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Lemon C, Rizer N, Bradshaw J. Climate Change. Emerg Med Clin North Am 2024; 42:679-693. [PMID: 38925782 DOI: 10.1016/j.emc.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
As human-induced climate change warms the planet, its health impacts will affect all populations, but certain groups will be more vulnerable to its impacts. Given its role as a health care safety net, emergency medicine will play a crucial role in addressing these health conditions. Additionally, with its expertise in disaster medicine, interdisciplinary collaboration, and health care systems knowledge, emergency medicine has the potential to lead the health care sector's response to climate change.
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Affiliation(s)
- Christopher Lemon
- Department of Emergency Medicine, Johns Hopkins School of Medicine, The Johns Hopkins University School of Medicine, Davis Building, Suite 3220, Smith Avenue, Baltimore, MD 21209, USA.
| | - Nicholas Rizer
- Department of Emergency Medicine, Johns Hopkins Medicine, The Johns Hopkins University School of Medicine, Davis Building, Suite 3220, Smith Avenue, Baltimore, MD 21209, USA
| | - Jace Bradshaw
- Department of Emergency Medicine, Johns Hopkins Medicine, The Johns Hopkins University School of Medicine, Davis Building, Suite 3220, Smith Avenue, Baltimore, MD 21209, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine
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2
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Ali KJ, Ehsan S, Tran A, Haugstetter M, Singh H. Diagnostic Excellence in the Context of Climate Change: A Review. Am J Med 2024:S0002-9343(24)00403-0. [PMID: 38925497 DOI: 10.1016/j.amjmed.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Climate change is leading to a rise in heat-related illnesses, vector-borne diseases, and numerous negative impacts on patients' physical and mental health outcomes. Concurrently, healthcare contributes about 4.6% of global greenhouse gas emissions. Low-value care, such as overtesting and overdiagnosis, contributes to unnecessary emissions. In this review, we describe diagnostic excellence in the context of climate change and focus on two topics. First, climate change is affecting health, leading to the emergence of certain diseases, some of which are new, while others are increasing in prevalence and/or becoming more widespread. These conditions will require timely and accurate diagnosis by clinicians who may not be used to diagnosing them. Second, diagnostic quality issues, such as overtesting and overdiagnosis, contribute to climate change through unnecessary emissions and waste and should be targeted for interventions. We also highlight implications for clinical practice, research, and policy. Our findings call for efforts to engage healthcare professionals and policymakers in understanding the urgent implications for diagnosis in the context of climate change and reducing global greenhouse gas emissions to enhance both patient and planetary outcomes.
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Affiliation(s)
- Kisha J Ali
- MedStar Institute for Quality and Safety, MedStar Health Research Institute, Columbia, MD
| | - Sara Ehsan
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Alberta Tran
- MedStar Institute for Quality and Safety, MedStar Health Research Institute, Columbia, MD
| | - Monika Haugstetter
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas.
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3
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Seidel D, Wurster S, Jenks JD, Sati H, Gangneux JP, Egger M, Alastruey-Izquierdo A, Ford NP, Chowdhary A, Sprute R, Cornely O, Thompson GR, Hoenigl M, Kontoyiannis DP. Impact of climate change and natural disasters on fungal infections. THE LANCET. MICROBE 2024; 5:e594-e605. [PMID: 38518791 DOI: 10.1016/s2666-5247(24)00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Abstract
The effects of climate change and natural disasters on fungal pathogens and the risks for fungal diseases remain incompletely understood. In this literature review, we examined how fungi are adapting to an increase in the Earth's temperature and are becoming more thermotolerant, which is enhancing fungal fitness and virulence. Climate change is creating conditions conducive to the emergence of new fungal pathogens and is priming fungi to adapt to previously inhospitable environments, such as polluted habitats and urban areas, leading to the geographical spread of some fungi to traditionally non-endemic areas. Climate change is also contributing to increases in the frequency and severity of natural disasters, which can trigger outbreaks of fungal diseases and increase the spread of fungal pathogens. The populations mostly affected are the socially vulnerable. More awareness, research, funding, and policies on the part of key stakeholders are needed to mitigate the effects of climate change and disaster-related fungal diseases.
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Affiliation(s)
- Danila Seidel
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Sebastian Wurster
- ECMM Excellence Center for Medical Mycology, Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Jeffrey D Jenks
- Durham County Department of Public Health, Durham, NC, USA; Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| | - Hatim Sati
- Department of Global Coordination and Partnership on Antimicrobial Resistance, WHO, Geneva, Switzerland
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses Chroniques, ECMM Excellence Center for Medical Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France; University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail) - UMR_S 1085, Rennes, France
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nathan P Ford
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India; National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver Cornely
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany; German Centre of Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Koln), University of Cologne, Cologne, Germany
| | - George R Thompson
- University of California Davis Center for Valley Fever, University of California Davis, Sacramento, CA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA; Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed, Graz, Austria.
| | - Dimitrios P Kontoyiannis
- ECMM Excellence Center for Medical Mycology, Division of Internal Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
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Agudelo Higuita NI, Beatty NL, Forsyth C, Henao-Martínez AF, Manne-Goehler J. Chagas disease in the United States: a call for increased investment and collaborative research. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100768. [PMID: 38798947 PMCID: PMC11127192 DOI: 10.1016/j.lana.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is a highly overlooked parasitic infection within the United States. It affects an estimated 300,000 individuals, often remaining asymptomatic for years before triggering severe complications such as cardiomyopathy in 30-40% of cases. While many contract the disease in Latin America, its transmission by local vectors in the southern U.S. presents a significant challenge. Unfortunately, limited access to diagnosis and treatment persists, alongside unresolved gaps in healthcare systems and disease pathogenesis. In this viewpoint, we discuss the need for focused research and public health initiatives, with U.S. research institutions playing a crucial role in developing new treatments and identifying biomarkers. Furthermore, investigating the genetic variations of T. cruzi between North and South America is vital for improving diagnostic and treatment strategies. Urgent action is required to implement national and local programs, bolstering healthcare responses and advancing research efforts.Q4As per journal style section heading 'Introduction' is mandatory, hence we have introduced the heading. Please check, and correct if necessary.ResolvedQ5If there are any drug dosages in your article, please verify them and indicate that you have done so by initialing this query.ResolvedQ6Please supply the year of publication.ResolvedFootnoteView Edit Log9.
