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Chua PLC, Tobias A, Madaniyazi L, Ng CFS, Phung VLH, Fu SH, Rodriguez PS, Brown P, Coelho MDSZS, Saldiva PHN, Scovronick N, Deshpande A, Salazar MAS, Dorotan MMC, Tantrakarnapa K, Kliengchuay W, Abrutzky R, Carrasco-Escobar G, Roye D, Hales S, Hashizume M. Association between precipitation and mortality due to diarrheal diseases by climate zone: A multi-country modeling study. Environ Epidemiol 2024; 8:e320. [PMID: 39027089 PMCID: PMC11257672 DOI: 10.1097/ee9.0000000000000320] [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] [Received: 01/21/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Precipitation could affect the transmission of diarrheal diseases. The diverse precipitation patterns across different climates might influence the degree of diarrheal risk from precipitation. This study determined the associations between precipitation and diarrheal mortality in tropical, temperate, and arid climate regions. Methods Daily counts of diarrheal mortality and 28-day cumulative precipitation from 1997 to 2019 were analyzed across 29 locations in eight middle-income countries (Argentina, Brazil, Costa Rica, India, Peru, the Philippines, South Africa, and Thailand). A two-stage approach was employed: the first stage is conditional Poisson regression models for each location, and the second stage is meta-analysis for pooling location-specific coefficients by climate zone. Results In tropical climates, higher precipitation increases the risk of diarrheal mortality. Under extremely wet conditions (95th percentile of 28-day cumulative precipitation), diarrheal mortality increased by 17.8% (95% confidence interval [CI] = 10.4%, 25.7%) compared with minimum-risk precipitation. For temperate and arid climates, diarrheal mortality increases in both dry and wet conditions. In extremely dry conditions (fifth percentile of 28-day cumulative precipitation), diarrheal mortality risk increases by 3.8% (95% CI = 1.2%, 6.5%) for temperate and 5.5% (95% CI = 1.0%, 10.2%) for arid climates. Similarly, under extremely wet conditions, diarrheal mortality risk increases by 2.5% (95% CI = -0.1%, 5.1%) for temperate and 4.1% (95% CI = 1.1%, 7.3%) for arid climates. Conclusions Associations between precipitation and diarrheal mortality exhibit variations across different climate zones. It is crucial to consider climate-specific variations when generating global projections of future precipitation-related diarrheal mortality.
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Affiliation(s)
- Paul L. C. Chua
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Lina Madaniyazi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Vera Ling Hui Phung
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sze Hang Fu
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Peter S. Rodriguez
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Patrick Brown
- Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Noah Scovronick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aniruddha Deshpande
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Wissanupong Kliengchuay
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Rosana Abrutzky
- Instituto de Investigaciones Gino Germani, Facultad de Ciencias Sociales, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Carrasco-Escobar
- Scripps Institution of Oceanography, University of California, San Diego, California
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Simon Hales
- Department of Public Health, University of Otago, Newtown, Wellington, New Zealand
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Peñuelas Martinez M, Carmena D, Guzmán Herrador BR, Palau Miguel M, Saravia Campelli G, García Álvarez RM, Guerrero-Vadillo M, Dashti A, Köster PC, Guevara Alemany E, Simón Soria F, Fuentes Corripio I, Varela Martínez C, Sierra Moros MJ. Marked increase in cryptosporidiosis cases, Spain, 2023. Euro Surveill 2024; 29. [PMID: 38994603 PMCID: PMC11241854 DOI: 10.2807/1560-7917.es.2024.29.28.2300733] [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: 07/13/2024] Open
Abstract
BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.
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Affiliation(s)
- Marina Peñuelas Martinez
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- These authors contributed equally to the work and share first authorship
- Escuela Internacional de Doctorado, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - David Carmena
- These authors contributed equally to the work and share first authorship
- CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
- National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Bernardo R Guzmán Herrador
- These authors contributed equally to the work and share first authorship
- Coordinating Centre for Health Alerts and Emergencies, Ministry of Health, Madrid, Spain
| | | | | | - Rosa María García Álvarez
- Hospital Clínico Universitario de Santiago (A Coruña), Santiago de Compostela, Spain
- Coordinating Centre for Health Alerts and Emergencies, Ministry of Health, Madrid, Spain
| | - María Guerrero-Vadillo
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Dashti
- National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Pamela C Köster
- Faculty of Medicine, Alfonso X El Sabio University (UAX), Villanueva de la Cañada, Spain
- Faculty of Health Sciences, Alfonso X El Sabio University (UAX), Villanueva de la Cañada, Madrid, Spain
- National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | | | - Fernando Simón Soria
- Coordinating Centre for Health Alerts and Emergencies, Ministry of Health, Madrid, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isabel Fuentes Corripio
- These authors contributed equally to the work and share last authorship
