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Nazario S, González-Sepúlveda L, Telón-Sosa B, Rivas-Tumanyan S. Place of death from asthma differs by age, race, and ethnicity. Ann Allergy Asthma Immunol 2023; 131:268-269. [PMID: 37225001 DOI: 10.1016/j.anai.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Sylvette Nazario
- Allergy-Immunology Section, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Lorena González-Sepúlveda
- Hispanic Alliance for Clinical & Translational Research, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Bonnie Telón-Sosa
- Allergy-Immunology Section, Internal Medicine Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Sona Rivas-Tumanyan
- Hispanic Alliance for Clinical & Translational Research, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
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Bolaños-Rosero B, Hernández-González X, Cavallín-Calanche HE, Godoy-Vitorino F, Vesper S. Impact of Hurricane Maria on mold levels in the homes of Piñones, Puerto Rico. AIR QUALITY, ATMOSPHERE, & HEALTH 2022; 16:661-668. [PMID: 37312968 PMCID: PMC10259649 DOI: 10.1007/s11869-022-01297-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 12/07/2022] [Indexed: 06/15/2023]
Abstract
Hurricane Maria struck Puerto Rico on September 20, 2017, severely impacting the island. In order to quantify the impact of the hurricane on the indoor air quality, we evaluated the fungal levels in households (n = 20) of the Piñones community for the period of 2018 and 2019. For each dust sample collected, the 36 Environmental Relative Moldiness Index (ERMI) molds were quantified using qPCR assays, and then Shannon Diversity Index (SDI) values for the fungal populations were calculated. Homes were in five separate regions, regarding their proximity in the studied area. We found that for regions with reported least water damage, the SDI values were similar for both sampled years, but for regions that reported mid-to-high level of damage region, the SDI values were significantly higher. Households that reported remediation actions between the two sampled years showed similar values for the second year as those that did not report any major impact. Our preliminary data provides insights into the significant impacts of hurricanes into indoor fungal environment.
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Affiliation(s)
- B Bolaños-Rosero
- Department of Microbiology and Medical Zoology, University of Puerto Rico, San Juan, PR, USA
| | - X Hernández-González
- Department of Microbiology and Medical Zoology, University of Puerto Rico, San Juan, PR, USA
| | | | - F Godoy-Vitorino
- Department of Microbiology and Medical Zoology, University of Puerto Rico, San Juan, PR, USA
| | - S Vesper
- Center for Environmental Measurement and Modeling, United States Environmental Protection Agency, Cincinnati, OH, USA
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Vélez-Torres LN, Bolaños-Rosero B, Godoy-Vitorino F, Rivera-Mariani FE, Maestre JP, Kinney K, Cavallin H. Hurricane María drives increased indoor proliferation of filamentous fungi in San Juan, Puerto Rico: a two-year culture-based approach. PeerJ 2022; 10:e12730. [PMID: 35261816 PMCID: PMC8898552 DOI: 10.7717/peerj.12730] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/11/2021] [Indexed: 01/07/2023] Open
Abstract
Extensive flooding caused by Hurricane María in Puerto Rico (PR) created favorable conditions for indoor growth of filamentous fungi. These conditions represent a public health concern as contamination by environmental fungi is associated with a higher prevalence of inflammatory respiratory conditions. This work compares culturable fungal spore communities present in homes that sustained water damage after Hurricane María to those present in dry, non-flooded homes. We collected air samples from 50 houses in a neighborhood in San Juan, PR, 12 and 22 months after Hurricane María. Self-reported data was used to classify the homes as flooded, water-damage or dry non-flooded. Fungi abundances, composition and diversity were analyzed by culturing on two media. Our results showed no significant differences in indoor fungal concentrations (CFU/m3) one year after the Hurricane in both culture media studied (MEA and G25N). During the second sampling period fungal levels were 2.7 times higher in previously flooded homes (Median = 758) when compared to dry homes (Median = 283), (p-value < 0.005). Fungal profiles showed enrichment of Aspergillus species inside flooded homes compared to outdoor samples during the first sampling period (FDR-adjusted p-value = 0.05). In contrast, 22 months after the storm, indoor fungal composition consisted primarily of non-sporulated fungi, most likely basidiospores, which are characteristic of the outdoor air in PR. Together, this data highlights that homes that suffered water damage not only have higher indoor proliferation of filamentous fungi, but their indoor fungal populations change over time following the Hurricane. Ultimately, after nearly two years, indoor and outdoor fungal communities converged in this sample of naturally ventilated homes.