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Affiliation(s)
- Nelson Iván Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Norman L. Beatty
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Colin Forsyth
- Drugs for Neglected Diseases Initiative–North America, New York, NY, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Amato A, Cavallo C, Marín-García PJ, Emmanuele G, Tomasello M, Tomasella C, Floridia V, Liotta L, Llobat L. Effect of Breed on Hematological and Biochemical Parameters of Apparently Healthy Dogs Infected with Zoonotic Pathogens Endemic to the Mediterranean Basin. Animals (Basel) 2024; 14:1516. [PMID: 38891563 PMCID: PMC11171318 DOI: 10.3390/ani14111516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Dogs are considered the main reservoir of several zoonoses endemic to the Mediterranean Basin. In this study, a prevalence of infections and coinfections of canine vector-borne diseases was analyzed in apparently healthy dogs of different canine pure breeds in Sicily (Italy), where these diseases are endemic. The seroprevalence of Leishmania infantum, Ricketsia ricketsii, Anaplasma phagocytophilum, and Erlichia canis was assessed, as single and coinfections. Biochemical and hematological parameters were evaluated, and epidemiological factors, including sex, age, and canine breed, were recovered. The most frequent infection was L. infantum (45.61%), following R. ricketsii (36.84%), both as single, double, or triple coinfections. Coinfections change the biochemical and hematological parameters of the host, and canine breeds are related to the infection frequency and the parameters observed during infections. Changes in the complete blood count (CBC) and biochemical values also differ between canine breeds, with the Cirneco dell'Etna dogs infected with L. infantum being the animals presenting the most interesting results in our study. High values of RBC, hemoglobin, hematocrit, mean corpuscular hemoglobin (MCH), the albumin/globulin (A/G) ratio, and albumin and low levels of β-2 globulin and γ-globulin were found only in this canine breed, suggesting some resistance to infection in these dogs. Future studies about the immune response of this canine breed could be interesting to determine their possible resistance to zoonotic pathogens, such as L. infantum.
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Affiliation(s)
- Annalisa Amato
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (A.A.); (C.C.); (V.F.)
| | - Carmelo Cavallo
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (A.A.); (C.C.); (V.F.)
| | - Pablo Jesús Marín-García
- Departamento Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos (PASAPTA), Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain;
| | - Giovanni Emmanuele
- BIOGENE, Veterinary Diagnostic Center, 95127 Catania, Italy; (G.E.); (M.T.); (C.T.)
| | - Mario Tomasello
- BIOGENE, Veterinary Diagnostic Center, 95127 Catania, Italy; (G.E.); (M.T.); (C.T.)
| | - Cristina Tomasella
- BIOGENE, Veterinary Diagnostic Center, 95127 Catania, Italy; (G.E.); (M.T.); (C.T.)
| | - Viviana Floridia
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (A.A.); (C.C.); (V.F.)
| | - Luigi Liotta
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy; (A.A.); (C.C.); (V.F.)
| | - Lola Llobat
- Molecular Mechanisns of Zoonotic Diseases (MMOPS) Research Group, Departamento Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos (PASAPTA), Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, 46113 Valencia, Spain
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Cerqueira-Silva T, Pescarini JM, Cardim LL, Leyrat C, Whitaker H, Antunes de Brito CA, Brickley EB, Barral-Netto M, Barreto ML, Teixeira MG, Boaventura VS, Paixão ES. Risk of death following chikungunya virus disease in the 100 Million Brazilian Cohort, 2015-18: a matched cohort study and self-controlled case series. THE LANCET. INFECTIOUS DISEASES 2024; 24:504-513. [PMID: 38342106 DOI: 10.1016/s1473-3099(23)00739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Chikungunya virus outbreaks have been associated with excess deaths at the ecological level. Previous studies have assessed the risk factors for severe versus mild chikungunya virus disease. However, the risk of death following chikungunya virus disease compared with the risk of death in individuals without the disease remains unexplored. We aimed to investigate the risk of death in the 2 years following chikungunya virus disease. METHODS We used a population-based cohort study and a self-controlled case series to estimate mortality risks associated with chikungunya virus disease between Jan 1, 2015, and Dec 31, 2018, in Brazil. The dataset was created by linking national databases for social programmes, notifiable diseases, and mortality. For the matched cohort design, individuals with chikungunya virus disease recorded between Jan 1, 2015, and Dec 31, 2018, were considered as exposed and those who were arbovirus disease-free and alive during the study period were considered as unexposed. For the self-controlled case series, we included all deaths from individuals with a chikungunya virus disease record, and each individual acted as their own control according to different study periods relative to the date of disease. The primary outcome was all-cause natural mortality up to 728 days after onset of chikungunya virus disease symptoms, and secondary outcomes were cause-specific deaths, including ischaemic heart diseases, diabetes, and cerebrovascular diseases. FINDINGS In the matched cohort study, we included 143 787 individuals with chikungunya virus disease who were matched, at the day of symptom onset, to unexposed individuals using sociodemographic factors. The incidence rate ratio (IRR) of death within 7 days of chikungunya symptom onset was 8·40 (95% CI 4·83-20·09) as compared with the unexposed group and decreased to 2·26 (1·50-3·77) at 57-84 days and 1·05 (0·82-1·35) at 85-168 days, with IRR close to 1 and wide CI in the subsequent periods. For the secondary outcomes, the IRR of deaths within 28 days after disease onset were: 1·80 (0·58-7·00) for cerebrovascular diseases, 3·75 (1·33-17·00) for diabetes, and 3·67 (1·25-14·00) for ischaemic heart disease, and there was no evidence of increased risk in the subsequent periods. For the self-controlled