- National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Carmen Varela Martínez
- These authors contributed equally to the work and share last authorship
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Sierra Moros
- These authors contributed equally to the work and share last authorship
- Coordinating Centre for Health Alerts and Emergencies, Ministry of Health, Madrid, Spain
- CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
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Grover EN, Crooks JL, Carlton EJ, Paull SH, Allshouse WB, Jervis RH, James KA. Investigating the relationship between extreme weather and cryptosporidiosis and giardiasis in Colorado: A multi-decade study using distributed-lag nonlinear models. Int J Hyg Environ Health 2024; 260:114403. [PMID: 38830305 DOI: 10.1016/j.ijheh.2024.114403] [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: 03/14/2024] [Revised: 05/10/2024] [Accepted: 05/25/2024] [Indexed: 06/05/2024]
Abstract
Environmentally-mediated protozoan diseases like cryptosporidiosis and giardiasis are likely to be highly impacted by extreme weather, as climate-related conditions like temperature and precipitation have been linked to their survival, distribution, and overall transmission success. Our aim was to investigate the relationship between extreme temperature and precipitation and cryptosporidiosis and giardiasis infection using monthly weather data and case reports from Colorado counties over a twenty-one year period. Data on reportable diseases and weather among Colorado counties were collected using the Colorado Electronic Disease Reporting System (CEDRS) and the Daily Surface Weather and Climatological Summaries (Daymet) Version 3 dataset, respectively. We used a conditional Poisson distributed-lag nonlinear modeling approach to estimate the lagged association (between 0 and 12-months) between relative temperature and precipitation extremes and the risk of cryptosporidiosis and giardiasis infection in Colorado counties between 1997 and 2017, relative to the risk found at average values of temperature and precipitation for a given county and month. We found distinctly different patterns in the associations between temperature extremes and cryptosporidiosis, versus temperature extremes and giardiasis. When maximum or minimum temperatures were high (90th percentile) or very high (95th percentile), we found a significant increase in cryptosporidiosis risk, but a significant decrease in giardiasis risk, relative to risk at the county and calendar-month mean. Conversely, we found very similar relationships between precipitation extremes and both cryptosporidiosis and giardiasis, which highlighted the prominent role of long-term (>8 months) lags. Our study presents novel insights on the influence that extreme temperature and precipitation can have on parasitic disease transmission in real-world settings. Additionally, we present preliminary evidence that the standard lag periods that are typically used in epidemiological studies to assess the impacts of extreme weather on cryptosporidiosis and giardiasis may not be capturing the entire relevant period.
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Affiliation(s)
- Elise N Grover
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
| | - James L Crooks
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Sara H Paull
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Rachel H Jervis
- Colorado Department of Public Health and the Environment, Denver, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
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Robertson LJ, Woolsey ID, Jiménez-Meléndez A. Current and potential future impacts of food- and water-borne parasites in a changing world: A Norwegian perspective. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2024; 5:100181. [PMID: 38883144 PMCID: PMC11178983 DOI: 10.1016/j.crpvbd.2024.100181] [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: 03/26/2024] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Abstract
In 2021, the Norwegian Scientific Committee for Food and Environment published a multi-criteria risk ranking of 20 potentially food-borne pathogens in Norway. The pathogens ranked included five parasite taxa (3 species, one genus, one family): Toxoplasma gondii, Echinococcus multilocularis, Giardia duodenalis, Cryptosporidium spp., and Anisakidae. Two of these, T. gondii and E. multilocularis, scored very highly (1st and 3rd place, respectively), Cryptosporidium was about midway (9th place), and G. duodenalis and Anisakidae ranked relatively low (15th and 20th place, respectively). Parasites were found, on average, more likely to present an increasing food-borne disease burden in the future than the other pathogens. Here, we review the current impact of these five potentially food-borne parasites in Norway, and factors of potential importance in increasing their future food-borne disease burden. Climate change may affect the contamination of water and fresh produce with transmission stages of the first four parasites, potentially leading to increased infection risk. Alterations in host distribution (potentially due to climate change, but also other factors) may affect the occurrence and distribution of Toxoplasma, Echinococcus, and Anisakidae, and these, coupled with changes in food consumption patterns, could also affect infection likelihood. Transmission of food-borne pathogens is complex, and the relative importance of different pathogens is affected by many factors and will not remain static. Further investigation in, for example, ten-years' time, could provide a different picture of the relative importance of different pathogens. Nevertheless, there is clearly the potential for parasites to exert a greater risk to public health in Norway than currently occurs.
