Direct and indirect effects of climate change on the risk of infection by water-transmitted pathogens

Air Temperature and Gastroenteritis Among Rohingya Populations in Bangladesh Refugee Camps

Importance

The Rohingya displaced population in Bangladesh is the largest stateless population in the world. Infectious diseases, such as gastroenteritis, respiratory infections, and fever, are among the major health problems the Rohingya population has faced. Although associations between gastroenteritis and air temperature have been reported in various regions, no study has yet been carried out among the displaced populations.

Objectives

To evaluate the association between air temperature and risk of gastroenteritis among the forcibly displaced Rohingya population in refugee camps in Bangladesh.

Design, Setting, and Participants

In this cross-sectional study, daily time series data derived from facility-based case reports were collected in 2 clinics organized by the UNHCR (United Nations High Commissioner for Refugees) in Kutupalong and Nayapara registered camps from January 1, 2019, to December 31, 2021. Statistical analysis was conducted from April 2023 to September 2024.

Exposure

Hourly 2-m air temperature from ERA5-Land by the European Centre for Medium-Range Weather Forecasts.

Main Outcomes and Measures

The daily number of gastroenteritis cases recorded in the camp clinics was the main outcome measure. Nonlinear lagged associations between daily temperature and gastroenteritis cases were modeled using a quasi-Poisson generalized linear model to account for overdispersion coupled with a distributed lag nonlinear model including a maximum 21-day lag. Covariates from the literature were adjusted in the model.

Results

A total of 33 280 gastroenteritis cases (95% among individuals aged ≥5 years; 71% female) were recorded in Kutupalong and 31 165 gastroenteritis cases (99% among individuals aged ≥5 years; 67% female) were recorded in Nayapara. Further examination revealed a potential U-shaped curve in Kutupalong with minimum risk temperature (MRT) set at 26 °C. Cumulative relative risk (RR) at the 10th percentile temperature (21.1 °C) was 2.31 (95% CI, 1.18-4.65), while RR at 90th percentile temperature (28.5 °C) was 1.78 (95% CI, 1.24-2.56) relative to MRT. In Nayapara, a nearly linear risk increase was observed with decreasing temperature. Cumulative RR at the 10th percentile temperature (21 °C) was 1.32 (95% CI, 0.78-2.24), while the RR at the 90th percentile temperature (28.3 °C) was 0.75 (95% CI, 0.56-0.99). Lagged effects were delayed in nature. In Kutupalong, cold temperatures (10th percentile) were associated with statistically significant gastroenteritis risks at approximately 15 to 20 days (range: RR, 1.06 [95% CI, 1.00-1.13] to RR, 1.10 [95% CI, 1.00-1.21]). In Nayapara, gastroenteritis risks were correspondingly higher at longer lags (lag, 18 days; RR, 1.05 [95% CI, 1.00-1.10]).

Conclusions and Relevance

In this cross-sectional study of the Rohingya displaced population in Bangladesh, cold temperatures were associated with an increase in the risk of gastroenteritis. It is important to understand the association of climatic factors with the health of displaced communities, whose population is expected to grow in the future.

Navigating the nexus: unraveling the impact of sustainability and the circular economy on food safety

Sustainable food production systems can be achieved through a circular economy, yet the whole system remains susceptible to various known, emerging, or even unknown/novel food safety hazards and contaminants. These upcycled foods can introduce related risks for human or animal health and ecological balance. These potential risks can be effectively mitigated by adopting integrated smart "safe-by-design" approaches. These multi-effective strategies can cascade far beyond consequences by addressing all potential food safety risks at each stage of the food supply chain, even at the post-consumption stage. Sustainability through circularity without harming food production systems can be achieved by integrating and harmonizing evidence-based risk control strategies, fostered with extensive and objective-oriented research and development and preemptive ideological relationships with relevant stakeholders. The current review aimed at addressing the possible occurrence and risks associated with potential emerging or unknown hazards/contaminants linked to various production systems, along with relevant mitigation strategies. It also highlights the importance of implementing quality control measures and safety precautions throughout the food supply chain to prevent the occurrence and propagation of hazardous substances. Agricultural production systems can be transformed into sustainable entities by vigilant monitoring of end-products quality through the use of upcycled technologies.

Targeted prevention strategy: Exploring the interaction effect of environmental and social factors on infectious diseases

Human disease and health issues are globally significant and closely related to environmental and social factors. However, the interaction effects of such factors on diseases are unclear, which has resulted in a lack of targeted prevention strategies. By taking infectious diseases in China as an example, this study uses an interpretable machine learning method to analyze the impact of environmental and social factors on disease, including industrial SO2 emissions, sanitary toilet coverage rate, and sunshine duration. The modeling results confirm the existence of a nonlinear relationship between infectious diseases incidence and each of the potential factors. That is, increased SO2 emissions can increase infectious diseases incidence, whereas broad sanitary toilet coverage can reduce such risk. This study examines the interaction of the driving factors and reveals that variation in the sunshine duration can affect the impact of SO2 emissions on infectious diseases incidence. This study proposes the use of multilevel risk trigger points (RTPs) to develop early warning and targeted regulation measures and classifies the points as primary, secondary, and tertiary. For example, for Henan Province, the RTPs of SO2 emissions are 291,031, 897,579, and 1,381,342 tons, whereas those for Shandong are 362,802, 1,177,650, and 1,658,118 tons. At the tertiary RTP level, SO2 emissions can significantly increase infectious disease incidence, which has prompted policymakers to implement pollution reduction and disease prevention measures. This study clarifies the role and interaction effects of environmental and social factors on infectious diseases to aid in precise disease prevention and environmental health management.

Increasing trends in faecal pollution revealed over a decade in the central Adriatic Sea (Italy)

Faecal contamination of the coastal sea poses widespread hazard to human and environmental health and is predicted to rise in response to global change and human pressure. For better management and risk reduction it is thus imperative to clarify and predict trends of faecal pollution over spatial and temporal scales, and to assess links with climate and other variables. Here, we investigated the spatio-temporal variation in the Faecal Indicator Bacteria (FIB) Escherichia coli and enterococci, over a time frame spanning 11 years (2011-2021) along a coastal area covering approximately 40 km and 59 bathing sites in the Marche region (Adriatic Sea, Italy), characterized by intense beach tourism, high riverine inputs, resident population, maritime traffic and industrial activities. Our analysis, that considers 5,183 measurements during the bathing season (April to October), shows that FIB abundance varied significantly among years. A general, although not significant, increase over time of both FIB was observed, mainly due to a general reduction of structural zeros (i.e., zeros originated from the actual absence of the response variable) over the examined time period. FIB abundances displayed their maxima and minima in different years according to the municipality, with overall peaks recorded in different months (May-June or September), whereas the lowest values were always observed in October. FIB levels were not significantly related neither to rainfalls nor to river discharge, but the activation of combined sewer overflows (CSOs), typically occurring after intense rainfall events, appeared as a necessary condition for the high faecal contamination levels. Considering climate change scenarios predicting significant increases in extreme weather events, our findings support the usefulness of analysing long-term trends to identify pollution sources, and the prioritization of control strategies to better manage the release of microbial pollutants from combined sewer overflows in coastal waters to reduce human risks.

Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh

BACKGROUND

A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change.

OBJECTIVES

Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change.

METHODS

We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters.

RESULTS

Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null.

DISCUSSION

Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.

Prevalence of Cryptosporidium infection in children from China: a systematic review and meta-analysis

Cryptosporidium is an important zoonotic pathogen that causes diarrhea in humans and animals, and a leading cause of diarrhea morbidity and mortality in children under 5 years old. However, the meta-analysis of Cryptosporidium infection in children in China has not been published. We searched the databases for articles published on the prevalence of Cryptosporidium infection in children in China since the inception of these databases to 31 October 2022. The prevalence of Cryptosporidium infection in children was estimated using a random effects model. The results showed that 111 datasets from 24 provinces were selected for the final quantitative analysis. The estimated pooled Cryptosporidium infection prevalence in children in China was 2.9% (3300/126,381). The highest prevalence rate was in southwestern China (4.8%, 365/7766). Subgroup analysis indicated that the Cryptosporidium infection rate in children aged < 3 years (4.9%, 330/8428) was significantly higher than that in children aged 3-6 years (2.5%, 609/26,080) and >6 years (2.6%, 647/27,586). Six Cryptosporidium species were detected in children in China from the selected studies. C. hominis was the dominant species (77.1%, 145/188) and the proportions of subgenotype IaA14R4 of C. hominis was highest (42.8%, 62/145). The findings suggest that Chinese children is in a low level of Cryptosporidium infection, however, the geographical distribution of the infection is extensive. We suggest that measures should be taken to ensure the healthy growth of Chinese children by improving the water environment, increasing public health facilities, strengthening children's health education, and developing sound Cryptosporidium infection control programs.

Climate Change and the Epidemiology of Infectious Diseases in the United States

The earth is rapidly warming, driven by increasing atmospheric carbon dioxide and other gases that result primarily from fossil fuel combustion. In addition to causing arctic ice melting and extreme weather events, climatologic factors are linked strongly to the transmission of many infectious diseases. Changes in the prevalence of infectious diseases not only reflect the impacts of temperature, humidity, and other weather-related phenomena on pathogens, vectors, and animal hosts but are also part of a complex of social and environmental factors that will be affected by climate change, including land use, migration, and vector control. Vector- and waterborne diseases and coccidioidomycosis are all likely to be affected by a warming planet; there is also potential for climate-driven impacts on emerging infectious diseases and antimicrobial resistance. Additional resources for surveillance and public health activities are urgently needed, as well as systematic education of clinicians on the health impacts of climate change.

Systematic review of climate change effects on reproductive health

Climate change is a major risk factor for overall health, including reproductive health, and well-being. Increasing temperatures, due mostly to increased greenhouse gases trapping excess heat in the atmosphere, result in erratic weather patterns, wildfires, displacement of large communities, and stagnant water resulting in vector-borne diseases that, together, have set the stage for new and devastating health threats across the globe. These conditions disproportionately affect disadvantaged and vulnerable populations, including women, pregnant persons, young children, the elderly, and the disabled. This review reports on the evidence for the adverse impacts of air pollution, wildfires, heat stress, floods, toxic chemicals, and vector-borne diseases on male and female fertility, the developing fetus, and obstetric outcomes. Reproductive health care providers are uniquely positioned and have an unprecedented opportunity to educate patients and policy makers about mitigating the impact of climate change to assure reproductive health in this and future generations.

Associations between ambient temperature and enteric infections by pathogen: a systematic review and meta-analysis

BACKGROUND

Numerous studies have quantified the associations between ambient temperature and enteric infections, particularly all-cause enteric infections. However, the temperature sensitivity of enteric infections might be pathogen dependent. Here, we sought to identify pathogen-specific associations between ambient temperature and enteric infections.

METHODS

We did a systematic review and meta-analysis by searching PubMed, Web of Science, and Scopus for peer-reviewed research articles published from Jan 1, 2000, to Dec 31, 2019, and also hand searched reference lists of included articles and excluded reviews. We included studies that quantified the effects of ambient temperature increases on common pathogen-specific enteric infections in humans. We excluded studies that expressed ambient temperature as a categorical or diurnal range, or in a standardised format. Two authors screened the search results, one author extracted data from eligible studies, and four authors verified the data. We obtained the overall risks by pooling the relative risks of enteric infection by pathogen for each 1°C temperature rise using random-effects modelling and robust variance estimation for the correlated effect estimates. Between-study heterogeneity was measured using I², τ², and Q-statistic. Publication bias was determined using funnel plot asymmetry and the trim-and-fill method. Differences among pathogen-specific pooled estimates were determined using subgroup analysis of taxa-specific meta-analysis. The study protocol was not registered but followed the PRISMA guidelines.

FINDINGS

We identified 2981 articles via database searches and 57 articles from scanning reference lists of excluded reviews and included articles, of which 40 were eligible for pathogen-specific meta-analyses. The overall increased risks of incidence per 1°C temperature rise, expressed as relative risks, were 1·05 (95% CI 1·04-1·07; I² 97%) for salmonellosis, 1·07 (1·04-1·10; I² 99%) for shigellosis, 1·02 (1·01-1·04; I² 98%) for campylobacteriosis, 1·05 (1·04-1·07; I² 36%) for cholera, 1·04 (1·01-1·07; I² 98%) for Escherichia coli enteritis, and 1·15 (1·07-1·24; I² 0%) for typhoid. Reduced risks per 1°C temperature increase were 0·96 (95% CI 0·90-1·02; I² 97%) for rotaviral enteritis and 0·89 (0·81-0·99; I² 96%) for noroviral enteritis. There was evidence of between-pathogen differences in risk for bacterial infections but not for viral infections.