case series study, 1933 individuals died after having had chikungunya virus disease and were included in the analysis. The IRR of all-cause natural death within 7 days of symptom onset of chikungunya virus disease was 8·75 (7·18-10·66) and decreased to 1·59 (1·26-2·00) at 57-84 days and 1·09 (0·92-1·29) at 85-168 days. For the secondary outcomes, the IRRs of deaths within 28 days after disease onset were: 2·73 (1·50-4·96) for cerebrovascular diseases, 8·43 (5·00-14·21) for diabetes, and 2·38 (1·33-4·26) for ischaemic heart disease, and there was no evidence of increased risk at 85-168 days. INTERPRETATION Chikungunya virus disease is associated with an increased risk of death for up to 84 days after symptom onset, including deaths from cerebrovascular diseases, ischaemic heart diseases, and diabetes. This study highlights the need for equitable access to approved vaccines and effective anti-chikungunya virus therapeutics and reinforces the importance of robust vector-control efforts to reduce viral transmission. FUNDING Brazilian National Research Council (CNPq), Fundação de Amparo à Pesquisa do Estado da Bahia, Wellcome Trust, and UK Medical Research Council. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Thiago Cerqueira-Silva
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Luciana L Cardim
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Clémence Leyrat
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Manoel Barral-Netto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria G Teixeira
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane S Boaventura
- Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Enny S Paixão
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Norman FF, Gonzalez-Sanz M. Pulmonary infections in the returning traveler. Curr Opin Pulm Med 2024; 30:243-251. [PMID: 38323419 DOI: 10.1097/mcp.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW The recent COVID-19 pandemic has shaped the epidemiology of other infectious diseases globally. International tourist arrivals are increasing and recovering to prepandemic levels. This review focuses on respiratory infections in travelers, highlighting the characteristics of the main imported viral, bacterial, fungal, and parasitic infections with pulmonary involvement. RECENT FINDINGS A recent systematic review estimated a prevalence of respiratory symptoms in travelers of around 35%, increasing to nearly 65% in the context of mass gatherings. Common viral and bacterial pathogens account for the majority of respiratory infections with an identified cause; however, recent data focus on the need for surveillance of emerging infections such as MERS-CoV, henipaviruses and multidrug resistant bacteria, which may be spread through travel. Fungal and parasitic respiratory infections are less common, and acquisition is usually associated with specific risk factors or exposure in endemic areas. Special risk groups, such as immunocompromised travelers, may be particularly vulnerable, presenting with severe disease or reactivation of latent infections. SUMMARY The next significant international epidemic could involve another new infectious agent causing respiratory disease and spreading via mobile populations. Official protocols should be adhered to, and public health interventions implemented for effective control. Continued and globally coordinated investments in research for new vaccines, therapeutic agents, disease modeling, and digital tracking strategies are essential.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS
- Universidad de Alcalá
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Gonzalez-Sanz
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS
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Zurita A, Trujillo I, Cutillas C. New records of pathogenic bacteria in different species of fleas collected from domestic and peridomestic animals in Spain. A potential zoonotic threat? Comp Immunol Microbiol Infect Dis 2024; 107:102153. [PMID: 38460359 DOI: 10.1016/j.cimid.2024.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
Climate change is causing many vectors of infectious diseases to expand their geographic distribution as well as the pathogens they transmit are also conditioned by temperature for their multiplication. Within this context, it is worth highlighting the significant role that fleas can play as vectors of important pathogenic bacteria. For this purpose, our efforts focused on detecting and identifying a total of 9 bacterial genera (Rickettsia sp.; Bartonella sp.; Yersinia sp.; Wolbachia sp., Mycobacterium sp., Leishmania sp., Borrelia sp., Francisella sp. and Coxiella sp.) within fleas isolated from domestic and peridomestic animals in the southwestern region of Spain (Andalusia). Over a 19-months period, we obtained flea samples from dogs, cats and hedgehogs. A total of 812 fleas was collected for this study. Five different species were morphologically identified, including C. felis, C. canis, S. cuniculi, P. irritans, and A. erinacei. Wolbachia sp. was detected in all five species identified in our study which a total prevalence of 86%. Within Rickettsia genus, two different species, R. felis and R. asembonensis were mainly identified in C. felis and A. erinacei, respectively. On the other hand, our results revealed a total of 131 fleas testing positive for the presence of Bartonella sp., representing a prevalence rate of 16% for this genus identifying two species B. henselae and B. clarridgeiae. Lastly, both Y. pestis and L. infantum were detected in DNA of P. irritans and C. felis, respectively isolated from dogs. With these data we update the list of bacterial zoonotic agents found in fleas in Spain, emphasizing the need to continue conducting future experimental studies to assess and confirm the potential vectorial role of certain synanthropic fleas.
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Affiliation(s)
- Antonio Zurita
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Profesor García González 2, Seville 41012, Spain.
| | - Ignacio Trujillo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Profesor García González 2, Seville 41012, Spain.
| | - Cristina Cutillas
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Profesor García González 2, Seville 41012, Spain.
