title: Spatial and Temporal Spread of Acute Viral Respiratory Infections in Young Children Living in High-altitude Rural Communities: A Prospective Household-based Study.
abstract: Few studies have described patterns of transmission of viral acute respiratory infections (ARI) in children in developing countries. We examined the spatial and temporal spread of viral ARI among young children in rural Peruvian highland communities. Previous studies have described intense social interactions in those communities, which could influence the transmission of viral infections.
  
  
  
  We enrolled and followed children <3 years of age for detection of ARI during the 2009 to 2011 respiratory seasons in a rural setting with relatively wide geographic dispersion of households and communities. Viruses detected included influenza, respiratory syncytial virus (RSV), human metapneumovirus and parainfluenza 2 and 3 viruses (PIV2, PIV3). We used geospatial analyses to identify specific viral infection hot spots with high ARI incidence. We also explored the local spread of ARI from index cases using standard deviational ellipses.
  
  
  
  Geospatial analyses revealed hot spots of high ARI incidence around the index cases of influenza outbreaks and RSV outbreak in 2010. Although PIV3 in 2009 and PIV2 in 2010 showed distinct spatial hot spots, clustering was not in proximity to their respective index cases. No significant aggregation around index cases was noted for other viruses. Standard deviational ellipse analyses suggested that influenza B and RSV in 2010, and human metapneumovirus in 2011 spread temporally in alignment with the major road network.
  
  
  
  Despite the geographic dispersion of communities in this rural setting, we observed a rapid spread of viral ARI among young children. Influenza strains and RSV in 2010 had distinctive outbreaks arising from their index cases.
authors.affiliation: From the *Vanderbilt Institute for Global Health, Nashville, Tennessee; †Department of Health Policy and ‡Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; §Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and ‖Instituto de Investigación Nutricional, Lima, Perú.
authors.forename: Charlotte Buehler
authors.initials: CB
authors.lastname: Cherry
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: John V
authors.initials: JV
authors.lastname: Williams
authors.forename: Ana I
authors.initials: AI
authors.lastname: Gil
authors.forename: Hector
authors.initials: H
authors.lastname: Verastegui
authors.forename: Claudio F
authors.initials: CF
authors.lastname: Lanata
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
mesh_terms: D000208:Acute Disease; D000531:Altitude; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010568:Peru / Q000453:epidemiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012424:Rural Population / Q000706:statistics & numerical data*; D062211:Spatio-Temporal Analysis; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology