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Multiple studies have identified links between climate and West Nile virus disease since the virus arrived in North America. Here we sought to extend these results by developing a Health Impact Function (HIF) to generate county-level estimates of the expected annual number of West Nile neuroinvasive disease (WNND) cases based on the county’s historical WNND incidence, annual average temperature, and population size. To better understand the potential impact of projected temperature change on WNND risk, we used the HIF to project the change in expected annual number of WNND cases attributable to changing temperatures by 2050 and by 2090 using data from five global climate models under two representative concentration pathways (RCP4.5 and RCP8.5). To estimate the costs of anticipated changes, as well as to enable comparisons with other public health impacts, projected WNND cases were allocated to nonfatal and fatal outcomes, then monetized using a cost-of-illness estimate and the U.S. Environmental Protection Agency’s value of a statistical life, respectively. We found that projected future temperature and population changes could increase the expected annual number of WNND cases to ≈2000 - 2200 cases by 2050 and to ≈2700 - 4300 cases by 2090, from a baseline of 970 cases. Holding population constant at future levels while varying temperature from a 1995 baseline, we estimated projected temperature change alone is responsible for ≈590 and ≈960 incremental WNND cases in 2050 and 2090 (respectively) under the RCP4.5 scenario, and ≈820 and ≈2500 cases in 2050 and 2090 (respectively) for the RCP8.5 scenario, with substantial regional variation. The monetized impact of these temperature-attributable incremental cases is estimated at $0.5 billion in 2050 and $1.0 billion in 2090 under the RCP4.5 scenario, and $0.7 billion in 2050 and $2.6 billion in 2090 under the RCP8.5 scenario (undiscounted 2015 U.S. dollars).

Impacts of Increasing Temperature on the Future Incidence of West Nile Neuroinvasive Disease in the United States