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Obame-Nkoghe J, Agossou AE, Mboowa G, Kamgang B, Caminade C, Duke DC, Githeko AK, Ogega OM, Engone Elloué N, Sarr FB, Nkoghe D, Kengne P, Ndam NT, Paupy C, Bockarie M, Voua Otomo P. Climate-influenced vector-borne diseases in Africa: a call to empower the next generation of African researchers for sustainable solutions. Infect Dis Poverty 2024; 13:26. [PMID: 38486340 PMCID: PMC10938833 DOI: 10.1186/s40249-024-01193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
We look at the link between climate change and vector-borne diseases in low- and middle-income countries in Africa. The large endemicity and escalating threat of diseases such as malaria and arboviral diseases, intensified by climate change, disproportionately affects vulnerable communities globally. We highlight the urgency of prioritizing research and development, advocating for robust scientific inquiry to promote adaptation strategies, and the vital role that the next generation of African research leaders will play in addressing these challenges. Despite significant challenges such as funding shortages within countries, various pan-African-oriented funding bodies such as the African Academy of Sciences, the Africa Research Excellence Fund, the Wellcome Trust, the U.S. National Institutes of Health, and the Bill and Melinda Gates Foundation as well as initiatives such as the African Research Initiative for Scientific Excellence and the Pan-African Mosquito Control Association, have empowered (or are empowering) these researchers by supporting capacity building activities, including continental and global networking, skill development, mentoring, and African-led research. This article underscores the urgency of increased national investment in research, proposing the establishment of research government agencies to drive evidence-based interventions. Collaboration between governments and scientific communities, sustained by pan-African funding bodies, is crucial. Through these efforts, African nations are likely to enhance the resilience and adaptive capacity of their systems and communities by navigating these challenges effectively, fostering scientific excellence and implementing transformative solutions against climate-sensitive vector-borne diseases.
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Affiliation(s)
- Judicaël Obame-Nkoghe
- Molecular and Cellular Biology Laboratory (LabMC), Biology Department, University of Science and Technology of Masuku, BP 901, Franceville, Gabon.
- Ecology and Health Research Unit, Interdisciplinary Center for Medical Research of Franceville, BP 769, Franceville, Gabon.
- Department of Zoology and Entomology, Faculty of Natural and Agricultural Sciences, University of the Free State, Private Bag x13, Phuthaditjhaba, 9866, Republic of South Africa.
| | - Adjoavi Esse Agossou
- Laboratory of Pharmacology and Improved Traditional Medicines, Department of Animal Physiology, Faculty of Science and Technology, University of Abomey-Calavi, BP 526, Cotonou, Benin
| | - Gerald Mboowa
- The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, Uganda
- Africa Centers for Disease Control and Prevention, African Union Commission, Roosevelt Street, P.O. Box 3243, W21 K19, Addis Ababa, Ethiopia
| | - Basile Kamgang
- Centre for Research in Infectious Diseases, P.O. Box 13591, Yaoundé, Cameroon
| | - Cyril Caminade
- Earth System Physics Department, The Abdus Salam International Centre for Theoretical Physics, Trieste, Italy
| | - Dawn C Duke
- Africa Research Excellence Fund, 99 Charterhouse Street, London, EC1M 6HR, UK
| | | | | | - Nestor Engone Elloué
- Center for Phylosophical Studies and Research (CERP), Omar Bongo University (UOB), BP 13131, Libreville, Gabon
| | - Fatou Bintou Sarr
- UMRED, Health Training and Research Unit, University of Iba Der Thiam of Thiès, BP 967, Thiès, Senegal
| | - Dieudonné Nkoghe
- National Parasitic Diseases Control Program, Ministry of Health, Libreville, Gabon
| | - Pierre Kengne
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
| | - Nicaise T Ndam
- MERIT, IRD, Paris Cité University, 75006, Paris, France
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, LG 54, Accra, Ghana
| | | | - Moses Bockarie
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Patricks Voua Otomo
- Department of Zoology and Entomology, Faculty of Natural and Agricultural Sciences, University of the Free State, Private Bag x13, Phuthaditjhaba, 9866, Republic of South Africa
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10
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Garraud O, Lozano M, Vuk T. What are the new challenges facing blood transfusion? Transfus Clin Biol 2024; 31:1-2. [PMID: 38302232 DOI: 10.1016/j.tracli.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Olivier Garraud
- Sainbiose-INSERM U_1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France.
| | - Miquel Lozano
- Clinic University Hospital Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Tomislav Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
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11
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Rabin AS. It's Time for Health Professionals to Break the Climate Taboo. Ann Am Thorac Soc 2024; 21:200-201. [PMID: 38019092 PMCID: PMC10848905 DOI: 10.1513/annalsats.202309-816vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Alexander S. Rabin
- Pulmonary Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; and
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
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12
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George AM, Ansumana R, de Souza DK, Niyas VKM, Zumla A, Bockarie MJ. Climate change and the rising incidence of vector-borne diseases globally. Int J Infect Dis 2024; 139:143-145. [PMID: 38096974 DOI: 10.1016/j.ijid.2023.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Affiliation(s)
- Angella M George
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone.
| | - Rashid Ansumana
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone; School of Public Health and Tropical Medicine, Tulane University, US.
| | - Dziedzom K de Souza
- Department of Parasitology and Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana.
| | - Vettakkara Kandy Muhammed Niyas
- Department of Infectious Diseases, KIMSHEALTH, International Society for Infectious Diseases, Thiruvananthapuram, Kerala, India; International Society for Infectious Diseases.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Moses J Bockarie
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone; International Society for Infectious Diseases.
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13
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Colston JM. Elucidating the Impacts of Climate on Dengue Transmission Through Mathematical Models: New Evidence From a Recent Outbreak on the Island of Réunion. J Infect Dis 2024; 229:1-3. [PMID: 37988607 DOI: 10.1093/infdis/jiad473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Josh M Colston
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, 345 Crispell Drive, Building MR-6, Charlottesville, Virginia
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14
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Hudson J, Egan S. Marine diseases and the Anthropocene: Understanding microbial pathogenesis in a rapidly changing world. Microb Biotechnol 2024; 17:e14397. [PMID: 38217393 PMCID: PMC10832532 DOI: 10.1111/1751-7915.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024] Open
Abstract
Healthy marine ecosystems are paramount for Earth's biodiversity and are key to sustaining the global economy and human health. The effects of anthropogenic activity represent a pervasive threat to the productivity of marine ecosystems, with intensifying environmental stressors such as climate change and pollution driving the occurrence and severity of microbial diseases that can devastate marine ecosystems and jeopardise food security. Despite the potentially catastrophic outcomes of marine diseases, our understanding of host-pathogen interactions remains an understudied aspect of both microbiology and environmental research, especially when compared to the depth of information available for human and agricultural systems. Here, we identify three avenues of research in which we can advance our understanding of marine disease in the context of global change, and make positive steps towards safeguarding marine communities for future generations.
