{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T22:14:52Z","timestamp":1783116892306,"version":"3.54.6"},"reference-count":57,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,5,1]]},"abstract":"<jats:p>West Nile virus (WNV) infection recently became a major public health concern in the western hemisphere. This article describes recent information regarding previously unrecognized mechanisms of WNV transmission and reviews clinical manifestations of WNV infection, diagnostic tests, and prevention strategies from a pediatric perspective. WNV is transmitted to humans primarily through the bite of infected mosquitoes, but during the epidemic that spread across North America in 2002, transmission of WNV through blood transfusions and organ transplantation was described for the first time. Individual case reports indicate that WNV can be transmitted also in utero and probably through breast milk. Although most WNV infections are asymptomatic, the virus causes a broad range of manifestations from uncomplicated febrile illness to meningitis, neuropathies, paralysis, and encephalitis. Severe manifestations of WNV infection are far more common in adults than in children, but 105 cases of neuroinvasive WNV disease were reported among children in the United States in 2002. The distribution of the virus in North America continues to spread. WNV infection can be diagnosed by detecting WNV-specific antibody in cerebrospinal fluid or serum, or by detecting the virus or viral nucleic acid in cerebrospinal fluid, blood, or tissues. Cornerstones of prevention include personal protection against mosquitoes, including wearing insect repellent, reducing populations of vector mosquitoes, and screening the blood supply for WNV-contaminated blood donations.<\/jats:p>","DOI":"10.1542\/peds.113.5.1375","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:53:04Z","timestamp":1092444784000},"page":"1375-1381","source":"Crossref","is-referenced-by-count":119,"title":["West Nile Virus Infection: A Pediatric Perspective"],"prefix":"10.1542","volume":"113","author":[{"given":"Edward B.","family":"Hayes","sequence":"first","affiliation":[{"name":"Arbovirus Disease Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Arbovirus Disease Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2004,5,1]]},"reference":[{"key":"2021121010051281600_R1","doi-asserted-by":"crossref","unstructured":"Smithburn KC, Hughes TP, Burke AW, Paul JH. A neurotropic virus isolated from the blood of a native of Uganda. Am J Trop Med.\u20081940;20:471\u2013492","DOI":"10.4269\/ajtmh.1940.s1-20.471"},{"key":"2021121010051281600_R2","doi-asserted-by":"crossref","unstructured":"Hayes CG. West Nile fever. In: Monath TP, ed. The Arboviruses: Epidemiology and Ecology. Vol. 5. Boca Raton, FL: CRC Press; 1989:59\u201388","DOI":"10.1201\/9780429289200-3"},{"key":"2021121010051281600_R3","unstructured":"Spigland I, Jasinska-Klingberg W, Hofshi E, Goldblum N. Clinical and laboratory observations in an outbreak of West Nile fever in Israel in 1957. Harefuah.\u20081958;54:275\u2013281"},{"key":"2021121010051281600_R4","unstructured":"Carey DE, Rodrigues FM, Myers RM, Webb JK. Arthropod-borne viral infections in children in Vellore, South India, with particular reference to dengue and West Nile viruses. Indian Pediatr.\u20081968;5:285\u2013296"},{"key":"2021121010051281600_R5","unstructured":"George S, Gourie-Devi M, Rao JA, Prasad SR, Pavri KM. Isolation of West Nile virus from the brains of children who had died of encephalitis. Bull World Health Organ.