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This study aimed at estimating, in a prospective scenario, the potential economic impact of a possible epidemic of WNV infection in Belgium, based on 2012 values for the equine and human health sectors, in order to increase preparedness and help decision-makers. Modelling of risk areas, based on the habitat suitable for , the main vector of the virus, allowed us to determine equine and human populations at risk. Characteristics of the different clinical forms of the disease based on past epidemics in Europe allowed morbidity among horses and humans to be estimated. The main costs for the equine sector were vaccination and replacement value of dead or euthanised horses. The choice of the vaccination strategy would have important consequences in terms of cost. Vaccination of the country’s whole population of horses, based on a worst-case scenario, would cost more than EUR 30 million; for areas at risk, the cost would be around EUR 16–17 million. Regarding the impact on human health, short-term costs and socio-economic losses were estimated for patients who developed the neuroinvasive form of the disease, as no vaccine is available yet for humans. Hospital charges of around EUR 3,600 for a case of West Nile neuroinvasive disease and EUR 4,500 for a case of acute flaccid paralysis would be the major financial consequence of an epidemic of West Nile virus infection in humans in Belgium.


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  1. Hayes EB, Komar N, Nasci RS, Montgomery SP, O’Leary DR, Campbell GL. Epidemiology and transmission dynamics of West Nile virus disease. Emerg Infect Dis. 2005;11(8):1167-73.  https://doi.org/10.3201/eid1108.050289a  PMID: 16102302 
  2. Rossi SL, Ross TM, Evans JD. West Nile virus. Clin Lab Med. 2010;30(1):47-65. Error! Hyperlink reference not valid. https://doi.org/10.1016/j.cll.2009.10.006  PMID: 20513541 
  3. Brault AC. Changing patterns of West Nile virus transmission: altered vector competence and host susceptibility. Vet Res. 2009;40(2):43. http://www.ncbi.nlm.nih.gov/pubmed/19406093 https://doi.org/10.1051/vetres/2009026  PMID: 19406093 
  4. Centre for Food Safety and Public Health (CFSPH)/Institute for International Cooperation in Animal Biologics. West Nile virus infection. 2013. Ames, IA: Iowa State University. [Accessed 18 Dec 2014]. Available from: http://www.cfsph.iastate.edu/Factsheets/pdfs/west_nile_fever.pdf
  5. Leblond A, Hendrikx P, Sabatier P. West Nile virus outbreak detection using syndromic monitoring in horses. Vector Borne Zoonotic Dis. 2007;7(3):403-10.  https://doi.org/10.1089/vbz.2006.0593  PMID: 17767410 
  6. Murray KO, Mertens E, Despres P. West Nile virus and its emergence in the United States of America. Vet Res 2010; 41:67 http://www.ncbi.nlm.nih.gov/pubmed/21188801
  7. European Food Safety Agency (EFSA) and European Centre for Disease Prevention and Control. (ECDC). Information on specific zoonoses and zoonotic agents – West Nile virus. In: EU Summary report on zoonoses, zoonotic agents and food-borne outbreaks 2012. EFSA Journal 2014;12:3547.
  8. Bournez L, Beck C, Troyano-Groux A, Lecollinet S. Short item. Reemergence of West Nile virus in South-Eastern France in 2015 and equine epizootics. Bull Epid Santé Anim Alim.2015;72:34-5.
  9. Cnops L, Papa A, Lagra F, Weyers P, Meersman K, Patsouros N, et al. West Nile virus infection in Belgian traveler returning from Greece. Emerg Infect Dis. 2013;19(4):684-5.  https://doi.org/10.3201/eid1904.121594  PMID: 23762912 
  10. Balenghien T, Vazeille M, Grandadam M, Schaffner F, Zeller H, Reiter P, et al. Vector competence of some French Culex and Aedes mosquitoes for West Nile virus. Vector Borne Zoonotic Dis. 2008;8(5):589-95.  https://doi.org/10.1089/vbz.2007.0266  PMID: 18447623 
  11. Engler O, Savini G, Papa A, Figuerola J, Groschup MH, Kampen H, et al. European surveillance for West Nile virus in mosquito populations. Int J Environ Res Public Health. 2013;10(10):4869-95.  https://doi.org/10.3390/ijerph10104869  PMID: 24157510 
  12. Hanon JB, Uyttenhoef A, Fecher-Bourgeois F, Kirschvink N, Haubruge E, Duquesne B, et al. Estimation quantitative des pertes économiques directes et indirectes subies par les éleveurs Wallons dans le cadre de la fièvre catarrhale ovine (sérotype 8) durant la période 2006-2007. [Quantitative estimation of direct and indirect economic losses undergone by Walloon cattle holders within the framework of ovine catharral fever (serotype 8) between 2006 and 2007]. Epidémiol Santé Anim.2009;56:187-95. French.