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Affiliation(s)
- Jennifer Hudson
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental SciencesThe University of New South WalesSydneyNew South WalesAustralia
| | - Suhelen Egan
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental SciencesThe University of New South WalesSydneyNew South WalesAustralia
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15
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Tejo AM, Hamasaki DT, Menezes LM, Ho YL. Severe dengue in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:16-33. [PMID: 38263966 PMCID: PMC10800775 DOI: 10.1016/j.jointm.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 01/25/2024]
Abstract
Dengue fever is considered the most prolific vector-borne disease in the world, with its transmission rate increasing more than eight times in the last two decades. While most cases present mild to moderate symptoms, 5% of patients can develop severe disease. Although the mechanisms are yet not fully comprehended, immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients: increased vascular permeability that may shock and thrombocytopenia, and coagulopathy that can induce hemorrhage. The risk factors of severe disease include previous infection by a different serotype, specific genotypes associated with more efficient replication, certain genetic polymorphisms, and comorbidities such as diabetes, obesity, and cardiovascular disease. The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality. This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
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Affiliation(s)
- Alexandre Mestre Tejo
- Intensive Care Unit, Department of Intensive Medicine of the Cancer Institute of the State of São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Toshie Hamasaki
- Transfusion Medicine and Cell Therapy Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Letícia Mattos Menezes
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Yeh-Li Ho
- Intensive Care Unit of Infectious Disease Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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16
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Chitre SD, Crews CM, Tessema MT, Plėštytė-Būtienė I, Coffee M, Richardson ET. The impact of anthropogenic climate change on pediatric viral diseases. Pediatr Res 2024; 95:496-507. [PMID: 38057578 PMCID: PMC10872406 DOI: 10.1038/s41390-023-02929-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.
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Affiliation(s)
- Smit D Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Cecilia M Crews
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mesfin Teklu Tessema
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
- International Rescue Committee, New York, NY, USA.
| | | | - Megan Coffee
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- International Rescue Committee, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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17
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Loconsole D, Centrone F, Sallustio A, Casulli D, Colella V, Mongelli O, Venturi G, Bella A, Marino L, Martinelli D, Chironna M. Abrupt Increase in Detection of Locally Acquired West-Nile-Virus-Lineage-2-Mediated Neuroinvasive Disease in a Previously Non-Endemic Area of Southern Italy (2023). Viruses 2023; 16:53. [PMID: 38257753 PMCID: PMC10819189 DOI: 10.3390/v16010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
West Nile virus (WNV) is a public health concern in Europe. Rising temperatures and the migration of potential vectors promote the spread of viruses to previously unaffected areas. In 2023, the Apulia region of Southern Italy experienced an unexpected increase in West Nile neuroinvasive disease (WNND); no such cases had been reported in the previous 10 years. Overall, eight autochthonous cases of WNV infection were identified between July and October 2023, six of which were WNND. All cases were male (median age, 73 years). Two of the cases were blood donors. All WNND cases were hospitalized and all recovered within a few weeks. Surveillance data showed that, in the Apulia region, WNV Lineage 2 was detected in humans, mosquitoes, and horses. Based on the number of WNND cases reported, we can assume that a high number of infections occurred during the summer period. Changes in the climate in the region over recent years could be considered among the main drivers of the rapid increase in WNV infections. Therefore, integrated surveillance should be strengthened to avoid the potential massive spread of WNV in Southern Italy. Moreover, the implementation of whole-genome sequencing of WNV strains, as well as seroepidemiological studies in the area, will facilitate a better understanding of circulation dynamics.
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Affiliation(s)
- Daniela Loconsole
- Hygiene Section, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (D.L.)
| | - Francesca Centrone
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Anna Sallustio
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Daniele Casulli
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Vito Colella
- Hygiene Section, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (D.L.)
| | - Onofrio Mongelli
- Department of Health Promotion and Animal Welfare, Apulia Region, 70124 Bari, Italy
| | - Giulietta Venturi
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Leonardo Marino
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 71121 Foggia, Italy
| | - Domenico Martinelli
- Hygiene Section, Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Maria Chironna
- Hygiene Section, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (D.L.)
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18
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Rom WN. Annals of Education: Teaching Climate Change and Global Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:41. [PMID: 38248506 PMCID: PMC10815579 DOI: 10.3390/ijerph21010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024]
Abstract
The climate crisis is a health emergency: breaking temperature records every successive month, increasing mortality from hurricanes/cyclones resulting in >USD150 billion/year in damages, and mounting global loss of life from floods, droughts, and food insecurity. An entire course on climate change and global public health was envisioned, designed for students in public health, and delivered to Masters level students. The course content included the physical science behind global heating, heat waves, extreme weather disasters, arthropod-related diseases, allergies, air pollution epidemiology, melting ice and sea level rise, climate denialism, renewable energy and economics, social cost of carbon, and public policy. The methods included student engagement in presenting two air pollution epidemiological or experimental papers on fossil fuel air pollution. Second, they authored a mid-term paper on a specific topic in the climate crisis facing their locale, e.g., New York City. Third, they focused on a State, evaluating their climate change laws and their plans to harness renewable wind, solar, storage, nuclear, and geothermal energy. Students elsewhere covered regional entities' approach to renewable energy. Fourth, the global impact was presented by student teams presenting a country's nationally determined contribution to the Paris Climate Agreement. Over 200 Master's students completed the course; the participation and feedback demonstrated markedly improved knowledge and evaluation of the course over time.
