title: Landscape and regional environmental analysis of the spatial distribution of hantavirus human cases in europe.
abstract: BACKGROUND
  In Europe, the most prevalent hantavirus, Puumala virus, is transmitted by bank voles and causes nephropathia epidemica in human. The European spatial distribution of nephropathia epidemica is investigated here for the first time with a rich set of environmental variables.
  
  
  METHODS
  The influence of variables at the landscape and regional level is studied through multilevel logistic regression, and further information on their effects across the different European ecoregions is obtained by comparing an overall niche model (boosted regression trees) with regressions by ecoregion.
  
  
  RESULTS
  The presence of nephropathia epidemica is likely in populated regions with well-connected forests, more intense vegetation activity, low soil water content, mild summers, and cold winters. In these regions, landscapes with a higher proportion of built-up areas in forest ecotones and lower minimum temperature in winter are expected to be more at risk. Climate and forest connectivity have a stronger effect at the regional level. If variables are staying at their current values, the models predict that nephropathia epidemica may know intensification but should not spread (although southern Sweden, the Norwegian coast, and the Netherlands should be kept under watch).
  
  
  CONCLUSIONS
  Models indicate that large-scale modeling can lead to a very high predictive power. At large scale, the effect of one variable on disease may follow three response scenarios: the effect may be the same across the entire study area, the effect can change according to the variable value, and the effect can change depending on local specificities. Each of these scenarios impacts large-scale modeling differently.
authors: Georges Lemaître Centre for Earth and Climate Research, Earth and Life Institute, Université Catholique de Louvain (UCL) , Louvain-la-Neuve , Belgium.
authors: Caroline Brigitte
authors: CB
authors: Zeimes
authors: Epidemiology Unit of Infectious Diseases, Scientific Institute of Public Health , Brussels , Belgium.
authors: Sophie
authors: S
authors: Quoilin
authors: Natural Resources Institute Finland , Vantaa , Finland.
authors: Heikki
authors: H
authors: Henttonen
authors: Infectious Disease Control Unit, Department of Infectious Diseases, National Institute for Health and Welfare , Helsinki , Finland.
authors: Outi
authors: O
authors: Lyytikäinen
authors: Infectious Disease Control Unit, Department of Virology, University of Helsinki , Helsinki , Finland.
authors: Olli
authors: O
authors: Vapalahti
authors: Unité de Biologie des Infections Virales Emergentes, Centre National de Référence des Hantavirus, Institut Pasteur , Lyon , France.
authors: Jean-Marc
authors: JM
authors: Reynes
authors: Department of Viroscience, ErasmusMC , Rotterdam , Netherlands ; Centre for Infectious Disease Control, Rijksinstituut voor Volksgezondheid en Milieu (RIVM) , Bilthoven , Netherlands.
authors: Chantal
authors: C
authors: Reusken
authors: Centre for Infectious Disease Control, Rijksinstituut voor Volksgezondheid en Milieu (RIVM) , Bilthoven , Netherlands.
authors: Arno N
authors: AN
authors: Swart
authors: Department of Virology, Norwegian Institute of Public Health , Oslo , Norway.
authors: Kirsti
authors: K
authors: Vainio
authors: The Swedish Institute for Infectious Disease Control , Stockholm , Sweden.
authors: Marika
authors: M
authors: Hjertqvist
authors: Georges Lemaître Centre for Earth and Climate Research, Earth and Life Institute, Université Catholique de Louvain (UCL) , Louvain-la-Neuve , Belgium.
authors: Sophie O
authors: SO
authors: Vanwambeke
keywords: environmental modeling; hantavirus; large scale model; multilevel logistic regression; spatial model