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Du S, Chien LC, Bush KF, Giri S, Richardson LA, Li M, Jin Q, Li T, Nicklett EJ, Li R, Zhang K. Short-term associations between precipitation and gastrointestinal illness-related hospital admissions: A multi-city study in Texas. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 951:175247. [PMID: 39111450 DOI: 10.1016/j.scitotenv.2024.175247] [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: 03/25/2024] [Revised: 07/09/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Abstract
The ongoing climate change crisis presents challenges to the global public health system. The risk of gastrointestinal illness (GI) related hospitalization increases following extreme weather events but is largely under-reported and under-investigated. This study assessed the association between precipitation and GI-related hospital admissions in four major cities in Texas. Daily data on GI-related hospital admissions and precipitation from 2004 to 2014 were captured from the Texas Department of State Health Services and the National Climate Data Center. Distributed lagged nonlinear modeling approaches were employed to examine the association between precipitation and GI-related hospital admissions. Results showed that the cumulative risk ratios (RRs) of GI-related hospital admissions were elevated in the 2 weeks following precipitation events; however, there were differences observed across study locations. The cumulative RR of GI-related hospitalizations was significantly higher when the amount of daily precipitation ranged from 3.3 mm to 13.5 mm in Dallas and from 6.0 mm to 24.5 mm in Houston. Yet, substantial increases in the cumulative RRs of GI-related hospitalizations were not observed in Austin or San Antonio. Age-specific and cause-specific GI-related hospitalizations were also found to be associated with precipitation events following the same pattern. Among them, Houston depicted the largest RR for overall GI and subgroup GI by age and cause, particularly for the overall GI among children aged 6 and under (RR = 1.35; 95 % CI = 1.11, 1.63), diarrhea-caused GI among children aged 6 and under (RR = 1.38, 95 % CI = 1.13, 1.69), and other-caused GI among children age 6 and under (RR = 1.46; 95 % CI = 1.12, 1.80). The findings underscore the need for public health interventions and adaptation strategies to address climate change-related health outcomes such as GI illness associated with extreme precipitation events.
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Affiliation(s)
- Shichao Du
- Department of Sociology, School of Social Development and Public Policy, Fudan University, Shanghai, China.
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada at Las Vegas, Las Vegas, NV, USA.
| | - Kathleen F Bush
- Center for Environmental Health, New York State Department of Health, Albany, NY, USA.
| | - Sharmila Giri
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA.
| | - Leigh Ann Richardson
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada at Las Vegas, Las Vegas, NV, USA.
| | - Mo Li
- Department of Civil and Environmental Engineering, University of California, Irvine, CA, USA.
| | - Qingxu Jin
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA; Resilient, Intelligent, Sustainable, and Energy-efficient (RISE) Infrustructure Material Labatory, Michigan State University, East Lansing, MI, USA.
| | - Tianxing Li
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI, USA.
| | - Emily Joy Nicklett
- Department of Social Work, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA.
| | - Ruosha Li
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
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Geremew G, Cumming O, Haddis A, Freeman MC, Ambelu A. Rainfall and Temperature Influences on Childhood Diarrhea and the Effect Modification Role of Water and Sanitation Conditions: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:823. [PMID: 39063400 PMCID: PMC11276699 DOI: 10.3390/ijerph21070823] [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: 03/22/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 07/28/2024]
Abstract
The latest report from the Intergovernmental Panel on Climate Change (IPCC) highlighted the worsening impacts of climate change. Two climate factors-temperature and rainfall uncertainties-influence the risk of childhood diarrhea, which remains a significant cause of morbidity and mortality in low- and middle-income countries. They create a conducive environment for diarrhea-causing pathogens and overwhelm environmental prevention measures. This study aimed to produce comprehensive evidence on the association of temperature and rainfall variability with the risk of childhood diarrhea and the influence of water and sanitation conditions on those associations. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach. Records published in English from 2006 to 2023 were searched on 8 January 2024 via PubMed, EMBASE, ScienceDirect, Scopus, the Cochrane Library, and Google/Google Scholar using comprehensive search terms. We assessed studies for any risk of bias using the Navigation Guide and rated the quality of the evidence using the GRADE approach. The heterogeneity among estimates was assessed using I-squared statistics (I2). The findings of the analysis were presented with forest plots using an incidence rate ratio (IRR). A meta-analysis was conducted on effect modifiers (water supply and sanitation conditions) using a random effects model with a 95% confidence interval (CI). The statistical analyses were conducted using R 4.3.2 software and Review Manager 5.3. A total of 2017 records were identified through searches, and only the 36 articles that met the inclusion criteria were included. The analysis suggests a small positive association between increased temperature and the occurrence of under-five diarrhea, with the pooled IRR = 1.04; 95% CI [1.03, 1.05], at I2 = 56% and p-value < 0.01, and increased rainfall and U5 diarrhea, with IRR = 1.14; 95% CI [1.03, 1.27], at I2 = 86% and p-value < 0.01. The meta-analysis indicated a positive association between unimproved latrine facilities and drinking water sources with a rainfall-modified effect on U5 diarrhea, with IRR = 1.21; 95% CI [0.95, 1.53], at I2 = 62% and p-value = 0.03. We found that an increase in mean temperature and rainfall was associated with an increased risk of childhood diarrhea. Where there were unimproved latrine facilities and drinking water sources, the increase in mean rainfall or temperature would increase the incidence of childhood diarrhea. The results of this review help in assessing the effectiveness of current intervention programs, making changes as needed, or creating new initiatives to lower the prevalence of childhood diarrhea.
