Деякі арбовірусні енцефаліти

Virus	Distribution	Mortality Rate	Comments
Chikungunya virus	Florida, Puerto Rico, the U. S. Virgin Islands Common in Africa, India, Guam, Southeast Asia, New Guinea, China, Mexico, Central America Reunion Islands, limited areas of Europe	< 1% overall, but in patients > 60, there is increased risk of death for 3 months after symptom onset, including deaths from cerebrovascular diseases, ischemic heart diseases, and diabetes*	Should be considered in US travelers who develop encephalitis after visiting endemic areas Can lead to severe encephalitis and even death, especially in infants and people > 65
Colorado tick fever virus	Western United States and Canada in areas that are 4,000 to 10,000 ft above sea level	Rarely causes death	Causes a nonspecific febrile illness, rarely complicated by meningitis or encephalitis
Japanese encephalitis virus	Asia and the western Pacific; uncommon in the United States (mainly in travelers returning from endemic areas)	< 1% overall, but up to 30% of severe cases†	Affects mainly children Usually mild and self-limiting, but severe in about 1 in 250 cases Vaccine used in endemic areas and recommended for travelers to these areas
La Crosse virus (California virus)	Primarily in the north central United States but geographically widespread	Probably < 1% ‡	Is probably underrecognized Accounts for most cases of arbovirus encephalitis in children
St. Louis encephalitis virus	Mostly in urban areas of the central and southeastern United States but also in western states	—	Occurs in periodic urban epidemics; otherwise sporadic and rare
Powassan virus	Primarily in the northeastern states and the Great Lakes region of the United States Southeastern Canada and Russia (southeastern Siberia, northeast of Vladivostok)	About 10 to 15%§	Although rare, appears to be increasing since 2007; occurs in the late spring to mid-fall, when ticks are most active Should be considered in patients with encephalitis, especially those with a history of tick bite, a lot of time spent outdoors, and/or residence in or recent travel to an endemic area
Tick-borne encephalitis virus	Northern Asia, Russia, and many parts of Europe	Usually 1–2% but varies based on subtype (0.5–35%)¶	Occurs from early spring to late summer when ticks are most active Highest incidence and most severe symptoms in people ≥ 50 years Should be suspected in travelers who have a nonspecific febrile illness that progresses to neuroinvasive disease within 4 weeks after arriving from an endemic area and who may have been exposed to ticks
Venezuelan equine encephalitis	Mainly in parts in South and Central America; only rarely in the United States (mainly in travelers returning from endemic areas)	0–1%^[a], primarily in children	Vaccine available for equines; investigational vaccine used in laboratory workers at risk
West Nile virus	Throughout the continental United States and other parts of North America Africa, Europe, the Middle East, and West Asia	About 9% of patients with involvement of the central nervous system (CNS)^[b]	As of 2017, spread from the East Coast, where it first appeared in 1999, to all of the western states
Eastern equine encephalitis virus	Eastern United States; a few cases in the Great Lakes states	About 50‒70%^[c]	Occurs as small epidemics every 10‒20 years, mainly among young children and people > 55
Western equine encephalitis virus	—	—	For unknown reasons, has largely disappeared from the United States since 1988
Zika virus	Florida South America, Central America, Caribbean Islands, Pacific Islands, Cape Verde (a nation of islands off the northwest coast of Africa), Southeast Asia	—	There have been no cases of local transmission of Zika virus in the continental United States since 2018 (^[d]ref) May cause a dengue-like illness and has been implicated in causing Guillain-Barré syndrome, severe brain damage, and microcephaly in infants of infected mothers
* Cerqueira-Silva T, Pescarini JM, Cardim CL, et al: Risk of death following chikungunya virus disease in the 100 million Brazilian cohort, 2015–18: A matched cohort study and self-controlled case series. Lancet Infectious Diseases 25(5):504-513, 2024. † LaBeaud AD, Bashir F, King CH: Measuring the burden of arboviral diseases: The spectrum of morbidity and mortality from four prevalent infections. Population Health Metrics 9:1, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024945/pdf/1478-7954-9-1.pdf ‡ Vahey GV, Lindsey NP, Staples JE, et al:: La Crosse virus disease in the United States, 2003–2019. Am J Trop Med Hyg 105(3):807-812, 2021. doi: 10.4269/ajtmh.21-0294 §Centers for Disease Control and Prevention: Powassan virus. Historic data (2004–2023). Accessed July 5, 2024. ¶ Hills SL, Poehling KA, Chen WH, et al: Tick-borne encephalitis vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recommen Rep 72(5):1-29, 2023. ^[a]Centers for Disease Control and Prevention: Venezuelan equine encephalitis—Colombia, 1995. MMWR 44(39):721-724, 1995 ^[b] Fagre AC, Lyons S, Staples JE, et al: West Nile virus and other nationally notifiable arboviral diseases—United States, 2021. MMWR 72(34):901-906, 2023. ^[c]Centers for Disease Control and Prevention: Eastern Equine Encephalitis Virus. Accessed July 5, 2024. ^[d]Zika Cases in the United States. Centers for Disease Control and Prevention. Accessed May 31, 2024.

