Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents

Impacts of climate change on the microbial safety of pre-harvest leafy green vegetables as indicated by Escherichia coli O157 and Salmonella spp

The likelihood of leafy green vegetable (LGV) contamination and the associated pathogen growth and survival are strongly related to climatic conditions. Particularly temperature increase and precipitation pattern changes have a close relationship not only with the fate and transport of enteric bacteria, but also with their growth and survival. Using all relevant literature, this study reviews and synthesises major impacts of climate change (temperature increases and precipitation pattern changes) on contamination sources (manure, soil, surface water, sewage and wildlife) and pathways of foodborne pathogens (focussing on Escherichia coli O157 and Salmonella spp.) on pre-harvested LGVs. Whether climate change increases their prevalence depends not only on the resulting local balance of the positive and negative impacts but also on the selected regional climate change scenarios. However, the contamination risks are likely to increase. This review shows the need for quantitative modelling approaches with scenario analyses and additional laboratory experiments. This study gives an extensive overview of the impacts of climate change on the contamination of pre-harvested LGVs and shows that climate change should not be ignored in food safety management and research.

Effects of bacterial, chemical, physical and meteorological variables on virus removal by a wastewater treatment plant

The purpose of wastewater treatment is to minimize chemical and microbial contamination of recipient waters. The present study evaluated the impacts of meteorological variables, such as temperature and rainfall, on the removal of human viruses and indicators by a wastewater treatment plant servicing Pisa, Italy. Data were obtained during four sampling campaigns from 2007 to 2010. Wastewater sewage samples were analyzed for human adenovirus (HAdV) and norovirus using quantitative molecular techniques. In parallel, Escherichia coli, enterococci and somatic coliphages were measured, and meteorological and chemical data were recorded. We detected a continuous presence of HAdV in both influent and effluent samples with an average removal rate of 2.01 log10 Genomic Copies/l. An association between meteorological parameters and viral removal rates was detected only for rainfall and HAdV removal during a specific sampling campaign. No correlation was found between viral data and microbial, chemical and physical ones. Viral removal rates were not strongly influenced by meteorological conditions and were unrelated to other process indicators routinely monitored. Our results suggest that HAdV is a suitable parameter to assess the viral removal efficiency of wastewater treatment plants, particularly in the case of heavy rainfall.

Escherichia coli pathotypes in Pakistan from consecutive floods in 2010 and 2011

This study compares Escherichia coli pathotypes circulating among children in Pakistan during the floods of 2010 and 2011 and from sporadic cases outside flood affected areas. Using multiplex polymerase chain reaction 115 of 205 stool samples (56.29%) were positive for diarrheagenic E. coli from specimens taken during the floods compared with 50 of 400 (12.5%) stool samples being positive for sporadic cases. The E. coli pathotypes were categorized as Enteropathogenic E. coli 33 (28.69%) and 13 (26%), Enterotoxigenic E. coli 29 (25.21%) and 15 (30%), Enteroaggregative E. coli 21 (18.2%) and 18 (36%), Enterohemorrhagic E. coli 5 (4.34%) and 1 (2%) from flood and sporadic cases, respectively. Furthermore, patients co-infected with more than one pathotype were 26 (22.60%) and 3 (6%) from flood and sporadic cases, respectively. The study shows an unexpectedly high rate of isolation of E. coli pathotypes suggesting Pakistan as an endemic region that requires active surveillance particularly during flood periods.

Potential changes in disease patterns and pharmaceutical use in response to climate change

As climate change alters environmental conditions, the incidence and global patterns of human diseases are changing. These modifications to disease profiles and the effects upon human pharmaceutical usage are discussed. Climate-related environmental changes are associated with a rise in the incidence of chronic diseases already prevalent in the Northern Hemisphere, for example, cardiovascular disease and mental illness, leading to greater use of associated heavily used Western medications. Sufferers of respiratory diseases may exhibit exacerbated symptoms due to altered environmental conditions (e.g., pollen). Respiratory, water-borne, and food-borne toxicants and infections, including those that are vector borne, may become more common in Western countries, central and eastern Asia, and across North America. As new disease threats emerge, substantially higher pharmaceutical use appears inevitable, especially of pharmaceuticals not commonly employed at present (e.g., antiprotozoals). The use of medications for the treatment of general symptoms (e.g., analgesics) will also rise. These developments need to be viewed in the context of other major environmental changes (e.g., industrial chemical pollution, biodiversity loss, reduced water and food security) as well as marked shifts in human demographics, including aging of the population. To identify, prevent, mitigate, and adapt to potential threats, one needs to be aware of the major factors underlying changes in the use of pharmaceuticals and their subsequent release, deliberately or unintentionally, into the environment. This review explores the likely consequences of climate change upon the use of medical pharmaceuticals in the Northern Hemisphere.