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Affiliation(s)
- William N Rom
- Department of Global and Environmental Health, School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
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19
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Coccia M. New directions of technologies pointing the way to a sustainable global society. SUSTAINABLE FUTURES 2023; 5:100114. [DOI: 10.1016/j.sftr.2023.100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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20
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Oberlin AM, Wylie BJ. Vector-borne disease, climate change and perinatal health. Semin Perinatol 2023; 47:151841. [PMID: 37852894 DOI: 10.1016/j.semperi.2023.151841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Vector-borne diseases (VBDs) are caused by infectious pathogens that spread from an infected human or animal reservoir to an uninfected human via a vector (mosquito, tick, rodent, others) and remain an important cause of morbidity and mortality worldwide. Pregnant individuals and their fetuses are especially at risk, as certain pathogens, such as Zika virus, have specific implications in pregnancy and for neonatal health. Global climate change is affecting the incidence and geographic spread of many VBDs. Thus, it is important for clinicians in the fields of obstetrics/gynecology and newborn medicine, regardless of geographic location, to familiarize themselves with a basic understanding of these conditions and how climate change is altering their distributions. In this chapter, we review the incidence, clinical presentation, implications during pregnancy and intersection with climate change for four of the most important VBDs in pregnancy: malaria, Zika, dengue and Chagas disease. Although not exhaustive of all VBDs, a more extensive table is included for reference, and our discussion provides a helpful framework for understanding other vector-borne pathogens and perinatal health.
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Affiliation(s)
- Austin M Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Founding Director, The Collaborative for Women's Environmental Health at Columbia University, United States.
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21
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Chiu KHY, Sridhar S, Yuen KY. Preparation for the next pandemic: challenges in strengthening surveillance. Emerg Microbes Infect 2023; 12:2240441. [PMID: 37474466 PMCID: PMC10478602 DOI: 10.1080/22221751.2023.2240441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/22/2023]
Abstract
The devastating Coronavirus Disease 2019 (COVID-19) pandemic indicates that early detection of candidates with pandemic potential is vital. However, comprehensive metagenomic sequencing of the total microbiome is not practical due to the astronomical and rapidly evolving numbers and species of micro-organisms. Analysis of previous pandemics suggests that an increase in human-animal interactions, changes in animal and arthropod distribution due to climate change and deforestation, continuous mutations and interspecies jumping of RNA viruses, and frequent travels are important factors driving pandemic emergence. Besides measures mitigating these factors, surveillance at human-animal interfaces targeting animals with unusual tolerance to viral infections, sick heathcare workers, and workers at high biosafety level laboratories is crucial. Surveillance of sick travellers is important when alerted by an early warning system of a suspected outbreak due to unknown agents. These samples should be screened by multiplex nucleic acid amplification and subsequent unbiased next-generation sequencing. Novel viruses should be isolated in routine cell cultures, complemented by organoid cultures, and then tested in animal models for interspecies transmission potential. Potential agents are candidates for designing rapid diagnostics, therapeutics, and vaccines. For early detection of outbreaks, there are advantages in using event-based surveillance and artificial intelligence (AI), but high background noise and censorship are possible drawbacks. These systems are likely useful if they channel reliable information from frontline healthcare or veterinary workers and large international gatherings. Furthermore, sufficient regulation of high biosafety level laboratories, and stockpiling of broad spectrum antiviral drugs, vaccines, and personal protective equipment are indicated for pandemic preparedness.
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Affiliation(s)
- Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, People's Republic of China
| | - Siddharth Sridhar
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Kwok-Yung Yuen
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Department of Infectious Disease and Microbiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- Centre for Virology, Vaccinology and Therapeutics, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, People's Republic of China
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22
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Huits R, Wallender E, Angelo KM, Libman M, Hamer DH. A Zebra Among the Horses: Clinical Implications of Malaria in the United States. Ann Intern Med 2023; 176:1269-1270. [PMID: 37487212 DOI: 10.7326/m23-1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy (R.H.)
| | - Erika Wallender
- Malaria Branch and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia (E.W.)
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (K.M.A.)
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada (M.L.)
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine; Center for Emerging Infectious Disease Policy and Research, Boston University; and National Emerging Infectious Disease Laboratory, Boston, Massachusetts (D.H.H.)
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23
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Marie V, Gordon ML. The (Re-)Emergence and Spread of Viral Zoonotic Disease: A Perfect Storm of Human Ingenuity and Stupidity. Viruses 2023; 15:1638. [PMID: 37631981 PMCID: PMC10458268 DOI: 10.3390/v15081638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Diseases that are transmitted from vertebrate animals to humans are referred to as zoonotic diseases. Although microbial agents such as bacteria and parasites are linked to zoonotic events, viruses account for a high percentage of zoonotic diseases that have emerged. Worryingly, the 21st century has seen a drastic increase in the emergence and re-emergence of viral zoonotic disease. Even though humans and animals have coexisted for millennia, anthropogenic factors have severely increased interactions between the two populations, thereby increasing the risk of disease spill-over. While drivers such as climate shifts, land exploitation and wildlife trade can directly affect the (re-)emergence of viral zoonotic disease, globalisation, geopolitics and social perceptions can directly facilitate the spread of these (re-)emerging diseases. This opinion paper discusses the "intelligent" nature of viruses and their exploitation of the anthropogenic factors driving the (re-)emergence and spread of viral zoonotic disease in a modernised and connected world.
