Inter-annual associations between precipitation and human incidence of West Nile virus in the United States.

Higher-than-average precipitation levels may cause mosquito outbreaks if mosquitoes are limited by larval habitat availability. Alternatively, recent ecological research suggests that drought events can lead to mosquito outbreaks the following year due to changes in food web structure. By either mechanism, these mosquito outbreaks may contribute to human cases of West Nile Virus (WNV) in the recent United States outbreak. Using countylevel precipitation and human WNV incidence data (2002-2004), we tested the impacts of above and below-average rainfall on the prevalence of WNV in human populations both within and between years. We found evidence that human WNV incidence is most strongly associated with annual precipitation from the preceding year. Human outbreaks of WNV are preceded by above-average rainfall in the eastern United States and below-average rainfall in the western United States in the prior year. While no direct mechanism may be determined from this study, we hypothesize that differences in the ecology of mosquito vectors may be responsible for the opposite relationships between precipitation and WNV outbreaks between the eastern and western United States.