Two adults in central North Carolina have died after contracting West Nile virus, the North Carolina Department of Health and Human Services announced, though the agency has not released where in the region the deaths occurred. The news adds a grim marker to a year in which the mosquito-borne illness has already shown up in blood donations and mosquito traps across multiple counties.
NCDHHS reported the deaths on social media, according to the Raleigh News & Observer, which first reported the fatalities. The department had already confirmed its first West Nile virus case of the year in a Gaston County resident earlier in 2026, and a West Nile virus-positive blood donor was separately identified in Mecklenburg County through routine screening this year, the paper reported.
West Nile virus is carried by wild birds and spreads to people through bites from infected mosquitoes, which pick up the virus by biting infected birds, where it multiplies. The virus does not spread from person to person. Most infected people experience no symptoms at all, while about one in five develop fever, headache, body aches and joint pain, and roughly one in 150 develop severe neurological illness marked by high fever, neck stiffness, disorientation, seizures and paralysis, the state agency said, per the same report. There is no vaccine or specific medication to cure the infection, and NCDHHS has urged anyone who is ill or believes they may have been exposed to contact a health care provider.
Why Official Case Counts Likely Undercount the Real Spread
State regulations only require healthcare providers to report the most severe, neuroinvasive cases of West Nile virus, which means the published tallies capture just a sliver of actual infections. Health officials estimate that for every recorded neuroinvasive case, as many as 20 febrile cases and 100 asymptomatic infections go unreported, according to a NCDHHS clinical guidance memo distributed to state clinicians in August.
That gap helps explain why a single season can look mild on paper while transmission quietly continues. In 2024, North Carolina recorded 27 neuroinvasive West Nile virus cases and three deaths, an all-time record for the state in a single year, before the count dropped to 11 cases in 2025, per NCDHHS data. Nearly all reported neuroinvasive cases in the state result in hospitalization, the same state records show.
State lab surveillance had already flagged trouble months before this week's announcement. NCDHHS detected West Nile virus in mosquito batches collected across Cabarrus, Forsyth and Mecklenburg counties in July, weeks ahead of the state's first confirmed human case in Gaston County and the subsequent adult deaths, the department said in an August press release.
Insecticide Resistance Complicates Mosquito Control
Standard mosquito spraying may be losing some of its punch. Researchers at NC State University reported this year that Asian tiger mosquito populations in Wake County have developed increasing resistance to pyrethroids, the synthetic insecticide class most commonly used in municipal spraying programs, as reported by ABC11 WTVD.
Durham County health officials have already shown how local governments respond to these warnings: they ordered targeted mosquito spraying in central Durham, including Trinity Park, last October after elevated West Nile virus risk turned up in local mosquito traps.
NCDHHS has also flagged a specific medical vulnerability beyond age. In its August clinical guidance memo, the department advised doctors that patients receiving B cell-depleting or immunomodulating therapies face an elevated risk of developing severe arboviral illness, a warning distributed by the agency's Communicable Disease Branch.
A National Surge in Severe Cases
North Carolina's numbers reflect a broader national pattern. CDC surveillance data compiled in January showed total reported human West Nile virus cases across the United States reached 2,076 in 2025, up from 1,466 cases in 2024, according to a summary from Vector Disease Control International.
Severe neuroinvasive cases nationwide rose 41% and related deaths increased by 32% in 2025 compared with typical historical baselines, the American Medical Association reported during a joint webinar with the CDC in December 2025. Separately, researchers from NOAA and the CDC published a study in September establishing the first weather-based predictive model meant to forecast seasonal West Nile virus caseloads using historical climate data, offering public health agencies a potential early-warning tool for future mosquito spikes.
Mosquitoes that commonly transmit West Nile virus are found statewide and are most active between dusk and dawn. Health experts recommend applying EPA-registered repellent such as DEET and reapplying it regularly, especially after sunset, along with wearing long sleeves and long pants and limiting outdoor activity during peak mosquito hours. Intact, tightly fitted window and door screens are also advised.
Residents are encouraged to dump standing water after every rainfall from flowerpot saucers, toys, buckets and tires, and to change water in birdbaths and pet bowls regularly. Keeping gutters clean and in good repair, replacing corrugated downspout extensions with smooth ones, and ensuring rain barrels have tight-fitting screens or lids can all reduce mosquito breeding sites. For standing water that cannot be drained, health experts recommend using EPA-approved larvicides.