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Affiliation(s)
- Gorfu Geremew
- Department of Environmental Health Science and Technology, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Alemayehu Haddis
- Department of Environmental Health Science and Technology, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa P.O. Box 1165, Ethiopia;
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Haley BM, Sun Y, Jagai JS, Leibler JH, Fulweiler R, Ashmore J, Wellenius GA, Heiger-Bernays W. Association between Combined Sewer Overflow Events and Gastrointestinal Illness in Massachusetts Municipalities with and without River-Sourced Drinking Water, 2014-2019. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:57008. [PMID: 38775485 PMCID: PMC11110654 DOI: 10.1289/ehp14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Combined sewer overflow (CSO) events release untreated wastewater into surface waterbodies during heavy precipitation and snowmelt. Combined sewer systems serve ∼ 40 million people in the United States, primarily in urban and suburban municipalities in the Midwest and Northeast. Predicted increases in heavy precipitation events driven by climate change underscore the importance of quantifying potential health risks associated with CSO events. OBJECTIVES The aims of this study were to a) estimate the association between CSO events (2014-2019) and emergency department (ED) visits for acute gastrointestinal illness (AGI) among Massachusetts municipalities that border a CSO-impacted river, and b) determine whether associations differ by municipal drinking water source. METHODS A case time-series design was used to estimate the association between daily cumulative upstream CSO discharge and ED visits for AGI over lag periods of 4, 7, and 14 days, adjusting for temporal trends, temperature, and precipitation. Associations between CSO events and AGI were also compared by municipal drinking water source (CSO-impacted river vs. other sources). RESULTS Extreme upstream CSO discharge events (> 95 th percentile by cumulative volume) were associated with a cumulative risk ratio (CRR) of AGI of 1.22 [95% confidence interval (CI): 1.05, 1.42] over the next 4 days for all municipalities, and the association was robust after adjusting for precipitation [1.17 (95% CI: 0.98, 1.39)], although the CI includes the null. In municipalities with CSO-impacted drinking water sources, the adjusted association was somewhat less pronounced following 95th percentile CSO events [CRR = 1.05 (95% CI: 0.82, 1.33)]. The adjusted CRR of AGI was 1.62 in all municipalities following 99th percentile CSO events (95% CI: 1.04, 2.51) and not statistically different when stratified by drinking water source. DISCUSSION In municipalities bordering a CSO-impacted river in Massachusetts, extreme CSO events are associated with higher risk of AGI within 4 days. The largest CSO events are associated with increased risk of AGI regardless of drinking water source. https://doi.org/10.1289/EHP14213.
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Affiliation(s)
- Beth M. Haley
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yuantong Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jyotsna S. Jagai
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robinson Fulweiler
- Department of Earth & Environment, Boston University, Boston, Massachusetts, USA
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | | | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Wendy Heiger-Bernays
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Projecting the Impacts of a Changing Climate: Tropical Cyclones and Flooding. Curr Environ Health Rep 2022; 9:244-262. [PMID: 35403997 DOI: 10.1007/s40572-022-00340-0] [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: 01/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW There is clear evidence that the earth's climate is changing, largely from anthropogenic causes. Flooding and tropical cyclones have clear impacts on human health in the United States at present, and projections of their health impacts in the future will help inform climate policy, yet to date there have been few quantitative climate health impact projections. RECENT FINDINGS Despite a wealth of studies characterizing health impacts of floods and tropical cyclones, many are better suited for qualitative, rather than quantitative, projections of climate change health impacts. However, a growing number have features that will facilitate their use in quantitative projections, features we highlight here. Further, while it can be difficult to project how exposures to flood and tropical cyclone hazards will change in the future, climate science continues to advance in its capabilities to capture changes in these exposures, including capturing regional variation. Developments in climate epidemiology and climate science are opening new possibilities in projecting the health impacts of floods and tropical cyclones under a changing climate.