Virus

Distribution

Mortality Rate

Comments

Florida, Puerto Rico, the U. S. Virgin Islands

Common in Africa, India, Guam, Southeast Asia, New Guinea, China, Mexico, Central America Reunion Islands, limited areas of Europe

< 1% overall, but in patients > 60, there is increased risk of death for 3 months after symptom onset, including deaths from cerebrovascular diseases, ischemic heart diseases, and diabetes*

Should be considered in US travelers who develop encephalitis after visiting endemic areas

Can lead to severe encephalitis and even death, especially in infants and people > 65

Colorado tick fever virus

Western United States and Canada in areas that are 4,000 to 10,000 ft above sea level

Rarely causes death

Causes a nonspecific febrile illness, rarely complicated by meningitis or encephalitis

Japanese encephalitis virus

Asia and the western Pacific; uncommon in the United States (mainly in travelers returning from endemic areas)

< 1% overall, but up to 30% of severe cases†

Affects mainly children

Usually mild and self-limiting, but severe in about 1 in 250 cases

Vaccine used in endemic areas and recommended for travelers to these areas

La Crosse virus (California virus)

Primarily in the north central United States but geographically widespread

Probably < 1% ‡

Is probably underrecognized

Accounts for most cases of arbovirus encephalitis in children

St. Louis encephalitis virus

Mostly in urban areas of the central and southeastern United States but also in western states

—

Occurs in periodic urban epidemics; otherwise sporadic and rare

Powassan virus

Primarily in the northeastern states and the Great Lakes region of the United States

Southeastern Canada and Russia (southeastern Siberia, northeast of Vladivostok)

About 10 to 15%§

Although rare, appears to be increasing since 2007; occurs in the late spring to mid-fall, when ticks are most active

Should be considered in patients with encephalitis, especially those with a history of tick bite, a lot of time spent outdoors, and/or residence in or recent travel to an endemic area

Tick-borne encephalitis virus

Northern Asia, Russia, and many parts of Europe

Usually 1–2% but varies based on subtype (0.5–35%)¶

Occurs from early spring to late summer when ticks are most active

Highest incidence and most severe symptoms in people ≥ 50 years

Should be suspected in travelers who have a nonspecific febrile illness that progresses to neuroinvasive disease within 4 weeks after arriving from an endemic area and who may have been exposed to ticks

Venezuelan equine encephalitis

Mainly in parts in South and Central America; only rarely in the United States (mainly in travelers returning from endemic areas)

0–1%^[a], primarily in children

Vaccine available for equines; investigational vaccine used in laboratory workers at risk

West Nile virus

Throughout the continental United States and other parts of North America

Africa, Europe, the Middle East, and West Asia

About 9% of patients with involvement of the central nervous system (CNS)^[b]

As of 2017, spread from the East Coast, where it first appeared in 1999, to all of the western states

Eastern equine encephalitis virus

Eastern United States; a few cases in the Great Lakes states

About 50‒70%^[c]

Occurs as small epidemics every 10‒20 years, mainly among young children and people > 55

Western equine encephalitis virus

—

For unknown reasons, has largely disappeared from the United States since 1988

Zika virus

Florida

South America, Central America, Caribbean Islands, Pacific Islands, Cape Verde (a nation of islands off the northwest coast of Africa), Southeast Asia

—

There have been no cases of local transmission of Zika virus in the continental United States since 2018 (^[d]ref)

May cause a dengue-like illness and has been implicated in causing Guillain-Barré syndrome, severe brain damage, and microcephaly in infants of infected mothers

* Cerqueira-Silva T, Pescarini JM, Cardim CL, et al: Risk of death following chikungunya virus disease in the 100 million Brazilian cohort, 2015–18: A matched cohort study and self-controlled case series. Lancet Infectious Diseases 25(5):504-513, 2024.

† LaBeaud AD, Bashir F, King CH: Measuring the burden of arboviral diseases: The spectrum of morbidity and mortality from four prevalent infections. Population Health Metrics 9:1, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024945/pdf/1478-7954-9-1.pdf

‡ Vahey GV, Lindsey NP, Staples JE, et al:: La Crosse virus disease in the United States, 2003–2019. Am J Trop Med Hyg 105(3):807-812, 2021. doi: 10.4269/ajtmh.21-0294

§Centers for Disease Control and Prevention: Powassan virus. Historic data (2004–2023). Accessed July 5, 2024.

¶ Hills SL, Poehling KA, Chen WH, et al: Tick-borne encephalitis vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recommen Rep 72(5):1-29, 2023.

^[a]Centers for Disease Control and Prevention: Venezuelan equine encephalitis—Colombia, 1995. MMWR 44(39):721-724, 1995

^[b] Fagre AC, Lyons S, Staples JE, et al: West Nile virus and other nationally notifiable arboviral diseases—United States, 2021. MMWR 72(34):901-906, 2023.

^[c]Centers for Disease Control and Prevention: Eastern Equine Encephalitis Virus. Accessed July 5, 2024.

^[d]Zika Cases in the United States. Centers for Disease Control and Prevention. Accessed May 31, 2024.

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