Abstract
In 2010, 47 human cases of West Nile virus (WNV)infection, including 12 laboratory-confirmed and 35 probable cases, were identified in Turkey. These were the first cases detected during routine surveillance.The patients were from 15 provinces, mainly located in the western part of the country. Incidence was 0.19/100,000 with a maximum of 1.39 in Sakarya province.Forty of the total 47 cases showed neuroinvasive manifestation. Median age was 58 years with a range of four to 86. Ten of the patients died. Enhanced surveillance in humans and animals and mosquito control measures were implemented. The WNV infections were included in the national notifiable diseases list as of April 2011. In 2011, three probable and two confirmed cases of WNV infection were diagnosed in provinces where infections had been detected in the previous year, supporting a lower activity than 2010. However,detection of WNV infections in humans in 2010 and 2011 consecutively, may indicate that WNV has become endemic in the western part of Turkey. Field epidemiological studies were undertaken to understand more about the nature of infection in Turkey.
Highlights
On 12 August 2010, the Manisa Provincial Health Directorate and the Ministry of Health in Turkey were informed about an increase in the number of hospitalised patients with encephalitis-like symptoms of unknown etiology
This study describes the human West Nile virus (WNV) infection cases identified in Turkey between July 2010 and December 2011
Acute and convalescence period serum samples were collected from all suspected cases upon the first day of hospitalisation, within 8 to 14 days and at 21 days after the onset of illness to be tested by enzyme-linked immunosorbent assay (ELISA) and IFA to find IgG and IgM antibodies against WNV, and by plaque-reduction neutralisation test (PRNT) to detect specific neutralising antibodies
Summary
On 12 August 2010, the Manisa Provincial Health Directorate and the Ministry of Health in Turkey were informed about an increase in the number of hospitalised patients with encephalitis-like symptoms of unknown etiology. A preliminary case definition based on the clinical picture, and a case management algorithm were immediately set up by a Scientific Commission at national level, consisting of experts from universities and from the Ministry of Health (MOH), and sent to provincial health facilities. According to the case management algorithm, the blood and cerebrospinal fluid (CSF) samples of suspected cases were sent to national reference laboratories, Refik Saydam. Of 12 suspected cases from Manisa province, three tested positive for WNV infection by serology and neutralisation, while another showed a WNV-specific antibody response in a serum sample. These were the first acute human WNV infection cases documented in Turkey. Neuroinvasive cases were probably diagnosed as ‘viral meningitis’ and not investigated further
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