How West Nile Virus Infections Are Treated

The treatment of a West Nile virus infection depends on the severity of the illness it causes. It can cause a range of clinical syndromes, from a mild flu-like illness (or no symptoms at all) to life-threatening neurological disease with meningitis or encephalitis

Explore what's usually recommended in both scenarios, as well as tips for prevention and more.

Mild West Nile Infections

People who develop a mild case of West Nile fever usually experience some combination of fever, muscle aches, headaches, weakness and fatigue, sore throat, and possibly gastrointestinal problems.

These people usually diagnose themselves with a “bad summer cold,” and treat themselves in the standard ways with rest, fluids, and analgesics. Doctors are not commonly involved, and people with mild West Nile illness most often recover fully within a few days.

Serious West Nile Infections

Unfortunately, West Nile virus can also cause a much more severe illness, especially if it invades the central nervous system and causes meningitis or encephalitis. People with this form of the infection can experience very high fever, paralysis, confusion, seizures, coma, ​and death. Aggressive treatment in a person with a severe West Nile virus infection is mandatory.

The treatment of people with serious West Nile virus infections is largely supportive. That is, aggressive measures are taken to bring down the fever, keep up hydration levels, and maintain metabolic and cardiovascular stability—while waiting for the body’s immune responses to finally clear the infection. Such measures may require treatment in an intensive care unit, perhaps for weeks or longer.

Antiviral medications

Antiviral therapy has not been shown in clinical trials to be of measurable benefit to people with serious West Nile virus infections. However, several of these treatments have been attempted, and there are some anecdotal reports of benefit.

Antiviral agents that have been tried include:

  • Ribavarin: The benefits of this drug against West Nile virus are largely theoretical—it has not even been shown to work in animal models. In one uncontrolled clinical trial during a West Nile outbreak in Israel, the drug was found to be ineffective.
  • Intravenous immunoglobulin: Here again, the potential benefit with intravenous immunoglobulin (IVIG) is theoretical. Making antibodies (immunoglobulin) against West Nile virus is thought to be a chief mechanism by which humans get rid of the virus, so giving IVIG which contains high levels of anti-West Nile antibodies “ought” to work. Unfortunately, the only randomized clinical trial that was conducted to test the effect of IVIG for West Nile virus failed to demonstrate a benefit.
  • Interferon. Interferon seems to be effective against West Nile virus when it is tested in certain animal models. But only a few scattered reports of benefit in patients treated with interferon have been reported; other reports have suggested interferon may be detrimental.

    Given this experience with antiviral medication, we can only say that this approach has not been particularly promising. So supportive care remains the mainstay of treatment for West Nile virus infections.

    Prevention

    The best “treatment” for West Nile virus is prevention. Measures for preventing West Nile virus infections include:

    • Mosquito control programs. Mosquito control programs can be used to eliminate obvious mosquito breeding sites, and larvicidal agents can be sprayed to kill mosquito larvae before they become adults. Such public health measures, when applied strategically, have been shown to substantially limit the incidence of West Nile infection in some communities.
    • Personal protection measures. You should keep your property clear of stagnant pools or puddles that can become breeding grounds for mosquitoes. While outdoors, especially during dusk or dawn when mosquitos tend to be the most active, you should apply insect repellant, and keep as much of your skin covered as possible.
    • Blood donor screening programs. In most developed countries, donated blood products are tested for the presence of West Nile virus before they are transfused. This precaution is thought to have substantially reduced the risk of acquiring West Nile virus from blood transfusions (and that risk was quite low in the first place).

    Vaccination

    Very active efforts are under way to develop vaccines against West Nile virus. In fact, several vaccines already have been licensed for horses (which can also become quite ill with West Nile virus). However, gaining approval for human use, with this or any other medical treatment, is a far more rigorous and time-consuming process than for animals.

    Still, several human vaccines against West Nile virus are currently being tested, and early reports indicate that at least some of them are quite promising. But none of these potential vaccines have begun Phase 3 clinical trials (the last, lengthy step before FDA approval), and it is expected that no West Nile vaccine is likely to be approved for human use before 2020, at the earliest.

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