INTERPRETATION

Temperature sensitivity of enteric infections can vary according to the enteropathogen causing the infection, particularly for bacteria. Thus, we encourage a pathogen-specific health adaptation approach, such as vaccination, given the possibility of increasingly warm temperatures in the future.

FUNDING

Japan Society for the Promotion of Science (Kakenhi) Grant-in-Aid for Scientific Research.

Natural recreational waters and the risk that exposure to antibiotic resistant bacteria poses to human health

Antimicrobial resistance (AMR) is widely recognised as a considerable threat to human health, wellbeing and prosperity. Many clinically important antibiotic resistance genes are understood to have originated in the natural environment. However, the complex interactions between humans, animals and the environment makes the health implications of environmental AMR difficult to quantify. This narrative review focuses on the current state of knowledge regarding antibiotic resistant bacteria (ARB) in natural bathing waters and implications for human health. It considers the latest research focusing on the transmission of ARB from bathing waters to humans. The limitations of existing evidence are discussed, as well as research priorities. The authors are of the opinion that future studies should include faecally contaminated bathing waters and people exposed to these environments to accurately parameterise environment-to-human transmission.

Climate Change Impacts on Microbiota in Beach Sand and Water: Looking Ahead

Beach sand and water have both shown relevance for human health and their microbiology have been the subjects of study for decades. Recently, the World Health Organization recommended that recreational beach sands be added to the matrices monitored for enterococci and Fungi. Global climate change is affecting beach microbial contamination, via changes to conditions like water temperature, sea level, precipitation, and waves. In addition, the world is changing, and humans travel and relocate, often carrying endemic allochthonous microbiota. Coastal areas are amongst the most frequent relocation choices, especially in regions where desertification is taking place. A warmer future will likely require looking beyond the use of traditional water quality indicators to protect human health, in order to guarantee that waterways are safe to use for bathing and recreation. Finally, since sand is a complex matrix, an alternative set of microbial standards is necessary to guarantee that the health of beach users is protected from both sand and water contaminants. We need to plan for the future safer use of beaches by adapting regulations to a climate-changing world.

Impact of heavy precipitation events on pathogen occurrence in estuarine areas of the Puzi River in Taiwan

Pathogen populations in estuarine areas are dynamic, as they are subject to multiple natural and anthropogenic challenges. Heavy rainfall events bring instability to the aquatic environment in estuaries, causing changes in pathogen populations and increased environmental sanitation and public health concerns. In this study, we investigated the effects of heavy precipitation on the occurrence of pathogens in the Puzi River estuary, which is adjacent to the largest inshore oyster farming area in Taiwan. Our results indicated that Vibrio parahaemolyticus and adenovirus were the most frequently detected pathogens in the area. There was a significant difference (Mann-Whitney U test, p < 0.01) in water quality parameters, including total coliform, Escherichia coli, water temperature, turbidity, salinity, and dissolved oxygen, between groups with and without V. parahaemolyticus. In addition, the detection rate was negatively correlated with the average daily rainfall (r2 > 0.8). There was no significant difference between water quality parameters and the presence/absence of adenovirus, but a positive correlation was observed between the average daily rainfall and the detection rate of adenovirus (r2 ≥ 0.75). We conclude that heavy precipitation changes estuarine water quality, causing variations in microbial composition, including pathogens. As extreme weather events become more frequent due to climate change, the potential impacts of severe weather events on estuarine environments require further investigation.

Determining and forecasting drought susceptibility in southwestern Iran using multi-criteria decision-making (MCDM) coupled with CA-Markov model

Forecasting drought and determining relevant data to predict drought are an important topic for decision-makers and planners. It is critical to predicting drought in the south of Fars province, an important agricultural center in Iran located in arid and semi-arid climates. The purpose of this study was to generate a drought map in 2019 using 12 parameters: altitude, aridity index, erosion, groundwater depth, land use, PET (Potential evapotranspiration), precipitation days, precipitation, slope, soil texture, soil salinity, and distance to river, and predict drought maps in 2030 and 2040 using the cellular automata (CA)-Markov model spatially. The fuzzy method was first used to homogenize the data. Next, by evaluating each parameter, the weight of each parameter was calculated using the analytic hierarchy process (AHP), and a map of drought-prone areas was generated. The results of the fuzzy-AHP method showed that the eastern and southeastern regions of the study area were prone to drought. The four most predictive parameters in causing drought, i.e., aridity index, PET, precipitation, and soil texture, were selected using the Best search method and were then chosen as the input to determine drought mapping using the fuzzy and AHP methods. Finally, the CA-Markov model was used to predict future drought maps, and the results showed that in 2030 and 2040 the drought situation in the east and south of the study area would intensify.

Global prevalence of Cryptosporidium spp. in cats: A systematic review and meta-analysis

The One-Health approach highlights that the health of human populations is closely connected to the health of animals and their shared environment. Cryptosporidiosis is an opportunistic zoonotic disease considering as global public health concern. Cats are considered as one of potential host for transmitting the Cryptosporidium spp. infection to humans. A random-effects meta-analysis model was used to estimate the overall and the subgroup-pooled prevalence of Cryptosporidium spp. across studies, and the variance between studies (heterogeneity) were quantified by I² index. Eighty articles (including 92 datasets), from 29 countries met eligibility criteria for analysis. The pooled global prevalence (95% CI) of Cryptosporidium spp. in cats was 6% (4-8%), being highest in Africa 14% (0-91%) and lowest in South and Central America 4% (3-7%) countries. Considering the detection methods, the pooled prevalence was estimated to be 26% (1-67%) using serological detection methods, 6% (3-10%) using coproantigen detection methods, 5% (3-7%) using molecular detection methods, and 4% (3-7%) using microscopic detection methods. The highest prevalence of Cryptosporidium spp. was found in stray cats 10% (5-17%), while pet (domestic) cats 4% (3-7%) had the lowest prevalence. These results emphasize the role of cats as reservoir hosts for human-infecting Cryptosporidium spp. Prevention and control of this zoonosis in cats should receive greater attention by health officials and health policymakers, especially in countries where prevalence are highest.

