Pediatric West Nile Virus-Associated Neuroinvasive Disease: A Review of the Literature

Pediatr Neurol. 2019 Mar:92:16-25. doi: 10.1016/j.pediatrneurol.2018.07.019. Epub 2018 Nov 28.


Over the past two decades, West Nile virus has become the most common arbovirus in North America, leading to several outbreaks and infecting thousands of people. Mosquitos help transmit the virus in the majority of cases, but transmission occurs via blood transfusions, organ transplantation, and possibly pregnancy and breastfeeding. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases have been reported in the United States, with over 700 cases occurring in children from 2003 to 2016. Neuroinvasive disease presents as meningitis, encephalitis, or acute flaccid paralysis, and carries a high likelihood of poor outcome, including severe neurological disability or death. To date, no pharmacologic treatment has proven effective. Therapeutic clinical trials have not been successfully completed due to the sporadic nature of viral outbreaks and resultant poor study enrollment. Although older age and chronic disease are risk factors for neuroinvasive West Nile virus disease in adults, the specific factors that influence the risk in pediatric populations have not been fully elucidated. This review summarizes the most recent literature regarding West Nile virus-associated neuroinvasive disease, especially as it pertains to the pediatric population. Moreover, the review describes the epidemiology, clinical, laboratory, and radiographic findings, and outlines the various therapies that have been trialed and potential future research directions.

Keywords: Acute flaccid paralysis; Children; Flavivirus; Viral encephalitis; West Nile encephalitis; West Nile meningitis; West Nile virus.

Publication types

  • Review

MeSH terms

  • Central Nervous System Viral Diseases* / diagnosis
  • Central Nervous System Viral Diseases* / epidemiology
  • Central Nervous System Viral Diseases* / etiology
  • Central Nervous System Viral Diseases* / therapy
  • Child
  • Humans
  • Meningitis, Viral* / diagnosis
  • Meningitis, Viral* / epidemiology
  • Meningitis, Viral* / etiology
  • Meningitis, Viral* / therapy
  • Myelitis* / diagnosis
  • Myelitis* / epidemiology
  • Myelitis* / etiology
  • Myelitis* / therapy
  • Neuromuscular Diseases* / diagnosis
  • Neuromuscular Diseases* / epidemiology
  • Neuromuscular Diseases* / etiology
  • Neuromuscular Diseases* / therapy
  • West Nile Fever* / complications
  • West Nile Fever* / diagnosis
  • West Nile Fever* / epidemiology
  • West Nile Fever* / therapy
  • West Nile virus / pathogenicity*

Supplementary concepts

  • acute flaccid myelitis