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No human arbovirus vaccine is currently available (two equine encephalitis vaccines are available) Mosquito control (repellents, protective clothing, and insecticides) is effective in prevention Since 2003, all blood donations in the United States are screened with the nucleic acid amplification tests for West Nile virus Laboratory precautions are indicated for handling all pathogens, in particular the West Nile virus A vaccine against Japanese B encephalitis is recommended for travelers to rural areas of East Asia, though the risk of disease acquisition among the exposed is estimated at only 1:1,000,000 This vaccination appears to provide protection against the West Nile pathogen (since both agents are related flaviviruses) in certain settings such as among laboratory workers Newer cell-culture derived vaccines with less risk of hypersensitivity reactions and encephalitis and longer lasting immunogenicity will likely replace the older mouse brain derived vaccine

Influenza-like prodrome of fever, chills, malaise, and cough, followed by meningitis with associated stiff neck Aseptic meningitis with positive Kernig s sign, headache, nausea, vomiting, and lethargy Cerebrospinal fluid: slight increase of protein, lymphocytic pleocytosis (500 3000/mcL); low glucose in 25% of patients Complement-fixing antibodies within 2 weeks

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Many of the concepts used throughout this book, and any book on programming, are actually metaphors. We get so used to the metaphors that we forget they are metaphors. You are used to talking about a window in your program, but of course there is no such thing; there is just a rectangle with text and images in it. It looks like a window into your document, so we call it a window. Of course, you don t actually have a document either, just bits in memory. No folders, no buttons these are all just metaphors. There are many levels to these metaphors. When you see a window on the screen, the window metaphor is enhanced by an image drawn on your monitor. That image is created by lighting tiny dots, called pixels. These pixels are lit in response to instructions written in your C# program. Each C# instruction is itself a metaphor; there is just a series of 1s and 0s. Of course, the 1s and 0s are just metaphors for electricity in wires. Of course, electricity is a metaphor, as are electrons, as is quantum physics. You get the idea. Good metaphors can be very powerful. The art of object-oriented programming is really the art of conceiving good metaphors to simplify solving complex problems.

Lymphocytic choriomeningitis is an arenaviral infection of the CNS (related to the pathogen causing Argentinian hemorrhagic fever, discussed below) The main reservoir of infection is the infected house mouse Other rodents (such as rats, guinea pigs, and even pet hamsters), monkeys, dogs, and swine are also potential reservoirs The virus is shed by the infected animal via nasal secretions, urine, and feces, with transmission to humans probably through exposure to animal droppings via contaminated food and dust Human cases of lymphocytic choriomeningitis are most common in autumn The virus is not spread person to person, though vertical transmission occurs and lymphocytic choriomeningitis is a potential fetal teratogen Rare cases related to solid organ transplantation are reported The incubation period is 8 13 days to the appearance of systemic manifestations and 15 21 days to the appearance of meningeal symptoms Outbreaks occur among persons with rodent exposure Complications of clinical disease are rare This disease is principally confined to the eastern seaboard and northeastern states of the United States, and serologic evidence of infection is increased among women, the elderly, and members of lower socioeconomic groups, residing in mice-infested dwellings

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Although specific antiviral therapy is not available for most causative entities, vigorous supportive measures can be helpful Such measures include reduction of intracranial pressure (mannitol) and monitoring of intraventricular pressure The efficacy of corticosteroids in these infections is not established Preliminary evidence that ribavirin was useful in West Nile encephalitis has now been substantiated Other therapeutic options such as interferon- and immunoglobulin are not proven to be effective

The prognosis is always guarded, especially at the extremes of age Sequelae may become apparent late in the course of what appears to be a successful recovery The prognosis is generally better for Western equine than for Eastern equine or St Louis encephalitis St Louis encephalitis is reportedly associated with a postinfectious encephalomyelitis As of 2002, the case fatality rate for recognized cases of arboviral encephalitis was 5% Most of the deaths from West Nile infection are due to neuroinvasive disease (8 12% mortality rate) Most infections result in seroconversion only and do not result in clinical illness

Carson PJ et al Long-term clinical and neuropsychological outcomes of West Nile virus infection Clin Infect Dis 2006 Sep 15;43(6):723 30 [PMID 16912946]

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Symptoms are biphasic The prodromal illness is characterized by fever, chills, headache, myalgia, cough, and vomiting,

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