背景:尼帕病毒是一种人畜共患副粘病毒,在南亚和东南亚引起疾病暴发,致死率高。然而,对病毒的潜在地理范围和风险模式的了解很差。我们旨在建立南亚和东南亚人类和动物尼帕病毒感染的时空和系统发育综合数据库。
方法:在此地理空间建模分析中,我们开发了一个综合数据库,其中包含1998年至2021年人类和动物中尼帕病毒感染分布的信息。我们进行了系统动力学分析以检查病毒的进化和迁移途径,并进行了荟萃分析以估计调整后的病死率。我们使用两个增强回归树模型来确定尼帕病毒在溢出事件和流行地区发生的潜在生态驱动因素,并绘制了尼帕病毒流行的潜在风险区域。
结果:记录了9个国家的749人和8种蝙蝠感染了尼帕病毒。根据病毒的66个完整基因组,我们确定了两个进化枝-孟加拉国进化枝和马来西亚进化枝-最近的共同祖先的时间估计为1863年。调整后的病死率在国家之间差异很大,孟加拉国进化枝的病死率高于马来西亚进化枝。多变量荟萃回归分析显示病死率估计值与病毒进化枝之间存在显著关系(p=0.0021),来源国(p=0·016),男性患者比例(p=0.036),和前往医疗机构的旅行时间(p=0.036)。与温度相关的生物气候变量和中翼龙的发生概率是溢出和地方性感染模型的重要因素。
结论:尼帕病毒的合适生态位比以前报道的更广泛。未来的监测工作应侧重于根据最新预测的高风险地区。具体来说,加强人畜共患病监测工作,增强实验室检测能力,在迄今尚未报告人类病例的预计高风险地区实施公共卫生教育将是至关重要的。此外,需要加强野生动物监测,并调查有记录的人类病例的地区的潜在传播方式。
背景:中国重点研发项目.
BACKGROUND: Nipah virus is a zoonotic paramyxovirus responsible for disease outbreaks with high fatality rates in south and southeast Asia. However, knowledge of the potential geographical extent and risk patterns of the virus is poor. We aimed to establish an integrated spatiotemporal and phylogenetic database of Nipah virus infections in humans and animals across south and southeast Asia.
METHODS: In this geospatial modelling analysis, we developed an integrated database containing information on the distribution of Nipah virus infections in humans and animals from 1998 to 2021. We conducted phylodynamic analysis to examine the evolution and migration pathways of the virus and meta-analyses to estimate the adjusted case-fatality rate. We used two boosted regression tree models to identify the potential ecological drivers of Nipah virus occurrences in spillover events and endemic areas, and mapped potential risk areas for Nipah virus endemicity.
RESULTS: 749 people and eight bat species across nine countries were documented as being infected with Nipah virus. On the basis of 66 complete genomes of the virus, we identified two clades-the Bangladesh clade and the Malaysia clade-with the time of the most recent common ancestor estimated to be 1863. Adjusted case-fatality rates varied widely between countries and were higher for the Bangladesh clade than for the Malaysia clade. Multivariable meta-regression analysis revealed significant relationships between case-fatality rate estimates and viral clade (p=0·0021), source country (p=0·016), proportion of male patients (p=0·036), and travel time to health-care facilities (p=0·036). Temperature-related bioclimate variables and the probability of occurrence of Pteropus medius were important contributors to both the spillover and the endemic infection models.
CONCLUSIONS: The suitable niches for Nipah virus are more extensive than previously reported. Future surveillance efforts should focus on high-risk areas informed by updated projections. Specifically, intensifying zoonotic surveillance efforts, enhancing laboratory testing capacity, and implementing public health education in projected high-risk areas where no human cases have been reported to date will be crucial. Additionally, strengthening wildlife surveillance and investigating potential modes of transmission in regions with documented human cases is needed.
BACKGROUND: The Key Research and Development Program of China.