Feasible Risk of West Nile Virus in the British Isles
West Nile virus (WNV) has previously been identified as a vector-borne pathogen of concern to UK public and veterinary health. The presence of WNV in the UK has not been recorded, despite surveillance in humans, horses, and wild birds, but serological studies of resident and migratory birds have reported virus-specific neutralizing antibodies to WNV, Usutu virus (USUV) and Sindbis viruses (SINV). Transmission of the virus to humans and horses is reliant upon competent bridge vectors transmitting the virus from an enzootic bird-mosquito-bird cycle to bird-mosquito-human/horse transmission, where humans and horses are dead-end hosts. Thirty four species of mosquito have been recorded in the British Isles, nine of which have been implicated in WNV transmission elsewhere.
West Nile virus (WNV) transmitted by mosquitoes (Diptera: Culicidae) infects various vertebrates, being pathogenic for birds, horses and humans. After its discovery in tropical Africa, sporadic outbreaks of WNV occurred during recent decades in Eurasia, but not the British Isles. WNV reached New York in 1999 and spread to California by 2003, causing widespread outbreaks of West Nile encephalitis across North America, transmitted by many species of mosquitoes, mainly Culex spp. The periodic reappearance of WNV in parts of continental Europe (from southern France to Romania) gives rise to concern over the possibility of WNV invading the British Isles. The British Isles have about 30 endemic mosquito species, several with seasonal abundance and other eco-behavioural characteristics predisposing them to serve as potential WNV bridge vectors from birds to humans.
So far there is no proof of any arbovirus transmission by mosquitoes in the British Isles, although antibodies to Sindbis, Tahyna, Usutu and West Nile viruses have been detected in British birds. Neighbouring European countries have enzootic WNV and human infections transmitted by mosquito species that are present in the British Isles. However, except for localized urban infestations of Cx. pipiens biotype molestus that can be readily eliminated, there appear to be few situations in the British Isles where humans and livestock are exposed to sustained risks of exposure to potential WNV vectors. Monitoring of mosquitoes and arbovirus surveillance are required to guard the British Isles against WNV outbreaks and introduction of more anthropophilic mosquitoes such as Stegomyia albopicta (Skuse) and Ochlerotatus japonicus (Theobald) that have recently invaded Europe, since they transmit arboviruses elsewhere.
Diagnosis and treatment
WNV can usually be diagnosed with a blood test. If meningitis is suspected, a sample of cerebrospinal fluid (the fluid surrounding your brain and spinal cord) will be removed during a lumbar puncture and tested.
There is no specific treatment for the infection. If your symptoms are mild, they will usually get better without treatment in a few days and you won’t normally experience any long-term side effects.
If your symptoms are more severe, you will need to go to hospital. Treatment may include intravenous fluids (given through a drip in your arm), medication to control seizures, and help with breathing.
Even with treatment, severe WNV can lead to long-term problems such as fatigue (extreme tiredness), muscle weakness and memory problems.
As there is no specific treatment or vaccine for WNV, it’s best to avoid being bitten by mosquitoes when visiting affected areas. The mosquitoes that carry WNV are most active around dusk and dawn.
You should follow the advice below while you are away:
- Wear loose-fitting, long-sleeved tops and long trousers that cover up your skin as much as possible.
- Use an insect repellent on exposed skin, taking care to avoid your eyes. Repellents containing 50% diethyltoluamide (DEET) are thought to be the most effective.
- Insect-proof screens on windows and doors and mosquito nets impregnated with insecticide over the bed will reduce mosquito bites inside. Air conditioning in the room may also help.
- Avoid areas where there are likely to be large numbers of mosquitoes, such as near stagnant pools of water.
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