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Transmission cycle of West Nile virus to humans and horses

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Birds are the main reservoirs of West Nile virus, and on infection, the virus replicates to levels allowing for transmission to mosquito vectors. In horse and human infections, the viremia is too low for transmission to mosquito vectors; thus, they are dead-end hosts. Other modes of transmission in humans include horizontal transmission by organ transplantation, blood transfusion, and occupationally via sharp instruments. Vertical transmission from mother to child occurs via placental transfer and through breast milk. (Source: Schwarz ER, Long MT. Comparison of West Nile virus disease in humans and horses: exploiting similarities for enhancing syndromic surveillance. Viruses 2023;15[6]:1230. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)