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Epidemiology

Powassan Virus (POWV) is the only known tick-borne virus to be endemic in North America[1]. POWV human illnesses have been reported in the United States, Canada and Russia[1]. POWV has different genetic variations including deer tick virus (DTV) which is transmitted by the black legged deer tick, Ixodes scapularis[2]. It has two distinct lineages. POWV lineage I is transmitted by the Ixodes cookei which is endemic in the Great Lakes region of the United States[3]. POWV lineage II is transmitted by Ixodes scapularis which is endemic in the Northeast United States[3]. Humans can become infected in 15-30 minutes after tick attachment[3][1][4].

Ixodes ticks have three life stages that require a host: larva, nymph and adult[5]. Each stage requires a blood meal to progress to the next life stage. The nymph stage frequently bites humans and is the stage in which I. scapularis is most likely to infection a human host with a pathogen[6]. The most common reservoir (or host) for I. scapularis are white-footed mouse and white-tail deer[3][7]. The most common reservoirs for I. cookei are skunks, woodchucks and squirrels[3]. Humans are incidental hosts which means the ticks do not need to feed on humans to survive, humans are merely the host they find at the time for their next blood meal[8].

In the US, the highest incidence of POWV is in Minnesota and Wisconsin, with Massachusetts and New York also having higher incidence than other states in the Great Lakes or Northeast region[1]. POWV was included in the list of nationally notifiable diseases to the U.S. Centers for Disease Control and Prevention (CDC) in 2002[8]. Between 2009 and 2018, 133 cases of neuroinvasive POWV and 12 cases of non-neuroinvasive POWV were reported to the CDC[9]. Since its discovery in 1958, there have only been 150 reported human illnesses caused by POWV[1]. The incidence rate of POWV in the United States was 1 case per year from 1958-2005, and has risen to an average of 10 cases per year since then[1].

Currently, POWV is detected with IgM antibody capture ELISA of an IgM immunofluorescence antibody (IFA) assay, plaque reduction neutralization test (PRNT), detection of virus-specific nucleic acids, isolation in culture, or a >4-fold increase in antibody titers from paired acute and convalescent sera[10]. These specific tests for POWV can only be done at a state lab or the CDC[1]. Diagnostic criteria as set by the CDC are: resides in an endemic area, reported tick exposure, and presented with fever, altered mental status, seizures and focal neurological deficits and blood, tissue or cerebrospinal fluid (CSF) are positive on Powassan IgM or Powassan PRNT tests[3][1].

  1. ^ a b c d e f g h Kemenesi, Gábor; Bányai, Krisztián (2018-12-12). "Tick-Borne Flaviviruses, with a Focus on Powassan Virus". Clinical Microbiology Reviews. 32 (1): e00106–17, /cmr/32/1/e00106–17.atom. doi:10.1128/CMR.00106-17. ISSN 0893-8512. PMC 6302355. PMID 30541872.{{cite journal}}: CS1 maint: PMC format (link)
  2. ^ Robich, Rebecca M.; Cosenza, Danielle S.; Elias, Susan P.; Henderson, Elizabeth F.; Lubelczyk, Charles B.; Welch, Margret; Smith, Robert P. (2019-08-07). "Prevalence and Genetic Characterization of Deer Tick Virus (Powassan Virus, Lineage II) in Ixodes scapularis Ticks Collected in Maine". The American Journal of Tropical Medicine and Hygiene. 101 (2): 467–471. doi:10.4269/ajtmh.19-0281. ISSN 0002-9637. PMC 6685567. PMID 31218999.{{cite journal}}: CS1 maint: PMC format (link)
  3. ^ a b c d e f Patel, Kavin M.; Johnson, Jennie; Zacharioudakis, Ioannis M.; Boxerman, Jerrold L.; Flanigan, Timothy P.; Reece, Rebecca M. (2018). "First confirmed case of Powassan neuroinvasive disease in Rhode Island". IDCases. 12: 84–87. doi:10.1016/j.idcr.2018.03.016. PMC 6010959. PMID 29942757.{{cite journal}}: CS1 maint: PMC format (link)
  4. ^ Eisen, Lars (March 2018). "Pathogen transmission in relation to duration of attachment by Ixodes scapularis ticks". Ticks and Tick-borne Diseases. 9 (3): 535–542. doi:10.1016/j.ttbdis.2018.01.002. PMC 5857464. PMID 29398603.{{cite journal}}: CS1 maint: PMC format (link)
  5. ^ Mansfield, Karen L.; Jizhou, Lv; Phipps, L. Paul; Johnson, Nicholas (2017-07-11). "Emerging Tick-Borne Viruses in the Twenty-First Century". Frontiers in Cellular and Infection Microbiology. 7: 298. doi:10.3389/fcimb.2017.00298. ISSN 2235-2988. PMC 5504652. PMID 28744449.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  6. ^ Johnson, Tammi L.; Graham, Christine B.; Maes, Sarah E.; Hojgaard, Andrias; Fleshman, Amy; Boegler, Karen A.; Delory, Mark J.; Slater, Kimetha S.; Karpathy, Sandor E.; Bjork, Jenna K.; Neitzel, David F. (September 2018). "Prevalence and distribution of seven human pathogens in host-seeking Ixodes scapularis (Acari: Ixodidae) nymphs in Minnesota, USA". Ticks and Tick-borne Diseases. 9 (6): 1499–1507. doi:10.1016/j.ttbdis.2018.07.009. PMC 6594169. PMID 30055987.{{cite journal}}: CS1 maint: PMC format (link)
  7. ^ Williams, Scott C.; Little, Eliza A.H.; Stafford, Kirby C.; Molaei, Goudarz; Linske, Megan A. (July 2018). "Integrated control of juvenile Ixodes scapularis parasitizing Peromyscus leucopus in residential settings in Connecticut, United States". Ticks and Tick-borne Diseases. 9 (5): 1310–1316. doi:10.1016/j.ttbdis.2018.05.014.
  8. ^ a b Eisen, Rebecca J.; Eisen, Lars (April 2018). "The Blacklegged Tick, Ixodes scapularis : An Increasing Public Health Concern". Trends in Parasitology. 34 (4): 295–309. doi:10.1016/j.pt.2017.12.006. PMC 5879012. PMID 29336985.{{cite journal}}: CS1 maint: PMC format (link)
  9. ^ "Statistics & Maps | Powassan | CDC". www.cdc.gov. 2019-07-10. Retrieved 2019-11-18.
  10. ^ Frost, Holly M.; Schotthoefer, Anna M.; Thomm, Angela M.; Dupuis, Alan P.; Kehl, Sue C.; Kramer, Laura D.; Fritsche, Thomas R.; Harrington, Yvette A.; Knox, Konstance K. (August 2017). "Serologic Evidence of Powassan Virus Infection in Patients with Suspected Lyme Disease1". Emerging Infectious Diseases. 23 (8): 1384–1388. doi:10.3201/eid2308.161971. ISSN 1080-6040. PMC 5547799. PMID 28726610.{{cite journal}}: CS1 maint: PMC format (link)

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