Projected burden of disease for Salmonella infection due to increased temperature in Australian temperate and subtropical regions

OBJECTIVE

This study aimed to project the future disability burden of Salmonella infection associated with increased temperature in future in temperate and subtropical regions of Australia in order to provide recommendations for public health policy to respond to climate change.

METHODS

Years Lost due to Disabilities (YLDs) were used as the measure of the burden of disease in this study. Regions in temperate and subtropical Australia were selected for this study. Future temperature change scenarios in the study were based on Australian projections, developed by the Commonwealth Scientific and Industrial Research Organization (CSIRO). YLDs for Salmonella infection in 2000 were calculated as the baseline data. YLDs for Salmonella infection in 2030 and 2050 under future temperature change scenarios were projected based on the quantitative relationship between temperature and disease examined in previously published regression models. Future demographic change was also considered in this analysis.

RESULTS

Compared with the YLDs in 2000, increasing temperature and demographic changes may lead to a 9%-48% increase in the YLDs for Salmonella infection by 2030 and a 31%-87% increase by 2050 in the temperate region, and a 51%-100% increase by 2030 and an 87%-143% increase by 2050 in the subtropical region, if other factors remain constant.

CONCLUSION

Temperature-related health burden of Salmonella infection in Australia may increase in the future due to change in climate and demography in the absence of effective public health interventions. Relevant public health strategies should be developed at an early stage to prevent and reduce the health burden of climate change.

Impact of ambient temperature on children's health: a systematic review

Children are vulnerable to temperature extremes. This paper aimed to review the literature regarding the relationship between ambient temperature and children's health and to propose future research directions. A literature search was conducted in February 2012 using the databases including PubMed, ProQuest, ScienceDirect, Scopus and Web of Science. Empirical studies regarding the impact of ambient temperature on children's mortality and morbidity were included. The existing literature indicates that very young children, especially children under one year of age, are particularly vulnerable to heat-related deaths. Hot and cold temperatures mainly affect cases of infectious diseases among children, including gastrointestinal diseases, malaria, hand, foot and mouse disease, and respiratory diseases. Pediatric allergic diseases, like eczema, are also sensitive to temperature extremes. During heat waves, the incidences of renal disease, fever and electrolyte imbalance among children increase significantly. Future research is needed to examine the balance between hot- and cold-temperature related mortality and morbidity among children; evaluate the impacts of cold spells on cause-specific mortality in children; identify the most sensitive temperature exposure and health outcomes to quantify the impact of temperature extremes on children; elucidate the possible modifiers of the temperature and children's health relationship; and project children's disease burden under different climate change scenarios.

Global distribution of outbreaks of water-associated infectious diseases

BACKGROUND

Water plays an important role in the transmission of many infectious diseases, which pose a great burden on global public health. However, the global distribution of these water-associated infectious diseases and underlying factors remain largely unexplored.

METHODS AND FINDINGS

Based on the Global Infectious Disease and Epidemiology Network (GIDEON), a global database including water-associated pathogens and diseases was developed. In this study, reported outbreak events associated with corresponding water-associated infectious diseases from 1991 to 2008 were extracted from the database. The location of each reported outbreak event was identified and geocoded into a GIS database. Also collected in the GIS database included geo-referenced socio-environmental information including population density (2000), annual accumulated temperature, surface water area, and average annual precipitation. Poisson models with Bayesian inference were developed to explore the association between these socio-environmental factors and distribution of the reported outbreak events. Based on model predictions a global relative risk map was generated. A total of 1,428 reported outbreak events were retrieved from the database. The analysis suggested that outbreaks of water-associated diseases are significantly correlated with socio-environmental factors. Population density is a significant risk factor for all categories of reported outbreaks of water-associated diseases; water-related diseases (e.g., vector-borne diseases) are associated with accumulated temperature; water-washed diseases (e.g., conjunctivitis) are inversely related to surface water area; both water-borne and water-related diseases are inversely related to average annual rainfall. Based on the model predictions, "hotspots" of risks for all categories of water-associated diseases were explored.