Prevalence of Cryptosporidium in pigs in China: A systematic review and meta-analysis

Cryptosporidium is an important zoonotic parasite that can infect a variety of hosts, including pigs and humans, through water and food. Many studies on Cryptosporidium infection in pigs have been reported worldwide. However, the meta-analysis of Cryptosporidium infection in pigs in China has not been published. This study retrieved articles related to Cryptosporidium in pigs in China by using four databases: Chinese National Knowledge Infrastructure (CNKI), PubMed, VIP Chinese journal database and Wanfang Data. We retrieved 40 studies related to Cryptosporidium infection in China, and those articles were harvested from the inception to 1 January 2020. We estimated that the overall prevalence of pigs with Cryptosporidium in the selected period was 12.2% (4,349/30,404). In the sampling year subgroup, the prevalence rate after 2010 was the lowest at 8.7% (2,087/18,100). In Northern China, the Cryptosporidium prevalence was 47.9% (34/71). By contrast, the prevalence of Cryptosporidium in Southwestern China was only 6.9% (778/6,445). The infection rate of Cryptosporidium in diarrhoea pigs of 15.6% (74/384) was higher than that in non-diarrhoea pigs at 10.8% (378/2,840). Among the four age groups, the prevalence of weaning pigs of 16.2% (530/3,243) was the highest, and the difference was significant (p < .05). The prevalence of Cryptosporidium in extensive farming was 25.7% (660/3,121), which was significantly higher than in intensive farming 8.7% (566/6,336), and the prevalence of infection was related to the farming modes (p < .05). We also analysed the impact of different geographic factor subgroups (longitude, latitude, precipitation, temperature, humidity, climate and altitude) on the prevalence of pigs. The results showed that cryptosporidiosis was widespread in pigs in China. We suggest that appropriate control schemes should be developed according to the differences in breeding patterns and geographic conditions in different regions, and effective management measures should be developed to reduce the spread between pigs.

Campylobacter infections expected to increase due to climate change in Northern Europe

Global climate change is predicted to alter precipitation and temperature patterns across the world, affecting a range of infectious diseases and particularly foodborne infections such as Campylobacter. In this study, we used national surveillance data to analyse the relationship between climate and campylobacteriosis in Denmark, Finland, Norway and Sweden and estimate the impact of climate changes on future disease patterns. We show that Campylobacter incidences are linked to increases in temperature and especially precipitation in the week before illness, suggesting a non-food transmission route. These four countries may experience a doubling of Campylobacter cases by the end of the 2080s, corresponding to around 6,000 excess cases per year caused only by climate changes. Considering the strong worldwide burden of campylobacteriosis, it is important to assess local and regional impacts of climate change in order to initiate timely public health management and adaptation strategies.

Pathogen-Specific Impacts of the 2011-2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites-Loreto, Peru-were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens-including vaccines as they become available-in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.

Impacts of a changing earth on microbial dynamics and human health risks in the continuum between beach water and sand

Although infectious disease risk from recreational exposure to waterborne pathogens has been an active area of research for decades, beach sand is a relatively unexplored habitat for the persistence of pathogens and fecal indicator bacteria (FIB). Beach sand, biofilms, and water all present unique advantages and challenges to pathogen introduction, growth, and persistence. These dynamics are further complicated by continuous exchange between sand and water habitats. Models of FIB and pathogen fate and transport at beaches can help predict the risk of infectious disease from beach use, but knowledge gaps with respect to decay and growth rates of pathogens in beach habitats impede robust modeling. Climatic variability adds further complexity to predictive modeling because extreme weather events, warming water, and sea level change may increase human exposure to waterborne pathogens and alter relationships between FIB and pathogens. In addition, population growth and urbanization will exacerbate contamination events and increase the potential for human exposure. The cumulative effects of anthropogenic changes will alter microbial population dynamics in beach habitats and the assumptions and relationships used in quantitative microbial risk assessment (QMRA) and process-based models. Here, we review our current understanding of microbial populations and transport dynamics across the sand-water continuum at beaches, how these dynamics can be modeled, and how global change factors (e.g., climate and land use) should be integrated into more accurate beachscape-based models.

Climate change and One Health

The journal The Lancet recently published a countdown on health and climate change. Attention was focused solely on humans. However, animals, including wildlife, livestock and pets, may also be impacted by climate change. Complementary to the high relevance of awareness rising for protecting humans against climate change, here we present a One Health approach, which aims at the simultaneous protection of humans, animals and the environment from climate change impacts (climate change adaptation). We postulate that integrated approaches save human and animal lives and reduce costs when compared to public and animal health sectors working separately. A One Health approach to climate change adaptation may significantly contribute to food security with emphasis on animal source foods, extensive livestock systems, particularly ruminant livestock, environmental sanitation, and steps towards regional and global integrated syndromic surveillance and response systems. The cost of outbreaks of emerging vector-borne zoonotic pathogens may be much lower if they are detected early in the vector or in livestock rather than later in humans. Therefore, integrated community-based surveillance of zoonoses is a promising avenue to reduce health effects of climate change.

Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions

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.

Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China

BACKGROUND

Previous studies have always focused on the impact of various meteorological factors on Hand-foot-mouth disease (HFMD). However, only few studies have investigated the simultaneous effects of climate and air pollution on HFMD incidence.

METHODS

Daily HFMD counts among children aged 0-14 years in Guilin city were collected from 2014 to 2016. Distributed lag nonlinear models (DLNM) were used to assess the effects of extreme meteorological factors and air pollution indicators, as well as the effects of different lag days on HFMD incidence. Furthermore, this study explored the variability across gender and age groups.

RESULTS

Extreme temperatures, high precipitation and low-O₃ concentration increased the risk of HFMD. Hot effect was stronger and longer lasting than cold effect. Risks of rainy effect and low-O₃ effect continued to increase as lag days extended, with the maximum RR values: 1.60 (1.38, 1.86) (90th vs median) and 1.48 (1.16, 1.89) (1th vs median) at 0-14 lag days, respectively. By contrast, extremely high wind speed, low precipitation, low PM_2.5 and high O₃ exerted a certain protective effect on HFMD incidence. The corresponding minimum RR values were: 0.85 (0.74, 0.98) (90th vs median) at 0-14 lag days, 0.98 (0.97, 0.99) (10th vs median) at 0-14 lag days, 0.73 (0.61, 0.88) (1th vs median) at 0-14 lag days and 0.81 (0.73, 0.90) (99th vs median) at 0-7 lag days, respectively. Male children and children aged 0-1 years (followed by 1-3 years) were the most susceptible subgroups to extreme climatic effects and air pollution.

CONCLUSIONS

Our results indicated that daily meteorological factors and air pollution exert non-linear and delayed effects on pediatric HFMD, and such effects vary depending on gender and age. These findings may serve as a reference for the development of an early warning system and for the adoption of specific interventions for vulnerable groups.

