title: Relating increasing hantavirus incidences to the changing climate: the mast connection.
abstract: BACKGROUND
  Nephropathia epidemica (NE), an emerging rodent-borne viral disease, has become the most important cause of infectious acute renal failure in Belgium, with sharp increases in incidence occurring for more than a decade. Bank voles are the rodent reservoir of the responsible hantavirus and are known to display cyclic population peaks. We tried to relate these peaks to the cyclic NE outbreaks observed since 1993. Our hypothesis was that the ecological causal connection was the staple food source for voles, being seeds of deciduous broad-leaf trees, commonly called "mast". We also examined whether past temperature and precipitation preceding "mast years" were statistically linked to these NE outbreaks.
  
  
  RESULTS
  Since 1993, each NE peak is immediately preceded by a mast year, resulting in significantly higher NE case numbers during these peaks (Spearman R = -0.82; P = 0.034). NE peaks are significantly related to warmer autumns the year before (R = 0.51; P < 0.001), hotter summers two years before (R = 0.32; P < 0.001), but also to colder (R = -0.25; P < 0.01) and more moist summers (R = 0.39; P < 0.001) three years before. Summer correlations were even more pronounced, when only July was singled out as the most representative summer month.
  
  
  CONCLUSIONS
  NE peaks in year 0 are induced by abundant mast formation in year-1, facilitating bank vole survival during winter, thus putting the local human population at risk from the spring onwards of year 0. This bank vole survival is further promoted by higher autumn temperatures in year-1, whereas mast formation itself is primed by higher summer temperatures in year-2. Both summer and autumn temperatures have been rising to significantly higher levels during recent years, explaining the virtually continuous epidemic state since 2005 of a zoonosis, considered rare until recently. Moreover, in 2007 a NE peak and an abundant mast formation occurred for the first time within the same year, thus forecasting yet another record NE incidence for 2008. We therefore predict that with the anticipated climate changes due to global warming, NE might become a highly endemic disease in Belgium and surrounding countries.
authors.affiliation: Hantavirus Reference Center, Laboratory of Clinical Virology, Department of Microbiology & Immunology, Rega Institute, Minderbroedersstraat 10, B3000 Leuven, Belgium. jan.clement@uzleuven.be
authors.forename: Jan
authors.initials: J
authors.lastname: Clement
authors.forename: Jurgen
authors.initials: J
authors.lastname: Vercauteren
authors.forename: Willem W
authors.initials: WW
authors.lastname: Verstraeten
authors.forename: Geneviève
authors.initials: G
authors.lastname: Ducoffre
authors.forename: José M
authors.initials: JM
authors.lastname: Barrios
authors.forename: Anne-Mieke
authors.initials: AM
authors.lastname: Vandamme
authors.forename: Piet
authors.initials: P
authors.lastname: Maes
authors.forename: Marc
authors.initials: M
authors.lastname: Van Ranst
mesh_terms: D000818:Animals; D003411:Arvicolinae / Q000254:growth & development*; D001530:Belgium / Q000453:epidemiology; D002980:Climate; D018778:Hantavirus Infections / Q000453:epidemiology*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D012621:Seasons; D012639:Seeds / Q000254:growth & development*; D013696:Temperature; D014197:Trees / Q000254:growth & development; D015047:Zoonoses / Q000453:epidemiology