Department of Entomology and Plant Pathology, University of Tennessee, Knoxville, Tennessee, United States of America.
Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, Tennessee, United States of America.
PLoS Negl Trop Dis. 2023 Jan 19;17(1):e0011065. doi: 10.1371/journal.pntd.0011065. eCollection 2023 Jan.
La Crosse virus (LACV) is a mosquito-borne pathogen that causes more pediatric neuroinvasive disease than any other arbovirus in the United States. The geographic focus of reported LACV neuroinvasive disease (LACV-ND) expanded from the Midwest into Appalachia in the 1990s, and most cases have been reported from a few high-risk foci since then. Here, we used publicly available human disease data to investigate changes in the distribution of geographic LACV-ND clusters between 2003 and 2021 and to investigate socioeconomic and demographic predictors of county-level disease risk in states with persistent clusters. We used spatial scan statistics to identify high-risk clusters from 2003-2021 and a generalized linear mixed model to identify socioeconomic and demographic predictors of disease risk. The distribution of LACV-ND clusters was consistent during the study period, with an intermittent cluster in the upper Midwest and three persistent clusters in Appalachia that included counties in east Tennessee / western North Carolina, West Virginia, and Ohio. In those states, county-level cumulative incidence was higher when more of the population was white and when median household income was lower. Public health officials should target efforts to reduce LACV-ND incidence in areas with consistent high risks.
拉科斯特病毒（LACV）是一种通过蚊子传播的病原体，它在美国引起的小儿神经侵袭性疾病比任何其他虫媒病毒都多。报告的拉科斯特病毒神经侵袭性疾病（LACV-ND）的地理重点从 20 世纪 90 年代的中西部扩展到阿巴拉契亚地区，此后大多数病例都来自少数几个高风险焦点地区。在这里，我们使用公开的人类疾病数据来调查 2003 年至 2021 年期间地理 LACV-ND 集群分布的变化，并调查在持续存在集群的州中，县一级疾病风险的社会经济和人口统计学预测因素。我们使用空间扫描统计来识别 2003-2021 年的高风险集群，并使用广义线性混合模型来识别疾病风险的社会经济和人口统计学预测因素。在研究期间，LACV-ND 集群的分布保持一致，在上中西部地区有一个间歇性集群，在阿巴拉契亚地区有三个持续存在的集群，包括田纳西州东部/北卡罗来纳州西部、西弗吉尼亚州和俄亥俄州的县。在这些州，当更多的人口是白人并且家庭收入中位数较低时，县一级的累积发病率更高。公共卫生官员应针对发病率持续较高的地区开展减少 LACV-ND 发病率的工作。
