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Adv."],"published-print":{"date-parts":[[2025,11,28]]},"abstract":"<jats:p>Urban environments may alter the landscape of disease transmission with implications for control. Yet, it is unclear whether urban-rural differences exist in the dynamics of childhood respiratory diseases, given specific mixing patterns in younger age groups. Here, we leverage county-level data on respiratory syncytial virus (RSV) from the United States to reveal an urban-rural gradient in both the intensity and age structure of the RSV epidemic, where urban locations experience more prolonged epidemics with higher burden in infants (under 1\u00a0year of age). We develop a mechanistic epidemiological model to show that these differences can be explained by daycare utilization rates in children under 5. Using our model to consider control measures, we find that expanding seasonal immunization access in urban and rural areas may limit the risk of off season RSV epidemics.<\/jats:p>","DOI":"10.1126\/sciadv.ady5457","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T19:01:51Z","timestamp":1764183711000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Urban contact patterns shape respiratory syncytial virus epidemics with implications for vaccination"],"prefix":"10.1126","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8487-1617","authenticated-orcid":true,"given":"Presley","family":"Kimball","sequence":"first","affiliation":[{"name":"Division of Applied Mathematics, Brown University, Providence, RI, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3271-9856","authenticated-orcid":true,"given":"Jean-Sebastien","family":"Casalegno","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, H\u00f4pital de la Croix-Rousse, Centre de Biologie Nord, Institut des Agents Infectieux, Laboratoire de Virologie, Lyon, France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-0938","authenticated-orcid":true,"given":"Pamela P.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University of Illinois Urbana-Champaign, Champaign, IL, USA."},{"name":"Department of Statistics, University of Illinois Urbana-Champaign, Champaign, IL, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2282-8613","authenticated-orcid":true,"given":"Ayesha S.","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Department of Demography, University of California, Berkeley, CA, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5432-1235","authenticated-orcid":true,"given":"Bjorn","family":"Sandstede","sequence":"additional","affiliation":[{"name":"Division of Applied Mathematics, Brown University, Providence, RI, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2661-8103","authenticated-orcid":true,"given":"Rachel E.","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Brown University, Providence, RI, USA."},{"name":"Institute at Brown for Environment and Society, Brown University, Providence, RI, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"221","reference":[{"key":"e_1_3_2_2_2","unstructured":"Centers for Disease Control: Respiratory Syncytial Virus https:\/\/cdc.gov\/rsv\/."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.5.17-00284"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1004591"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-019-13562-y"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.aat6030"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.1172330"},{"key":"e_1_3_2_8_2","unstructured":"CDC Immunizations to Protect Infants (2024) https:\/\/cdc.gov\/rsv\/vaccines\/protect-infants.html."},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2213836"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-021-00639-z"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518977113"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-017-02064-4"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40572-020-00293-2"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"R. 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