West Nile virus in North America: perspectives on epidemiology and intervention.

West Nile virus (WNV) invaded New York in 1999 and rapidly swept across the North American continent to the West Coast, north into southern Canada and south into Latin America, with minimal genetic change. Regional epidemics in equines and humans typically have included a year of viral introduction with minimal activity, successful overwintering, explosive amplification to epidemic levels the following year and then rapid subsidence. Overwintering possibly included long-term mosquito or avian infections, continued low-level transmission at southern latitudes and dispersal by south-north migrants. Explosive amplification has been associated with infections in several corvid species and other urban birds that produce elevated viremias capable of efficiently infecting even moderately susceptible mosquito species. Intervention has included mass vaccination of equines, and proactive and reactive mosquito control. Proactive mosquito control in areas with established infrastructure has been successful in reducing case incidence.