The known unknowns of Powassan virus ecology

Powassan virus (POWV; Family: Flaviviridae, Genus: Flavivirus) is the sole North American member of the tick-borne encephalitis sero-complex. While associated with high rates of morbidity and mortality, POWV has historically been of little public health concern due to low incidence rates. However, over the last 20 yr, incidence rates have increased highlighting the growing epidemiological threat. Currently, there are no vaccines or therapeutics with tick habitat reduction, acaricide application, and public awareness programs being our primary means of intervention. The effectiveness of these control strategies is dependent on having a sound understanding of the virus's ecology. In this Forum, we review what is currently known about POWV ecology, identify gaps in our knowledge, and discuss prevailing and alternative hypotheses about transmission dynamics, reservoir hosts, and spatial focality.