What You Need To Know
Key Points or Updates:
- CDC issued a health advisory on August 11th to notify clinicians about the risk of severe arboviral neuroinvasive disease among patients who are receiving B cell-depleting or B cell-modulating medications, particularly anti-CD20 monoclonal antibodies (mAbs). These medications are used for treating B cell malignancies, many autoimmune conditions, and transplant rejection. Among published case reports of arboviral neuroinvasive disease in patients on anti-CD20 mAbs, overall mortality was approximately 40%, and most survivors experienced long-term neurologic sequelae.
- Arboviruses that circulate in New Jersey include West Nile Virus, Eastern Equine Encephalitis, and Jamestown Canyon virus, all transmitted by mosquitoes, and Powassan virus, transmitted by ticks.
- There are no approved treatments, prophylactic agents, or human vaccines to prevent these arboviruses, so preventing mosquito and tick bites is critical.
- Because patients receiving these medications might not form antibodies against a new infection, diagnosis of arboviral infection often requires molecular rather than serologic testing. Molecular testing is available at some commercial laboratories and can be requested through NJDOH.
Action Items:
- Educate patients about the risk of severe arboviral disease and advise them to use personal protective measures to prevent mosquito and tick bites.
- If an arboviral infection is suspected in a patient receiving B cell-depleting mAbs, preferentially order molecular testing (i.e., RT-PCR or mNGS).
- To request public health testing, submit a complete Arboviral Testing Request worksheet via encrypted e-mail to CDSVectorTeam@doh.nj.gov.
Contact Information:
- CDS Vector-borne Disease Team, CDSVectorTeam@doh.nj.gov