Systemic and Ophthalmic Manifestations of West Nile Virus Infection

Yos Priestley; Marcia Thiel; Steven B. Koevary


Expert Rev Ophthalmol. 2008;3(3):279-292. 

In This Article


There is no currently approved treatment for WNV. Symptomatic patients are given supportive therapy such as intravenous fluids if they have experienced prolonged nausea, vomiting and diarrhea, pain relievers, ventilator support as required, and treatment for the prevention of secondary infections. Elderly patients with functional damage as a result of WNE were found to benefit from routine geriatric neurological rehabilitation.[85]

There are a number of treatments under investigation for WNE and meningitis, including ribavirin, IFN-α2b, anti-WNV immunoglobulin, antisense gene-targeted compounds, and minocycline, a broad spectrum tetracycline antibiotic. In cases of WNV infection with anterior chamber involvement, as mentioned previously, topical steroids such as prednisolone have been found to be effective.[61,63,69]

A vaccine developed by Acambis is currently in Phase II clinical trials. The vaccine, called ChimeriVax™-WN02 is a live, attenuated recombinant vaccine produced by replacing pre-membrane and enveloped genes of an infectious yellow fever 17D virus with equivalent WNV genes.[86,87] After a single dose, the vaccine was shown to produce a strong immune response, characterized by the production of neutralizing antibodies as well as CD4+ and CD8+ T cells against the virus. In double-blind clinical trials, the immune response occurred in human participants within 14-28 days after receiving the vaccine.[88]

A WNV recombinant protein vaccine is also under investigation. This chimeric protein vaccine, being developed by the VaxInnate Corporation, is capable of eliciting both innate and adaptive immunity to the WNV. The vaccine was produced by fusing a modified version of bacterial flagellin to the domain III of the WNV envelope glycoprotein (E DIII).[89] In mice, the vaccine was shown to successfully induce protective immunity without use of an adjuvant.[89] That said, inoculation with the WNV E DIII protein along with an adjuvant was shown to induce a Th1 immune response in mice, supporting its potential use in patients.[90] Recently, mapping and analysis of WNV-specific monoclonal antibodies has been explored in an attempt to develop a safer, although less conventional, vaccine.[91] Vaccination of populations at risk of developing severe WNV infection may reduce the number of fatalities due to WNV in the USA.


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