CONCLUSIONS

At the global scale, water-associated infectious diseases are significantly correlated with socio-environmental factors, impacting all regions which are affected disproportionately by different categories of water-associated infectious diseases.

Integrated evaluation of environmental parameters influencing Vibrio occurrence in the coastal Northern Adriatic Sea (Italy) facing the Venetian lagoon

In the marine environment, the persistence and abundance of Vibrio are related to a number of environmental parameters. The influence of the different environmental variables in determining the Vibrio occurrence could be different in the specific geographic areas around the world. Moreover, oceanographic parameters are generally interdependent and should not be considered separately when their influence on bacterial presence and concentration is tested. In this study, an integrated approach was used to identify key parameters determining the abundance of Vibrio spp in marine samples from the Venetian Lagoon in Italy, which is an important area for fish farming and tourism. Multivariate techniques have been adopted to analyze the dataset: using PCA, it was shown that a relatively high proportion of the total variance in this area was mainly due to two independent variables, namely salinity and temperature. Using cluster analysis, it was possible to categorize different groups with homogeneous features as regards space ("stations") and time ("seasons") distribution, as well as to quantify the values of environmental variables and the Vibrio abundances in each category. Furthermore, integrating key environmental factors and bacterial concentration values, it was possible to identify levels of salinity and sea surface temperature which were optimal for Vibrio concentration in water, plankton, and sediment samples. The identification of key environmental variables conditioning Vibrio occurrence should facilitate ocean monitoring, making it possible to predict unexpected variations in marine microflora which determine possible public health risks in coastal areas.

Hospitalization of the elderly in the United States for nonspecific gastrointestinal diseases: a search for etiological clues

The frequency of hospitalization among the elderly in the United States caused by gastrointestinal diseases between 1991 and 2004 increased dramatically, especially hospitalization of elderly individuals with nonspecific diagnoses. We analyzed 6 640 304 gastrointestinal disease-associated hospitalization records in this 14-year period by comparing the peak times of nonspecific gastrointestinal diseases with those of specific diseases. We found that most nonspecific gastrointestinal diseases peak concurrently with viral enteritis, suggesting a lack of diagnostic testing for viruses, which may adversely affect the efficiency of prevention, surveillance, and treatment efforts.

Weather, water quality and infectious gastrointestinal illness in two Inuit communities in Nunatsiavut, Canada: potential implications for climate change

Climate change is expected to cause changes in precipitation quantity, intensity, frequency and duration, which will subsequently alter environmental conditions and might increase the risk of waterborne disease. The objective of this study was to describe the seasonality of and explore associations between weather, water quality and occurrence of infectious gastrointestinal illnesses (IGI) in two communities in Nunatsiavut, Canada. Weather data were obtained from meteorological stations in Nain (2005-2008) and Rigolet (2008). Free-chlorine residual levels in drinking water were extracted from municipal records (2005-2008). Raw surface water was tested weekly for total coliform and E. coli counts. Daily counts of IGI-related clinic visits were obtained from health clinic registries (2005-2008). Analysis of weather and health variables included seasonal-trend decomposition procedures based on Loess. Multivariable zero-inflated Poisson regression was used to examine potential associations between weather events (considering 0-4 week lag periods) and IGI-related clinic visits. In Nain, water volume input (rainfall + snowmelt) peaked in spring and summer and was positively associated with levels of raw water bacteriological variables. The number of IGI-related clinic visits peaked in the summer and fall months. Significant positive associations were observed between high levels of water volume input 2 and 4 weeks prior, and IGI-related clinic visits (P < 0.05). This study is the first to systematically gather, analyse and compare baseline data on weather, water quality and health in Nunatsiavut, and illustrates the need for high quality temporal baseline information to allow for detection of future impacts of climate change on regional Inuit human and environmental health.

Assessing the vulnerability of eco-environmental health to climate change

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change.