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Quist AJL, Fliss MD, Wade TJ, Delamater PL, Richardson DB, Engel LS. Hurricane flooding and acute gastrointestinal illness in North Carolina. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 809:151108. [PMID: 34688737 PMCID: PMC8770555 DOI: 10.1016/j.scitotenv.2021.151108] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 05/28/2023]
Abstract
Hurricanes often flood homes and industries, spreading pathogens. Contact with pathogen-contaminated water can result in diarrhea, vomiting, and/or nausea, known collectively as acute gastrointestinal illness (AGI). Hurricanes Matthew and Florence caused record-breaking flooding in North Carolina (NC) in October 2016 and September 2018, respectively. To examine the relationship between hurricane flooding and AGI in NC, we first calculated the percent of each ZIP code flooded after Hurricanes Matthew and Florence. Rates of all-cause AGI emergency department (ED) visits were calculated from NC's ED surveillance system data. Using controlled interrupted time series, we compared AGI ED visit rates during the three weeks after each hurricane in ZIP codes with a third or more of their area flooded to the predicted rates had these hurricanes not occurred, based on AGI 2016-2019 ED trends, and controlling for AGI ED visit rates in unflooded areas. We examined alternative case definitions (bacterial AGI) and effect measure modification by race and age. We observed an 11% increase (rate ratio (RR): 1.11, 95% CI: 1.00, 1.23) in AGI ED visit rates after Hurricanes Matthew and Florence. This effect was particularly strong among American Indian patients and patients aged 65 years and older after Florence and elevated among Black patients for both hurricanes. Florence's effect was more consistent than Matthew's effect, possibly because little rain preceded Florence and heavy rain preceded Matthew. When restricted to bacterial AGI, we found an 85% (RR: 1.85, 95% CI: 1.37, 2.34) increase in AGI ED visit rate after Florence, but no increase after Matthew. Hurricane flooding is associated with an increase in AGI ED visit rate, although the strength of effect may depend on total storm rainfall or antecedent rainfall. American Indians and Black people-historically pushed to less desirable, flood-prone land-may be at higher risk for AGI after storms.
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Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Mike Dolan Fliss
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Timothy J Wade
- Public Health and Environmental Systems Division, United States Environmental Protection Agency, Chapel Hill, NC 27514, USA
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Chapel Hill, NC 27514, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
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Feliciano RJ, Boué G, Membré JM. Overview of the Potential Impacts of Climate Change on the Microbial Safety of the Dairy Industry. Foods 2020; 9:E1794. [PMID: 33287137 PMCID: PMC7761758 DOI: 10.3390/foods9121794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022] Open
Abstract
Climate change is expected to affect many different sectors across the food supply chain. The current review paper presents an overview of the effects of climate change on the microbial safety of the dairy supply chain and suggest potential mitigation strategies to limit the impact. Raw milk, the common raw material of dairy products, is vulnerable to climate change, influenced by changes in average temperature and amount of precipitation. This would induce changes in the microbial profile and heat stress in lactating cows, increasing susceptibility to microbial infection and higher levels of microbial contamination. Moreover, climate change affects the entire dairy supply chain and necessitates adaptation of all the current food safety management programs. In particular, the review of current prerequisite programs might be needed as well as revisiting the current microbial specifications of the receiving dairy products and the introduction of new pretreatments with stringent processing regimes. The effects on microbial changes during distribution and consumer handling also would need to be quantified through the use of predictive models. The development of Quantitative Microbial Risk Assessment (QMRA) models, considering the whole farm-to-fork chain to evaluate risk mitigation strategies, will be a key step to prioritize actions towards a climate change-resilient dairy industry.
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Affiliation(s)
| | | | - Jeanne-Marie Membré
- Secalim UMR1014, INRAE, Oniris Chantrerie, CS 40706, CEDEX 3, 44307 Nantes, France; (R.J.F.); (G.B.)
