Predicting eastern equine encephalitis spread in North America: An ecological study.

Eastern equine encephalitis (EEE) is a rare but lethal mosquito-borne zoonotic disease. Recent years have seen incursion into new areas of the USA, and in 2019 the highest number of human cases in decades. Due to the low detection rate of EEE, previous studies were unable to quantify large-scale and recent EEE ecological dynamics. We used Bayesian spatial generalized-linear mixed model to quantify the spatiotemporal dynamics of human EEE incidence in the northeastern USA. In addition, we assessed whether equine EEE incidence has predictive power for human cases, independently from other environmental variables. The predictors of the model were selected based on variable importance. Human incidence increased with temperature seasonality, but decreased with summer temperature, summer, fall, and winter precipitation. We also found EEE transmission in equines strongly associated with human infection (OR: 1.57; 95% CI: 1.52-1.60) and latitudes above 41.9°N after 2018. The study designed for sparse dataset described new and known relationships between human and animal EEE and environmental factors, including geographical directionality. Future models must include equine cases as a risk factor when predicting human EEE risks. Future work is still necessary to ascertain the establishment of EEE in northern latitudes and the robustness of the available data.