What You Need To Know
Key Points or Updates:
(1) We are starting to see a seasonally expected increase in West Nile virus (WNV) activity with detections in mosquitoes in several parts of the state. There are no reported human WNV cases this year, but they are generally reported starting in mid-late July and often extend through early fall.
(2) Locally acquired arboviruses of concern in NJ include WNV, Eastern equine encephalitis (EEE), and Jamestown Canyon virus (JCV), transmitted by mosquitoes; and Powassan virus (POWV), transmitted by ticks. Heartland and Bourbon viruses have been detected in ticks in NJ, but no human cases have been reported.
(3) For most people, WNV and other arboviruses cause asymptomatic infection or a mild to moderate febrile illness. Older adults, persons with certain chronic medical conditions, or those with weakened immune systems are at greater risk of developing severe illness, which can present as encephalitis, meningitis, or acute flaccid paralysis, and can result in death or survival with long-lasting neurological sequelae. Medical care is supportive.
(4) Healthcare providers should be alert for potential cases of WNV and other arboviral diseases throughout the summer and fall months and consider testing for specific arboviruses. While testing for WNV is available at many commercial laboratories, testing for other arboviruses is primarily performed at public health laboratories.
(5) IgM antibody testing is recommended to detect acute infection for most arboviruses in immunocompetent persons, but molecular testing, in addition to IgM antibody testing, should be considered for immunosuppressed patients. IgM antibodies can persist in some patients for an extended period and clinical correlation is required. Single specimen IgG antibody tests should not be used as they cannot distinguish between acute and prior infection.
(6) CDS requests that serum (and CSF if available) specimens be sent to the NJDOH Public Health and Environmental Laboratories (PHEL) for patients who are hospitalized with neuroinvasive disease (e.g., encephalitis, meningitis, acute flaccid paralysis) of unknown etiology or for patients presenting with a febrile illness of unknown etiology if an arboviral disease is suspected. Specimens will be tested using the PHEL arboviral panel (WNV, EEE, JCV, POWV) with additional testing, if indicated, performed at CDC (e.g., Heartland and Bourbon).
Action Items:
(1) Healthcare providers:
a. Consider mosquito and tickborne arboviruses in patients presenting with neuroinvasive disease (e.g., encephalitis, meningitis, acute flaccid paralysis) of unknown etiology or with a febrile illness of unknown etiology if an arboviral disease is suspected.
b. Submit specimens to NJDOH for arboviral panel testing, particularly for viruses where commercial testing is unavailable (e.g., POWV, EEE, JCV). Review online instructions for requesting arboviral testing or contact CDSVectorTeam@doh.nj.gov to discuss testing needs. Specialized vector-borne disease testing at PHEL or CDC requires CDS review/pre approval.
c. Review the NJ Vector-borne Disease dashboard to monitor the burden of vector-borne diseases in NJ residents, as well as what pathogens mosquitoes and ticks have tested positive for in NJ. Weekly reports that provide a snapshot of vector-borne disease activity are posted online from May-November, are sent via LINCS, and can be sent via email upon