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Affiliation(s)
- Veronna Marie
- Microbiology Laboratory, Department of Analytical Services, Rand Water, Vereeniging 1939, South Africa
| | - Michelle L. Gordon
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa;
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24
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Suh Nchang A, Shinyuy LM, Noukimi SF, Njong S, Bambara S, Kalimba EM, Kamga J, Ghogomu SM, Frederich M, Talom JLL, Souopgui J, Robert A. Knowledge about Asymptomatic Malaria and Acceptability of Using Artemisia afra Tea among Health Care Workers (HCWs) in Yaoundé, Cameroon: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6309. [PMID: 37444156 PMCID: PMC10341543 DOI: 10.3390/ijerph20136309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Malaria is the most widespread endemic disease in Cameroon, and asymptomatic Plasmodium (gametocyte) carriers (APCs) constitute more than 95% of infectious human reservoirs in malaria endemic settings. This study assesses the knowledge of asymptomatic malaria (ASM) among health care workers (HCWs) in health facilities (HFs) in the Centre Region of Cameroon and the acceptability of using Artemisia afra tea to treat APCs. A cross-sectional descriptive survey was conducted among 100 HCWs, in four randomly selected HFs in the Centre Region, in the period of 1-20 April 2022, using semi-structured self-administered questionnaires. Logistic regression analyses were performed to determine factors associated with knowledge. More than seven in eight (88%) respondents were aware of the existence of ASM, 83% defined ASM correctly, 75% knew how it was diagnosed, 70% prescribe ACTs for APCs, and 51.1% were informed about ASM transmission. The professional category of HCWs was significantly associated with their knowledge of the existence and transmission of ASM, and longevity of service was associated with knowledge of transmission (p < 0.05). Two-thirds (67%) of respondents knew about Artemisia afra tea, 53.7% believed that it was effective in treating ASM, and 79% were willing to prescribe it if authorized. There was a fair level of knowledge of ASM among HCWs in the study settings.
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Affiliation(s)
- Abenwie Suh Nchang
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | - Lahngong Methodius Shinyuy
- Laboratory of Pharmacognosy, Department of Pharmacy, Center of Interdisciplinary Research on Medicine (CIRM), University of Liege, 4000 Liège, Belgium; (L.M.S.); (M.F.)
| | - Sandra Fankem Noukimi
- Embriology and Biotechnology Laboratory, IBMM-ULB, 6041 Gosselies, Belgium; (S.F.N.); (J.S.)
| | - Sylvia Njong
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | - Sylvie Bambara
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
| | | | - Joseph Kamga
- Biotechnology Unit, University of Buea, Buea P.O. Box 63, Cameroon; (J.K.); (S.M.G.)
| | | | - Michel Frederich
- Laboratory of Pharmacognosy, Department of Pharmacy, Center of Interdisciplinary Research on Medicine (CIRM), University of Liege, 4000 Liège, Belgium; (L.M.S.); (M.F.)
| | | | - Jacob Souopgui
- Embriology and Biotechnology Laboratory, IBMM-ULB, 6041 Gosselies, Belgium; (S.F.N.); (J.S.)
| | - Annie Robert
- Department of Epidemiology and Biostatistics (EPID), Institute de Recherche Expérimentale et Clinique (IREC), Public Health School, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium; (S.N.); (S.B.); (A.R.)
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25
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González-Sanz M, Berzosa P, Norman FF. Updates on Malaria Epidemiology and Prevention Strategies. Curr Infect Dis Rep 2023; 25:1-9. [PMID: 37361492 PMCID: PMC10248987 DOI: 10.1007/s11908-023-00805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The objective of this review was to provide an update on recent malaria epidemiology, both globally and in non-endemic areas, to identify the current distribution and repercussions of genetically diverse Plasmodium species and summarize recently implemented intervention and prevention tools. Recent Findings Notable changes in malaria epidemiology have occurred in recent years, with an increase in the number of total cases and deaths globally during 2020-2021, in part attributed to the COVID-19 pandemic. The emergence of artemisinin-resistant species in new areas and the expanding distribution of parasites harbouring deletions of the pfhrp2/3 genes have been concerning. New strategies to curb the burden of this infection, such as vaccination, have been implemented in certain endemic areas and their performance is currently being evaluated. Summary Inadequate control of malaria in endemic regions may have an effect on imported malaria and measures to prevent re-establishment of transmission in malaria-free areas are essential. Enhanced surveillance and investigation of Plasmodium spp. genetic variations will contribute to the successful diagnosis and treatment of malaria in future. Novel strategies for an integrated One Health approach to malaria control should also be strengthened.
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Affiliation(s)
- Marta González-Sanz
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre for Tropical Medicine, Carlos III Health Institute, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Francesca F. Norman
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
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26
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Yang H, Nguyen TN, Chuang TW. An Integrative Explainable Artificial Intelligence Approach to Analyze Fine-Scale Land-Cover and Land-Use Factors Associated with Spatial Distributions of Place of Residence of Reported Dengue Cases. Trop Med Infect Dis 2023; 8:tropicalmed8040238. [PMID: 37104363 PMCID: PMC10142856 DOI: 10.3390/tropicalmed8040238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
Dengue fever is a prevalent mosquito-borne disease that burdens communities in subtropical and tropical regions. Dengue transmission is ecologically complex; several environmental conditions are critical for the spatial and temporal distribution of dengue. Interannual variability and spatial distribution of dengue transmission are well-studied; however, the effects of land cover and use are yet to be investigated. Therefore, we applied an explainable artificial intelligence (AI) approach to integrate the EXtreme Gradient Boosting and Shapley Additive Explanation (SHAP) methods to evaluate spatial patterns of the residences of reported dengue cases based on various fine-scale land-cover land-use types, Shannon's diversity index, and household density in Kaohsiung City, Taiwan, between 2014 and 2015. We found that the proportions of general roads and residential areas play essential roles in dengue case residences with nonlinear patterns. Agriculture-related features were negatively associated with dengue incidence. Additionally, Shannon's diversity index showed a U-shaped relationship with dengue infection, and SHAP dependence plots showed different relationships between various land-use types and dengue incidence. Finally, landscape-based prediction maps were generated from the best-fit model and highlighted high-risk zones within the metropolitan region. The explainable AI approach delineated precise associations between spatial patterns of the residences of dengue cases and diverse land-use characteristics. This information is beneficial for resource allocation and control strategy modification.