\u20081984;62:879\u2013882"},{"key":"2021121010051281600_R6","doi-asserted-by":"crossref","unstructured":"Tsai TF, Popovici F, Cernescu C, Campbell GL, Nedelcu NI, for the Investigative Team. West Nile encephalitis epidemic in southeastern Romania. Lancet.\u20081998;352:767\u2013771","DOI":"10.1016\/S0140-6736(98)03538-7"},{"key":"2021121010051281600_R7","doi-asserted-by":"crossref","unstructured":"Platonov AE, Shipulin GA, Shipulina OY, et al. Outbreak of West Nile virus infection, Volgograd Region, Russia, 1999. Emerg Infect Dis.\u20082001;7:128\u2013132","DOI":"10.3201\/eid0701.010118"},{"key":"2021121010051281600_R8","doi-asserted-by":"crossref","unstructured":"Chowers MY, Lang R, Nassar F, et al. Clinical characteristics of the West Nile fever outbreak, Israel, 2000. Emerg Infect Dis.\u20082001;7:675\u2013678","DOI":"10.3201\/eid0704.017414"},{"key":"2021121010051281600_R9","doi-asserted-by":"crossref","unstructured":"Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med.\u20082001;344:1807\u20131814","DOI":"10.1056\/NEJM200106143442401"},{"key":"2021121010051281600_R10","doi-asserted-by":"crossref","unstructured":"Mostashari F, Bunning ML, Kitsutani PT, et al. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet.\u20082001;358:261\u2013264","DOI":"10.1016\/S0140-6736(01)05480-0"},{"key":"2021121010051281600_R11","doi-asserted-by":"crossref","unstructured":"O'Leary DR, Marfin AA, Montgomery SP, et al. The epidemic of West Nile virus in the United States, 2002. Vector Borne Zoonotic Dis. 2004;4:61\u201370","DOI":"10.1089\/153036604773083004"},{"key":"2021121010051281600_R12","doi-asserted-by":"crossref","unstructured":"Iwamoto M, Jernigan DB, Guasch A, et al. Transmission of West Nile virus from an organ donor to four transplant recipients. N Engl J Med.\u20082003;348:2196\u20132203","DOI":"10.1056\/NEJMoa022987"},{"key":"2021121010051281600_R13","doi-asserted-by":"crossref","unstructured":"Harrington T, Kuehnert MJ, Kamel H, et al. West Nile virus infection transmitted by blood transfusion. Transfusion.\u20082003;43:1018\u20131022","DOI":"10.1046\/j.1537-2995.2003.00481.x"},{"key":"2021121010051281600_R14","doi-asserted-by":"crossref","unstructured":"Pealer LN, Marfin AA, Petersen LR, et al. Transmission of West Nile virus through blood transfusion in the United States in 2002. N Engl J Med.\u20082003;349:1236\u20131245","DOI":"10.1056\/NEJMoa030969"},{"key":"2021121010051281600_R15","unstructured":"Centers for Disease Control and Prevention. Intrauterine West Nile virus infection\u2014New York, 2002. MMWR Morb Mortal Wkly Rep.\u20082002;51:1135\u20131136"},{"key":"2021121010051281600_R16","unstructured":"Centers for Disease Control and Prevention. Possible West Nile virus transmission to an infant through breast-feeding\u2014Michigan, 2002. MMWR Morb Mortal Wkly Rep.\u20082002;51:877\u2013878"},{"key":"2021121010051281600_R17","doi-asserted-by":"crossref","unstructured":"Alpert SG, Fergerson J, Noel LP. Intrauterine West Nile virus: ocular and systemic findings. Am J Ophthalmol.\u20082003;136:733\u2013735","DOI":"10.1016\/S0002-9394(03)00452-5"},{"key":"2021121010051281600_R18","doi-asserted-by":"crossref","unstructured":"Chapa JB, Ahn JT, DiGiovanni LM, Ismail MA. West Nile virus encephalitis during pregnancy. Obstet Gynecol.\u20082003;102:229\u2013231","DOI":"10.1097\/00006250-200308000-00006"},{"key":"2021121010051281600_R19","doi-asserted-by":"crossref","unstructured":"Brinton MA. The molecular biology of West Nile virus: a new invader of the western hemisphere. Annu Rev Microbiol.