The Epidemiology Of Mayaro Virus In The Americas: A Systematic Review And Key Parameter Estimates For Outbreak Modelling

Mayaro virus (MAYV) is an arbovirus that is endemic to tropical forests in Central and South America, particularly within the Amazon basin. In recent years, concern has increased regarding MAYV's ability to invade urban areas and cause epidemics across the region. We conducted a systematic literature review to characterise the evolutionary history of MAYV, its transmission potential, and exposure patterns to the virus. We analysed data from the literature on MAYV infection to produce estimates of key epidemiological parameters, including the generation time and the basic reproduction number, R-0. We also estimated the force-of-infection (FOI) in epidemic and endemic settings. Seventy-six publications met our inclusion criteria. Evidence of MAYV infection in humans, animals, or vectors was reported in 14 Latin American countries. Nine countries reported evidence of acute infection in humans confirmed by viral isolation or reverse transcription-PCR (RT-PCR). We identified at least five MAYV outbreaks. Seroprevalence from population based cross-sectional studies ranged from 21% to 72%. The estimated mean generation time of MAYV was 15.2 days (95% CrI: 11.7-19.8) with a standard deviation of 6.3 days (95% CrI: 4.2-9.5). The per-capita risk of MAYV infection (FOI) ranged between 0.01 and 0.05 per year. The mean R-0 estimates ranged between 2.1 and 2.9 in the Amazon basin areas and between 1.1 and 1.3 in the regions outside of the Amazon basin. Although MAYV has been identified in urban vectors, there is not yet evidence of sustained urban transmission. MAYV's enzootic cycle could become established in forested areas within cities similar to yellow fever virus.Author summary Each year, diseases that are transmitted by mosquitoes cause substantial deaths and disability across the world. We performed a systematic literature review of Mayaro virus (MAYV) and estimated key epidemiological parameters that can be used to improve future outbreak response. We estimated the generation time and basic reproduction number for a historical outbreak. Our results suggest that the force-of-infection of MAYV in endemic settings is low. We did not find evidence of substantial urban transmission of MAYV. Nevertheless, similarities between MAYV and yellow fever virus epidemiology suggest that MAYV could emerge in urban areas. Local transmission of MAYV has never been reported outside of Central and South America. Our results highlight the need to continue monitoring emerging arboviruses in the Americas.