Spatial-temporal dynamics and virus interference of respiratory viruses: Insights from multi-pathogen surveillance in China

BACKGROUND: It is evident that respiratory viruses exhibit a discernible spatial and temporal transmission pattern, and severe acute respiratory syndrome (SARS-CoV-2) has profoundly altered the dynamics of these pathogens. The viral interference has led to greater complexity in the surveillance. This study aims to examine the spatiotemporal transmission patterns of respiratory viruses in the post-pandemic era and assess the impact of virus interactions on virus outbreaks. METHODS: A multi-pathogen surveillance program was conducted in Taizhou, Zhejiang Province, commencing in 2021. The study utilized spatial-temporal modeling to analyze four respiratory viruses, namely SARS-CoV-2, influenza, human rhinovirus (HRV) and respiratory syncytial virus (RSV), with the objective of identifying interaction patterns and their lagged effects. RESULTS: Each virus is influenced to varying degrees by economic and traffic-related factors. Even after adjusting for spatiotemporal variables and baseline factors, significant interactions were observed between different viruses. These interactions were not always bidirectional and demonstrated specific patterns and lag times. RSV outbreaks are influenced by HRV, but the converse is not true. The effect of SARS-CoV-2 on influenza manifested 12 weeks later, whereas influenza affected SARS-CoV-2 with only 1-week lag. Potential competitive relationships between viruses were also evident in their spatial distribution, such as the nearly opposite high- and low-prevalence areas of influenza and HRV. Furthermore, the coexistence of multiple pathogens resulted in substantial alterations to virus diffusion patterns and epidemic duration. CONCLUSIONS: This study integrates multi-pathogen surveillance with spatiotemporal modeling, confirming that the viral interference relationships derived from population-level incidence data are consistent with experimental findings, thereby revealing potential interactions between SARS-CoV-2 and other viruses. Our findings confirm that SARS-CoV-2 has altered transmission patterns of respiratory viruses and highlight the critical role of viral interactions in shaping epidemic dynamics.