Recent outbreaks of WNV encephalitis in humans have occurred in several places, e.g., in Algeria (1994), in Romania (1996-1997) when the disease course was recognized as more aggressive to humans than in the past, in Russia (1999), in the United States (1999-2004), and in Israel (2000).
Several WNF outbreaks were reported in Israel in the 1950s and one in 1980, but by the end of the 20th century, it was a forgotten disease. After a long absence, WNV was diagnosed in goose flocks in summer 1998. In summer 1999, 3 cases of WNV were reported in humans (2 deaths) and in 2000, a large outbreak occurred with 429 cases (35 deaths) between August and November (ICDC website). This eruption occurred after summers of both medical and climatic warning signs. The three previous summers of 1998, 1999, and 2000 were extremely hot, warmer than ever recorded, with long heat waves (Bin, 2001; Paz, 2006). It is interesting to note that the development of the Israeli outbreak in summer 2000 was comparable to the cases in the Danube Valley in Romania (1996) and in NYC (1999). Despite the climatic dissimilarity between the three regions, all are characterized by warm and humid summers. Each of the three outbreaks appeared after a long period of intense heat (Paz, 2006).
Recent studies observed several impacts of climate change in Israel, as well as in the whole eastern Mediterranean basin: during the second half of the 20th century, an increase in the minimum and maximum summer temperature was detected (Ben-Gai et al., 1999). The frequency of heat waves has risen, with worsening severity (Paz, 2006; Paz et al., 2007). Drought tendency was identified
(Alpert et al., 2002; IPCC, 2007) with an increase in the uncertain behavior of the precipitation patterns (Paz and Kutiel, 2003). As Israel is located along the Syrian-African Rift, it is a major stopover for huge flocks of migrating birds, especially during the transition seasons. Since wild birds are the reservoir of WNV, this geographical location is crucially important for the disease transfer. Indeed, the virus was found in Israel in recent years in a large variety of birds (ICDC website), which frequently interact with mosquitoes in areas of standing water.
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