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To the Editor—Gibney et al recently reported finding no West Nile virus (WNV) RNA in urine samples collected from 40 patients at 6.5–6.7 years after acute WNV disease [1]. These findings were in contrast to Murray et al, who detected WNV RNA in urine samples collected from 5 of 25 patients (20%) at 1.6–6.7 years after their initial infections [2]. We present results from a prospective evaluation of WNV RNA in urine specimens collected from 63 persons within 5 months after their acute WNV infection. During the 2010 WNV outbreak in Maricopa County, Arizona, we identified persons with laboratory evidence of acute WNV infection, including detection of WNV immunoglobulin M antibodies in serum or cerebrospinal fluid samples from patients with a clinically compatible illness or WNV RNA in serum samples from asymptomatic blood donors. Information on demographic characteristics, medical history, current medications, and clinical illness was obtained by medical record review and interview with patients or their surrogate. A urine sample was collected during a site visit. The study was approved by the Centers for Disease Control and Prevention (CDC) and Arizona Department of Health Services (ADHS) human subjects review boards, and participants provided informed consent before enrollment. Immediately after collection, urine specimens were separated into 3 aliquots, frozen on dry ice, and transported at the end of each study day to ADHS, where they were stored for #7 weeks at 270 C before being batch-shipped to the CDC. Urine samples were tested for WNV RNA by using both reverse-transcription polymerase chain reaction (RT-PCR) and transcription-mediated amplification (TMA), as previously described [1, 3, 4]. In addition, we added an internal RNA control (Dengue virus type 2) to each urine specimen to assess for potential inhibitory components [1]. Of the 63 enrolled participants, 35 (56%) were male, and the median age was 52 years (range, 15–83 years) (Table 1). Thirty-two participants (51%) were classified as having WNV neuroinvasive disease (ie, meningitis, encephalitis, or acute flaccid paralysis), and 26 (41%) reported $1 underlying medical condition. The median time from onset of clinical signs for WNV disease cases or blood donation for viremic donors to urine collection was 90 days (range, 18–129 days). Urine was collected either as a cleancatch specimen (60 of 63 [95%]) or from an indwelling catheter (3 of 63 [5%]). Urine specimens from all 63 participants tested negative for WNV RNA by RTPCR. One (1.6%) tested positive by TMA; urine culture was not performed. WNV RNA was detected by RT-PCR and TMA in 2 spiked control urine specimens, which had been frozen, stored, and thawed under the same conditions as the participant specimens. Testing of participants’ urine samples following addition of the RNA control yielded positive Dengue virus RT-PCR results for every participant. The WNV RNA–positive urine sample was collected 29 days after symptom onset from a woman aged 83 years who

Evaluation for West Nile Virus (WNV) RNA in Urine of Patients Within 5 Months of WNV Infection