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Affiliation(s)
- Lucy J Robertson
- Parasitology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences (NMBU), P.O. Box 5003, NO-1432 Ås, Norway
| | - Ian D Woolsey
- Parasitology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences (NMBU), P.O. Box 5003, NO-1432 Ås, Norway
| | - Alejandro Jiménez-Meléndez
- Parasitology, Faculty of Veterinary Medicine, Norwegian University of Life Sciences (NMBU), P.O. Box 5003, NO-1432 Ås, Norway
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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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Egan S, Barbosa AD, Feng Y, Xiao L, Ryan U. Critters and contamination: Zoonotic protozoans in urban rodents and water quality. WATER RESEARCH 2024; 251:121165. [PMID: 38290188 DOI: 10.1016/j.watres.2024.121165] [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: 10/28/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
Rodents represent the single largest group within mammals and host a diverse array of zoonotic pathogens. Urbanisation impacts wild mammals, including rodents, leading to habitat loss but also providing new resources. Urban-adapted (synanthropic) rodents, such as the brown rat (R. norvegicus), black rat (R. rattus), and house mouse (Mus musculus), have long successfully adapted to living close to humans and are known carriers of zoonotic pathogens. Two important enteric, zoonotic protozoan parasites, carried by rodents, include Cryptosporidium and Giardia. Their environmental stages (oocysts/cysts), released in faeces, can contaminate surface and wastewaters, are resistant to common drinking water disinfectants and can cause water-borne related gastritis outbreaks. At least 48 species of Cryptosporidium have been described, with C. hominis and C. parvum responsible for the majority of human infections, while Giardia duodenalis assemblages A and B are the main human-infectious assemblages. Molecular characterisation is crucial to assess the public health risk linked to rodent-related water contamination due to morphological overlap between species. This review explores the global molecular diversity of these parasites in rodents, with a focus on evaluating the zoonotic risk from contamination of water and wasterwater with Cryptosporidium and Giardia oocysts/cysts from synanthropic rodents. Analysis indicates that while zoonotic Cryptosporidium and Giardia are prevalent in farmed and pet rodents, host-specific Cryptosporidium and Giardia species dominate in urban adapted rodents, and therefore the risks posed by these rodents in the transmission of zoonotic Cryptosporidium and Giardia are relatively low. Many knowledge gaps remain however, and therefore understanding the intricate dynamics of these parasites in rodent populations is essential for managing their impact on human health and water quality. This knowledge can inform strategies to reduce disease transmission and ensure safe drinking water in urban and peri‑urban areas.
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Affiliation(s)
- Siobhon Egan
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia.
| | - Amanda D Barbosa
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia; CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF 70040-020, Brazil
| | - Yaoyu Feng
- Guangdong Laboratory for Lingnan Modern Agriculture, Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Lihua Xiao
- Guangdong Laboratory for Lingnan Modern Agriculture, Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Una Ryan
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia
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Ethan CJ, Sanchez J, Grant L, Tustin J, Young I. Relationship between extreme precipitation and acute gastrointestinal illness in Toronto, Ontario, 2012-2022. Epidemiol Infect 2024; 152:e32. [PMID: 38329089 PMCID: PMC10894888 DOI: 10.1017/s0950268824000207] [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: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Extreme precipitation events are occurring more intensely in Canada. This can contaminate water sources with enteric pathogens, potentially increasing the risk of acute gastrointestinal illness. This study aimed to investigate the relationship between extreme precipitation and emergency department (ED) visits for acute gastrointestinal illness in Toronto from 2012 to 2022. Distributed lag non-linear models were constructed on ED visit counts with a Quasi Poisson distribution. Extreme precipitation was modelled as a 21-day lag variable, with a linear relationship assumed at levels ≧95th percentile. Separate models were also conducted on season-specific data sets. Daily precipitation and gastrointestinal illness ED visits ranged between 0 to 126 mm, and 12 to 180 visits respectively. Overall, a 10-mm increase in precipitation >95th percentile had no significant relationship with the risk of ED visits. However, stratification by seasons revealed significant relationships during spring (lags 1-19, peak at lag 14 RR = 1.04; 95% CI: 1.03, 1.06); the overall cumulative effect across the 21-day lag was also significant (RR = 1.94; 95% CI: 1.47, 2.57). Extreme precipitation has a seasonal effect on gastrointestinal health outcomes in Toronto city, suggesting varying levels of enteric pathogen exposures through drinking water or other environmental pathway during different seasons.
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Affiliation(s)
- Crystal J. Ethan
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Johanna Sanchez
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Lauren Grant
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ian Young
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
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Ortega Chamorro LC, Cañón Barriga JE. Urban risks due to climate change in the Andean municipality of Pasto, Colombia: A Bayesian network approach. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2017-2032. [PMID: 36646454 DOI: 10.1111/risa.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current trends of climate change will increase people's exposure to urban risks related to events such as landslides, floods, forest fires, food production, health, and water availability, which are stochastic and very localized in nature. This research uses a Bayesian network (BN) approach to analyze the intensity of such urban risks for the Andean municipality of Pasto, Colombia, under climate change scenarios. The stochastic BN model is linked to correlational models and local scenarios of representative concentration trajectories (RCP) to project the possible risks to which the municipality of Pasto will be exposed in the future. The results show significant risks in crop yields, food security, water availability and disaster risks, but no significant risks on the incidence of acute diarrheal diseases (ADD) and acute respiratory infections (ARI), whereas positive outcomes are likely to occur in livestock production, influenced by population growth. The advantage of the BN approach is the possibility of updating beliefs in the probabilities of occurrence of events, especially in developing, intermediate cities with information-limited contexts.