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Affiliation(s)
- Lorraine N. Vélez-Torres
- Department of Microbiology & Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Benjamín Bolaños-Rosero
- Department of Microbiology & Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Filipa Godoy-Vitorino
- Department of Microbiology & Medical Zoology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | | | - Juan P. Maestre
- Department of Civil, Architectural, and Environmental Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kerry Kinney
- Department of Civil, Architectural, and Environmental Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Humberto Cavallin
- School of Architecture, University of Puerto Rico, Río Piedras Campus, San Juan, PR, USA
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Outdoor Mold and Respiratory Health: State of Science of Epidemiological Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:768-784.e3. [PMID: 34648953 DOI: 10.1016/j.jaip.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fungal spores are the predominant biological particulates in outdoor air. However, in contrast to pollens or outdoor air pollution, little is known about their respiratory health risks. OBJECTIVES The objectives were to conduct the first review of epidemiological studies on the short- and long-term effects of outdoor mold exposure on respiratory health in children and adults. METHODS Health outcomes included asthma, lung function, and rhinitis. Cross-sectional and longitudinal epidemiological studies using quantitative measures of outdoor mold exposure (optical microscopy, culture-based methods) were selected, providing that important confounding factors including temporal trends or meteorological factors were accounted for. A systematic literature search was performed up to June 2020, leading to the selection of 37 publications. RESULTS Most studies were longitudinal and investigated short-term effects. There is evidence of an association between outdoor fungal exposure and an increase in asthma exacerbation among children for total spores, 2 phyla (ascomycetes, basidiomycetes), and 2 taxa (Cladosporium, Alternaria). A few studies also suggested an association for Coprinus, Ganoderma, Aspergillus-Penicillium, Botrytis, and Epicoccum in children, but this needs to be confirmed. Some studies reported mold associations with rhinitis, lung function, and among adults, but these were few in number or inconsistent. DISCUSSION Further ecological studies in different regions that measure exposure to all taxa over several years are required to better understand their impact on rhinitis, asthma exacerbations and lung function. Larger panel studies are necessary to identify threshold effects in susceptible individuals. Finally, further research should assess the long-term effects of outdoor mold.
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Roblin DW, Jones JW, Fuller CH. Pollen Exposure and Associated Healthcare Utilization: A Population-based Study Using Health Maintenance Organization Data in the Washington, DC, Area. Ann Am Thorac Soc 2021; 18:1642-1649. [PMID: 33794139 PMCID: PMC8522299 DOI: 10.1513/annalsats.202008-976oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: Most studies of the healthcare utilization impact of pollen exposure have focused on emergency department visits or hospital admissions. However, other frequent but lower cost services-phone calls and e-mails to providers and office visits-may also be affected. Objectives: The objective of our study was to estimate the impact of tree and grass pollen exposures on respiratory-related healthcare utilization across a range of medical services, including calls and e-mails to providers, nonurgent face-to-face visits, urgent and emergent care visits, and hospitalizations. Methods: We conducted a retrospective observational study of daily tree and grass pollen counts linked to electronic health records of Kaiser Permanente beneficiaries in the metropolitan Washington, DC, area for 2013-2014. Results: The proportion of Kaiser Permanente beneficiaries with respiratory-related healthcare utilization was significantly greater (for P ⩽ 0.05) given a 1 standard deviation increase in same-day pollen exposure. For tree pollen, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.77% (95% confidence interval [CI], 0.07-4.17%) for urgent and emergent care visits to 12.84% (95% CI, 11.02-14.65%) for provider calls/e-mails. For grass pollen exposure, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.42% (95% CI, 0.39-2.46) for provider face-to-face visits to 11.09% (95% CI, 9.26-12.92) for provider calls/e-mails. Conclusions: Increased pollen exposure was associated with increases in healthcare utilization across a range of services, with relatively higher increases in provider calls/e-mails and lower increases in emergent or acute care. If climate change increases intensity and geographic scope of pollen exposure as predicted and if this study's estimates of association of peak pollen exposure on healthcare utilization are generalizable, then the impact of climate change on healthcare utilization may be significant.
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Affiliation(s)
- Douglas W. Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland
| | - Jordan W. Jones
- Economic Research Service, U.S. Department of Agriculture, Kansas City, Missouri; and
| | - Christina H. Fuller
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia
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Manjourides J, Zimmerman E, Watkins DJ, Carpenito T, Vélez-Vega CM, Huerta-Montañez G, Rosario Z, Ayala I, Vergara C, Feric Z, Ondras M, Suh HH, Gu AZ, Brown P, Cordero JF, Meeker JD, Alshawabkeh A. Cohort profile: Center for Research on Early Childhood Exposure and Development in Puerto Rico. BMJ Open 2020; 10:e036389. [PMID: 32690520 PMCID: PMC7371225 DOI: 10.1136/bmjopen-2019-036389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Puerto Rican children experience high rates of asthma and obesity. Further, infants born in Puerto Rico are more at risk for being born prematurely compared with infants on the mainland USA. Environmental exposures from multiple sources during critical periods of child development, potentially modified by psychosocial factors, may contribute to these adverse health outcomes. To date, most studies investigating the health effects of environmental factors on infant and child health have focused on single or individual exposures. PARTICIPANTS Infants currently in gestation whose mother is enrolled in Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, and infants and children already born to mothers who participated in the PROTECT study. FINDINGS TO DATE Data collection and processing remains ongoing. Demographic data have been collected on 437 mother-child pairs. Birth outcomes are available for 420 infants, neurodevelopmental outcomes have been collected on 319 children. Concentrations of parabens and phenols in maternal spot urine samples have been measured from 386 mothers. Center for Research on Early Childhood Exposure and Development mothers have significantly higher urinary concentrations of dichlorophenols, triclosan and triclocarban, but lower levels of several parabens compared with reference values from a similar population drawn from the National Health and Nutrition Examination Survey. FUTURE PLANS Data will continue to be collected through recruitment of new births with a target of 600 children. Seven scheduled follow-up visits with existing and new participants are planned. Further, our research team continues to work with healthcare providers, paediatricians and early intervention providers to support parent's ability to access early intervention services for participants.
