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Venezuelan Equine Encephalitis Treatment & Management

  • Author: Robert W Derlet, MD; Chief Editor: Burke A Cunha, MD  more...
 
Updated: Apr 15, 2016
 

Approach Considerations

No specific treatment other than supportive care is available. Venezuelan equine encephalitis virus is an RNA virus; therefore, antivirals that have been successful against deoxyribonucleic acid (DNA) viruses are ineffective. Treatment of Venezuelan equine encephalitis is symptomatic and in the ED most likely involves correcting fluid deficiencies.

Patients with neurologic manifestations of Venezuelan equine encephalitis should be transferred to a facility that can provide intensive care treatment, if necessary.

Supportive care in nonneurologic Venezuelan equine encephalitis

Patients with nonneurologic Venezuelan equine encephalitis virus infection generally require only supportive care, including fluid management for dehydration and electrolyte derangement caused by fever and vomiting.

Supportive care in Venezuelan equine encephalitis with neurologic manifestations

Patients with neurologic manifestations of Venezuelan equine encephalitis require prompt supportive care to reduce the risk of mortality.

Appropriate measures include standard anticonvulsant therapy as treatment for seizures; fluid management for dehydration and electrolyte imbalance produced by fever, vomiting, decreased oral intake, and inappropriate ADH secretion; and proper airway and respiratory management in those progressing to coma.

Neurosurgical evaluation and monitoring for increased intracranial pressure are beneficial. Prevention and treatment of secondary bacterial infection significantly improve the patient's prognosis.

Consultations

Contact an infectious disease specialist if Venezuelan equine encephalitis is suspected. In addition, involve the county and/or state health department. Neurosurgical evaluation and monitoring for increased intracranial pressure, when possible, is beneficial.

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Vaccine Development

Trials are currently underway to develop a vaccine for Venezuelan equine encephalitis. C-84 is a formalin-inactivated vaccine. V3526 is a newer live attenuated vaccine. TC-83 also is a live-attenuated vaccine. Studies have shown that the V3526 vaccine has been safe and efficacious in the treatment of horses. Vaccination with V3526 results in a lack of detectable viremia. However, further research is needed to determine whether this vaccine will safely confer immunity in humans.[10, 11, 12]

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Deterrence and Prevention

Protection from mosquito bites in endemic areas is important. Visitors to endemic areas should take appropriate precautions to avoid mosquito bites, including proper clothing, insect repellant, and mosquito nets. Large-scale aerial insecticide applications may decrease the number of disease-carrying mosquitoes.

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Contributor Information and Disclosures
Author

Robert W Derlet, MD Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System

Robert W Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Iris Reyes, MD Associate Professor of Clinical Emergency Medicine, Advisory Dean, Office of Student Affairs, University of Pennsylvania School of Medicine

Iris Reyes, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Sarah M Perman, MD, MS Resident, Department of Emergency Medicine, University of Pennsylvania Health Systems

Sarah M Perman, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John R Richards, MD, FAAEM Professor, Department of Emergency Medicine, University of California, Davis, Medical Center

John R Richards, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Jerry L Mothershead, MD Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References
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  4. Carrara AS, Coffey LL, Aguilar PV, et al. Venezuelan equine encephalitis virus infection of cotton rats. Emerg Infect Dis. 2007 Aug. 13(8):1158-65. [Medline]. [Full Text].

  5. Estrada-Franco JG, Navarro-Lopez R, Freier JE, et al. Venezuelan equine encephalitis virus, southern Mexico. Emerg Infect Dis. 2004 Dec. 10(12):2113-21. [Medline].

  6. Jackson AC, Rossiter JP. Apoptotic cell death is an important cause of neuronal injury in experimental Venezuelan equine encephalitis virus infection of mice. Acta Neuropathol. 1997 Apr. 93(4):349-53. [Medline].

  7. CDC. Venezuelan equine encephalitis--Colombia, 1995. MMWR Morb Mortal Wkly Rep. 1995 Oct 6. 44(39):721-4. [Medline].

  8. Morrison AC, Forshey BM, Notyce D, et al. Venezuelan equine encephalitis virus in Iquitos, Peru: urban transmission of a sylvatic strain. PLoS Negl Trop Dis. 2008. 2(12):e349. [Medline]. [Full Text].

  9. Estrada-Franco JG, Navarro-Lopez R, Freier JE, et al. Venezuelan equine encephalitis virus, southern Mexico. Emerg Infect Dis. 2004 Dec. 10(12):2113-21. [Medline]. [Full Text].

  10. Fine DL, Roberts BA, Teehee ML, et al. Venezuelan equine encephalitis virus vaccine candidate (V3526) safety, immunogenicity and efficacy in horses. Vaccine. 2007 Feb 26. 25(10):1868-76. [Medline].

  11. Reed DS, Glass PJ, Bakken RR, Barth JF, Lind CM, da Silva L, et al. Combined alphavirus replicon particle vaccine induces durable and cross-protective immune responses against equine encephalitis viruses. J Virol. 2014 Aug 13. [Medline].

  12. Herbert AS, Kuehne AI, Barth JF, Ortiz RA, Nichols DK, Zak SE, et al. Venezuelan equine encephalitis virus replicon particle vaccine protects nonhuman primates from intramuscular and aerosol challenge with ebolavirus. J Virol. 2013 May. 87(9):4952-64. [Medline]. [Full Text].

 
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