@article{cd0fe1a3bcb847778450c782926cefce,
title = "Human West Nile Virus Disease Outbreak in Pakistan, 2015–2016",
abstract = "Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological disease in human patients in this country. Of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 105 were positive for WNV IgM antibodies, and 71 of these patients possessed WNV-specific neutralizing antibodies. Cross-reactivity of WNV IgM antibodies with Japanese encephalitis virus (JEV) occurred in 75 of these 105 patients. WNV co-infections with Dengue viruses were not a contributing factor for the severity of disease. Nor did prior exposure to dengue virus contribute to incidence of neurological involvement in WNV-infected patients. Patients with WNV infections were more likely to present with altered mental status, seizures, and reduced Glasgow Coma scores when compared with JEV-infected patients. Human WNV cases and vector numbers exhibited a temporal correlation with climate.",
keywords = "Dengue virus, Japanese encephalitis virus, West Nile virus, arboviral disease, encephalitis",
author = "Erum Khan and Barr, {Kelli L.} and Farooqi, {Joveria Qais} and Dhani Prakoso and Alizeh Abbas and Khan, {Zain Yar} and Shanze Ashi and Kehkashan Imtiaz and Z. Aziz and Faisal Malik and Lednicky, {John A.} and Long, {Maureen T.}",
note = "Funding Information: Special thanks to Naeem Akhtar Assistant Meteorologist Pakistan Meteorological Department, University Road Karachi for sharing the metrological data. We are grateful to Ms. Sally Beachboard, who has spent many hours determining supply routes for private vendors and in negotiating costs of supplies for our work in both the United States and Pakistan. We are grateful for the taxonomic keys provided by the Navy Entomology Center of Excellence, Jacksonville, Florida. We thank WRCEVA for sharing isolates of DENV and JEV. Funding. This work was supported by the Defense Threat Reduction Agency, Basic Research Award HDTRA1-14-1-0022, to the University of Florida. The contents do not necessarily reflect the position or the policy of the federal government, and no official endorsement should be inferred. Funding Information: With the dissolution of the Pakistan Federal Ministry of Health in 2011, reporting and surveillance for arboviral diseases have become largely non-existent and, when performed, is highly localized and mostly funded by foreign granting agencies. Pakistan is at a continual risk of suffering large epidemics of vector-borne diseases for a variety of reasons. Geopolitical instability, annual flooding, and poor health care infrastructure lead to frequent internal human and animal displacement. Moreover, the construction of super highways and shipping ports for efficient travel between Africa and China has left Pakistan vulnerable to the introduction of foreign diseases. Pakistan has recently witnessed an increased burden of arboviral infections, primarily from Crimean-Congo hemorrhagic fever virus, WNV, Chikungunya virus (CHIKV), and Dengue viruses (DENVs) affecting the economic, social, and political aspects of people{\textquoteright}s lives (7, 20–22). More recently, active circulation of DENV, WNV, and CHIKV has been reported in humans living in the Punjab province of Pakistan (22). Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2018 Khan, Barr, Farooqi, Prakoso, Abbas, Khan, Ashi, Imtiaz, Aziz, Malik, Lednicky and Long.",
year = "2018",
month = feb,
day = "27",
doi = "10.3389/fpubh.2018.00020",
language = "English",
volume = "6",
journal = "Frontiers in Public Health",
issn = "2296-2565",
publisher = "Frontiers Media S.A.",
}
