Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Kendra Ratnapradipa, PhD

Second Committee Member

Joseph Fauver, PhD

Third Committee Member

Jeff Hamik, MS


Objectives: West Nile virus (WNV) is a mosquito-borne flavivirus that is naturally sustained in a Culex mosquito-bird-mosquito transmission cycle and can cause disease in birds, equines, and humans. Most human infections with WNV are asymptomatic; however, West Nile fever (WNF), or West Nile neuroinvasive disease (WNND) can develop and be fatal in some circumstances. Between 2005 and 2021 there have been over 1,800 cumulative cases of WNV in Nebraska, which currently ranks as fourth in the United States for reported cases. WNV cases are a mandatory reportable disease in Nebraska through an electronic reporting system managed by the Nebraska Department of Health and Human Services (NDHHS). This passive surveillance system has been in place since 2005; however, no analysis has been done on WNV surveillance data in Nebraska. The objective of this study is to examine trends in WNV infections in Nebraska from 2005-2021 and examine characteristics between WNF and WNND cases between 2005 and 2021.

Methods: To examine the burden of WNV disease in Nebraska, descriptive epidemiology using data reported in Nebraska Electronic Disease Surveillance System (NEDSS) from 2005-2021 was performed using the SAS analysis tool. WNF and WNND cases were compared using Chi Square analysis, and predictors for developing WNND were examined by logistic regression analysis. Finally, maps to visualize the cumulative incidence by local health department (LHD) jurisdictions were created using ArcGIS software.

Results: 1,822 cases met the inclusion and exclusion criteria for analysis. Case counts have varied every year between 2005-2021, with noticeable outbreaks occurring in 2006, 2013, and 2018. The average cumulative incidence for Nebraska between 2005-2021 was 5.86 cases per 100,000 people. Urban residence, people aged 65+, Hispanic ethnicity, and races other than white or black were significant predictors for developing WNND.

Conclusion: The overall burden of WNV in Nebraska remains higher than the national average. Continued surveillance and better understanding of the distribution of disease across Nebraska create the best opportunity for utilization of prevention and control resources.

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