Waterborne Diseases Arising From Climate Change

As a result of increased frequency and intensity of heat waves, increased floods and droughts, change in climate will affect biological, physical, and chemical components of water through different paths thus enhancing the risk of waterborne diseases. Identifying the role of weather in waterborne infection is a priority public health research issue as climate change is predicted to increase the frequency of extreme precipitation and temperature events. This chapter provides evidence that precipitation and temperature can affect directly or indirectly water quality and consequently affect the health human. This chapter also highlights the complex relationship between precipitation or temperature and transmission of waterborne disease such as diarrheal disease, gastroenteritis, cryptosporidiosis, giardiasis, and cholera.

A REVIEW OF WATER QUALITY RESPONSES TO AIR TEMPERATURE AND PRECIPITATION CHANGES 2: NUTRIENTS, ALGAL BLOOMS, SEDIMENT, PATHOGENS

In this paper we review the published, scientific literature addressing the response of nutrients, sediment, pathogens and cyanobacterial blooms to historical and potential future changes in air temperature and precipitation. The goal is to document how different attributes of water quality are sensitive to these drivers, to characterize future risk, to inform management responses and to identify research needs to fill gaps in our understanding. Results suggest that anticipated future changes present a risk of water quality and ecosystem degradation in many U.S. locations. Understanding responses is, however, complicated by inherent high spatial and temporal variability, interactions with land use and water management, and dependence on uncertain changes in hydrology in response to future climate. Effects on pollutant loading in different watershed settings generally correlate with projected changes in precipitation and runoff. In all regions, increased heavy precipitation events are likely to drive more episodic pollutant loading to water bodies. The risk of algal blooms could increase due to an expanded seasonal window of warm water temperatures and the potential for episodic increases in nutrient loading. Increased air and water temperatures are also likely to affect the survival of waterborne pathogens. Responding to these challenges requires understanding of vulnerabilities, and management strategies to reduce risk.

Maxent estimation of aquatic Escherichia coli stream impairment

BACKGROUND

The leading cause of surface water impairment in United States' rivers and streams is pathogen contamination. Although use of fecal indicators has reduced human health risk, current approaches to identify and reduce exposure can be improved. One important knowledge gap within exposure assessment is characterization of complex fate and transport processes of fecal pollution. Novel modeling processes can inform watershed decision-making to improve exposure assessment.

METHODS

We used the ecological model, Maxent, and the fecal indicator bacterium Escherichia coli to identify environmental factors associated with surface water impairment. Samples were collected August, November, February, and May for 8 years on Sinking Creek in Northeast Tennessee and analyzed for 10 water quality parameters and E. coli concentrations. Univariate and multivariate models estimated probability of impairment given the water quality parameters. Model performance was assessed using area under the receiving operating characteristic (AUC) and prediction accuracy, defined as the model's ability to predict both true positives (impairment) and true negatives (compliance). Univariate models generated action values, or environmental thresholds, to indicate potential E. coli impairment based on a single parameter. Multivariate models predicted probability of impairment given a suite of environmental variables, and jack-knife sensitivity analysis removed unresponsive variables to elicit a set of the most responsive parameters.

RESULTS

Water temperature univariate models performed best as indicated by AUC, but alkalinity models were the most accurate at correctly classifying impairment. Sensitivity analysis revealed that models were most sensitive to removal of specific conductance. Other sensitive variables included water temperature, dissolved oxygen, discharge, and NO3. The removal of dissolved oxygen improved model performance based on testing AUC, justifying development of two optimized multivariate models; a 5-variable model including all sensitive parameters, and a 4-variable model that excluded dissolved oxygen.

DISCUSSION

Results suggest that E. coli impairment in Sinking Creek is influenced by seasonality and agricultural run-off, stressing the need for multi-month sampling along a stream continuum. Although discharge was not predictive of E. coli impairment alone, its interactive effect stresses the importance of both flow dependent and independent processes associated with E. coli impairment. This research also highlights the interactions between nutrient and fecal pollution, a key consideration for watersheds with multiple synergistic impairments. Although one indicator cannot mimic theplethora of existing pathogens in water, incorporating modeling can fine tune an indicator's utility, providing information concerning fate, transport, and source of fecal pollution while prioritizing resources and increasing confidence in decision making.

Monitoring biofilm function in new and matured full-scale slow sand filters using flow cytometric histogram image comparison (CHIC)

While slow sand filters (SSFs) have produced drinking water for more than a hundred years, understanding of their associated microbial communities is limited. In this study, bacteria in influent and effluent water from full-scale SSFs were explored using flow cytometry (FCM) with cytometric histogram image comparison (CHIC) analysis; and routine microbial counts for heterotrophs, total coliforms and Escherichia coli. To assess if FCM can monitor biofilm function, SSFs differing in age and sand composition were compared. FCM profiles from two established filters were indistinguishable. To examine biofilm in the deep sand bed, SSFs were monitored during a scraping event, when the top layer of sand and the schmutzdecke are removed to restore flow through the filter. The performance of an established SSF was stable: total organic carbon (TOC), pH, numbers of heterotrophs, coliforms, E. coli, and FCM bacterial profile were unaffected by scraping. However, the performance of two newly-built SSFs containing new and mixed sand was compromised: breakthrough of both microbial indicators and TOC occurred following scraping. The compromised performance of the new SSFs was reflected in distinct effluent bacterial communities; and, the presence of microbial indicators correlated to influent bacterial communities. This demonstrated that FCM can monitor SSF performance. Removal of the top layer of sand did not alter the effluent water from the established SSF, but did affect that of the SSFs containing new sand. This suggests that the impact of the surface biofilm on effluent water is greater when the deep sand bed biofilm is not established.

Heavy rainfall and risk of infectious intestinal diseases in the most populous city in Vietnam

The association between heavy rainfall and infectious intestinal diseases (IID) has not been well described and little research has been conducted in developing countries. This study examines the association between heavy rainfall and hospital admissions for IID in Ho Chi Minh City, the most populous city in Vietnam. An interrupted time-series method was used to examine the effect of each individual heavy rainfall event (HRE) on IID. The percentage changes in post-HRE level and trends of IID were estimated for 30days following each HRE. Then a random-effect meta-analysis was used to quantify the pooled estimate of effect sizes of all HREs on IID. The pooled estimates were calculated over a 21day lag period. The effects of a HRE on IID varied across individual HREs. The pooled estimates indicate that the levels of IID following a HRE increased from 7.3% to 13.5% for lags from 0 to 21days, however statistically significant increases were only observed for lags from 4 to 6days (13.5%, 95%CI: 1.4-25.4; 13.3%, 95%CI: 1.5-25.0; and 12.9%, 95%CI: 1.6-24.1 respectively). An average decrease of 0.11% (95%CI: -0.55-0.33) per day was observed for the post-HRE trend. This finding has important implications for the projected impacts on residents living in this city which is highly vulnerable to increased heavy rainfall associated with climate change. Adaptation and intervention programs should be developed to prevent this additional burden of disease and to protect residents from the adverse impacts of extreme weather events.

