Table 1.

Descriptive summary of epidemiological studies published from 2007 until October 2018 on WNV infection in occupational settings.

References	Country year	Study design	Risk group	Outcomes (cases/deaths)	Main results
Smith (2016)	USA, na	Case report	1 security guard	Diagnosis of WNV encephalopathy.	Employees with WNV complications may not be ready to return to work full duty and may need a flexible return to work or accommodations via a reduced schedule until fully recovered.
Vieira et al. (2015)	Brazil, 2014	Case report	52-year-old ranch worker	Encephalitis and flaccid paralysis at admission in hospital, high titres of antibodies against WNV.	This report exemplifies importance of acute viral encephalitis surveillance.
Venter and Swanepoel (2010)	South Africa, na	Case report	1 veterinarian and 1 laboratorist	Both resulted in neurological disease.	Laboratorist acquired infection by needle stick injury. Veterinary student acquired infection while performing an autopsy, gloves were the only protective gear worn. Human cases of aseptic meningoencephalitis should be screened to determine if WNV cases can be detected.
Venter et al. (2009)	South Africa, na	Case report	1 laboratorist	Symptoms included backache, neck stiffness and malaise; on day 8 rash, mild fever, meningoencephalitis and photophobia; and on day 9, arthralgia.	This case confirms the neurovirulent potential of lineage 2 WNV strain.
Remoli et al. (2018)	Italy, 2018	Epidemiological study	101 workers (farmers and agricultural workers) and 100 controls.	About 0% IgG positive.	No seropositivity for WNV was detected, although the study was carried out in a geographical area where outbreaks have been documented in the past; limited number of subjects may be responsible for the results. Surveys in outdoor workers could provide early warning on the emergence of arboviruses in specific regions and individuals.
van Eeden, Swanepoel and Venter (2014)	South Africa, 2011–2012	Epidemiological study	127 veterinarians	About 7.9% antibodies positive.	Indications that veterinarians might be at increased risk of WNV infection.
Karakoç et al. (2013)	Turkey, 2009	Epidemiological study	182 individuals at high risk (farmers, agricultural workers and traders); 125 at low risk (housewives, teachers, students and priest).	About 20.87% IgG positive (risk group workers).	In univariate analysis serologic positivity in the high-risk group was more statistically significant than in the low-risk group (73% versus 56%,P = 0.026). In multivariate analysis, being in an occupational risk group (OR = 2.2, CI 1.02–4.04, P = 0.044) was found to be a risk factor for WNV serologic positivity.
Barzon et al. (2009)	Italy, 2008–2009	Epidemiological study	321 farmers	About 0.9% IgG positive, n = 3, 0.6% IgM and IgG positive.	Workers employed in farms with WNV-positive horses; this infection appears to be widespread among horses in north-eastern Italy. Both 1998 and 2008 Italian outbreaks could be related to a continuous endemic circulation of WNV.
Spataro et al. (2008)	Italy, 2006	Epidemiological study	1280 (health care workers, hunters, stable workers as jockey and grooms, fowlers, veterinary surgeons and blood donors)	About 0% antibodies positive.	The study supplies an answer in considering the absence of risk infection in the category examined. However, programs of antibodies survey are useful to predict which effects could have the presence of WNV infection.
Bernabeu-Wittel et al. (2007)	Spain, na	Epidemiological study	504 subjects from general population including farmers, stockbreeders, veterinarians, rangers, foresters, and extermination and pest control workers	About 2.8% IgG positive subjects at occupational risk.	P = 0.048 for activity in any risk profession (involving close contact with animals, nature and wetlands or mosquitoes).

na = not available