Climate variations and Salmonella infection in Australian subtropical and tropical regions

This study aims to quantify the relationship between climate variations and cases of Salmonella infection in subtropical and tropical areas in Australia. Brisbane in a subtropical area and Townsville in a tropical area of Queensland were selected as the study regions. Local meteorological variables and notified cases of Salmonella infection from January 1990 to July 2005 were provided by local authorities. Spearman correlation and time-series adjusted Poisson regression were applied controlling for autoregression, lag effects, seasonal variation and long-term trend. Natural cubic spline and Hockey Stick model were used to estimate a potential threshold temperature. Spearman correlation indicated that maximum and minimum temperatures, relative humidity at 9 am and 3 pm, and rainfall were all positively correlated with the number of cases in both Brisbane and Townsville, with the lag values of the effects up to 2 weeks in Brisbane and 2 months in Townsville. Only temperature and rainfall were significantly included in the regression models in both regions. The models suggested that a potential 1 degrees C rise in maximum or minimum temperature may cause a very similar increase in the number of cases in the two regions. No threshold for the effect of maximum or minimum temperature on Salmonella infection was detected in either region. The association between climate variations and Salmonella infection could be very similar in subtropical and tropical regions in Australia. Temperature and rainfall may be used as key meteorological predictors for the number of cases in both regions.

Impact of drainage networks on cholera outbreaks in Lusaka, Zambia

OBJECTIVES

We investigated the association between precipitation patterns and cholera outbreaks and the preventative roles of drainage networks against outbreaks in Lusaka, Zambia.

METHODS

We collected data on 6542 registered cholera patients in the 2003-2004 outbreak season and on 6045 cholera patients in the 2005-2006 season. Correlations between monthly cholera incidences and amount of precipitation were examined. The distribution pattern of the disease was analyzed by a kriging spatial analysis method. We analyzed cholera case distribution and spatiotemporal cluster by using 2590 cholera cases traced with a global positioning system in the 2005-2006 season. The association between drainage networks and cholera cases was analyzed with regression analysis.

RESULTS

Increased precipitation was associated with the occurrence of cholera outbreaks, and insufficient drainage networks were statistically associated with cholera incidences.

CONCLUSIONS

Insufficient coverage of drainage networks elevated the risk of cholera outbreaks. Integrated development is required to upgrade high-risk areas with sufficient infrastructure for a long-term cholera prevention strategy.

Climate change and occupational safety and health: establishing a preliminary framework

The relationship between global climate change and occupational safety and health has not been extensively characterized. To begin such an effort, it may be useful to develop a framework for identifying how climate change could affect the workplace; workers; and occupational morbidity, mortality, and injury. This article develops such a framework based on a review of the published scientific literature from 1988-2008 that includes climatic effects, their interaction with occupational hazards, and their manifestation in the working population. Seven categories of climate-related hazards are identified: (1) increased ambient temperature, (2) air pollution, (3) ultraviolet exposure, (4) extreme weather, (5) vector-borne diseases and expanded habitats, (6) industrial transitions and emerging industries; and (7) changes in the built environment. This review indicates that while climate change may result in increasing the prevalence, distribution, and severity of known occupational hazards, there is no evidence of unique or previously unknown hazards. However, such a possibility should not be excluded, since there is potential for interactions of known hazards and new conditions leading to new hazards and risks.

Climate change and food safety: an emerging issue with special focus on Europe

According to general consensus, the global climate is changing, which may also affect agricultural and livestock production. The potential impact of climate change on food security is a widely debated and investigated issue. Nonetheless, the specific impact on safety of food and feed for consumers has remained a less studied topic. This review therefore identifies the various food safety issues that are likely to be affected by changes in climate, particularly in Europe. Amongst the issues identified are mycotoxins formed on plant products in the field or during storage; residues of pesticides in plant products affected by changes in pest pressure; trace elements and/or heavy metals in plant products depending on changes in their abundance and availability in soils; polycyclic aromatic hydrocarbons in foods following changes in long-range atmospheric transport and deposition into the environment; marine biotoxins in seafood following production of phycotoxins by harmful algal blooms; and the presence of pathogenic bacteria in foods following more frequent extreme weather conditions, such as flooding and heat waves. Research topics that are amenable to further research are highlighted.

