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Prognosis for West Nile Virus not as good as reported.
Submit responseIn the August issue of Annals of Internal Medicine, Dr, Mark Loeb, et al. produced an elegant study, “Prognosis after West Nile Virus Infection”. The conclusion suggests that everyone with West Nile Virus, even the neuroinvasive type, will completely recover within one year. The results of this study have received widespread media attention. Unfortunately, the conclusion is not supported by the data and is misleading. This misleading conclusion is detrimental to our public health efforts to educate the public about the dangers of West Nile Virus and about why they should try to prevent getting mosquito bites.
As a survivor of West Nile Virus neuroinvasive disease, I run a support group for West Nile Virus victims in Dallas, Texas. Obviously, a support group represents a self-selected group of patients who have not had a good outcome. Nevertheless, we have many members who have lingering problems of extreme fatigue, cognitive delay, persistent muscle weakness from polio-like paralysis, balance problems, and/or muscle pain, even after two to four years. In this self-selected cohort of patients, it is certainly not true that everyone returned to normal within 12 months.
In Dr. Loeb’s cohort of patients it is also not true that everyone returned to normal in 12 months. He specifically excluded the seven patients who died before enrollment (a 1.9% mortality rate), the three patients who died between 30 days and 24 months, and the seven patients with acute flaccid paralysis (4% of the cohort). One patient was excluded at day 30 because the patient was on a ventilator, which is the hallmark of the severest form of West Nile Virus.
A better conclusion from the data would be that most people recover from West Nile Virus and that those who are going to recover completely do so within one year.
Dr. Loeb’s research into West Nile Virus is a critical step forward in our understanding of the short term outcome from the disease. More work is needed in looking at the long term outcomes.
Conflict of Interest:
None declared