  13. Martinelle L, Dal Pozzo F, Gauthier B, Kirschvink N, Saegerman C. Field veterinary survey on clinical and economic impact of Schmallenberg virus in Belgium. Transbound Emerg Dis. 2014;61(3):285-8.  https://doi.org/10.1111/tbed.12030  PMID: 23279714 
  14. Stirling A. Risk, precaution and science: towards a more constructive policy debate. Talking point on the precautionary principle. EMBO Rep. 2007;8(4):309-15.  https://doi.org/10.1038/sj.embor.7400953  PMID: 17401403 
  15. Stirling A. Science, precaution, and the politics of technological risk: converging implications in evolutionary and social scientific perspectives. Ann N Y Acad Sci. 2008;1128(1):95-110.  https://doi.org/10.1196/annals.1399.011  PMID: 18469218 
  16. Byford S, Torgerson DJ, Raftery J. Economic note: cost of illness studies. BMJ. 2000;320(7245):1335.  https://doi.org/10.1136/bmj.320.7245.1335  PMID: 10807635 
  17. European Environment Agency (EEA). CLC2006 technical guidelines. No 17/2007. Copenhagen: EEA; 2007. Available from: http://www.eea.europa.eu/publications/technical_report_2007_17
  18. Durand B, Lecollinet S, Beck C, Martínez-López B, Balenghien T, Chevalier V. Identification of hotspots in the European union for the introduction of four zoonotic arboviroses by live animal trade. PLoS One. 2013;8(7):e70000. http://www.ncbi.nlm.nih.gov/pubmed/23894573 https://doi.org/10.1371/journal.pone.0070000  PMID: 23894573 
  19. Federal Public Service (FPS) of Economy, Small and Medium Enterprises (SMEs), Self-employed and Energy. Population, chiffres population 2010-2014. [Population, Population figures 2010-2014]. Updated 17 Jul 2014. Belgium: FPS Economy, SMEs, Self-Employed and Energy. [Accessed 18 Dec 2014]. French. Available from: http://statbel.fgov.be/fr/modules/publications/statistiques/population/population_-_chiffres_population_2010_-_2012.jsp
  20. Ndiva Mongoh M, Hearne R, Dyer NW, Khaitsa ML. The economic impact of West Nile virus infection in horses in the North Dakota equine industry in 2002. Trop Anim Health Prod. 2008;40(1):69-76.  https://doi.org/10.1007/s11250-007-9055-8  PMID: 18551781 
  21. Mont-le-Soie European Horse Centre, Department of Rural Economy (University of Liege) and Unit of Economy and Rural Development, Gembloux Agro-Bio Tech (University of Liege). Le poids socio-économique de la filière équine en Wallonie. [The socio-economic importance of equine industry in Wallonia]. Grand Halleux: Centre Européen du Cheval; March 2010. [Accessed 18 Dec 2014]. [Accessed 1 Jul 2016]. French.
