summarized in this review, not only to support our understanding of endemic WNV, but also to strengthen research on emerging arboviruses with similar clinical manifestations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2637-9) contains supplementary material, which is available to authorized users.

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“…Rings from outside in refer to: C. Rings from outside in refer to:1. Civen 2006 [63]1. Asnis 2000 [71]1.…”

Section: Resultsmentioning

confidence: 99%

“…Also, there was a lack of data on the pediatric population. Only three studies [36, 57, 63] have this focus and noted markedly lower mortality in children compared to adults [57]. The incidence of WNND is also lower in children, as they are likely to remain asymptomatic or have milder disease [57].…”

Section: Discussionmentioning

confidence: 99%

Epidemiologic and clinical parameters of West Nile virus infections in humans: a scoping review

et al. 2017

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“…24 In case reports from the United States, Canada, and Israel, the most common clinical findings among children with WNV disease have included fever, headache, stiff neck, altered mental status, fatigue, generalized weakness, myalgia, maculopapular rash, and gastrointestinal symptoms. 4,6,16 However, encephalitis mimicking herpes simplex virus infection, poliomyelitis-like syndrome, myocarditis, hepatitis, chorioretinitis, and vitreitis have also been described as complications of WNV infections among children. 3,9,13,15,17 Routine clinical laboratory tests are not generally of use in distinguishing WNV infection from other viral infections.…”

Section: Discussionmentioning

confidence: 97%

West Nile Virus Disease in Children, United States, 1999–2007

et al. 2009

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The epidemiological characteristics of WNV disease in children are similar to adult case subjects; however, WNND is more likely to manifest as meningitis in children than in older adults. WNV should be considered in the differential diagnosis for pediatric patients presenting with febrile illness, meningitis, encephalitis, or acute flaccid paralysis, particularly during seasonal outbreaks in endemic areas.

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“…Most children with symptomatic WNV infection present with WNF; of those who develop neuroinvasive disease, it most frequently manifests as meningitis [78,79,80]. However, severe and fatal encephalitis [81], poliomyelitis [82,83], rhombencephalitis [84] and hepatitis [85] have all been described in children with WNV infection.…”

Section: West Nile Virus Infection In Childrenmentioning

confidence: 99%

Clinical Manifestations and Outcomes of West Nile Virus Infection

Sejvar

2014

Viruses

204

177

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Since the emergence of West Nile virus (WNV) in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND) is manifested as meningitis, encephalitis or an acute anterior (polio) myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden.

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West Nile Virus Infection in the Pediatric Population

Cited by 35 publications

References 12 publications

Epidemiologic and clinical parameters of West Nile virus infections in humans: a scoping review

Epidemiologic and clinical parameters of West Nile virus infections in humans: a scoping review

West Nile Virus Disease in Children, United States, 1999–2007

Clinical Manifestations and Outcomes of West Nile Virus Infection

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