Climate change and waterborne disease risk in the Great Lakes region of the U.S

Extremes of the hydrologic cycle will accompany global warming, causing precipitation intensity to increase, particularly in middle and high latitudes. During the twentieth century, the frequency of major storms has already increased, and the total precipitation increase over this time period has primarily come from the greater number of heavy events. The Great Lakes region is projected to experience a rise these extreme precipitation events. For southern Wisconsin, the precipitation rate of the 10 wettest days was simulated using a suite of seven global climate models from the UN Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report. For each ranking, the precipitation rate of these very heavy events increases in the future. Overall, the models project that extreme precipitation events will become 10% to 40% stronger in southern Wisconsin, resulting in greater potential for flooding, and for the waterborne diseases that often accompany high discharge into Lake Michigan. Using 6.4 cm (2.5 in) of daily precipitation as the threshold for initiating combined sewer overflow into Lake Michigan, the frequency of these events is expected to rise by 50% to 120% by the end of this century. The combination of future thermal and hydrologic changes may affect the usability of recreational beaches. Chicago beach closures are dependent on the magnitude of recent precipitation (within the past 24 hours), lake temperature, and lake stage. Projected increases in heavy rainfall, warmer lake waters, and lowered lake levels would all be expected to contribute to beach contamination in the future. The Great Lakes serve as a drinking water source for more than 40 million people. Ongoing studies and past events illustrate a strong connection between rain events and the amount of pollutants entering the Great Lakes. Extreme precipitation under global warming projections may overwhelm the combined sewer systems and lead to overflow events that can threaten both human health and recreation in the region.

Weather and notified Campylobacter infections in temperate and sub-tropical regions of Australia: an ecological study

BACKGROUND

The relationship between weather and food-borne diseases has been of great concern recently. However, the impact of weather variations on food-borne disease may vary in different areas with various geographic, weather and demographic characteristics. This study was designed to quantify the relationship between weather variables and Campylobacter infections in two Australian cities with different local climatic conditions.

METHODS

An ecological-epidemiological study was conducted, using weekly disease surveillance data and meteorological data, over the period 1990-2005, to quantify the relationship between maximum and minimum temperatures, rainfall, relative humidity and notifications of Campylobacter infections in Adelaide, with a temperate Mediterranean climate, and Brisbane, with a sub-tropical climate. Spearman correlation and time-series adjusted Poisson regression analyses were performed taking into account seasonality, lag effects and long-term trends.

RESULTS

The results indicate that weekly maximum and minimum temperatures were inversely associated with the weekly number of cases in Adelaide, but positively correlated with the number of cases in Brisbane, with relevant lagged effects. The effects of rainfall and relative humidity on Campylobacter infection rates varied in the two cities.

CONCLUSION

Weather might have different effect on Campylobacter infections in different cities. Further studies are needed for a better understanding of these relationships for they may indicate epidemiologic factors important for control of these infections.

Expression and characterization of the biofilm-related and carnosine-hydrolyzing aminoacylhistidine dipeptidase from Vibrio alginolyticus

The biofilm-related and carnosine-hydrolyzing aminoacylhistidine dipeptidase (pepD) gene from Vibrio alginolyticus was cloned and sequenced. The recombinant PepD protein was produced and biochemically characterized and the putative active-site residues responsible for metal binding and catalysis were identified. The recombinant enzyme, which was identified as a homodimeric dipeptidase in solution, exhibited broad substrate specificity for Xaa-His and His-Xaa dipeptides, with the highest activity for the His-His dipeptide. Sequence and structural homologies suggest that the enzyme is a member of the metal-dependent metallopeptidase family. Indeed, the purified enzyme contains two zinc ions per monomer. Reconstitution of His.Tag-cleaved native apo-PepD with various metal ions indicated that enzymatic activity could be optimally restored when Zn2+ was replaced with other divalent metal ions, including Mn2+, Co2+, Ni2+, Cu2+ and Cd2+, and partially restored when Zn2+ was replaced with Mg2+. Structural homology modeling of PepD also revealed a 'catalytic domain' and a 'lid domain' similar to those of the Lactobacillus delbrueckii PepV protein. Mutational analysis of the putative active-site residues supported the involvement of His80, Asp119, Glu150, Asp173 and His461 in metal binding and Asp82 and Glu149 in catalysis. In addition, individual substitution of Glu149 and Glu150 with aspartic acid resulted in the partial retention of enzymatic activity, indicating a functional role for these residues on the catalysis and zinc ions, respectively. These effects may be necessary either for the activation of the catalytic water molecule or for the stabilization of the substrate-enzyme tetrahedral intermediate. Taken together, these results may facilitate the design of PepD inhibitors for application in antimicrobial treatment and antibody-directed enzyme prodrug therapy.