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Uttajug A, Ueda K, Seposo X, Francis JM. Association between extreme rainfall and acute respiratory infection among children under-5 years in sub-Saharan Africa: an analysis of Demographic and Health Survey data, 2006-2020. BMJ Open 2023; 13:e071874. [PMID: 37185183 PMCID: PMC10152048 DOI: 10.1136/bmjopen-2023-071874] [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] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Despite an increase in the number of studies examining the association between extreme weather events and infectious diseases, evidence on respiratory infection remains scarce. This study examined the association between extreme rainfall and acute respiratory infection (ARI) in children aged <5 years in sub-Saharan Africa. SETTING Study data were taken from recent (2006-2020) Demographic and Health Survey data sets from 33 countries in sub-Saharan Africa. PARTICIPANTS 280 157 children aged below 5 years were included. OUTCOME MEASURES The proportions of ARI according to individual, household and geographical characteristics were compared using the χ2 test. The association between extreme rainfall (≥90th percentile) and ARI was examined using multivariate logistic regression for 10 of 33 countries with an adequate sample size of ARI and extreme rainfall events. The model was adjusted for temperature, comorbidity and sociodemographic factors as covariates. Stratification analyses by climate zone were also performed. RESULTS The prevalence of ARI in children aged <5 years ranged from 1.0% to 9.1% across sub-Saharan Africa. By country, no significant association was observed between extreme rainfall and ARI, except in Nigeria (OR: 2.14, 95% CI 1.06 to 4.31). Larger effect estimates were observed in the tropical zone (OR: 1.13, 95% CI 0.69 to 1.84) than in the arid zone (OR: 0.72, 95% CI 0.17 to 2.95), although the difference was not statistically significant. CONCLUSION We found no association between extreme rainfall and ARI in sub-Saharan Africa. Effect estimates tended to be larger in the tropical zone where intense rainfall events regularly occur. Comprehensive studies to investigate subsequent extreme climate events, such as flooding, are warranted in the future.
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Affiliation(s)
- Athicha Uttajug
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Xerxes Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Wang X, Wang X, Cao J. Environmental Factors Associated with Cryptosporidium and Giardia. Pathogens 2023; 12:pathogens12030420. [PMID: 36986342 PMCID: PMC10056321 DOI: 10.3390/pathogens12030420] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
Environmental factors significantly influence the transmission of intestinal protozoan diseases. Cryptosporidiosis and giardiasis are important zoonotic diseases characterized by diarrhea, and are mainly water or foodborne diseases caused by fecal-borne oocysts. The One Health approach effectively addresses environmentally influenced zoonotic diseases. However, the impact of environmental factors on the survival of Cryptosporidium/Giardia (oo)cysts or disease transmission is mostly uncharacterized. Associations between cryptosporidiosis and giardiasis incidence and environmental variables (e.g., climatic conditions, soil characteristics, and water characteristics) have been reported; however, the identified relationships are not consistently reported. Whether these are country-specific or global observations is unclear. Herein, we review the evidence for the influence of environmental factors on Cryptosporidium/Giardia and corresponding diseases from three perspectives: climatic, soil, and water characteristics. The (oo)cyst concentration or survival of Cryptosporidium/Giardia and the incidence of corresponding diseases are related to environmental variables. The associations identified varied among studies and have different levels of importance and lag times in different locations. This review summarizes the influence of relevant environmental factors on Cryptosporidium/Giardia from the One Health perspective and provides recommendations for future research, monitoring, and response.
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Affiliation(s)
- Xihan Wang
- Chinese Center for Tropical Diseases Research, School of Global Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Institute of Parasitic Diseases, Shanghai 200025, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai 200025, China
- World Health Organization Collaborating Center for Tropical Diseases, Shanghai 200025, China
- One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai 200025, China
| | - Xu Wang
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Institute of Parasitic Diseases, Shanghai 200025, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai 200025, China
- World Health Organization Collaborating Center for Tropical Diseases, Shanghai 200025, China
| | - Jianping Cao
- Chinese Center for Tropical Diseases Research, School of Global Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Institute of Parasitic Diseases, Shanghai 200025, China
- Key Laboratory of Parasite and Vector Biology, National Health Commission of the People's Republic of China, Shanghai 200025, China
- World Health Organization Collaborating Center for Tropical Diseases, Shanghai 200025, China
- One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai 200025, China
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11
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Andhikaputra G, Sapkota A, Lin YK, Chan TC, Gao C, Deng LW, Wang YC. The impact of temperature and precipitation on all-infectious-, bacterial-, and viral-diarrheal disease in Taiwan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 862:160850. [PMID: 36526204 DOI: 10.1016/j.scitotenv.2022.160850] [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: 08/19/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND The ongoing climate change will elevate the incidence of diarrheal in 2030-2050 in Asia, including Taiwan. This study investigated associations between meteorological factors (temperature, precipitation) and burden of age-cause-specific diarrheal diseases in six regions of Taiwan using 13 years of (2004-2016) population-based data. METHODS Weekly cause-specific diarrheal and meteorological data were obtained from 2004 to 2016. We used distributed lag non-linear model to assess age (under five, all age) and cause-specific (viral, bacterial) diarrheal disease burden associated with extreme high (99th percentile) and low (5th percentile) of climate variables up to lag 8 weeks in six regions of Taiwan. Random-effects meta-analysis was used to pool these region-specific estimates. RESULTS Extreme low temperature (15.30 °C) was associated with risks of all-infectious and viral diarrhea, with the highest risk for all-infectious diarrheal found at lag 8 weeks among all age [Relative Risk (RR): 1.44; 95 % Confidence Interval (95 % CI): 1.24-1.67]. The highest risk of viral diarrheal infection was observed at lag 2 weeks regardless the age. Extreme high temperature (30.18 °C) was associated with risk of bacterial diarrheal among all age (RR: 1.07; 95 % CI: 1.02-1.13) at lag 8 weeks. Likewise, extreme high precipitation (290 mm) was associated with all infectious diarrheal, with the highest risk observed for bacterial diarrheal among population under five years (RR: 2.77; 95 % CI: 1.60-4.79) at lag 8 weeks. Extreme low precipitation (0 mm) was associated with viral diarrheal in all age at lag 1 week (RR: 1.08; 95 % CI: 1.01-1.15)]. CONCLUSION In Taiwan, extreme low temperature is associated with an increased burden of viral diarrheal, while extreme high temperature and precipitation elevated burden of bacterial diarrheal. This distinction in cause-specific and climate-hazard specific diarrheal disease burden underscore the importance of incorporating differences in public health preparedness measures designed to enhance community resilience against climate change.
