West Nile virus in California, 2003-2018: A persistent threat

The California Arbovirus Surveillance Program was initiated over 50 years ago to track endemic encephalitides and was enhanced in 2000 to include West Nile virus (WNV) infections in humans, mosquitoes, sentinel chickens, dead birds and horses. This comprehensive, statewide program is a function of strong partnerships among the California Department of Public Health (CDPH), the University of California, and local vector control and public health agencies. This manuscript summarizes WNV surveillance data in California since WNV was first detected in 2003 in southern California. From 2003 through 2018, 6,909 human cases of WNV disease, inclusive of 326 deaths, were reported to CDPH, as well as 730 asymptomatic WNV infections identified during screening of blood and organ donors. Of these, 4,073 (59.0%) were reported as West Nile neuroinvasive disease. California's WNV disease burden comprised 15% of all cases that were reported to the U.S. Centers for Disease Control and Prevention during this time, more than any other state. Additionally, 1,299 equine WNV cases were identified, along with detections of WNV in 23,322 dead birds, 31,695 mosquito pools, and 7,340 sentinel chickens. Annual enzootic detection of WNV typically preceded detection in humans and prompted enhanced intervention to reduce the risk of WNV transmission. Peak WNV activity occurred from July through October in the Central Valley and southern California. Less than five percent of WNV activity occurred in other regions of the state or outside of this time. WNV continues to be a major threat to public and wild avian health in California, particularly in Southern California and the Central Valley during summer and early fall months. Local and state public health partners must continue statewide human and mosquito surveillance and facilitate effective mosquito control and bite prevention measures. Author summary West Nile virus (WNV) was first detected in the United States in 1999, and subsequently spread throughout the country. It is now the most commonly reported disease that is transmitted by mosquitoes in the United States. California has reported approximately 15% of all human WNV infections since the virus was first reported in the state in 2003. The California Department of Public Health works with partners throughout the state to conduct robust surveillance of WNV infections in mosquitoes, dead birds, and sentinel chickens, using these data to direct vector control activity and reduce the risk of WNV transmission to people. This article summarizes sixteen years of human, mosquito, chicken, equine, and dead wild bird surveillance for WNV in California, the most comprehensive description of WNV surveillance data to date. We found that WNV enzootic and human activity varied geographically and in intensity from year-to-year. Almost 95% of all WNV activity in California occurred in the Central Valley and southern California between April and November.