Epidemiological dynamics of enterovirus D68 in the United States and implications for acute flaccid myelitis
Epidemiological dynamics of enterovirus D68 in the United States and implications for acute flaccid myelitis
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DOI：
10.1126/scitranslmed.abd2400
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发表时间：
2021-03-10
影响因子：
17.1
通讯作者：
Grenfell, Bryan T.
中科院分区：
文献类型：
--
作者：
Park, Sang Woo;Pons-Salort, Margarita;Grenfell, Bryan T.
自2012年以来，急性弛缓性肌麻痹（AFM）最近在美国出现，作为一种罕见但严重的神经系统疾病。肠道病毒D 68（EV-D 68）被认为是主要的致病因子，但在美国对EV-D 68的有限监测阻碍了评估其因果关系的能力。利用2014年1月至2019年9月美国BioFire综合征趋势流行病学网络的监测数据，我们描述了EV-D 68的流行病学动态，并发现EV-D 68病例的平均时间存在纬度梯度，这可能是气候驱动的。我们还证明了EV-D 68与AFM的强时空关联。数学模型表明，最近的主要两年周期的EV-D 68动态可能不稳定。尽管如此，我们预测，在正常的流行病学条件下，2020年仍有可能发生EV-D 68大爆发，从而发生AFM爆发。2019冠状病毒病大流行的非药物干预措施很可能减少了2020年EV-D 68和AFM疫情的规模，说明了大流行病的更广泛流行病学影响。
Acute flaccid myelitis (AFM) recently emerged in the United States as a rare but serious neurological condition since 2012. Enterovirus D68 (EV-D68) is thought to be a main causative agent, but limited surveillance of EV-D68 in the United States has hampered the ability to assess their causal relationship. Using surveillance data from the BioFire Syndromic Trends epidemiology network in the United States from January 2014 to September 2019, we characterized the epidemiological dynamics of EV-D68 and found latitudinal gradient in the mean timing of EV-D68 cases, which are likely climate driven. We also demonstrated a strong spatiotemporal association of EV-D68 with AFM. Mathematical modeling suggested that the recent dominant biennial cycles of EV-D68 dynamics may not be stable. Nonetheless, we predicted that a major EV-D68 outbreak, and hence an AFM outbreak, would have still been possible in 2020 under normal epidemiological conditions. Nonpharmaceutical intervention efforts due to the ongoing COVID-19 pandemic are likely to have reduced the sizes of EV-D68 and AFM outbreaks in 2020, illustrating the broader epidemiological impact of the pandemic.