A 76-year-old resident of El Prat de Llobregat is the first person residing in the Barcelona Metropolitan Area who has been diagnosed with an indigenous case of West Nile fever, a disease caused by a virus spreading throughout Spain that this year It has also caused the first two human cases in the Valencian Community.
The woman was admitted a few weeks ago – the Generalitat of Catalonia has not specified the date – to the Bellvitge Hospital, where she had to be transferred to the ICU. “Currently, she remains in a social and health center in the process of recovery, since beyond the infection, her health is delicate,” explains a spokesperson for the Department of Health. To date, no more cases of the disease have been diagnosed in the same area, although the Generalitat had detected during the summer the presence of the Nile virus in a bird in Cornellà, a town located just a dozen kilometers from El Prat.
West Nile fever is caused by a virus of the genus flavivirus and is transmitted to humans through the bite of mosquitoes of the genus culex. Four out of five people are infected asymptomatically or with very mild symptoms, but the rest suffer from high fever, pain, fatigue, vomiting and, sometimes, a skin rash. “Within this group, a small part (1% of the total infected, according to a report from the National Epidemiological Surveillance Network) will develop a serious condition of encephalitis,” explains Antoni Trilla, head of the Preventive Medicine service at the Hospital. Clinic (Barcelona). In these patients, usually small children or older people with other underlying ailments, mortality approaches 10%.
The disease has been a serious public health problem in central and eastern Europe for decades, and now it is also beginning to be so in the west of the continent. So far this year, a dozen countries have registered 566 serious cases and 40 deaths, of which nine patients and one death correspond to Spain. The most affected countries are Italy (237 patients and 13 deaths) and Greece (131 and 18, respectively), according to the latest alert bulletin from the European Center for Disease Control and Prevention (ECDC).
In Spain, the virus – which circulates among birds and mosquitoes, and also affects horses – was detected for the first time in 2004 in some coots (birds) in Doñana. That same year, the first case was diagnosed in a person who had spent the holidays in the province of Badajoz, although hardly any more human cases were detected in the following 15 years (yes in birds and horses). The situation changed in 2020, when the provinces of Seville, Cádiz and Badajoz suffered a large outbreak with 77 seriously affected and eight deaths. Some of those infected also suffered neurological consequences.
Since then, although in smaller numbers, indigenous cases have been re-diagnosed in Spain every summer. In 2021 there were six, all of them in the province of Seville. Last year, there were four, although the disease was detected for the first time in two new provinces: Córdoba (one case) and Tarragona (two). The fourth diagnosis was in Cádiz.
The cases have already risen to nine this year. Of them, five have been detected in affected areas in previous summers (four in Badajoz and one in Seville) and the rest in new areas: one in Huelva (an 84-year-old woman who died in August), two in Valencia and now one in Barcelona. France is experiencing a process similar to that of Spain and during the summer the disease was diagnosed for the first time in places like Bordeaux.
Miguel Ángel Jiménez Clavero, researcher at the National Institute of Agricultural and Food Research and Technology (INIA-CSIC), highlights that the expansion of the virus has been constant in the last two decades. “We have observed an increase in incidence (in birds and horses) where it was already established and a geographical expansion into new territories. This translates into human cases in areas where until now they had not been detected,” he explains.
According to this expert, the process is due to several reasons: “The cause is the ecological changes that favor the presence and life cycle of Culex mosquitoes. In part, this is due to the climate changes that are taking place, but local factors such as the extension of irrigation, infrastructure actions, etc., can also influence it. What we have also observed is that when the virus reaches a new area and begins to spread, circulate among birds, it is most likely that it will end up becoming endemic.”
The Generalitat explains that the diagnosis of the case has not been easy, since it is not uncommon for the most used tests (PCR) to offer a negative result when, as in this case, “the person had been infected for some time” at the time of be treated and diagnosed. Given this situation, it is necessary to resort to serologies, which “have given positive results at various times”, but which must now be confirmed by the National Center for Microbiology. Until then, the case is officially considered “probable”, although “in the absence of alternative diagnoses”, according to the Generalitat, it has already been notified as a case of Nile fever to the Ministry of Health and the ECDC.
Given the detection of this latest case, the Catalan Government has notified “all health centers, both primary care and hospitals, to be alert to detect possible new cases.” An “entomological investigation” has also been carried out in the area where the woman lives to control the existing mosquito populations and, finally, it has been ordered that all blood donations carried out in Catalonia be analyzed to rule out the presence of the virus.
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