\u20082002;56:371\u2013402","DOI":"10.1146\/annurev.micro.56.012302.160654"},{"key":"2021121010051281600_R20","doi-asserted-by":"crossref","unstructured":"Lanciotti RS, Ebel GD, Deubel V, et al. Complete genome sequences and phylogenetic analysis of West Nile virus strains isolated from the United States, Europe, and the Middle East. Virology.\u20082002;298:96\u2013105","DOI":"10.1006\/viro.2002.1449"},{"key":"2021121010051281600_R21","doi-asserted-by":"crossref","unstructured":"Lanciotti RS, Roehrig JT, Deubel V, et al. Origin of the West Nile virus responsible for an outbreak of encephalitis in the northeastern United States. Science.\u20081999;286:2333\u20132337","DOI":"10.1126\/science.286.5448.2333"},{"key":"2021121010051281600_R22","doi-asserted-by":"crossref","unstructured":"Komar N. West Nile virus: epidemiology and ecology in North America. Adv Virus Res.\u20082003;61:185\u2013234","DOI":"10.1016\/S0065-3527(03)61005-5"},{"key":"2021121010051281600_R23","doi-asserted-by":"crossref","unstructured":"Diamond MS. Evasion of innate and adaptive immunity by flaviviruses. Immunol Cell Biol.\u20082003;81:196\u2013206","DOI":"10.1046\/j.1440-1711.2003.01157.x"},{"key":"2021121010051281600_R24","doi-asserted-by":"crossref","unstructured":"Solomon T, Vaughn DW. Pathogenesis and clinical features of Japanese encephalitis and West Nile virus infections. Curr Top Microbiol Immunol.\u20082002;267:171\u2013194","DOI":"10.1007\/978-3-642-59403-8_9"},{"key":"2021121010051281600_R25","doi-asserted-by":"crossref","unstructured":"Goldblum N, Sterk VM, Jasisnka-Klingberg W. The natural history of West Nile fever. II. Virological findings and the development of homologous and heterologous antibodies in West Nile infections in man. Am J Hyg.\u20081957;66:363\u2013380","DOI":"10.1093\/oxfordjournals.aje.a119908"},{"key":"2021121010051281600_R26","doi-asserted-by":"crossref","unstructured":"Shieh WJ, Guarner J, Layton M, et al. The role of pathology in an investigation of an outbreak of West Nile encephalitis in New York, 1999. Emerg Infect Dis.\u20082000;6:370\u2013372","DOI":"10.3201\/eid0604.000407"},{"key":"2021121010051281600_R27","doi-asserted-by":"crossref","unstructured":"Sampson BA, Armbrustmacher V. West Nile encephalitis: the neuropathology of four fatalities. Ann N Y Acad Sci.\u20082001;951:172\u2013178","DOI":"10.1111\/j.1749-6632.2001.tb02695.x"},{"key":"2021121010051281600_R28","doi-asserted-by":"crossref","unstructured":"Campbell GL, Marfin AA, Lanciotti RS, Gubler DJ. West Nile virus. Lancet Infect Dis.\u20082002;2:519\u2013529","DOI":"10.1016\/S1473-3099(02)00368-7"},{"key":"2021121010051281600_R29","doi-asserted-by":"crossref","unstructured":"Asnis DS, Conetta R, Teixeira AA, Waldman G, Sampson BA. The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. Clin Infect Dis.\u20082000;30:413\u2013418","DOI":"10.1086\/313737"},{"key":"2021121010051281600_R30","doi-asserted-by":"crossref","unstructured":"Weiss D, Carr D, Kellachan J, et al. Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000. Emerg Infect Dis.\u20082001;7:654\u2013658","DOI":"10.3201\/eid0704.017409"},{"key":"2021121010051281600_R31","unstructured":"Pepperell C, Rau N, Krajden S, et al. West Nile virus infection in 2002: morbidity and mortality among patients admitted to hospital in southcentral Ontario. Can Med Assoc J.\u20082003;168:1399\u20131405"},{"key":"2021121010051281600_R32","doi-asserted-by":"crossref","unstructured":"Hubalek Z, Halouzka J, Juricova Z. West Nile fever in Czechland. Emerg Infect Dis.\u20081999;5:594\u2013595","DOI":"10.3201\/eid0504.990430"},{"key":"2021121010051281600_R33","doi-asserted-by":"crossref","unstructured":"Petersen LR, Marfin AA, Gubler DJ. West Nile virus. JAMA.