  22. Durand B, Chevalier V, Pouillot R, Labie J, Marendat I, Murgue B, et al. West Nile virus outbreak in horses, southern France, 2000: results of a serosurvey. Emerg Infect Dis. 2002;8(8):777-82.  https://doi.org/10.3201/eid0808.010486  PMID: 12141961 
  23. Durand B, Dauphin G, Zeller H, Labie J, Schuffenecker I, Murri S, et al. Serosurvey for West Nile virus in horses in southern France. Vet Rec. 2005;157(22):711-3.  https://doi.org/10.1136/vr.157.22.711  PMID: 16311385 
  24. Weese JS, Baird JD, DeLay J, Kenney DG, Staempfli HR, Viel L, et al. West Nile virus encephalomyelitis in horses in Ontario: 28 cases. Can Vet J. 2003;44(6):469-73. PMID: 12839240 
  25. Murgue B, Murri S, Zientara S, Durand B, Durand JP, Zeller H. West Nile outbreak in horses in southern France, 2000: the return after 35 years. Emerg Infect Dis. 2001;7(4):692-6.  https://doi.org/10.3201/eid0704.017417  PMID: 11585534 
  26. Genain JL, Grosbois F, Zientara S. Fièvre de West-Nile. [West Nile fever]. Saint-Contest: Réseau d’Epidémio-Surveillance en Pathologie Equine (RESPE); 2010. [Accessed 18 Dec 2014]. French. Available from: http://www.respe.net/system/files/20100614_N_WestNile-GP.pdf
  27. European Centre for Disease Prevention and Control (ECDC). West Nile fever. In: Annual epidemiological report 2014 – emerging and vector-borne diseases. Stockholm: ECDC; 2014. p. 45-50. Available from: http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=1196
  28. Federal Agency for the Safety of the Food Chain (AFSCA). Scénario opérationnel pour la maladie due au virus West Nile ou fièvre du Nil Occidental. [Operational scenario for West Nile virus disease or West Nile Fever]. Brussels: AFSCA; 2009. [Accessed 18 Dec 2014]. French. Available from: http://www.favv.be/santeanimale/fievreniloccidental/_documents/ScenarioWNVv1.0_fr_20091201.pdf
  29. Federal Ministry of Agriculture. 1er février 2012. Arrêté royal portant des mesures de police sanitaire relatives aux encéphalites virales des équidés. [1 February 2012. Royal decree on animal health measures in case of viral equine encephalitis]. 3 Jul 2012. Brussels: Federal Ministry of Justice. [Accessed 18 Dec 2014]. French. Available from: http://www.ejustice.just.fgov.be/cgi/api2.pl?lg=fr&pd=2012-03-07&numac=2012024081
  30. Belgian Centre of Pharmacotherapeutics Information (CBIP). Virus de la fièvre du Nil occidental ou virus West Nile. [West Nile Fever virus or West Nile virus]. In: Répertoire Commenté des Médicaments à usage vétérinaire 2014. [Commented directory of veterinary drugs 2014]. Liege: CBIP; 2014. [Accessed 1 Jul 2016]. Available from: www.cbip-vet.be/fr/texts/FEQOOOL1AL2o.php#WNV
  31. French Agency for Food Health Security (AFSSA). Rapport sur la surveillance de l’infection à virus West Nile en France. [Report on the surveillance of West Nile virus infection in France]. Maisons-Alfort: AFSSA; 2004. [Accessed 18 Dec 2014]. French. Available from: http://www.ladocumentationfrancaise.fr/var/storage/rapports-publics/054000115/0000.pdf
  32. Animal and Plant Health Inspection Service (APHIS), Veterinary services (Centers for Epidemiology and Animal Health). Economic Impact of West Nile Virus on the Colorado and Nebraska Equine Industries: 2002. Washington, DC: United States Department of Agriculture (USDA); 2003. [Accessed 18 Dec 2014]. Available from: http://www.aphis.usda.gov/animal_health/nahms/equine/downloads/wnv2002_CO_NB.pdf
  33. United States Centers for Disease Control and Prevention (CDC). West Nile virus. Atlanta, GA: CDC. [Accessed 18 Dec 2014]. Available from: http://www.cdc.gov/ncidod/dvbid/westnile/resources/FightTheBite_Factsheet/MediaTools/print/WNV%20media%20factsheet_natnl.pdf
  34. European Centre for Disease Prevention and Control (ECDC). West Nile fever. Factsheet for health professionals. Stockholm: ECDC. [Accessed 24 Jun 2016]. Available from: http://ecdc.europa.eu/en/healthtopics/west_nile_fever/factsheet-for-health-professionals/Pages/factsheet_health_professionals.aspx
  35. Staples JE, Shankar MB, Sejvar JJ, Meltzer MI, Fischer M. Initial and long-term costs of patients hospitalized with West Nile virus disease. Am J Trop Med Hyg. 2014;90(3):402-9.  https://doi.org/10.4269/ajtmh.13-0206  PMID: 24515937 
  36. Charrel RN, de Lamballerie X, Durand JP, Gallian P, Attoui H, Biagini P, et al. Prevalence of antibody against West Nile virus in volunteer blood donors living in southeastern France. Transfusion 2001;41:1320-1.