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Lai H, Hales S, Woodward A, Walker C, Marks E, Pillai A, Chen RX, Morton SM. Effects of heavy rainfall on waterborne disease hospitalizations among young children in wet and dry areas of New Zealand. ENVIRONMENT INTERNATIONAL 2020; 145:106136. [PMID: 32987220 DOI: 10.1016/j.envint.2020.106136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
Heavy rainfall is associated with increased risk of waterborne disease. However, it is not known whether the risk increment differs between wet and dry regions. We examined this question in New Zealand, which has a wide geographical variation of annual rainfall totals (10th-90th percentile difference ≥3000 mm). We conducted a nested case-crossover study within a prospective child cohort (born in 2009-2010) for assessing transient health effects when modified by longitudinal exposures to rainfall. Short-term heavy rainfall effects on hospitalizations due to enteric bacterial and viral infectious causes at lag of 0-14 days were assessed using a Cox regression model adjusted for daily temperature, relative humidity and evapotranspiration. We derived quantiles of time-weighted long-term rainfall levels at the children's homes and these were added as an interaction term to the short-term effect model. Hospitalization risks were higher two days after heavy rainfall days (hazard ratio [95% confidence interval]: 1.73 [1.10-2.70]). The lowest-observable-adverse-effect-level was detected at the 94th percentile of daily rainfall total. Hospital admissions 1-2 days after heavy rainfall increased most in locations with the lowest and highest long-term rainfall. An interaction of this kind between short-term weather and long-term climate has not been reported previously. It is relevant to climate change risk assessments given global projections of increasing intensity of precipitation, against a background of more severe, and possibly more frequent, droughts and flooding.
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Affiliation(s)
- Hakkan Lai
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Centre for Longitudinal Research - He Ara Ki Mua, School of Population Health, University of Auckland, New Zealand.
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Alistair Woodward
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Caroline Walker
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Centre for Longitudinal Research - He Ara Ki Mua, School of Population Health, University of Auckland, New Zealand
| | - Emma Marks
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Centre for Longitudinal Research - He Ara Ki Mua, School of Population Health, University of Auckland, New Zealand
| | - Avinesh Pillai
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Department of Statistics, Faculty of Science, University of Auckland, New Zealand
| | - Rachel X Chen
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Department of Statistics, Faculty of Science, University of Auckland, New Zealand
| | - Susan M Morton
- Growing Up in New Zealand, School of Population Health, University of Auckland, New Zealand; Centre for Longitudinal Research - He Ara Ki Mua, School of Population Health, University of Auckland, New Zealand
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Kraay ANM, Man O, Levy MC, Levy K, Ionides E, Eisenberg JNS. Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:126001. [PMID: 33284047 PMCID: PMC7720804 DOI: 10.1289/ehp6181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Projected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence. OBJECTIVES In this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature. METHODS To this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness. RESULTS A total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio ( IRR ) = 1.26 ; 95% confidence interval (CI): 1.05, 1.51], with a tendency toward an inverse association for extreme rain following wet periods, albeit nonsignificant, with one of four relevant studies showing a significant inverse association (IRR = 0.911 ; 95% CI: 0.771, 1.08). Incidences of bacterial and parasitic diarrhea were more common during rainy seasons, providing pathogen-specific support for a concentration mechanism, but rotavirus diarrhea showed the opposite association. Information on timing of cases within the rainy season (e.g., early vs. late) was lacking, limiting further analysis. We did not find a linear association between nonextreme rain exposures and diarrheal disease, but several studies found a nonlinear association with low and high rain both being associated with diarrhea. DISCUSSION Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.
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Affiliation(s)
- Alicia N. M. Kraay
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Olivia Man
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
| | - Morgan C. Levy
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
- School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Edward Ionides
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
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Bastaraud A, Perthame E, Rakotondramanga JM, Mahazosaotra J, Ravaonindrina N, Jambou R. The impact of rainfall on drinking water quality in Antananarivo, Madagascar. PLoS One 2020; 15:e0218698. [PMID: 32542001 PMCID: PMC7295214 DOI: 10.1371/journal.pone.0218698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 04/06/2020] [Indexed: 01/23/2023] Open
Abstract
Low-income cities that are subject to high population pressure and vulnerable to climate events often have a low capacity to continuously deliver safe drinking water. Here we reported the results of a 32-year survey on the temporal dynamics of drinking water quality indicators in the city of Antananarivo. We analyzed the long-term evolution of the quality of the water supplied and characterized the interactions between climatic conditions and the full-scale water supply system. A total of 25,467 water samples were collected every week at different points in the supplied drinking water system. Samples were analyzed for total coliforms (TC), Escherichia coli (EC), intestinal Enterococci (IE), and Spores of Sulphite-Reducing Clostridia (SSRC). Nine-hundred-eighty-one samples that were identified as positive for one or more indicators were unevenly distributed over time. The breakpoint method identified four periods when the time series displayed changes in the level and profile of contamination (i) and the monthly pattern of contamination (ii), with more direct effects of rainfall on the quality of supplied drinking water. The modeling showed significantly different lags among indicators of bacteria occurrence after cumulative rainfall, which range from 4 to 8 weeks. Among the effects of low-income urbanization, a rapid demographic transition and the degradation of urban watersheds have gradually affected the quality of the water supplied and resulted in the more direct effects of rainfall events. We focused on the need to adopt an alternative perspective of drinking water and urban watersheds management.
