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Hotter temperatures this summer may portend a major outbreak of West Nile virus (WNV) during the peak summer season – through September – across the United States.

As of press time, WNV surveillance confirmed 192 cases and six deaths in 20 states, according to the Centers for Disease Control and Prevention (CDC).

Neurologists should be on guard for increased cases of neuroinvasive diseases acute viral meningitis, acute encephalitis, and acute flaccid paralysis, which have accounted for 84 of the 192 cases (44 percent) so far in 2006, CDC data show.

Kenneth L. Tyler, MD, a neuroinfectious disease expert and Reuler Lewin Family Professor of Neurology at the University of Colorado Health Sciences Center in Denver, told Neurology Today, “Clues to the diagnosis of viral meningitis may be the presence of an unexpectedly high proportion of neurophils in the CSF in a patient (with a normal gram stain and a normal glucose).

“Patients with encephalitis may have abnormal involuntary movements (for example, myoclonus, tremor) or generalized weakness (typically with depressed or absent reflexes), which is relatively unusual in other types of viral encephalitis,” he continued. “Acute flaccid paralysis is a polio-like syndrome in which patients suffer an acute onset of weakness with loss of reflexes and relatively preserved sensation, involving a single limb or multiple limbs. The syndrome commonly but not always occurs with other signs of WNV infection including fever and CSF abnormalities, and may be combined with symptoms of meningitis or encephalitis.”

People aged 50 and older and those with weakened immune systems are at higher risk for complications if infected, noted Dr. Tyler.

There are currently no vaccines or treatment for human cases. To reduce risk of infection, Dr. Tyler recommends insect repellent that contains DEET and minimizing time outdoors during dawn and dusk (peak mosquito activity times).

“I think WNV is here to stay, and we will likely continue to see several thousand cases a year throughout the US during summer months for the foreseeable future,” said Dr. Tyler.

For weekly updates on WNV human cases, visit

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Drug safety advocates may find themselves in an unexpected alliance with the biotechnology and pharmaceutical industries. The Boston Globe reported in a July 13 article that drug makers are pressuring Congress to increase FDA funds for safety tests. One expert told Neurology Today that the efforts may be successful given the industry's lobbying power.

In an industry conference held in July in Boston, James C. Greenwood, President of the Biotechnology Industry Organization, a group that lobbies on behalf of the biotechnology industry, said his goal is to increase FDA funds. Greenwood said that the fees the drug industry pays to have the FDA review their products have doubled from 1998 to 2005. Despite the increased fees, the agency still takes about a year to review a new drug. “Very simply, FDA is drowning under the weight of its added responsibilities and its budget woes, and it sees [user fees] as its life line,” he said.

According to the Globe, the FDA and drug makers will negotiate user fees behind closed doors through Labor Day.

Senators Edward M. Kennedy (D-MA) and Michael Enzi (R-WY) are expected to introduce a bill that would give the FDA greater oversight to monitor drug safety and would fund the initiatives by increasing industry fees.

Sheldon Krimsky, PhD, Professor of Urban & Environmental Policy & Planning at Tufts University, told Neurology Today that industry user fees create a conflict of interest among the private and public sectors. “Government employees and federal programs should be paid for by public funds and not by private funds that could be perceived to have an interest in the outcome of decisions.”

In his 2003 book, Science and the Private Interest, Dr. Krimsky recommends the development of a National Institute of Drug Testing, which would select an independent group to test each drug submitted for FDA approval.

©2006 American Academy of Neurology