  37. Mostashari F, Bunning ML, Kitsutani PT, Singer DA, Nash D, Cooper MJ, et al. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet. 2001;358(9278):261-4.  https://doi.org/10.1016/S0140-6736(01)05480-0  PMID: 11498211 
  38. Ladbury GA, Gavana M, Danis K, Papa A, Papamichail D, Mourelatos S, et al. Population seroprevalence study after a West Nile virus lineage 2 epidemic, Greece, 2010. PLoS One. 2013;8(11):e80432.  https://doi.org/10.1371/journal.pone.0080432  PMID: 24260390 
  39. Danis K, Papa A, Theocharopoulos G, Dougas G, Athanasiou M, Detsis M, et al. Outbreak of West Nile virus infection in Greece, 2010. Emerg Infect Dis. 2011;17(10):1868-72.  https://doi.org/10.3201/eid1710.110525  PMID: 22000357 
  40. Barber LM, Schleier JJ 3rd, Peterson RKD. Economic cost analysis of West Nile virus outbreak, Sacramento County, California, USA, 2005. Emerg Infect Dis. 2010;16(3):480-6.  https://doi.org/10.3201/eid1603.090667  PMID: 20202424 
  41. Gerkens S, Merkur S. Belgium: Health system review. Health Syst Transit. 2010;12(5):1-266, xxv. PMID: 21224177 
  42. Institut national d’assurance maladie-invalidité (INAMI). La nomenclature des prestations de santé. [Nomenclature of health services]. Updated 15 Jan 2015. Brussels: INAMI. [Accessed 18 Dec 2014]. French. Available from: http://www.inami.fgov.be/fr/nomenclature/Pages/default.aspx#.VJPypP8JAk
  43. Faudemer S, Pestieau P, Perelman S. (in French). Le prix de la vie: une approche ex post. [The price of life: an ex post approach]. Risques. 1994;19:117-32.
  44. Humblet MF, Vandeputte S, Fecher-Bourgeois F, Léonard P, Gosset C, Balenghien T, et al. WNF associated costs for the equine sector - Scenario 1. Supplementary material. Liege: University of Liege; 2016. Available from: http://orbi.ulg.ac.be/retrieve/269218/20160714_Additional_Data_WNF_Horses_8.5%25.pdf
  45. Humblet MF, Vandeputte S, Fecher-Bourgeois F, Léonard P, Gosset C, Balenghien T, et al. WNF associated costs for the equine sector - Scenario 2. Supplementary material. Liege: University of Liege; 2016. Available from: http://orbi.ulg.ac.be/retrieve/269219/20160714_Additional_Data_WNF_Horses_34%25.pdf
  46. Humblet MF, Vandeputte S, Fecher-Bourgeois F, Léonard P, Gosset C, Balenghien T, et al. WNND/AFP associated costs/losses in humans - 2% infection rate scenario. Supplementary material. Liege: University of Liege; 2016. Available from: http://orbi.ulg.ac.be/retrieve/269220/20160714_Additional_Data_WNF_Publ_Health_2%25.pdf
  47. Humblet MF, Vandeputte S, Fecher-Bourgeois F, Léonard P, Gosset C, Balenghien T, et al. WNND/AFP associated costs/losses in humans - 15% infection rate. Supplementary material. Liege: University of Liege; 2016. Available from: http://orbi.ulg.ac.be/retrieve/269221/20160714_Additional_Data_WNF_Publ_Health_15%25.pdf
  48. Cabre O, Grandadam M, Marié JL, Gravier P, Prangé A, Santinelli Y, et al. West Nile virus in horses, sub-Saharan Africa. Emerg Infect Dis. 2006;12(12):1958-60.  https://doi.org/10.3201/eid1212.060042  PMID: 17326952 
  49. Gavlan R, Rene A, Bae S, Singh KP. An analytical study of the perceptions, prevention strategies, treatment and economic impact of equine West Nile virus. Proceedings of the 3rd International Conference on Agricultural Statistics (ICAS III); 2-4 Nov 2004. Cancún, México. [Accessed 1 Jul 2016]. Available from: https://www.nass.usda.gov/mexsai/Papers/westnilep.pdf
