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Public safety officials are upgrading the West Nile Virus risk to high in the Boston area, raising the alarm for the mosquito-borne illness after a fourth case came to light this week.

The Massachusetts Department of Public Health said the case was a woman in her 50s in Middlesex County who was never hospitalized for the illness. The first three cases in the state this year were reported last week.

An investigation showed two of the four cases were exposed in the greater Boston area, which is what prompted increasing the threat level to high from moderate in 11 communities.

The communities covered by the warning include: Arlington, Boston, Belmont, Brookline, Cambridge, Chelsea, Everett, Medford, Newton, Somerville, and Watertown.

“Several individuals from the same area have developed West Nile virus,” Public Health Commissioner Monica Bharel said in a statement. “That means that there is an increased risk in this specific area and that additional people could become infected. We are particularly concerned about people over 50 and those who are immunocompromised as they are the ones most likely to develop (the) disease.”

People at high risk are urged to avoid outdoor activity at dusk and dawn, and local boards of health are asked to continue mosquito control efforts, official said. Also the use of insect repellant, tightly fitting window screens in homes, and dumping standing water are also encouraged.

Last year, Massachusetts saw 6 cases of the West Nile virus. Effects of the virus range from fever and flu-like symptoms to no symptoms at all.