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Affiliation(s)
- Alexandra Bastaraud
- Food Hygiene and Environment Laboratory, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Emeline Perthame
- The Center of Bioinformatics, Biostatistics and Integrative Biology (C3BI), Institut Pasteur Paris, Paris, France
| | | | - Jackson Mahazosaotra
- Food Hygiene and Environment Laboratory, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Noro Ravaonindrina
- Food Hygiene and Environment Laboratory, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Ronan Jambou
- Global Health Department, Institut Pasteur Paris, Paris, France
- * E-mail:
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Levy K, Smith SM, Carlton EJ. Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions. Curr Environ Health Rep 2019; 5:272-282. [PMID: 29721700 DOI: 10.1007/s40572-018-0199-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data. RECENT FINDINGS A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.
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Affiliation(s)
- Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Shanon M Smith
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, 80045, USA
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11
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Extreme Precipitation, Public Health Emergencies, and Safe Drinking Water in the USA. Curr Environ Health Rep 2019; 5:305-315. [PMID: 29687348 DOI: 10.1007/s40572-018-0200-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW This review examines the effectiveness of drinking water regulations to inform public health during extreme precipitation events. This paper estimates the vulnerability of specific populations to flooding in their public water system, reviews the literature linking precipitation to waterborne outbreaks, examines the role that Safe Drinking Water Act and Public Notification (PN) Rule have in public health emergencies, and reviews the effectiveness of the PN Rule during the 2017 Hurricane Maria in Puerto Rico. RECENT FINDINGS Public water systems in large metropolitan areas have substantial portions of their customer base at risk for a waterborne outbreak during a flooding event. The PN Rule are ambiguous for who is responsible for declaring a "waterborne emergency" following a natural disaster like Hurricane Maria. Revisions to the current PN Rule that mandate public notification and water quality sampling during extreme precipitation events are necessary to ensure the public is aware of their drinking water quality following these events.
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12
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Environmental Factors and the Microbial Quality of Urban Drinking Water in a Low-Income Country: The Case of Madagascar. WATER 2018. [DOI: 10.3390/w10101450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Access to piped water is often limited to urban areas in low-income countries, and the microbiological quality of drinking water varies due to technical and environmental constraints. To analyse the parameters that modulate the contamination of these systems, this study examines 16 years of microbial quality data for water supplied in 32 urban areas of Madagascar. A discriminant statistical approach and agglomerative hierarchical clusters were applied to environmental and climatic data. The microbial contamination varied between sites from 3.3 to 17.5%, and 78% of the supply systems showed large variations between years or months. Agglomerative hierarchical clusters (AHCs) revealed four supply system profiles that share a similar bacteriological evolution. Heavy rainfall and dry periods sustained increasing contamination, as reflected in levels of spores of sulphite-reducing clostridia (SSRC) and/or total coliforms (TC). SSRC were dominant in three profiles, with faecal indicator bacteria (FIB) dominant in the other. Principal component analysis demonstrated the main drivers of contamination: type of water source, implemented treatment, location of the site, population growth, lack of protection, agriculture, urbanization/sanitation, and flooding threats. Contamination increased over the 16-year period, reaching alarming levels. The protection of water sources should be a concern for public authorities.
