The CDC has issued a Health Alert Network advisory warning of the risk of severe arboviral neuroinvasive disease among patients receiving B cell-depleting or B cell-modulating medications, particularly anti-CD20 monoclonal antibodies.
Among published case reports of arboviral neuroinvasive disease in patients taking anti-CD20 monoclonal antibodies, overall mortality was approximately 40%, according to the Aug. 11 advisory. Most survivors experienced long-term neurologic sequelae, and West Nile virus was the most common infecting arbovirus.
The CDC also pointed to a novel presentation of chronic, neurodegenerative encephalitis developing over months to years in at least five patients receiving rituximab who were infected with an orthobunyavirus. All five patients died.
Because patients receiving medications that deplete B cells might not form antibodies against a new infection, the CDC recommended that clinicians preferentially order molecular testing when arboviral infection is suspected in patients receiving B cell-depleting monoclonal antibodies.
There are no approved treatments, prophylactic agents or human vaccines to prevent arboviral diseases endemic to the United States. The CDC urged clinicians to educate patients taking immunosuppressive medications about preventing mosquito and tick bites.
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