Waterborne Diseases and Climate Change: Impact and Implications

Waterborne diseases are caused by a multitude of pathogens and associated with a significant burden in both developed and developing countries. While the assessment of the adverse impacts of climate change on human heath from infectious diseases has mainly focused on vector-borne diseases, waterborne diseases prevalence and transmission patterns are also likely to be impacted by environmental change. This chapter will outline relevant waterborne pathogens, summarise the impact of climate change on disease transmission and explore climate change adaptation options in order to reduce the increased burden of waterborne diseases.

Climate Change and Water Scarcity: The Case of Saudi Arabia

BACKGROUND

Climate change is expected to bring increases in average global temperatures (1.4°C-5.8°C [34.52°F-42.44°F] by 2100) and precipitation levels to varying degrees around the globe. The availability and quality of water will be severely affected, and public health threats from the lack of this valuable resource will be great unless water-scarce nations are able to adapt. Saudi Arabia provides a good example of how the climate and unsustainable human activity go hand in hand in creating stress on and depleting water resources, and an example for adaptation and mitigation.

METHOD

A search of the English literature addressing climate change, water scarcity, human health, and related topics was conducted using online resources and databases accessed through the University at Albany, State University of New York library web page.

RESULTS

Water scarcity, which encompasses both water availability and water quality, is an important indicator of health. Beyond drinking, water supply is intimately linked to food security, sanitation, and hygiene, which are primary contributors to the global burden of disease. Poor and disadvantaged populations are the ones who will suffer most from the negative effects of climate change on water supply and associated human health issues. Examples of adaptation and mitigation measures that can help reduce the strain on conventional water resources (surface waters and fossil aquifers or groundwater) include desalination, wastewater recycling and reuse, and outsourcing food items or "virtual water trade." These are strategies being used by Saudi Arabia, a country that is water poor primarily due to decades of irresponsible irrigation practices. The human and environmental health risks associated with these adaptation measures are examined. Finally, strategies to protect human health through international collaboration and the importance of these efforts are discussed.

CONCLUSION

International, multidisciplinary cooperation and collaboration will be needed to promote global water security and to protect human health, particularly in low-income countries that do not have the resources necessary to adapt on their own.

Systems Approach to Climate, Water, and Diarrhea in Hubli-Dharwad, India

Anthropogenic climate change will likely increase diarrhea rates for communities with inadequate water, sanitation, or hygiene facilities including those with intermittent water supplies. Current approaches to study these impacts typically focus on the effect of temperature on all-cause diarrhea while excluding precipitation and diarrhea etiology while not providing actionable adaptation strategies. We develop a partially mechanistic, systems approach to estimate future diarrhea prevalence and design adaptation strategies. The model incorporates downscaled global climate models, water quality data, quantitative microbial risk assessment, and pathogen prevalence in an agent-based modeling framework incorporating precipitation and diarrhea etiology. It is informed using water quality and diarrhea data from Hubli-Dharwad, India-a city with an intermittent piped water supply exhibiting seasonal water quality variability vulnerable to climate change. We predict all-cause diarrhea prevalence to increase by 4.9% (Range: 1.5-9.0%) by 2011-2030, 11.9% (Range: 7.1-18.2%) by 2046-2065, and 18.2% (Range: 9.1-26.2%) by 2080-2099. Rainfall is an important modifying factor. Rotavirus prevalence is estimated to decline by 10.5% with Cryptosporidium and E. coli prevalence increasing by 9.9% and 6.3%, respectively, by 2080-2099 in this setting. These results suggest that ceramic water filters would be recommended as a climate adaptation strategy over chlorination. This work highlights the vulnerability of intermittent water supplies to climate change and the urgent need for improvements.

Climate change impact on infection risks during bathing downstream of sewage emissions from CSOs or WWTPs

Climate change is expected to influence infection risks while bathing downstream of sewage emissions from combined sewage overflows (CSOs) or waste water treatment plants (WWTPs) due to changes in pathogen influx, rising temperatures and changing flow rates of the receiving waters. In this study, climate change impacts on the surface water concentrations of Campylobacter, Cryptosporidium and norovirus originating from sewage were modelled. Quantitative microbial risk assessment (QMRA) was used to assess changes in risks of infection. In general, infection risks downstream of WWTPs are higher than downstream CSOs. Even though model outputs show an increase in CSO influxes, in combination with changes in pathogen survival, dilution within the sewage system and bathing behaviour, the effects on the infection risks are limited. However, a decrease in dilution capacity of surface waters could have significant impact on the infection risks of relatively stable pathogens like Cryptosporidium and norovirus. Overall, average risks are found to be higher downstream WWTPs compared to CSOs. Especially with regard to decreased flow rates, adaptation measures on treatment at WWTPs may be more beneficial for human health than decreasing CSO events.

Presence and survival of culturable Campylobacter spp. and Escherichia coli in a temperate urban estuary

Urban estuaries throughout the world typically contain elevated levels of faecal contamination, the extent of which is generally assessed using faecal indicator organisms (FIO) such as Escherichia coli. This study assesses whether the bacterial FIO, E. coli is a suitable surrogate for Campylobacter spp., in estuaries. The presence and survival dynamics of culturable E. coli and Campylobacter spp. are compared in the water column, bank sediments and bed sediments of the Yarra River estuary (located in Melbourne, Australia). The presence of E. coli did not necessarily indicate detectable levels of Campylobacter spp. in the water column, bed and bank sediments, but the inactivation rates of the two bacteria were similar in the water column. A key finding of the study is that E. coli and Campylobacter spp. can survive for up to 14days in the water column and up to 21days in the bed and bank sediments of the estuary. Preliminary data presented in this study also suggests that the inactivation rates of the two bacteria may be similar in bed and bank sediments. This undermines previous hypotheses that Campylobacter spp. cannot survive outside of its host and indicates that public health risks can persist in aquatic systems for up to three weeks after the initial contamination event.

