Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Dr. Elizabeth Eustis Turf


Objective: The purpose of this investigation was to describe the long-term effects and functional outcomes of patients in Virginia who were reported to the Virginia Department of Health with West Nile virus (WNV) non-neuroinvasive and neuroinvasive disease. The study identified the duration of symptoms after initial illness, the number of persons who fully recovered versus the number who continue to be symptomatic and how patients' quality of life differed after illness.Methods: The study population was drawn from 60 human cases that met the surveillance case definition for non-neuroinvasive and neuroinvasive WNV illness in Virginia between 2002-2004. Information was collected during personal interviews using a standard questionnaire. The questionnaire included questions on demographics, clinical signs and symptoms, existing medical conditions and the respondents' personal assessment of health. Statistical analysis were used to compare pre and post illness symptoms, respondents vs. non-respondents, and non-neuroinvasive respondents vs. neuroinvasive respondents. Results: Thirty-four patients were enrolled in the study. Five (14.7%) respondents had non-neuroinvasive disease and 29 (85.2%) had neuroinvasive disease. Thirty respondents (88.2%) reported being hospitalized. Respondents with non-neuroinvasive disease spent a median of 3.5 (range, 0-7) days in the hospital and were unable to resume normal activities for a median of 17 (range, 7-365) days. Respondents with neuroinvasive disease spent a median of 7.5 (range, 0-82) days in the hospital and were unable to resume normal activities for a median of 127.50 days (range, 0-1023). Two (40%) of the respondents that suffer from non-neuroinvasive illness were unable to resume normal activities for at least 90 days. Fifteen (51.7%) respondents with neuroinvasive disease were unable to resume normal activities for at least 90 days. At the time of the interview, 20% of respondents with non-neuroinvasive disease reported fatigue, tremors, arthralgia, paralysis and memory problems. Respondents with neuroinvasive disease reported fatigue (58.5%), weakness (51.7%), myalgias (37.9%), confusion (41.4%), and memory loss (55.2%). Conclusion: WNV illness, including non-neuroinvasive illness, may be more serious and prolonged than generally thought. Neuroinvasive disease resulted in long-term morbidity and non-neuroinvasive disease resulted in work absenteeism and extended recovery periods. The mortality rates and potential long-term effects associated with non-neuroinvasive and neuroinvasive illness emphasizes the importance of continuing to develop effective methods of targeting preventive education to high-risk populations while continuing to pursue longer-term solutions such as vaccines to prevent emerging infection. Further research is needed to document the long-term effects of WNV, especially in areas with a high number of WNV human cases with more non-neuroinvasive patients. WNV is an emerging infectious disease with a wide clinical spectrum and variable long-term effects; thus a public health concern.


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Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Epidemiology Commons