Abstract

Powassan virus (POWV) disease is a rare human disease caused by a tick-borne encephalitis group flavivirus maintained in a transmission cycle between Ixodes cookei and other ixodid ticks and small and medium-sized mammals. During 1958–1998, only 27 POWV disease cases (mostly Powassan encephalitis) were reported from eastern Canada and the northeastern United States (average, 0.7 cases per year). During 1999–2005, nine cases (described herein) of serologically confirmed POWV disease were reported in the United States (average, 1.3 cases per year): four from Maine, two from New York, and one each from Michigan, Vermont, and Wisconsin. The Michigan and Wisconsin cases are the first ever reported from the north-central United States. Of these nine patients, 5 (56%) were men, the median age was 69 years (range: 25-91 years), and 6 (67%) had onset during May–July. All but one patient developed encephalitis with acute onset of profound muscle weakness, confusion, and other severe neurologic signs. In one case, no neurologic symptoms were present but the presence of pleocytosis, an elevated cerebrospinal fluid (CSF) protein concentration, and POWV-specific immunoglobulin M in CSF suggested neuroinvasion. All patients recovered from their acute disease, but most had long-term neurologic sequelae. Periresidential ecologic investigations were performed in three cases, including tests of local mammals and ticks for evidence of POWV infection. Woodchucks (Marmota monax), striped skunks (Mephitis mephitis), and a raccoon (Procyon lotor) collected at two of the Maine case-patients' residences had neutralizing antibody titers to POWV. I. cookei were found on woodchucks and skunks and questing in grassy areas of one of these residences; all were negative for POWV. Although POWV disease is rare, it is probably under-recognized, and it causes significant morbidity, and thus is an additional tick-borne emerging infectious disease entity. Because no vaccine or specific therapy is available, the basis of prevention is personal protection from ticks (or “tick hygiene”) and reduced exposure to peridomestic wild mammals.

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cover image Vector-Borne and Zoonotic Diseases
Vector-Borne and Zoonotic Diseases
Volume 8Issue Number 6December 2008
Pages: 733 - 740
PubMed: 18959500

History

Published online: 15 December 2008
Published in print: December 2008
Published ahead of print: 30 October 2008

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    Steven R. Hinten
    Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado.
    Epidemiology Program Office, Division of Applied Public Health Training, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Atlanta, Georgia.
    Department of Defense.
    Geoffrey A. Beckett
    Division of Disease Control, Bureau of Health, Maine Department of Human Services, Augusta, Maine.
    Kathleen F. Gensheimer
    Division of Disease Control, Bureau of Health, Maine Department of Human Services, Augusta, Maine.
    Elizabeth Pritchard
    Maine Health & Environmental Testing Laboratory, Maine Department of Heath and Human Services, Augusta, Maine.
    Thomas M. Courtney
    Southern Maine Medical Center, Biddeford, Maine.
    Stephen D. Sears
    Maine General Medical Center, Augusta, Maine.
    Mercy Hospital, Portland, Maine.
    John M. Woytowicz
    Maine General Medical Center, Augusta, Maine.
    David G. Preston
    Maine General Medical Center, Waterville, Maine.
    Robert P. Smith, Jr.
    Vector-Borne Disease Laboratory, Maine Medical Center Research Institute, South Portland, Maine.
    Peter W. Rand
    Vector-Borne Disease Laboratory, Maine Medical Center Research Institute, South Portland, Maine.
    Eleanor H. Lacombe
    Vector-Borne Disease Laboratory, Maine Medical Center Research Institute, South Portland, Maine.
    Mary S. Holman
    Vector-Borne Disease Laboratory, Maine Medical Center Research Institute, South Portland, Maine.
    Charles B. Lubelczyk
    Vector-Borne Disease Laboratory, Maine Medical Center Research Institute, South Portland, Maine.
    Patsy Tassler Kelso
    Division of Health Surveillance, Vermont Department of Health, Burlington, Vermont.
    Andrew P. Beelen
    Veterans Affairs Medical Center, White River Junction, Vermont.
    Mary Grace Stobierski
    Communicable Disease Division, Bureau of Epidemiology, Michigan Department of Community Health, Lansing, Michigan.
    Mark J. Sotir
    Wisconsin Division of Public Health, Madison, Wisconsin.
    Division of Foodborne, Bacterial, and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta Georgia.
    Susan Wong
    Wadsworth Center, New York State Department of Health, Albany, New York.
    Gregory Ebel
    Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
    Olga Kosoy
    Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado.
    Joseph Piesman
    Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado.
    Grant L. Campbell
    Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado.
    Anthony A. Marfin
    Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, Department of Health and Human Services, Fort Collins, Colorado.
    Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, Cairo, Egypt.

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