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Front. Public Health | doi: 10.3389/fpubh.2018.00020

Human West Nile Virus Disease Outbreak in Pakistan 2015-2016

 Erum Khan1,  Kelli L. Barr2*,  Joveria Q. Farooqi1,  Dhani Prakoso2, Alizae Zain1, Shanze Ashi1, Kehkashan Imtiaz1, Faisal Malik1, Z Aziz1,  John A. Lednicky3 and  Maureen T. Long2
  • 1Department of Pathology and Laboratory Medicine, Aga Khan University, Pakistan
  • 2Department of Comparative Diagnostic and Population Medicine, University of Florida, United States
  • 3Environmental and Global Health, University of Florida, United States

: 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 the cause 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. Out 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 with 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: West Nile virus, Dengue Virus, Japanese encephalitis virus, Encephalitis, Arboviral disease

Received: 20 Nov 2017; Accepted: 22 Jan 2018.

Edited by:

Nicola Petrosillo, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (IRCCS), Italy

Reviewed by:

Lorenzo Zammarchi, Università degli Studi di Firenze, Italy
Evandro R. Winkelmann, Columbia University, United States  

Copyright: © 2018 Khan, Barr, Farooqi, Prakoso, Zain, Ashi, Imtiaz, Malik, Aziz, Lednicky and Long. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Kelli L. Barr, University of Florida, Department of Comparative Diagnostic and Population Medicine, 2015 SW 16th Avenue, Gainesville, 32608, Florida, United States,