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Affiliation(s)
- Gerry Andhikaputra
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan
| | - Amir Sapkota
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, United States of America
| | - Yu-Kai Lin
- Department of Health and Welfare, University of Taipei College of City Management, 101 Zhongcheng Road Sec. 2, Taipei 111, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei, Taiwan; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chuansi Gao
- Division of Ergonomics and Aerosol Technology, Faculty of Engineering, Lund University, Lund 223 62, Sweden
| | - Li-Wen Deng
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan
| | - Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli 320, Taiwan; Research Center for Environmental Changes, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei 11529, Taiwan.
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12
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Graydon RC, Mezzacapo M, Boehme J, Foldy S, Edge TA, Brubacher J, Chan HM, Dellinger M, Faustman EM, Rose JB, Takaro TK. Associations between extreme precipitation, drinking water, and protozoan acute gastrointestinal illnesses in four North American Great Lakes cities (2009-2014). JOURNAL OF WATER AND HEALTH 2022; 20:849-862. [PMID: 35635777 DOI: 10.2166/wh.2022.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Climate change is already impacting the North American Great Lakes ecosystem and understanding the relationship between climate events and public health, such as waterborne acute gastrointestinal illnesses (AGIs), can help inform needed adaptive capacity for drinking water systems (DWSs). In this study, we assessed a harmonized binational dataset for the effects of extreme precipitation events (≥90th percentile) and preceding dry periods, source water turbidity, total coliforms, and protozoan AGIs - cryptosporidiosis and giardiasis - in the populations served by four DWSs that source surface water from Lake Ontario (Hamilton and Toronto, Ontario, Canada) and Lake Michigan (Green Bay and Milwaukee, Wisconsin, USA) from January 2009 through August 2014. We used distributed lag non-linear Poisson regression models adjusted for seasonality and found extreme precipitation weeks preceded by dry periods increased the relative risk of protozoan AGI after 1 and 3-5 weeks in three of the four cities, although only statistically significant in two. Our results suggest that the risk of protozoan AGI increases with extreme precipitation preceded by a dry period. As extreme precipitation patterns become more frequent with climate change, the ability to detect changes in water quality and effectively treat source water of varying quality is increasingly important for adaptive capacity and protection of public health.
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Affiliation(s)
- Ryan C Graydon
- International Joint Commission: Great Lakes Regional Office, 100 Ouellette Avenue, 8th Floor, Windsor, ON N9A 6T3, Canada
| | | | - Jennifer Boehme
- International Joint Commission: Great Lakes Regional Office, 100 Ouellette Avenue, 8th Floor, Windsor, ON N9A 6T3, Canada
| | - Seth Foldy
- Public Health Institute at Denver Health, Denver, CO, USA
| | | | - Jordan Brubacher
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | | | - Joan B Rose
- Michigan State University, East Lansing, MI, USA
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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13
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Colston JM, Zaitchik BF, Badr HS, Burnett E, Ali SA, Rayamajhi A, Satter SM, Eibach D, Krumkamp R, May J, Chilengi R, Howard LM, Sow SO, Jahangir Hossain M, Saha D, Imran Nisar M, Zaidi AKM, Kanungo S, Mandomando I, Faruque ASG, Kotloff KL, Levine MM, Breiman RF, Omore R, Page N, Platts‐Mills JA, Ashorn U, Fan Y, Shrestha PS, Ahmed T, Mduma E, Yori PP, Bhutta Z, Bessong P, Olortegui MP, Lima AAM, Kang G, Humphrey J, Prendergast AJ, Ntozini R, Okada K, Wongboot W, Gaensbauer J, Melgar MT, Pelkonen T, Freitas CM, Kosek MN. Associations Between Eight Earth Observation-Derived Climate Variables and Enteropathogen Infection: An Independent Participant Data Meta-Analysis of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics. GEOHEALTH 2022; 6:e2021GH000452. [PMID: 35024531 PMCID: PMC8729196 DOI: 10.1029/2021gh000452] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/12/2021] [Accepted: 11/18/2021] [Indexed: 05/10/2023]
Abstract
Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen-specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens-adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia-was matched by date with hydrometeorological variables from a global Earth observation dataset-precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting for lags, nonlinearity, confounders, and threshold effects. Different variables showed complex, non-linear associations with infection risk varying in magnitude and direction depending on pathogen species. Rotavirus infection decreased markedly following increasing 7-day average temperatures-a relative risk of 0.76 (95% confidence interval: 0.69-0.85) above 28°C-while ETEC risk increased by almost half, 1.43 (1.36-1.50), in the 20-35°C range. Risk for all pathogens was highest following soil moistures in the upper range. Humidity was associated with increases in bacterial infections and decreases in most viral infections. Several virus species' risk increased following lower-than-average rainfall, while rotavirus and ETEC increased with heavier runoff. Temperature, soil moisture, and humidity are particularly influential parameters across all enteropathogens, likely impacting pathogen survival outside the host. Precipitation and runoff have divergent associations with different enteric viruses. These effects may engender shifts in the relative burden of diarrhea-causing agents as the global climate changes.