Correlation between CD4 counts of HIV patients and enteric protozoan in different seasons - an experience of a tertiary care hospital in Varanasi (India)

BACKGROUND

Protozoan infections are the most serious among all the superimposed infections in HIV patients and claim a number of lives every year. The line of treatment being different for diverse parasites necessitates a definitive diagnosis of the etiological agents to avoid empirical treatment. Thus, the present study has been aimed to elucidate the associations between diarrhoea and CD4 counts and to study the effect of HAART along with management of diarrhoea in HIV positive patients. This study is the first of its kind in this area where an attempt was made to correlate seasonal variation and intestinal protozoan infestations.

METHODS

The study period was from January 2006 to October 2007 wherein stool samples were collected from 366 HIV positive patients with diarrhea attending the ART centre, inpatient department and ICTC of S.S. hospital, I.M.S., B.H.U., Varanasi. Simultaneously, CD4 counts were recorded to assess the status of HIV infection vis-à-vis parasitic infection. The identification of pathogens was done on the basis of direct microscopy and different staining techniques.

RESULTS

Of the 366 patients, 112 had acute and 254 had chronic diarrhea. The percentages of intestinal protozoa detected were 78.5% in acute and 50.7% in chronic cases respectively. Immune restoration was observed in 36.6% patients after treatment on the basis of clinical observation and CD4 counts. In 39.8% of HIV positive cases Cryptosporidium spp. was detected followed by Microsporidia spp. (26.7%). The highest incidence of intestinal infection was in the rainy season. However, infection with Cyclospora spp. was at its peak in the summer. Patients with chronic diarrhea had lower CD4 cell counts. The maximum parasitic isolation was in the patients whose CD4 cell counts were below 200 cells/microl.

CONCLUSION

There was an inverse relation between the CD4 counts and duration of diarrhea. Cryptosporidium spp. was isolated maximum among all the parasites in the HIV patients. The highest incidence of infection was seen in the rainy season.

Preparing the U.S. health community for climate change

In society's effort to address and prepare for climate change, the health community itself must ensure that it is prepared. Health personnel will require flexible and iterative action plans to address climate change at the individual, hospital, local health department, state, and national levels. This requires that health workers analyze the impact of climate change with a view to human health, and then formulate robust policy and demonstrate authentic leadership. In this review, we summarize the status of the health community's preparation for climate change and provide specific recommendations for action at each level. Although preparation status and recommendations vary, our observation is that it is not enough for public health and medical care agencies and departments to develop policies and advocate change. They have a direct responsibility to demonstrate substantive leadership.

Climate change: the public health response

There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations.

Critical linkages between land-use transition and human health in the Himalayan region

This article reviews critical linkages between land-use transition and human health in the Himalayan region by applying ecosystem approaches to human health (or EcoHealth). Land-use transition in the Himalayan and similar regions includes sedentarization, agricultural intensification, habitat modification, migration, change of livelihoods and lifestyles, biodiversity loss, and increasing flash floods. These transitions, which can have impacts on human health, are driven by state policies, a market economy, and climate change. Human health is dependent on access to ecosystem services for food, nutrition, medicine, fiber and shelter, fresh water, and clear air. Ecosystem management has been a key means of controlling disease vectors and creating suitable habitats for human well-being. The paper identifies the web of environmental factors that influence human health. Institutional and policy issues for land-use and health transitions are also discussed.

Climate and cholera in KwaZulu-Natal, South Africa: the role of environmental factors and implications for epidemic preparedness

A cholera epidemic that took place in KwaZulu-Natal, South Africa (2000-2001) was employed to investigate the impact of climatic and environmental drivers on cholera dynamics. Precipitation (PRE), sea surface temperature (SST) and chlorophyll-a (CHL-a) data acquired from publicly available satellite and ground measurements were analysed together with disease incidence in an effort to assess the environmental contribution to the outbreak. SST (r(2)=0.749, lag=0 months) and PRE (r(2)=0.744, lag=2 months) showed strong associations with incidence. CHL-a showed a moderately strong (r(2)=0.656, lag=6 months) association with incidence while sea surface height (SSH) demonstrated a weak relationship with incidence (r(2)=0.326, lag=5 months). Our analysis tentatively supports a coastal transmission hypothesis, heavily influenced by localized PRE extremes. The role of SSH is likely attenuated by local coastal topography. Future work should clarify the mechanism linking coastal cholera reservoirs and the regional climate system to outbreaks in this region. Finally, we discuss benefits of further research in this area using extended remotely sensed and epidemiological datasets towards the development of early-warning systems and enhanced epidemic preparedness.

