title: A four year seasonal survey of the relationship between outdoor climate and epidemiology of viral respiratory tract infections in a temperate climate.
abstract: The relation between weather conditions, viral transmission and seasonal activity of respiratory viruses is not fully understood.
  
  
  
  To investigate the impact of outdoor weather in a temperate climate setting on the seasonal epidemiology of viruses causing respiratory tract infections, particularly influenza A (IFA).
  
  
  
  In total, 20,062 clinical nasopharyngeal swab samples referred for detection of respiratory pathogens using a multiplex PCR panel, between October 2010 and July 2013, were included. Results of PCR detection were compared with local meteorological data for the same period.
  
  
  
  Low temperature and vapor pressure (VP) were associated with weekly incidence of IFA, respiratory syncytial virus, metapneumovirus, bocavirus and adenovirus but no association with relative humidity was found. The incidence of human rhinovirus and enterovirus was independent of temperature. During seasonal IFA outbreaks, the weekly drop of average temperature (compared with the week before) was strongly associated with the IFA incidence recorded the following week.
  
  
  
  A sudden drop in outdoor temperature might activate the annual influenza epidemic in a temperate climate by facilitating aerosol spread in dry air. These conditions also seem to affect the incidence of other respiratory pathogens but not human rhino- or enterovirus, suggesting that routes of infection other than aerosol may be relevant for these agents.
authors.affiliation: Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden. Electronic address: nicklas.sundell@vgregion.se.
authors.forename: Nicklas
authors.initials: N
authors.lastname: Sundell
authors.affiliation: Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden.
authors.forename: Lars-Magnus
authors.initials: LM
authors.lastname: Andersson
authors.affiliation: Department of Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Brittain-Long
authors.affiliation: Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindh
authors.affiliation: Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Westin
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000821:virology; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000821:virology; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology*; D012229:Rhinovirus / Q000302:isolation & purification; D012621:Seasons; D011795:Surveys and Questionnaires; D013696:Temperature; D014887:Weather
keywords: Epidemiology; Influenza A; Meteorological factors; Respiratory viruses