\u20082003;290:524\u2013528","DOI":"10.1001\/jama.290.4.524"},{"key":"2021121010051281600_R34","doi-asserted-by":"crossref","unstructured":"Sejvar JJ, Haddad MB, Tierney BC, et al. Neurologic manifestations and outcome of West Nile virus infection. JAMA.\u20082003;290:511\u2013515","DOI":"10.1001\/jama.290.4.511"},{"key":"2021121010051281600_R35","doi-asserted-by":"crossref","unstructured":"Petersen LR, Marfin AA. West Nile virus: a primer for the clinician. Ann Intern Med.\u20082002;137:173\u2013179","DOI":"10.7326\/0003-4819-137-3-200208060-00009"},{"key":"2021121010051281600_R36","doi-asserted-by":"crossref","unstructured":"Li J, Loeb JA, Shy ME, et al. Asymmetric flaccid paralysis: a neuromuscular presentation of West Nile virus infection. Ann Neurol.\u20082003;53:703\u2013710","DOI":"10.1002\/ana.10575"},{"key":"2021121010051281600_R37","doi-asserted-by":"crossref","unstructured":"Sejvar JJ, Leis AA, Stokic DS, et al. Acute flaccid paralysis and West Nile virus infection. Emerg Infect Dis.\u20082003;9:788\u2013793","DOI":"10.3201\/eid0907.030129"},{"key":"2021121010051281600_R38","doi-asserted-by":"crossref","unstructured":"Roehrig JT, Nash D, Maldin B, et al. Persistence of virus-reactive serum immunoglobulin M antibody in confirmed West Nile virus encephalitis cases. Emerg Infect Dis.\u20082003;9:376\u2013379","DOI":"10.3201\/eid0903.020531"},{"key":"2021121010051281600_R39","unstructured":"Prober CG. Central nervous system infections. In: Bergman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, PA: Saunders; 2003:2038\u20132047"},{"key":"2021121010051281600_R40","doi-asserted-by":"crossref","unstructured":"Jordan I, Briese T, Fischer N, Lau JY, Lipkin WI. Ribavirin inhibits West Nile virus replication and cytopathic effect in neural cells. J Infect Dis.\u20082000;182:1214\u20131217","DOI":"10.1086\/315847"},{"key":"2021121010051281600_R41","doi-asserted-by":"crossref","unstructured":"Anderson JF, Rahal JJ. Efficacy of interferon alpha-2b and ribavirin against West Nile virus in vitro. Emerg Infect Dis.\u20082002;8:107\u2013108","DOI":"10.3201\/eid0801.010252"},{"key":"2021121010051281600_R42","doi-asserted-by":"crossref","unstructured":"Spiegel R, Miron D, Gavriel H, Horovitz Y. West Nile virus meningoencephalitis complicated by motor aphasia in Hodgkin's lymphoma. Arch Dis Child.\u20082002;86:441\u2013442","DOI":"10.1136\/adc.86.6.441"},{"key":"2021121010051281600_R43","doi-asserted-by":"crossref","unstructured":"Ben-Nathan D, Lustig S, Tam G, Robinzon S, Segal S, Rager-Zisman B. Prophylactic and therapeutic efficacy of human intravenous immunoglobulin in treating West Nile virus infection in mice. J Infect Dis.\u20082003;188:5\u201312","DOI":"10.1086\/376870"},{"key":"2021121010051281600_R44","doi-asserted-by":"crossref","unstructured":"Shimoni Z, Niven MJ, Pitlick S, Bulvik S. Treatment of West Nile virus encephalitis with intravenous immunoglobulin. Emerg Infect Dis.\u20082001;7:759","DOI":"10.3201\/eid0704.017432"},{"key":"2021121010051281600_R45","doi-asserted-by":"crossref","unstructured":"Hamdan A, Green P, Mendelson E, Kramer MR, Pitlik S, Weinberger M. Possible benefit of intravenous immunoglobulin therapy in a lung transplant recipient with West Nile virus encephalitis. Transpl Infect Dis.4:160\u2013162","DOI":"10.1034\/j.1399-3062.2002.01014.x"},{"key":"2021121010051281600_R46","doi-asserted-by":"crossref","unstructured":"Agrawal AG, Petersen LR. Human immunoglobulin as a treatment for West Nile virus infection. J Infect Dis.\u20082003;188:1\u20134","DOI":"10.1086\/376871"},{"key":"2021121010051281600_R47","unstructured":"Centers for Disease Control and Prevention. Guidelines for surveillance, prevention, and control of West Nile virus infection\u2014United States. MMWR Morb Mortal Wkly Rep.