Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). However, several other arboviruses also cause sporadic cases and seasonal outbreaks of neuroinvasive disease (i.e., meningitis, encephalitis, and acute flaccid paralysis) (1). This report summarizes surveillance data reported to CDC in 2013 for WNV and other nationally notifiable arboviruses, excluding dengue. Forty-seven states and the District of Columbia reported 2,469 cases of WNV disease. Of these, 1,267 (51%) were classified as WNV neuroinvasive disease, for a national incidence of 0.40 per 100,000 population. After WNV, the next most commonly reported cause of arboviral disease was La Crosse virus (LACV) (85 cases), followed by Jamestown Canyon virus (JCV) (22), Powassan virus (POWV) (15), and eastern equine encephalitis virus (EEEV) (eight). WNV and other arboviruses continue to cause serious illness in substantial numbers of persons annually. Maintaining surveillance remains important to help direct and promote prevention activities.

In the United States, most arboviruses are maintained in transmission cycles between arthropods and vertebrate hosts (typically birds or small mammals). Humans usually become infected when bitten by infected mosquitoes or ticks. Person-to-person transmission occurs rarely through blood transfusion and organ transplantation. Most human arboviral infections are asymptomatic. Symptomatic infections most often manifest as a systemic febrile illness and, less commonly, as neuroinvasive disease. Most endemic arboviral diseases are nationally notifiable and are reported to CDC through the ArboNET surveillance system (2,3). In addition to collecting data on human disease cases, ArboNET collects data on viremic blood donors, veterinary disease cases, and infections in mosquitoes, dead birds, and sentinel animals. Using standard definitions, human cases with laboratory evidence of recent arboviral infection are classified as neuroinvasive disease or nonneuroinvasive disease (2). Because of the substantial associated morbidity, detection and reporting of neuroinvasive disease cases is assumed to be more consistent and complete than for nonneuroinvasive disease cases. Therefore, incidence rates were calculated for neuroinvasive disease cases using U.S. Census Bureau 2013 mid-year population estimates.

In 2013, CDC received reports of 2,605 cases of nationally notifiable arboviral diseases, including those caused by WNV (2,469 cases), LACV (85), JCV (22), POWV (15), EEEV (eight), unspecified California serogroup virus (five), and St. Louis encephalitis virus (SLEV) (one). Cases were reported from 830 (26%) of the 3,141 U.S. counties; no cases were reported from Alaska or Hawaii. Of the 2,605 arboviral disease cases, 1,383 (53%) were reported as neuroinvasive disease, for a national incidence of 0.44 per 100,000 population.

A total of 2,469 WNV disease cases, including 1,267 (51%) neuroinvasive cases, were reported from 725 counties in 47 states and the District of Columbia (Table 1). WNV disease cases peaked in early September; 90% of cases had illness onset during July–September. The median age of patients was 55 years (interquartile range [IQR] = 41–67 years); 1,425 (58%) were male. Overall, 1,494 (61%) patients were hospitalized, and 119 (5%) died. The median age of patients who died was 78 years (IQR = 67–83 years).

Of the 1,267 WNV neuroinvasive disease patients, 669 (53%) had encephalitis, 486 (38%) had meningitis, and 112 (9%) had acute flaccid paralysis. Among the 112 patients with acute flaccid paralysis, 85 (76%) also had encephalitis or meningitis. The national incidence of neuroinvasive WNV disease was 0.40 per 100,000 population (Table 2). States with the highest incidence rates included North Dakota (8.9 per 100,000), South Dakota (6.8), Nebraska (2.9), and Wyoming (2.8) (Figure). Six states reported approximately half (51%) of the WNV neuroinvasive disease cases: California (237 cases), Texas (113), Colorado (90), Illinois (86), North Dakota (64), and Oklahoma (60). Neuroinvasive WNV disease incidence increased with age, with the highest incidence among persons aged ≥70 years. Among patients with neuroinvasive disease, 111 (9%) died.

The 85 LACV disease cases were reported from 59 counties in 12 states; 77 (91%) were neuroinvasive (Table 1). Dates of illness onset for LACV disease cases ranged from June through October; 71 (84%) had onset during July–September. Forty-nine (58%) patients were male. The median age of patients was 7 years (IQR = 4–11 years); 76 (89%) were aged <18 years. LACV neuroinvasive disease incidence was highest in West Virginia (0.54 per 100,000), Tennessee (0.35), North Carolina (0.13), and Ohio (0.12) (Table 2). Those four states reported 60 (78%) LACV neuroinvasive disease cases. A total of 80 (94%) patients were hospitalized; two (2%) died.

Twenty-two JCV disease cases were reported from 20 counties in 10 states; 15 (68%) were neuroinvasive (Table 1). Eight states (Georgia, Idaho, Massachusetts, Minnesota, New Hampshire, Oregon, Pennsylvania, and Rhode Island) reported their first JCV disease cases. Dates of illness onset ranged from January through November, with 14 (64%) of the 22 cases occurring during July–September. The median age of patients was 46 years (IQR = 32–57 years); 17 (77%) were male. Twelve (55%) patients were hospitalized; none died. In addition to the LACV and JCV cases, five cases of California serogroup virus disease were reported for which the specific infecting virus was unknown.

Fifteen POWV disease cases were reported from 13 counties in seven states; 12 (80%) were neuroinvasive (Table 1). Three states (Massachusetts, New Hampshire, and New Jersey) reported their first POWV disease cases. Dates of illness onset ranged from May through November; five (33%) had onset during April–June, and six (40%) had onset during July–September. The median age of patients was 69 years (IQR = 45–75 years); 11 (73%) were male. Thirteen (87%) patients were hospitalized; two (13%) died.

Eight EEEV disease cases were reported from six states, including the first cases ever reported from Arkansas and Connecticut (Table 1). All eight were neuroinvasive. Dates of illness onset ranged from January through December. The median age of patients was 56 years (IQR = 33–74 years); six (75%) were male. All eight patients were hospitalized; four (50%) died. The median age of patients who died was 62 years (IQR = 33–86 years).

One SLEV neuroinvasive disease case was reported from Texas; the patient was hospitalized and survived.