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Affiliation(s)
- Justin Manjourides
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Thomas Carpenito
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Carmen M Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Gredia Huerta-Montañez
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Zaira Rosario
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ishwara Ayala
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Carlos Vergara
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Zlatan Feric
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Martha Ondras
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Helen H Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - April Z Gu
- School of Civil and Environmental Engineering, Cornell University, Ithaca, New York, USA
| | - Phil Brown
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Sociology and Anthropology, Northeastern University, Boston, Massachusetts, USA
- Social Science Environmental Health Research Institute, Northeastern University, Boston, Massachusetts, USA
| | - José F Cordero
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
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Yu HR, Lin CHR, Tsai JH, Hsieh YT, Tsai TA, Tsai CK, Lee YC, Liu TY, Tsai CM, Chen CC, Chang CH, Hsu TY, Niu CK. A Multifactorial Evaluation of the Effects of Air Pollution and Meteorological Factors on Asthma Exacerbation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114010. [PMID: 32512940 PMCID: PMC7313451 DOI: 10.3390/ijerph17114010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/14/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023]
Abstract
In the real world, dynamic changes in air pollutants and meteorological factors coexist simultaneously. Studies identifying the effects of individual pollutants on acute exacerbation (AE) of asthma may overlook the health effects of the overall combination. A comprehensive study examining the influence of air pollution and meteorological factors is required. Asthma AE data from emergency room visits were collected from the Taiwan National Health Insurance Research Database. Complete monitoring data for air pollutants (SO2; NO2; O3; CO; PM2.5; PM10) and meteorological factors were collected from the Environmental Protection Agency monitoring stations. A bi-directional case-crossover analysis was used to investigate the effects of air pollution and meteorological factors on asthma AE. Among age group divisions, a 1 °C temperature increase was a protective factor for asthma ER visits with OR = 0.981 (95% CI, 0.971–0.991) and 0.985 (95% CI, 0.975–0.994) for pediatric and adult patients, respectively. Children, especially younger females, are more susceptible to asthma AE due to the effects of outdoor air pollution than adults. Meteorological factors are important modulators for asthma AE in both asthmatic children and adults. When studying the effects of air pollution on asthma AE, meteorological factors should be considered.
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Affiliation(s)
- Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
- Correspondence: ; Tel.: +886-7-5252000 (ext. 4339); Fax: +886-7-5254-301
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan;
- PhD Program in Environmental and Occupation Medicine, (Taiwan) National Health Research Institutes and Kaohsiung Medical University, Kaohsiung 80737, Taiwan
| | - Yun-Ting Hsieh
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan;
| | - Ti-An Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chang-Ku Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Yi-Chen Lee
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Ta-Yu Liu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Min Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Cheng Chen
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
| | - Chih-Hao Chang
- Department of Respiratory Therapy, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung 83301, Taiwan;
| | - Te-Yao Hsu
- Department of Obstetrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan;
| | - Chen-Kuang Niu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung 83301, Taiwan; (H.-R.Y.); (T.-A.T.); (C.-K.T.); (Y.-C.L.); (T.-Y.L.); (C.-M.T.); (C.-C.C.); (C.-K.N.)
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de Ángel Solá DE, Wang L, Vázquez M, Méndez-Lázaro PA. Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare, and respond to COVID-19. J Med Virol 2020; 92:1460-1468. [PMID: 32275090 PMCID: PMC7262109 DOI: 10.1002/jmv.25864] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/17/2022]
Abstract
The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID‐19 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle‐income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time‐based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short‐ and long‐term interventions to manage outbreaks at the international, national, and subnational levels in the region. Inter‐tropical regions have seen a slower spread of SARS‐CoV‐2 compared to temperate ones, suggesting viral spreading could likely be influenced by environmental factors. Other coronaviruses also seem to respond to environmental factors, with peaks closely following the geotemporal patterns of influenza. In the Caribbean, timing interventions to fight COVID‐19 around the projected peaks of influenza is a reasonable public health approach.
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Affiliation(s)
| | - Leyao Wang
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Marietta Vázquez
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Pablo A Méndez-Lázaro
- Department of Environmental Health, Graduate School of Public Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
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