Climate change and human health: present and future risks

There is near unanimous scientific consensus that greenhouse gas emissions generated by human activity will change Earth's climate. The recent (globally averaged) warming by 0.5 degrees C is partly attributable to such anthropogenic emissions. Climate change will affect human health in many ways-mostly adversely. Here, we summarise the epidemiological evidence of how climate variations and trends affect various health outcomes. We assess the little evidence there is that recent global warming has already affected some health outcomes. We review the published estimates of future health effects of climate change over coming decades. Research so far has mostly focused on thermal stress, extreme weather events, and infectious diseases, with some attention to estimates of future regional food yields and hunger prevalence. An emerging broader approach addresses a wider spectrum of health risks due to the social, demographic, and economic disruptions of climate change. Evidence and anticipation of adverse health effects will strengthen the case for pre-emptive policies, and will also guide priorities for planned adaptive strategies.

Cambio climático y salud pública: escenarios después de la entrada en vigor del Protocolo de Kioto

According to the reports of the intergovernmental panel for climatic change (IPCC) human beings of the present and near future are going to experiment, in fact we are already experimenting, important changes in the world climate. Conscious of the magnitude of the problem, international organizations have taken a series of initiatives headed to stop the climatic change and to reduce its impact. This willingness has been shaped into the agreements established in the Kyoto protocol, where countries commit to reduce greenhouse-effect gas emissions. Kyoto protocol has come into force on February 16th 2005 with the support of 141 signing countries. Among the major worries are the effects which climatic change may have upon health, such as: 1) changes in the morbidity- mortality related to temperature; 2) Effects on health related with extreme meteorological events (tornados, storms, hurricanes and extreme raining); 3) Air pollution and increase of associated health effects; d) Diseases transmitted by food and water and 4) Infectious diseases transmitted by vectors and by rodents. Even if all the countries in the world committed to the Kyoto Protocol, some consequences of the climatic change will be inevitable; among them some will have a negative impact on health. It would be necessary to adapt a key response strategy to minimize the impacts of climatic change and to reduce, at minimum cost, its adverse effects on health. From the Public Health position, a relevant role can and must be played concerning the understanding of the risks for health of such climatic changes, the design of surveillance systems to evaluate possible impacts, and the establishment of systems to prevent or reduce damages as well as the identification and development of investigation needs.

Frequency of infectious gastrointestinal illness in Australia, 2002: regional, seasonal and demographic variation

To estimate the frequency of infectious gastroenteritis across Australia, and to identify risk factors, we conducted a national telephone survey of 6087 randomly selected respondents in 2001-2002. The case definition was three or more loose stools and/or two or more vomits in a 24-hour period in the last 4 weeks, with adjustment to exclude non-infectious causes and symptoms secondary to a respiratory infection. Frequency data were weighted to the Australian population. Multivariate logistic regression was used to assess potential risk factors including season, region, demographic and socioeconomic status. Among contacted individuals, 67% responded. The case definition applied to 7% of respondents (450/6087) which extrapolates to 17.2 million (95% CI 14.5-19.9 million) cases of gastroenteritis in Australia in one year, or 0.92 (95% CI 0.77-1.06) cases/person per year. In the multivariate model, the odds of having gastroenteritis were increased in summer and in the warmest state, in young children, females, those with higher socioeconomic status and those without health insurance.

Vulnerability of waterborne diseases to climate change in Canada: a review

This project addresses two important issues relevant to the health of Canadians: the risk of waterborne illness and the health impacts of global climate change. The Canadian health burden from waterborne illness is unknown, although it presumably accounts for a significant proportion of enteric illness. Recently, large outbreaks with severe consequences produced by E. coli O157:H7 and Cryptosporidium have alarmed Canadians and brought demands for political action. A concurrent need to understand the health impacts of global climate changes and to develop strategies to prevent or prepare for these has also been recognized. There is mounting evidence that weather is often a factor in triggering waterborne disease outbreaks. A recent study of precipitation and waterborne illness in the United States found that more than half the waterborne disease outbreaks in the United States during the last half century followed a period of extreme rainfall. Projections of international global climate change scenarios suggest that, under conditions of global warming most of Canada may expect longer summers, milder winters, increased summer drought, and more extreme precipitation. Excess precipitation, floods, high temperatures, and drought could affect the risk of waterborne illness in Canada. The existing scientific information regarding most weather-related adverse health impacts and on the impacts of global climate change on health in Canada is insufficient for informed decision making. The results of this project address this need through the investigation of the complex systemic interrelationships between disease incidence, weather parameters, and water quality and quantity, and by projecting the potential impact of global climate change on those relationships.

