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15 October 2007

Volume 45, Number 8
Clinical Infectious Diseases 2007;45:1039–1046
1058-4838/2007/4508-0018$15.00
DOI: 10.1086/521911
EMERGING INFECTIONS INVITED ARTICLE

The Continuing Spread of West Nile Virus in the Western Hemisphere

Duane J. Gubler

Asia‐Pacific Institute of Tropical Medicine and Infectious Diseases and Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, Honolulu, Hawaii

West Nile virus (WNV) has historically been considered to be among the least virulent of the Japanese serogroup viruses of the family Flaviviridae, genus Flavivirus. However, recent epidemics associated with severe and fatal neuroinvasive disease have changed that perception. The emergence of a virus subtype with greater epidemic potential and virulence in the early 1990s facilitated the geographic expansion and westward spread of WNV; in 1999, it first appeared in the western hemisphere. Because of the broad host and vector range, the virus has become established in much of the region, and there is little chance that it will be eliminated. Transmission is difficult to predict and even more difficult to prevent and control. The cost‐effectiveness of human WNV vaccines is uncertain. The building of laboratory diagnostic, epidemiologic, and vector‐control capacity in WNV‐enzootic countries is critical to the development of effective prevention and control strategies for WNV infection, as well as for other potential emerging vectorborne viral diseases.

Received 3 May 2007; accepted 21 June 2007; electronically published 14 September 2007.

Reprints or correspondence: Dr. Duane J. Gubler, Dept. of Tropical Medicine and Medical Microbiology, John A. Burns School of Medicine, 651 Ilalo St., BSB 3rd Fl., Honolulu, HI 96813 ()

James M. Hughes and Mary E. Wilson, Section Editors

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