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Bell JE, Brown CL, Conlon K, Herring S, Kunkel KE, Lawrimore J, Luber G, Schreck C, Smith A, Uejio C. Changes in extreme events and the potential impacts on human health. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2018; 68:265-287. [PMID: 29186670 PMCID: PMC9039910 DOI: 10.1080/10962247.2017.1401017] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/19/2017] [Indexed: 05/20/2023]
Abstract
Extreme weather and climate-related events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, dust storms, flooding rains, coastal flooding, storm surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden. More information is needed about the impacts of climate change on public health and economies to effectively plan for and adapt to climate change. This paper describes some of the ways extreme events are changing and provides examples of the potential impacts on human health and infrastructure. It also identifies key research gaps to be addressed to improve the resilience of public health to extreme events in the future. IMPLICATIONS Extreme weather and climate events affect human health by causing death, injury, and illness, as well as having large socioeconomic impacts. Climate change has caused changes in extreme event frequency, intensity, and geographic distribution, and will continue to be a driver for change in the future. Some of these events include heat waves, droughts, wildfires, flooding rains, coastal flooding, surges, and hurricanes. The pathways connecting extreme events to health outcomes and economic losses can be diverse and complex. The difficulty in predicting these relationships comes from the local societal and environmental factors that affect disease burden.
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Affiliation(s)
- Jesse E Bell
- a Cooperative Institute for Climate and Satellites-NC , North Carolina State University , Asheville , NC , USA
| | - Claudia Langford Brown
- b Karna, LLC, for Climate and Health Program , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Kathryn Conlon
- c Climate and Health Program , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Stephanie Herring
- d National Oceanic and Atmospheric Administration , National Centers for Environmental Information , Boulder , CO , USA
| | - Kenneth E Kunkel
- a Cooperative Institute for Climate and Satellites-NC , North Carolina State University , Asheville , NC , USA
| | - Jay Lawrimore
- e National Oceanic and Atmospheric Administration , National Centers for Environmental Information , Asheville , NC , USA
| | - George Luber
- c Climate and Health Program , Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Carl Schreck
- a Cooperative Institute for Climate and Satellites-NC , North Carolina State University , Asheville , NC , USA
| | - Adam Smith
- e National Oceanic and Atmospheric Administration , National Centers for Environmental Information , Asheville , NC , USA
| | - Christopher Uejio
- f Department of Geography , Florida State University , Tallahassee , FL , USA
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Poulsen MN, Pollak J, Sills DL, Casey JA, Rasmussen SG, Nachman KE, Cosgrove SE, Stewart D, Schwartz BS. Residential proximity to high-density poultry operations associated with campylobacteriosis and infectious diarrhea. Int J Hyg Environ Health 2017; 221:323-333. [PMID: 29268955 DOI: 10.1016/j.ijheh.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
Poultry carry zoonotic bacteria that can cause gastroenteritis in humans. Environmental transmission of pathogens from poultry operations may increase gastrointestinal infection risk in surrounding communities. To evaluate associations between residential proximity to high-density poultry operations and individual-level diarrheal illnesses, we conducted a nested case-control study among 514,488 patients in Pennsylvania (2006-2015). Using electronic health records, we identified cases of five gastrointestinal outcomes: three pathogen-specific infections, including Escherichia coli (n = 1425), Campylobacter (n = 567), and Salmonella (n = 781); infectious diarrhea (n = 781); and non-specific diarrhea (2012-2015; n = 28,201). We estimated an inverse-distance squared activity metric for poultry operations based on farm and patient addresses. Patients in the second and fourth (versus first) quartiles of the poultry operation activity metric had increased odds of Campylobacter (AOR [CI], Q2: 1.36 [1.01, 1.82]; Q3: 1.38 [0.98, 1.96]; Q4: 1.75 [1.31, 2.33]). Patients in the second, third, and fourth quartiles had increased odds of infectious diarrhea (Q2: 1.76 [1.29, 2.39]; Q3: 1.76 [1.09, 2.85]; Q4: 1.60 [1.12, 2.30]). Stratification revealed stronger relations of fourth quartile and both Campylobacter and infectious diarrhea in townships, the most rural community type in the study geography. Increasing extreme rainfall in the week prior to diagnosis strengthened fourth quartile Campylobacter associations. The poultry operation activity metric was largely unassociated with E. coli, Salmonella, and non-specific diarrhea. Findings suggest high-density poultry operations may be associated with campylobacteriosis and infectious diarrhea in nearby communities, highlighting additional public health concerns of industrial agriculture.
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Affiliation(s)
- Melissa N Poulsen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah L Sills
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Joan A Casey
- Department of Environmental Science, Policy & Management, University of California, Berkeley, CA, USA
| | - Sara G Rasmussen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dalton Stewart
- Department of Civil and Environmental Engineering, Bucknell University, Lewisburg, PA, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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