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14
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Chong KC, Chan EYY, Lee TC, Kwok KL, Lau SYF, Wang P, Lam HCY, Goggins WB, Mohammad KN, Leung SY, Chan PKS. A 21-year retrospective analysis of environmental impacts on paediatric acute gastroenteritis in an affluent setting. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 764:142845. [PMID: 33183801 DOI: 10.1016/j.scitotenv.2020.142845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Extreme weather events happen more frequently along with global warming and they constitute a challenge for public health preparedness. For example, many investigations showed heavy rainfall was associated with an increased risk of acute gastroenteritis. In this study, we examined the associations between different meteorological factors and paediatric acute gastroenteritis in an affluent setting in China controlling for pollutant effects. METHODS Aggregated total weekly number of intestinal infection-related hospital admissions, and meteorological and air pollution data during 1998-2018 in Hong Kong were collected and analysed by a combination of quasi-Poisson generalized additive model and distributed lag nonlinear model. Study population was restricted to children under 5 years of age at the time of admission. RESULTS While heavy rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to intestinal infections, low temperature and humidity extremes (both relative humidity and vapour pressure) did. Compared with the temperature at which the lowest risk was detected (i.e. 22.5 °C), the risk was 6.4% higher (95% confidence interval: 0.0% to 13.0% at 15.1 °C (i.e. the 5th percentile)). We also found the risk of paediatric admission was statistically significantly associated with an increase in the number of extreme cold days in a week over the study period. CONCLUSION Cold condition may have greater impact on disease transmission through increased stability and infectivity of enteric viruses in affluent settings like Hong Kong and thus resulted in an increased risk for paediatric acute gastroenteritis. On the contrary, an insignificant impact from heavy rainfall and high temperature may indicate a minor effect on disease transmission through bacterial growth in contaminated food and water. With the identified impacts of weather factors, extreme weather events are likely to distort the prevalence and seasonal pattern of diarrhoeal diseases in the future.
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Affiliation(s)
- Ka Chun Chong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Centre for Health System and Policy Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Ying Yang Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Ka Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - Steven Yuk Fai Lau
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Pin Wang
- Yale School of Public Health, Yale University
| | - Holly Ching Yu Lam
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - William Bernard Goggins
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kirran N Mohammad
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Shuk Yu Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - Paul Kay Sheung Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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15
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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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16
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Ikiroma IA, Pollock KG. Influence of weather and climate on cryptosporidiosis-A review. Zoonoses Public Health 2020; 68:285-298. [PMID: 33225635 DOI: 10.1111/zph.12785] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 05/23/2020] [Accepted: 10/18/2020] [Indexed: 12/31/2022]
Abstract
Studies have shown that climatic factors can significantly influence transmission of many waterborne diseases. However, knowledge of the impact of climate variability on cryptosporidiosis is much less certain. Associations between the incidence of cryptosporidiosis and climatic variables have been reported in several countries. Given that the identified relationships were not consistently reported across studies, it is not known whether these were country-specific observations or can be considered more globally. Variation in the disease risk in both low- and middle-income countries and high-income countries presents new challenges and opportunities to enact responsive changes in research and public health policies. Available epidemiological evidence of the influence of weather and climate on cryptosporidiosis is reviewed. Fourteen studies met the inclusion criteria, and most studies showed that the incidence of cryptosporidiosis is highly sensitive to climatic conditions, especially temperature, rainfall and relative humidity. The identified associations varied across studies, with different conditions of importance and lag times across different locations. Therefore, there is a need for countries at risk to assess Cryptosporidium transmission routes based on the spatiotemporal patterns of the disease and what role climate and other socio-ecological changes play in the transmission. Information gathering will then allow us to provide information for evidence-based control strategies and mitigation of transmission. This review offers new perspectives on the role of climate variability on Cryptosporidium transmission. It highlights different epidemiological approaches adopted and provides the potential for future research and surveillance to reduce the disease burden. By evaluating the epidemiological transmission of this organism in high-income countries, all mitigation strategies, for example filtration and water catchment management, can be used as exemplars of preventing infection in low- to middle-income countries.
