Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08540, USA.
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
Sci Transl Med. 2021 Mar 10;13(584). doi: 10.1126/scitranslmed.abd2400.
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.
急性弛缓性脊髓炎（AFM）自 2012 年以来在美国作为一种罕见但严重的神经系统疾病出现。肠道病毒 D68（EV-D68）被认为是主要的致病因子，但美国对 EV-D68 的有限监测阻碍了评估其因果关系的能力。利用美国 BioFire 综合征趋势流行病学网络 2014 年 1 月至 2019 年 9 月的监测数据，我们描述了 EV-D68 的流行病学动态，并发现了 EV-D68 病例的平均时间存在纬度梯度，这可能与气候有关。我们还证明了 EV-D68 与 AFM 之间存在很强的时空关联。数学模型表明，EV-D68 近期占主导地位的两年周期动力学可能不稳定。尽管如此，我们预测，如果在正常的流行病学条件下，2020 年仍有可能发生主要的 EV-D68 爆发和随之而来的 AFM 爆发。由于正在进行的 COVID-19 大流行而采取的非药物干预措施可能会减少 2020 年 EV-D68 和 AFM 爆发的规模，这说明了大流行对更广泛的流行病学的影响。
