West Nile Virus and Diabetes   (August 22, 2012)

With 1,118 cases of West Nile virus infection reported through August 21, the U.S. is headed toward its biggest yearly case count since the disease was first detected here, according to the Centers for Disease Control and Prevention (CDC). I don’t know about you, but I didn’t know much about the illness except it had something to do with Texas and something to do with mosquitos, so it seemed a good time to brush up on what it is, and whether it has any particular concern for people with diabetes. So I dreamed up some questions, and went looking for answers on-line…

What is West Nile virus infection?

The CDC has a very detailed Fact Sheet, West Nile Virus: What You Need To Know at their website. The following information was extracted from that fact sheet:

*The West Nile virus (WNV) causes a seasonal epidemic that flares up in the summer and continues into the fall. Symptoms are unlikely (80% of infected people have no symptoms), but can  include fever, headache, aches, nausea, vomiting, swollen lymph glands, skin rash on the trunk of the body.  These symptoms can last for only a few days or for several weeks.  Sometimes severe symptoms including “high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent.” And death can and does occur: One author reported that that have been more than 1100 deaths from WNV in the U.S. from 1999 through 2010. 

*There’s no specific treatment.

*Prevention measures consist of community-based mosquito control programs plus personal protection measures to reduce the likelihood of being bitten by infected mosquitoes. And don’t pick up dead birds:  mosquitoes become infected when they feed on infected birds.

Why does it have that name?

The WNV was first identified in a patient in the West Nile sub-region of the nation of Uganda.

When did West Nile first become a US problem?

West Nile virus has been widely present in Africa, Europe, and Asia, but the first reported outbreak in the Western Hemisphere didn't occur until 1999, in the New York City area.

What about people with diabetes?

Somehow, I was not surprised to find that diabetes is a risk factor for getting a severe case of WNV disease, or dying of WNV. A CDC surveillence report of cases in the US from 2008-2010 listed medical risk factors for severe WNV disease (that is, requiring hospitalization or causing death) that they identified: these risk factors included chronic renal disease, history of cancer, history of alcohol abuse, diabetes, hypertension, and immune suppression.

The California Department of Health Services also found that “people with diabetes and high blood pressure were more likely to develop serious cases of WNV. Diabetics were four times more likely to have serious complications from WNV and people with high blood pressure were two times more likely to have serious complications from WNV.” (Quoted in Salud + Health)

And the first US report about WNV, in the New England Journal of Medicine in 2001, ominously reported that “the presence of diabetes mellitus was … significantly associated with death, even after adjustment for age.”

What should someone with diabetes do?

Pretty much the same as anyone else.

First, learn more about WNV. The CDC Fact Sheet mentioned above seems a good place to start.

Seek medical care immediately if you have severe headaches or confusion. BTW, the symptoms don’t start until 3-14 days after being bitten by an infected mosquito.

Prevent mosquito bites. The CDC advises:

• When you are outdoors, use insect repellent containing an EPA-registered active ingredient. Follow the directions on the package.
• Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.
• Make sure you have good screens on your windows and doors to keep mosquitoes out.
• Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.

Is there extra advice for people with diabetes?

The main thing I can think of is to seek medical attention urgently if you have unexplained hyperglycemia plus any of the symptoms that are listed for WNV: fever, confusion, body aches, nausea, vomiting, swollen lymph glands or a skin rash on the chest, stomach and back, headache, stiff neck, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, or paralysis.