Emergence of West Nile virus infection in Kerala, South India: A case of concern.

West Nile virus (WNV) infection is emerging as a disease of public health concern in Kerala state, India with recurring outbreaks since 2011. With its tropical climate, biodiversity hot spots of Western ghats, forest cover, plenty of water bodies and bird sanctuaries, Kerala provides an ideal ecological niche for vector breeding and transmission of WNV. In this work, we reflect on the peculiar features of the outbreaks of WNV fever in Kerala and highlight the knowledge gaps, research priorities and the need for effective control measures. Information on transmission patterns of WNV, its circulating lineages and identification of vectors is needed to adopt appropriate control strategies in the state. In addition to the active measures on the part of the health system to ensure vector control and to curtail transmission pathways of the disease, inclusion of the community in preventing WNV infection through awareness campaigns and other participatory control measures should be initiated in the pre-monsoon months.