Detection of hepatitis E virus and other livestock-related pathogens in Iowa streams

Manure application is a source of pathogens to the environment. Through overland runoff and tile drainage, zoonotic pathogens can contaminate surface water and streambed sediment and could affect both wildlife and human health. This study examined the environmental occurrence of gene markers for livestock-related bacterial, protozoan, and viral pathogens and antibiotic resistance in surface waters within the South Fork Iowa River basin before and after periods of swine manure application on agricultural land. Increased concentrations of indicator bacteria after manure application exceeding Iowa's state bacteria water quality standards suggest that swine manure contributes to diminished water quality and may pose a risk to human health. Additionally, the occurrence of HEV and numerous bacterial pathogen genes for Escherichia coli, Enterococcus spp., Salmonella sp., and Staphylococcus aureus in both manure samples and in corresponding surface water following periods of manure application suggests a potential role for swine in the spreading of zoonotic pathogens to the surrounding environment. During this study, several zoonotic pathogens were detected including Shiga-toxin producing E. coli, Campylobacter jejuni, pathogenic enterococci, and S. aureus; all of which can pose mild to serious health risks to swine, humans, and other wildlife. This research provides the foundational understanding required for future assessment of the risk to environmental health from livestock-related zoonotic pathogen exposures in this region. This information could also be important for maintaining swine herd biosecurity and protecting the health of wildlife near swine facilities.

Post-industrial river water quality-Fit for bathing again?

For the Ruhr River, bathing has been prohibited for decades. However, along with significant improvements of the hygienic water quality, there is an increasing demand of using the river for recreational purposes, in particular for bathing. In the "Safe Ruhr" interdisciplinary research project, demands, options and chances for lifting the bathing ban for the Ruhr River were investigated. As being the prominent reason for persisting recreational restrictions, microbiological water quality was in the focus of interest. Not only the faecal indicator organisms (FIOs) as required by the European Bathing Water Directive were considered, but also pathogens such as Salmonella, Pseudomonas aeruginosa, Legionella pneumophila, Campylobacter, Leptospira, enteroviruses and protozoan parasites. In this introductory paper, we firstly relate current recreational desires to historical experiences of river bathing. After recapitulating relevant microbial river contamination sources (predominantly sewage treatment plants, combined sewer overflows, and surface runoffs), we review existing knowledge about the relationships of FIOs and pathogens in rivers designated for recreational purposes, and then trace the evolution, rationale and validity of recreational freshwater quality criteria which are, despite obvious uncertainties, mostly relying on the FIO paradigm. In particular, the representativeness of FIOs is critically discussed. The working programme of Safe Ruhr, aiming at initiating and facilitating a process towards legalisation of Ruhr River bathing, is outlined. Sources of contamination can be technically handled which leaves the actual measures to political decisions. As contaminations are transient, only occasionally exceeding legal limits, a flexible bathing site management, warning bathers of non-safe situations, may amend technical interventions and offer innovative solutions. As a result, a situation-adapted system for lifting of the bathing ban for Ruhr River appears realistic.

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science, and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.

Effect of climate change on runoff of Campylobacter and Cryptosporidium from land to surface water

Faeces originating from wildlife, domestic animals or manure-fertilized fields, is considered an important source of zoonotic pathogens to which people may be exposed by, for instance, bathing or drinking-water consumption. An increase in runoff, and associated wash-off of animal faeces from fields, is assumed to contribute to the increase of disease outbreaks during periods of high precipitation. Climate change is expected to increase winter precipitation and extreme precipitation events during summer, but has simultaneously also other effects such as temperature rise and changes in evapotranspiration. The question is to what extent the combination of these effects influence the input of zoonotic pathogens to the surface waters. To quantitatively analyse the impacts of climate change on pathogen runoff, pathogen concentrations reaching surface waters through runoff were calculated by combining an input model for catchment pathogen loads with the Wageningen Lowland Runoff Simulator (WALRUS). Runoff of Cryptosporidium and Campylobacter was evaluated under different climate change scenarios and by applying different scenarios for sources of faecal pollution in the catchments, namely dairy cows and geese and manure fertilization. Model evaluation of these scenarios shows that climate change has little overall impact on runoff of Campylobacter and Cryptosporidium from land to the surface waters. Even though individual processes like runoff fluxes, pathogen release and dilution are affected, either positively or negatively, the net effect on the pathogen concentration in surface waters and consequently also on infection risks through recreation seems limited.

Climate change effects on airborne pathogenic bioaerosol concentrations: a scenario analysis

The most recent IPCC report presented further scientific evidence for global climate change in the twenty-first century. Important secondary effects of climate change include those on water resource availability, agricultural yields, urban healthy living, biodiversity, ecosystems, food security, and public health. The aim of this explorative study was to determine the range of expected airborne pathogen concentrations during a single outbreak or release in a future climate compared to a historical climatic period (1981-2010). We used five climate scenarios for the periods 2016-2045 and 2036-2065 defined by the Royal Netherlands Meteorological Institute and two conversion tools to create hourly future meteorological data sets. We modelled season-averaged airborne pathogen concentrations by means of an atmospheric dispersion model and compared these data to historical (1981-2010) modelled concentrations. Our results showed that modelled concentrations were modified several percentage points on average as a result of climate change. On average, concentrations were reduced in four out of five scenarios. Wind speed and global radiation were of critical importance, which determine horizontal and vertical dilution. Modelled concentrations decreased on average, but large positive and negative hourly averaged effects were calculated (from -67 to +639 %). This explorative study shows that further research should include pathogen inactivation and more detailed probability functions on precipitation, snow, and large-scale circulation.

A systematic review and meta-analysis of ambient temperature and diarrhoeal diseases

BACKGROUND

Global climate change is expected to increase the risk of diarrhoeal diseases, a leading cause of childhood mortality. However, there is considerable uncertainty about the magnitude of these effects and which populations bear the greatest risks.

METHODS

We conducted a systematic review using defined search terms across four major databases and, additionally, examined the references of 54 review articles captured by the search. We evaluated sources of heterogeneity by pathogen taxon, exposure measure, study quality, country income level and regional climate, and estimated pooled effect estimates for the subgroups identified in the heterogeneity analysis, using meta-analysis methods.

RESULTS

We identified 26 studies with 49 estimates. Pathogen taxa were a source of heterogeneity. There was a positive association between ambient temperature and all-cause diarrhoea (incidence rate ratio (IRR) 1.07; 95% confidence interval (CI) 1.03, 1.10) and bacterial diarrhoea (IRR 1.07; 95% CI 1.04, 1.10), but not viral diarrhoea (IRR 0.96; 95% CI 0.82, 1.11). These associations were observed in low-, middle- and high-income countries. Only one study of protozoan diarrhoea was identified.