Does ambient temperature affect foodborne disease?

BACKGROUND

Foodborne illness is a significant public health issue in most countries, including Australia. We examined the association between temperature and salmonellosis notifications, and compared these associations for 5 Australian cities.

METHODS

Log-linear models describing monthly salmonellosis notifications in terms of calendar time and monthly average temperatures were fitted over the period 1991 to 2001 for each city. We used a negative binomial chance model to accommodate overdispersion in the counts.

RESULTS

The long-term trend showed an increase in salmonellosis notifications in each of the 5 cities. There was a positive association between monthly salmonellosis notifications and mean monthly temperature of the previous month in every city. Seasonal patterns in salmonellosis notifications were fully explained by changes in temperature.

DISCUSSION

The strength of the association, the consistency across 5 cities, and a plausible biologic pathway suggest that higher ambient temperatures are a cause of higher salmonellosis notifications. The lag of 1 month suggests that temperature might be more influential earlier in the production process rather than at the food preparation stage. This knowledge can help to guide policy on food preparation and distribution. It also suggests a basis for an early warning system for increased risk from salmonellosis, and raises yet another possible health problem with global warming.

Public health effects of inadequately managed stormwater runoff

OBJECTIVES

This study investigated the scale of the public health risk from stormwater runoff caused by urbanization.

METHODS

We compiled turbidity data for municipal treated drinking water as an indication of potential risk in selected US cities and compared estimated costs of waterborne disease and preventive measures.

RESULTS

Turbidity levels in other US cities were similar to those linked to illnesses in Milwaukee, Wis, and Philadelphia, Pa. The estimated annual cost of waterborne illness is comparable to the long-term capital investment needed for improved drinking water treatment and stormwater management.

CONCLUSIONS

Although additional data on cost and effectiveness are needed, stormwater management to minimize runoff and associated pollution appears to make sense for protecting public health at the least cost.

Cutaneous manifestations of waterborne infections

Although waterborne pathogens are relatively uncommon causes of cutaneous infections, these agents are being recognized with increasing frequency. Humans are exposed to water through a variety of recreational and occupational activities. Poor sanitary conditions in developing nations place the human populations at constant risk. Some aquatically acquired skin infections respond well to therapy, whereas other diseases do not require a specific treatment. However, many of these infections are rare, and effective therapy has not been defined. Gram-negative bacilli constitute the largest group of aquatic pathogens that cause skin infections. Other agents include mycobacteria, fungi, viruses, and amoeba and other parasites. Toxins from aquatic animals and parasites are associated with cutaneous diseases. Because waterborne skin infections, which are caused by a wide variety of pathogens, occur infrequently, most of the literature on the topic are case reports. This paper reviews the aquatic pathogens associated with cutaneous infections in humans and the available treatments.

GIS and disease

Geographic information systems (GIS) and related technologies like remote sensing are increasingly used to analyze the geography of disease, specifically the relationships between pathological factors (causative agents, vectors and hosts, people) and their geographical environments. GIS applications in the United States have described the sources and geographical distributions of disease agents, identified regions in time and space where people may be exposed to environmental and biological agents, and mapped and analyzed spatial and temporal patterns in health outcomes. Although GIS show great promise in the study of disease, their full potential will not be realized until environmental and disease surveillance systems are developed that distribute data on the geography of environmental conditions, disease agents, and health outcomes over time based on user-defined queries for user-selected geographical areas.

Foodborne disease in the new millennium: out of the frying pan and into the fire?

About four million cases of foodborne infectious disease occur annually in Australia; new foodborne pathogens, such as enterohaemorrhagic Escherichia coli, are emerging. Climate change, combined with changes in how we produce and distribute food and how we behave as consumers, have the potential to affect foodborne disease in the coming century. Foodborne disease outbreaks are now more far-reaching (and sometimes global) due to modern mass food production and widespread food distribution. There are strong seasonal patterns for Salmonella and Campylobacter infection in Australia. Global warming may increase the incidence of infections, such as salmonellosis, and diseases caused by toxins, such as ciguatera.