\u20082000;49:25\u201328"},{"key":"2021121010051281600_R48","doi-asserted-by":"crossref","unstructured":"Fradin MS, Day JF. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med.\u20082002;347:13\u201318","DOI":"10.1056\/NEJMoa011699"},{"key":"2021121010051281600_R49","unstructured":"Koren G, Matsui D, Bailey B. DEET-based insect repellents: safety implications for children and pregnant and lactating women. Can Med Assoc J.\u20082003;169:209\u2013212"},{"key":"2021121010051281600_R50","doi-asserted-by":"crossref","unstructured":"Bell JW, Veltri JC, Page BC. Human exposure to N,N-diethyl-m-toluamide insect repellents reported to the American Association of Poison Control Centers 1993\u20131997. Int J Toxicol.\u20082002;21:341\u2013352","DOI":"10.1080\/10915810290096559"},{"key":"2021121010051281600_R51","unstructured":"American Academy of Pediatrics. Follow safety precautions when using DEET on children. Available at: www.aap.org\/family\/wnv-jun03.htm. Accessed March 12, 2004"},{"key":"2021121010051281600_R52","unstructured":"Canadian Pediatric Society. Insect repellents for children. Available at: www.caringforkids.cps.ca\/keepingkidssafe\/repellents.htm. Accessed March 12, 2004"},{"key":"2021121010051281600_R53","unstructured":"Centers for Disease Control and Prevention. Update: Detection of West Nile virus in blood donations\u2014United States, 2003. MMWR Morb Mortal Wkly Rep.\u20082003;52:916\u2013919"},{"key":"2021121010051281600_R54","doi-asserted-by":"crossref","unstructured":"Tesh RB, Arroyo J, Travassos Da Rosa AP, Guzman H, Xiao SY, Monath TP. Efficacy of killed virus vaccine, live attenuated chimeric virus vaccine, and passive immunization for prevention of West Nile virus encephalitis in hamster model. Emerg Infect Dis.\u20082002;8:1392\u20131397","DOI":"10.3201\/eid0812.020229"},{"key":"2021121010051281600_R55","doi-asserted-by":"crossref","unstructured":"Pletnev AG, Claire MSt, Elkins R, Speicher J, Murphy BR, Chanock RM. Molecularly engineered live-attenuated chimeric West Nile\/dengue virus vaccines protect rhesus monkeys from West Nile virus. Virology.\u20082003;314:190\u2013195","DOI":"10.1016\/S0042-6822(03)00450-1"},{"key":"2021121010051281600_R56","doi-asserted-by":"crossref","unstructured":"Chang GJ, Davis BS, Hunt AR, Holmes DA, Kuno G. Flavivirus DNA vaccines: current status and potential. Ann N Y Acad Sci.\u20082001;951:272\u2013285","DOI":"10.1111\/j.1749-6632.2001.tb02703.x"},{"key":"2021121010051281600_R57","doi-asserted-by":"crossref","unstructured":"Hall RA, Nisbet DJ, Pham KB, Pyke AT, Smith GA, Khromykh AA. DNA vaccine coding for the full-length infectious Kunjin virus RNA protects mice against the New York strain of West Nile virus. Proc Natl Acad Sci USA.\u20082003;100:10460\u201310464","DOI":"10.1073\/pnas.1834270100"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/5\/1375\/1003676\/zpe00504001375.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/113\/5\/1375\/1003676\/zpe00504001375.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T22:22:33Z","timestamp":1639174953000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/113\/5\/1375\/66664\/West-Nile-Virus-Infection-A-Pediatric-Perspective"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,5,1]]},"references-count":57,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2004,5,1]]},"published-print":{"date-parts":[[2004,5,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.113.5.1375","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,5,1]]}}}