CONCLUSIONS

Changes in temperature due to global climate change can and may already be affecting diarrhoeal disease incidence. The vulnerability of populations may depend, in part, on local pathogen distribution. However, evidence of publication bias and the uneven geographical distribution of studies limit the precision and generalizability of the pooled estimates.

Pathogen Loading From Canada Geese Faeces in Freshwater: Potential Risks to Human Health Through Recreational Water Exposure

Canada geese (Branta canadensis) faeces have been shown to contain pathogenic protozoa and bacteria in numerous studies over the past 15 years. Further, increases in both the Canada geese populations and their ideal habitat requirements in the United States (US) translate to a greater presence of these human pathogens in public areas, such as recreational freshwater beaches. Combining these factors, the potential health risk posed by Canada geese faeces at freshwater beaches presents an emerging public health issue that warrants further study. Here, literature concerning human pathogens in Canada geese faeces is reviewed and the potential impacts these pathogens may have on human health are discussed. Pathogens of potential concern include Campylobacter jejuni, Salmonella Typhimurium, Listeria monocytogenes, Helicobacter canadensis, Arcobacter spp., Enterohemorragic Escherichia coli pathogenic strains, Chlamydia psitacci, Cryptosporidium parvum and Giardia lamblia. Scenarios presenting potential exposure to pathogens eluted from faeces include bathers swimming in lakes, children playing with wet and dry sand impacted by geese droppings and other common recreational activities associated with public beaches. Recent recreational water-associated disease outbreaks in the US support the plausibility for some of these pathogens, including Cryptosporidium spp. and C. jejuni, to cause human illness in this setting. In view of these findings and the uncertainties associated with the real health risk posed by Canada geese faecal pathogens to users of freshwater lakes, it is recommended that beach managers use microbial source tracking and conduct a quantitative microbial risk assessment to analyse the local impact of Canada geese on microbial water quality during their decision-making process in beach and watershed management.

Microbial Transport and Fate in the Subsurface Environment: Introduction to the Special Section

Microorganisms constitute an almost exclusive form of life in the earth's subsurface environment (not including caves), particularly at depths exceeding the soil horizon. While of broad interest to ecology and geology, scientific interest in the fate and transport of microorganisms, particularly those introduced through the anthropogenic environment, has focused on understanding the subsurface environment as a pathway for human pathogens and on optimizing the use of microbial organisms for remediation of potable groundwater. This special section, inspired by the 2014 Ninth International Symposium for Subsurface Microbiology, brings together recent efforts to better understand the spatiotemporal occurrence of anthropogenic microbial groundwater contamination and the fate and transport of microbes in the subsurface environment: in soils, deep unsaturated zones, and within aquifer systems. Work includes field reconnaissance, controlled laboratory studies to improve our understanding of specific fate and transport processes, and the development and application of improved mechanistic understanding of microbial fate and transport processes in the subsurface environment. The findings confirm and also challenge the limitations of our current understanding of highly complex microbial fate and transport processes across spatiotemporal scales in the subsurface environment; they also add to the increasing knowledge base to improve our ability to protect drinking water resources and perform in situ environmental remediation.

Effect of Climate Change on the Concentration and Associated Risks of Vibrio Spp. in Dutch Recreational Waters

Currently, the number of reported cases of recreational- water-related Vibrio illness in the Netherlands is low. However, a notable higher incidence of Vibrio infections has been observed in warm summers. In the future, such warm summers are expected to occur more often, resulting in enhanced water temperatures favoring Vibrio growth. Quantitative information on the increase in concentration of Vibrio spp. in recreational water under climate change scenarios is lacking. In this study, data on occurrence of Vibrio spp. at six different bathing sites in the Netherlands (2009-2012) were used to derive an empirical formula to predict the Vibrio concentration as a function of temperature, salinity, and pH. This formula was used to predict the effects of increased temperatures in climate change scenarios on Vibrio concentrations. For Vibrio parahaemolyticus, changes in illness risks associated with the changed concentrations were calculated as well. For an average temperature increase of 3.7 °C, these illness risks were calculated to be two to three times higher than in the current situation. Current illness risks were, varying per location, on average between 10(-4) and 10(-2) per person for an entire summer. In situations where water temperatures reached maximum values, illness risks are estimated to be up to 10(-2) and 10(-1) . If such extreme situations occur more often during future summers, increased numbers of ill bathers or bathing-water-related illness outbreaks may be expected.

Environmental monitoring of waterborne Campylobacter: evaluation of the Australian standard and a hybrid extraction-free MPN-PCR method

Campylobacter is the leading agent of diarrheal disease worldwide. This study evaluates a novel culture-PCR hybrid (MPN-PCR) assay for the rapid enumeration of Campylobacter spp. from estuarine and wastewater systems. To first evaluate the current, culture-based, Australian standard, an inter-laboratory study was conducted on 69 subsampled water samples. The proposed Most-Probable Number (MPN)-PCR method was then evaluated, by analysing 147 estuarine samples collected over a 2 year period. Data for 14 different biological, hydrological and climatic parameters were also collated to identify pathogen-environment relationships and assess the potential for method specific bias. The results demonstrated that the intra-laboratory performance of the MPN-PCR was superior to that of AS/NZS (σ = 0.7912, P < 0.001; κ = 0.701, P < 0.001) with an overall diagnostic accuracy of ~94%. Furthermore, the analysis of both MPN-PCR and AS/NZS identified the potential for the introduction of method specific bias during assessment of the effects of environmental parameters on Campylobacter spp. numbers.

Extreme precipitation and beach closures in the great lakes region: evaluating risk among the elderly

As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the risk of gastrointestinal illness (GI)-related hospital admissions among individuals 65 and older in 12 Great Lakes cities from 2000 to 2006. Poisson regression models were fit in each city, controlling for temperature and long-term time trends. City-specific estimates were combined to form an overall regional risk estimate. Approximately 40,000 GI-related hospital admissions and over 100 beach closure days were recorded from May through September during the study period. Extreme precipitation (≥90th percentile) occurring the previous day (lag 1) is significantly associated with beach closures in 8 of the 12 cities (p < 0.05). However, no association was observed between beach closures and GI-related hospital admissions. These results support previous work linking extreme precipitation to compromised recreational water quality.