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Affiliation(s)
- Hsiu Yang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Thi-Nhung Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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27
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Lalmalsawma P, Balasubramani K, James MM, Pautu L, Prasad KA, Sarma DK, Balabaskaran Nina P. Malaria hotspots and climate change trends in the hyper-endemic malaria settings of Mizoram along the India-Bangladesh borders. Sci Rep 2023; 13:4538. [PMID: 36941291 PMCID: PMC10025798 DOI: 10.1038/s41598-023-31632-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
India has made tremendous progress in reducing malaria mortality and morbidity in the last decade. Mizoram State in North-East India is one of the few malaria-endemic regions where malaria transmission has continued to remain high. As Mizoram shares international borders with Bangladesh and Myanmar, malaria control in this region is critical for malaria elimination efforts in all the three countries. For identifying hotspots for targeted intervention, malaria data from 385 public health sub-centers across Mizoram were analyzed in the Geographic Information System. Almost all the sub-centers reporting high Annual Parasite Index (> 10) are located in Mizoram's districts that border Bangladesh. Getis-Ord Gi* statistic shows most of the sub-centers located along the Bangladesh border in the Lawngtlai and Lunglei districts to be the malaria hotspots. The hotspots also extended into the Mamit and Siaha districts, especially along the borders of Lawngtlai and Lunglei. Analysis of terrain, climatic, and land use/land cover datasets obtained from the Global Modelling and Assimilation Office and satellite images show Mizoram's western part (Lawngtlai, Lunglei, and Mamit districts) to experience similar topographic and climatic conditions as the bordering Rangamati district in the Chittagong division of Bangladesh. Climatic trends in this region from 1981 to 2021, estimated by the Mann-Kendall test and Sen's slope estimates, show an increasing trend in minimum temperature, relative humidity, rainfall, and the associated shift of climatic pattern (temperate to tropical monsoon) could facilitate malaria transmission. The quasi-Poisson regression model estimates a strong association (p < 0.001) between total malaria cases, temperature range, and elevation. The Kruskal-Wallis H test shows a statistically significant association between malaria cases and forest classes (p < 0.001). A regional coordination and strategic plan are required to eliminate malaria from this hyper-endemic malaria region of North-East India.
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Affiliation(s)
- Pachuau Lalmalsawma
- Integrated Disease Surveillance Programme, Health and Family Welfare Department, Aizawl, Mizoram, India
| | - K Balasubramani
- Department of Geography, School of Earth Sciences, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Meenu Mariya James
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Lalfakzuala Pautu
- Integrated Disease Surveillance Programme, Health and Family Welfare Department, Aizawl, Mizoram, India
- Department of Life Sciences, Pachhunga University College, Mizoram University, Aizawl, Mizoram, India
| | - Kumar Arun Prasad
- Department of Geography, School of Earth Sciences, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Devojit Kumar Sarma
- ICMR- National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India.
| | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India.
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India.
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28
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Khatib AN. Climate Change and Travel: Harmonizing to Abate Impact. Curr Infect Dis Rep 2023; 25:77-85. [PMID: 36987459 PMCID: PMC9975868 DOI: 10.1007/s11908-023-00799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/06/2023]
Abstract
Purpose of Review With climate change being the single biggest health threat facing humanity, this review aims to identify the climate-sensitive health risks to the traveler and to recognize the role that travel plays in contributing to the detrimental effects of climate change. With this understanding, adaptations for transformational action can be made. Recent Findings Travel and tourism, including transportation, food consumption, and accommodation, is responsible for a large percentage of the world’s carbon emissions which is contributing to the climate change crisis at an alarming rate. Climate change is a health emergency that is resulting in a rise of significant health impacts to the traveler including increased heat illnesses; food-, water-, and vector-borne diseases; and increasing risk of exposure to emerging infectious diseases. Patterns of future travel and destination choices are likely to change due to climactic factors such as temperature and extreme weather events, forced migration, degradation, and disappearance of popular and natural tourist destinations. Summary Global warming is and will continue to alter the landscape of travel medicine with expansion of transmission seasons and geographic ranges of disease, increased risk of infections and harmful marine toxins, and introduction of emerging infections to naïve populations. This will have implications for pre-travel counseling in assessing risk and discussing the environmental influences on travel. Travelers and stakeholders should be engaged in a dialogue to understand their “climate footprint,” to innovate sustainable solutions, and be empowered to make immediate, conscientious, and responsible choices to abate the impact of breaching critical temperature thresholds.
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Affiliation(s)
- Aisha N. Khatib
- Department of Family & Community Medicine, University of Toronto, Toronto, ON Canada
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29
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Rossi B, Barreca F, Benvenuto D, Braccialarghe N, Campogiani L, Lodi A, Aguglia C, Cavasio RA, Giacalone ML, Kontogiannis D, Moccione M, Malagnino V, Andreoni M, Sarmati L, Iannetta M. Human Arboviral Infections in Italy: Past, Current, and Future Challenges. Viruses 2023; 15:v15020368. [PMID: 36851582 PMCID: PMC9963149 DOI: 10.3390/v15020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Arboviruses represent a public health concern in many European countries, including Italy, mostly because they can infect humans, causing potentially severe emergent or re-emergent diseases, with epidemic outbreaks and the introduction of endemic circulation of new species previously confined to tropical and sub-tropical regions. In this review, we summarize the Italian epidemiology of arboviral infection over the past 10 years, describing both endemic and imported arboviral infections, vector distribution, and the influence of climate change on vector ecology. Strengthening surveillance systems at a national and international level is highly recommended to be prepared to face potential threats due to arbovirus diffusion.
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Affiliation(s)
- Benedetta Rossi
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Filippo Barreca
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Domenico Benvenuto
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Neva Braccialarghe
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Laura Campogiani
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Alessandra Lodi
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Camilla Aguglia
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | | | - Maria Laura Giacalone
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Dimitra Kontogiannis
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Martina Moccione
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Vincenzo Malagnino
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Clinic, Policlinico Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
- Department of System Medicine Tor Vergata, University of Rome, Via Montpellier 1, 00133 Rome, Italy
- Correspondence:
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