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17
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Brubacher J, Allen DM, Déry SJ, Parkes MW, Chhetri B, Mak S, Sobie S, Takaro TK. Associations of five food- and water-borne diseases with ecological zone, land use and aquifer type in a changing climate. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 728:138808. [PMID: 32570317 DOI: 10.1016/j.scitotenv.2020.138808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Food- and water-borne pathogens exhibit spatial heterogeneity, but attribution to specific environmental processes is lacking while anthropogenic climate change alters these processes. The goal of this study was to investigate ecology, land-use and health associations of these pathogens and to make future disease projections. METHODS The rates of five acute gastrointestinal illnesses (AGIs) (campylobacteriosis, Verotoxin- producing Escherichia coli, salmonellosis, giardiasis and cryptosporidiosis) from 2000 to 2013 in British Columbia, Canada, were calculated across three environmental variables: ecological zone, land use, and aquifer type. A correlation analysis investigated relationships between 19 climatic factors and AGI. Mean annual temperature at the ecological zone scale was used in a univariate regression model to calculate annual relative AGI risk per 1 °C increase. Future cases attributable to climate change were estimated into the 2080s. FINDINGS Each of the bacterial AGI rates was correlated with several annual temperature-related factors while the protozoan AGIs were not. In the regression model, combined relative risk for the three bacterial AGIs was 1.1 [95% CI: 1.02-1.21] for every 1 °C in mean annual temperature. Campylobacteriosis, salmonellosis and giardiasis rates were significantly higher (p < 0.05) in the urban land use class than in the rural one. In rural areas, bacteria and protozoan AGIs had significantly higher rates in the unconsolidated aquifers. Verotoxin-producing Escherichia coli rates were significantly higher in watersheds with more agricultural land, while rates of campylobacteriosis, salmonellosis and giardiasis were significantly lower in agricultural watersheds. Ecological zones with higher bacterial AGI rates were generally projected to expand in range by the 2080s. INTERPRETATION These findings suggest that risk of AGI can vary across ecosystem, land use and aquifer type, and that warming temperatures may be associated with an increased risk of food-borne AGI. In addition, spatial patterns of these diseases are projected to shift under climate change.
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Affiliation(s)
- Jordan Brubacher
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Blusson Hall 11518, Burnaby, BC V5A 1S6, Canada
| | - Diana M Allen
- Simon Fraser University, 7239 TASC 1 Building, 8888 University Drive Burnaby, BC V5A 1S6, Canada
| | - Stephen J Déry
- University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Margot W Parkes
- University of Northern British Columbia, 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Bimal Chhetri
- Alpine Pet Hospital, 1725 Baron Rd. Unit 2 Kelowna, BC V1X 7H1, Canada
| | - Sunny Mak
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Stephen Sobie
- Pacific Climate Impacts Consortium, University House 1, PO Box 1700 Stn CSC, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Blusson Hall 11518, Burnaby, BC V5A 1S6, Canada.
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18
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Chhetri BK, Galanis E, Sobie S, Brubacher J, Balshaw R, Otterstatter M, Mak S, Lem M, Lysyshyn M, Murdock T, Fleury M, Zickfeld K, Zubel M, Clarkson L, Takaro TK. Projected local rain events due to climate change and the impacts on waterborne diseases in Vancouver, British Columbia, Canada. Environ Health 2019; 18:116. [PMID: 31888648 PMCID: PMC6937929 DOI: 10.1186/s12940-019-0550-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/06/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Climate change is increasing the number and intensity of extreme weather events in many parts of the world. Precipitation extremes have been linked to both outbreaks and sporadic cases of waterborne illness. We have previously shown a link between heavy rain and turbidity to population-level risk of sporadic cryptosporidiosis and giardiasis in a major Canadian urban population. The risk increased with 30 or more dry days in the 60 days preceding the week of extreme rain. The goal of this study was to investigate the change in cryptosporidiosis and giardiasis risk due to climate change, primarily change in extreme precipitation. METHODS Cases of cryptosporidiosis and giardiasis were extracted from a reportable disease system (1997-2009). We used distributed lag non-linear Poisson regression models and projections of the exposure-outcome relationship to estimate future illness (2020-2099). The climate projections are derived from twelve statistically downscaled regional climate models. Relative Concentration Pathway 8.5 was used to project precipitation derived from daily gridded weather observation data (~ 6 × 10 km resolution) covering the central of three adjacent watersheds serving metropolitan Vancouver for the 2020s, 2040s, 2060s and 2080s. RESULTS Precipitation is predicted to steadily increase in these watersheds during the wet season (Oct. -Mar.) and decrease in other parts of the year up through the 2080s. More weeks with extreme rain (>90th percentile) are expected. These weeks are predicted to increase the annual rates of cryptosporidiosis and giardiasis by approximately 16% by the 2080s corresponding to an increase of 55-136 additional cases per year depending upon the climate model used. The predicted increase in the number of waterborne illness cases are during the wet months. The range in future projections compared to historical monthly case counts typically differed by 10-20% across climate models but the direction of change was consistent for all models. DISCUSSION If new water filtration measures had not been implemented in our study area in 2010-2015, the risk of cryptosporidiosis and giardiasis would have been expected to increase with climate change, particularly precipitation changes. In addition to the predicted increase in the frequency and intensity of extreme precipitation events, the frequency and length of wet and dry spells could also affect the risk of waterborne diseases as we observed in the historical period. These findings add to the growing evidence regarding the need to prepare water systems to manage and become resilient to climate change-related health risks.
