West Nile Virus

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KEY POINTS

• West Nile virus is an infection caused by a virus that your child can get from a mosquito bite.
• There is no medicine that cures West Nile virus. In most cases, you can care for your child at home. If your child has a serious infection, your child may need to stay at the hospital.
• The best way to avoid getting West Nile virus is to prevent mosquito bites.

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What is West Nile virus?

West Nile virus (WNV) is an infection caused by a virus that you can get from a mosquito bite. Most of the time the illness is mild, but sometimes it can cause inflammation (swelling) of the brain (encephalitis) or inflammation of the membranes that cover the brain and spinal cord (meningitis). The risk of serious infection is greatest for people who are over 60 years old or who have a weakened immune system.

What is the cause?

Wild and domestic birds, mainly crows, carry the WNV. Mosquitoes get infected when they bite infected birds. The infected mosquito can then pass the virus to you when it bites you.

The virus does not spread directly from an infected bird to a human, or from person to person. Rarely, WNV can be spread by contact with infected blood, such as through blood transfusion, organ transplant, or the sharing of needles or syringes contaminated with blood. WNV may also be spread from a mother to her unborn baby. The virus might also be spread through breast milk. However, the risk of spread of the virus to the baby is believed to be very low.

The risk of WNV is seasonal in the northern states of the US and usually starts in the spring. The peak time for infection is middle to late August. In milder southern climates, the risk for infection is year-round.

What are the symptoms?

Often there are no symptoms. Children are more likely to have symptoms than adults. When symptoms do occur, they usually start 3 to 14 days after a mosquito bite.

They are usually mild and last a few days. Symptoms may include:

• Fever
• Headache
• Body aches
• Nausea or vomiting
• Rash
• Swollen glands

In rare cases, when WNV affects the brain, it can be life threatening. The symptoms may include:

• Tremors, like a shaking of your hands that you cannot control
• Stiff neck
• High fever
• Severe headache
• Inability to move your body (paralysis)
• Weakness
• Confusion
• Seizures
• Coma

How is it diagnosed?

Your healthcare provider will ask about your child's symptoms and medical history and examine your child. Tests may include:

• Blood tests
• Lumbar puncture, also called a spinal tap, which uses a needle to get a sample of fluid from the area around the spinal cord to test for meningitis
• EEG, a test that measures the electrical activity of the brain
• CT scan, which uses X-rays and a computer to show detailed pictures of the brain
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the brain

How is it treated?

There is no medicine that cures WNV, and there is no vaccine to prevent it. If your child’s symptoms are mild, they will usually go away on their own. In most cases, you can care for your child at home. If the infection is serious, your child may need to stay at the hospital. At the hospital, your child may be given IV fluids, pain relievers, or other treatments.

Most people infected with WNV, including nearly all children, don’t get seriously ill, and they recover fully. Symptoms usually last 3 to 6 days, but they can last as long as several weeks or months.

If your child has a serious infection, your child may be sick for weeks or months. In the most serious cases, the nervous system or brain may be injured.

How can I take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Let your child rest if he or she is tired.
• Give acetaminophen or an anti-inflammatory medicine, such as ibuprofen, for fever, headache, or muscle aches.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. Read the label and give as directed. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome.
  • Acetaminophen may cause liver damage or other problems. Read the label carefully and give your child the correct dose as directed. Do not give more doses than directed. To make sure you don’t give your child too much, check other medicines your child takes to see if they also contain acetaminophen. Unless recommended by your healthcare provider, your child should not take this medicine for more than 5 days.

Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup.

How can I help prevent West Nile virus?

Take precautions to avoid mosquito bites:

• Stay indoors at dawn, dusk, and in the early evening, when mosquitoes are most likely to be around.
• Wear long pants and long-sleeved shirts, especially from dusk to dawn. This is the time when you are most likely to get bitten.
• Use an insect repellent whenever you are outdoors. Don't use more repellent than recommended in the package directions. Don't put repellent on open wounds or rashes. Don’t put it near your eyes or mouth. When using sprays for the skin, don’t spray the repellent directly on your face. Spray the repellent on your hands first and then put it on your face. Then wash the spray off your hands.
  • Adults should use repellent products with no more than 35% DEET. Children older than 2 months can use repellents with no more than 30% DEET. DEET should be applied just once a day. Wash it off your body when you go back indoors.
  • Picaridin may irritate the skin less than DEET and appears to be just as effective.
  • Spray clothes with repellents because mosquitoes may bite through thin clothing. Products containing permethrin are recommended for use on clothing, shoes, bed nets, and camping gear. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other insects and can keep working after laundering. Permethrin should be reapplied to clothing according to the instructions on the product label. Some commercial products are available pretreated with permethrin. Permethrin does not work as a repellent when it is put on the skin.
  • In some studies, oil of lemon eucalyptus, a plant-based repellent, provided as much protection as repellents with low concentrations of DEET, but it hasn't been as well tested as DEET. Oil of lemon eucalyptus should not be used on children under age 3.
  • Some repellents can make children ill if they put it in their mouth or swallow it. Never let young children play with or put repellent on themselves. Adults should put repellent on their own hands, and then put the repellent on the child’s body.
• Install or repair window and door screens so it is harder for mosquitoes to get indoors.
• Mosquitoes lay eggs in water. To reduce mosquito breeding, drain standing water. Routinely empty water from flowerpots, pet bowls, clogged rain gutters, swimming pool covers, buckets, barrels, cans, and other items that collect water.