  50. Federal Agency for the Safety of the Food Chain (AFSCA). Fièvre du Nil occidental (ou fièvre de West Nile). [West Nile Fever]. Updated 4 Apr 2015. Brussels: AFSCA. [Accessed 12 May 2015]. French. Available from: http://www.favv-afsca.be/santeanimale/fievreniloccidental/default.asp#situation
  51. Angenvoort J, Brault AC, Bowen RA, Groschup MH. West Nile viral infection of equids. Vet Microbiol. 2013;167(1-2):168-80.  https://doi.org/10.1016/j.vetmic.2013.08.013  PMID: 24035480 
  52. World Organisation for Animal Health (OIE). West Nile fever. In: Terrestrial Animal Health Code (2016). Paris: OIE; 2016. Chapter 8.18. Available from: http://www.oie.int/fileadmin/Home/eng/Health_standards/tahc/current/chapitre_wnf.pdf
  53. Zohrabian A, Meltzer MI, Ratard R, Billah K, Molinari NA, Roy K, et al. West Nile virus economic impact, Louisiana, 2002. Emerg Infect Dis. 2004;10(10):1736-44.  https://doi.org/10.3201/eid1010.030925  PMID: 15504258 
  54. Rizzoli A, Jiménez-Clavero MA, Barzon L, Cordioli P, Figuerola J, Koraka P, et al. The challenge of West Nile virus in Europe: knowledge gaps and research priorities. Euro Surveill. 2015;20(20):pii: 21135.  https://doi.org/10.2807/1560-7917.ES2015.20.20.21135  PMID: 26027485 
  55. Centers for Disease Control and Prevention (CDC). West Nile virus transmission via organ transplantation and blood transfusion - Louisiana, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(45):1263-7. Accessed12Jul2016. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5845a3.htm PMID: 19940831 
  56. European Commission. Commission Directive 2014/110/EU of 17 December 2014 amending Directive 2004/33/EC as regards temporary deferral criteria for donors of allogeneic blood donations. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 20.12.2014 L 366. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32014L0110&from=EN
  57. Kelley WE, Bradley K, Duncan A, Smith J. Blood donor screening for West Nile virus in Oklahoma and its contribution to disease surveillance, 2003-2013. J Okla State Med Assoc. 2015;108(8):351-6. PMID: 27188096 
  58. Zohrabian A, Hayes EB, Petersen LR. Cost-effectiveness of West Nile virus vaccination. Emerg Infect Dis. 2006;12(3):375-80.  https://doi.org/10.3201/eid1203.050782  PMID: 16704772 
  59. Coût journalier d’une infirmière. [Daily cost for a home nurse]. Brussels: National Institute of Health-Disabilities Insurance. [Accessed 1 Jul 2016]. French. Available from: http://www.inami.fgov.be/SiteCollectionDocuments/tarif_infirmiers_20140101.pdf
  60. Coût journalier pour un aide-soignant. [Daily cost for a caregiver]. Brussels: SETCa-BBTK BHV. [Accessed 1 Jul 2016]. French. Available from: www.aide-soignant.be/wp-content/uploads/2014/01/Baremes_1.12.2012.pdf
  61. Statistics Belgium. Le marché du travail en chiffres absolus. [Labour market in absolute terms]. Brussels: Statistics Belgium. [Accessed 1 Jul 2016]. French. Available from: http://statbel.fgov.be/fr/statistiques/chiffres/travailvie/emploi/chiffres/
  62. Sejvar JJ, Bode AV, Marfin AA, Campbell GL, Ewing D, Mazowiecki M, et al. West Nile virus-associated flaccid paralysis. Emerg Infect Dis. 2005;11(7):1021-7.  https://doi.org/10.3201/eid1107.040991  PMID: 16022775 

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