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These human cases of WNV disease represented the majority of cases notified in Italy in 2011; in addition, two cases of WNND were notified in the nearby Udine province in the Friuli-Venezia Giulia Region, four WNND cases were recorded in the Sardinia Region, and one case of WN fever in the Marche Region [10,11]. Patients from the Veneto Region were resident in relatively small areas in the provinces of Treviso and Venice surrounding the Piave and Livenza rivers, where WNV circulation had also been reported in 2010 [8] (Fig.?1). In the same areas, in September 2011, WNV nucleic acid amplification test screening led to the identification of four viraemic blood donors and one tissue donor, but in mid-August 2011, it missed a multi-organ donor who transmitted infection to four of five recipients, BMS-777607 solubility dmso two of whom (the kidney recipients) developed WNND. A detailed description of these cases has been reported elsewhere [12]. In one of the kidney recipients, who was evaluated by our laboratory, WNV RNA was still detectable in plasma, cerebrospinal fluid, urine and saliva at 1?month after transplantation. Following this experience, we monitored WNV RNA in the urine of WNV nucleic acid amplification test-positive blood donors and RVX-208 demonstrated that the virus was detectable also in urine when patients were viraemic (Barzon L and Pacenti M, unpublished observation). In all human cases of WNV infection in whom WNV RNA was detectable, the presence of WNV lineage 1 was demonstrated by a specific real-time reverse transcription-PCR assay, as reported elsewhere [8]. In the kidney transplant recipient and in a seronegative blood donor, who had a relatively high viral load, the whole viral genome was successfully amplified and sequenced from plasma Neratinib price and urine specimens. The two WNV full genome sequences were named Piave and Livenza (GenBank accession nos JQ928175 and JQ928174, respectively), because the two patients were resident near these two rivers (Fig.?1). Phylogenetic tree analysis classified both WNV genome sequences as lineage 1, clade 1a, within the monophyletic Western Mediterranean subtype (Fig.?2). The two genome sequences belonged to the same branch of the reconstructed phylogenetic tree, despite having 1.79% nucleotide divergence from each other, higher than expected from the fact that the viruses were detected almost simultaneously in close geographic areas. The two WNV genomes also had high nucleotide divergence (1.99% and 1.88%, respectively) from the strain circulating in Italy in 2008�C2009 (Fig.?2).