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Abstract
Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses 2 lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei ticks and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), whereas the deer tick virus (DTV) lineage is believed to be maintained between Ixodes scapularis ticks and the white-footed mouse (Peromyscus leucopus). We report 14 cases of Powassan encephalitis from New York during 2004-2012. Ten (72%) of the patients were residents of the Lower Hudson Valley, a Lyme disease-endemic area in which I. scapularis ticks account for most human tick bites. This finding suggests that many of these cases were caused by DTV rather than POWV. In 2 patients, DTV infection was confirmed by genetic sequencing. As molecular testing becomes increasingly available, more cases of Powassan encephalitis may be determined to be attributable to the DTV lineage.
Highlights
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases
Ten (72%) case-patients were from Westchester, Putnam, or Dutchess Counties, which are located in the Lower Hudson Valley (LHV), a highly Lyme disease–endemic region
9 cases of Powassan virus (POWV)/deer tick virus (DTV) infections were reported in New York before 2004 [19,20,22], none of those cases occurred in patients from the LHV (Figure 1)
Summary
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. LLC is accredited by the ACCME to provide continuing medical education for physicians. All other clinicians completing this activity will be issued a certificate of participation To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; [4] view/print certificate. Disclosure: Shannon O’Connor has disclosed no relevant financial relationships. MD, has disclosed no relevant financial relationships
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