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Affiliation(s)
- Bimal K Chhetri
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr. BLU 11300, Burnaby, British Columbia, Canada
| | - Eleni Galanis
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Sobie
- Pacific Climate Impacts Consortium, University of Victoria, Victoria, British Columbia, Canada
| | - Jordan Brubacher
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr. BLU 11300, Burnaby, British Columbia, Canada
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunny Mak
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Marcus Lem
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Trevor Murdock
- Pacific Climate Impacts Consortium, University of Victoria, Victoria, British Columbia, Canada
| | | | - Kirsten Zickfeld
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Len Clarkson
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr. BLU 11300, Burnaby, British Columbia, Canada.
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19
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Lal A, Konings P. Beyond reasonable drought: hotspots reveal a link between the 'Big Dry' and cryptosporidiosis in Australia's Murray Darling Basin. JOURNAL OF WATER AND HEALTH 2018; 16:1033-1037. [PMID: 30540277 DOI: 10.2166/wh.2018.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is little evidence on how the health impacts of drought vary spatially and temporally. With a focus on waterborne cryptosporidiosis, we identify spatio-temporal hotspots and by using interrupted time series analysis, examine the impact of Australia's Big Dry (2001-2009) in these disease clusters in the Murray Darling Drainage Basin. Analyses revealed a statistically significant hotspot in the north of the Australian Capital Territory (ACT) and a hotspot in the north-eastern end of the basin in Queensland. After controlling for long-term trend and seasonality in cryptosporidiosis, interrupted time series analysis of reported cases in these hotspots indicated a statistically significant link with the Big Dry. In both areas, the end of the Big Dry was associated with a lower risk of reported cryptosporidiosis; in the ACT, the estimated relative risk (RR) was 0.16 (95% confidence interval: 0.07; 0.33), and in Queensland the RR was 0.42 (95% confidence interval: 0.19; 0.42). Although these data do not establish a causal association, this research highlights the potential for drought-related health risks.
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Affiliation(s)
- Aparna Lal
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62A, Canberra, 2600, Australia E-mail:
| | - Paul Konings
- National Centre for Geographic and Resource Analysis in Primary Health Care, Australian National University, Canberra, 2600, Australia
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Setty KE, Enault J, Loret JF, Puigdomenech Serra C, Martin-Alonso J, Bartram J. Time series study of weather, water quality, and acute gastroenteritis at Water Safety Plan implementation sites in France and Spain. Int J Hyg Environ Health 2018; 221:714-726. [PMID: 29678324 PMCID: PMC5999030 DOI: 10.1016/j.ijheh.2018.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, can help drinking water suppliers to proactively identify potential risks and implement preventive barriers that improve safety. Few studies have investigated long-term impacts of WSPs, such as changes in drinking water quality or public health; however, some evidence from high-income countries associates WSP implementation with a reduction in diarrheal disease. To validate the previously observed linkages between WSPs and health outcomes, this time series study examined site-specific relationships between water-related exposures and acute gastroenteritis rates at three locations in France and Spain, including the role of WSP status. Relationships between control or exposure variables and health outcomes were tested using Poisson regression within generalized additive models. Controls included suspected temporal trends in disease reporting. Exposures included temperature, precipitation, raw water quality, and finished water quality (e.g., turbidity, free chlorine). In France, daily acute gastroenteritis cases were tracked using prescription reimbursements; Spanish data aggregated monthly acute gastroenteritis hospital visits. The models identified several significant relationships between indicators of exposure and acute gastroenteritis. Lag times of 6-9 days (including transit time) were most relevant for hydrological indicators (related to precipitation, runoff, and flow) at the two French sites, indicative of viral pathogens. Flush events (defined as surface runoff after a two-week antecedent dry period) linked to nonpoint source pollution were associated with a 10% increase in acute gastroenteritis rates at one location supplied by surface water. Acute gastroenteritis rates were positively associated with elevated turbidity average or maximum values in finished water at locations supplied by both surface and groundwater, by about 4% per 1-NTU increase in the two-week moving average of daily maxima or about 10% per 0.1 NTU increase in the prior month's average value. In some cases, risk appeared to be mitigated by WSP-related treatment interventions. Our results suggest drinking water exposure is associated with some potentially preventable gastrointestinal illness risk in high-income regions.
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Affiliation(s)
- Karen E Setty
- The University of North Carolina, Chapel Hill, Department of Environmental Sciences and Engineering, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, USA.
| | - Jerome Enault
- Suez, Centre International de Recherche sur l'Eau et l'Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France
| | - Jean-Francois Loret
- Suez, Centre International de Recherche sur l'Eau et l'Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France
| | - Claudia Puigdomenech Serra
- Centre Tecnològic de l'Aigua (CETAQUA), Water Technology Center, Carretera d'Esplugues, 75, 08940, Cornellà de Llobregat, Barcelona, Spain
| | - Jordi Martin-Alonso
- Aigües de Barcelona, Empresa Metropolitana de Gestió del Cicle Integral de l'Aigua, SA. (AB EMGCIA), Carrer General Batet 1-7, 08028, Barcelona, Spain
| | - Jamie Bartram
- The University of North Carolina, Chapel Hill, Department of Environmental Sciences and Engineering, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, USA
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