Criteria

Arboviral diseases, neuroinvasive and non-neuroinvasive 2015 Case Definition[41]

In the US, the Centers for Disease Control and Prevention (CDC) has published clinical criteria for diagnosis of arboviral infections (including EEEV infection) for the purpose of standardising the reporting of these infections. Clinical criteria are categorised into two primary groups: neuroinvasive disease and non-neuroinvasive disease.

Neuroinvasive disease

  • Meningitis, encephalitis, acute flaccid paralysis, or other acute signs of central or peripheral neurological dysfunction, as documented by a physician, AND

  • Absence of a more likely clinical explanation. Other clinically compatible symptoms of arbovirus disease include: headache, myalgia, rash, arthralgia, vertigo, vomiting, paresis, and/or nuchal rigidity.

Non-neuroinvasive disease

  • Fever (chills) as reported by the patient or a health-care provider, AND

  • Absence of neuroinvasive disease, AND

  • Absence of a more likely clinical explanation. Other clinically compatible symptoms of arbovirus disease include: headache, myalgia, rash, arthralgia, vertigo, vomiting, paresis, and/or nuchal rigidity.

The CDC has also published laboratory criteria to standardise the diagnosis of arboviral infections:

  • Isolation of virus from, or demonstration of specific viral antigen or nucleic acid in tissue, blood, cerebrospinal fluid (CSF), or other body fluid, OR

  • Four-fold or greater change in virus-specific quantitative antibody titres in paired sera, OR

  • Virus-specific IgM antibodies in serum with confirmatory virus-specific neutralising antibodies in the same or a later specimen, OR

  • Virus-specific IgM antibodies in CSF or serum.

Cases can also be classified as ‘probable’ or ‘confirmed’ based on serological findings.[41]

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