Knowledge Mapping for Climate Change and Food- and Waterborne Diseases

Interrelationship between climatic factors and incidence of FBD caused by Clostridioides difficile toxin B, Clostridium perfringens, Campylobacter spp., and Escherichia coli O157:H7

Foodborne diseases (FBDs) remain a global public health concern. Climatic factors such as wind-chill temperature, rainfall, and relative humidity affect the incidence of several FBDs. This study was performed to analyze how the various factors of the climate influence the incidence and severity of FBDs. This study retrospectively analyzed the results of multiplex polymerase chain reaction (mPCR) tests for diarrhea-causing bacteria performed on 2300 fecal samples obtained from patients at Dankook University Hospital, Cheonan, from June 2010 to December 2019. The Clostridioides difficile toxin B infection rate positively correlated with the intensity of sunshine, and the content of particulate matter. The Campylobacter spp. infection rate positively correlated with wind-chill temperature and the content of particulate matter. The Escherichia coli O157:H7 infection rate positively correlated with relative humidity. These findings may explain the dynamics and risks of Clostridioides difficile toxin B, Clostridium perfringens, Campylobacter spp., and Escherichia coli O157:H7 infection. They may help predict interrelationships among climatic factors and standardize national environmental health policies. However, in-depth research with large-scale data, molecular biology, and epidemiology would be required going forward. Future research would also require objective indicators of the changes in the prevalence of FBD-causing microbial pathogens for the effective prevention and management of these bacterial infections.

How globalization and climate change could affect foodborne parasites

Foodborne parasites, most of which are zoonotic, represent an important human health hazard. These pathogens which include both protozoa (e.g., Cryptosporidium spp., Cyclospora cayetanensis, Toxoplasma gondii) and helminths (e.g., liver and intestinal flukes, Fasciola spp., Paragonimus spp., Echinococcus spp., Taenia spp., Angiostrongylus spp., Anisakis spp., Ascaris spp., Capillaria spp., Toxocara spp., Trichinella spp., Trichostrongylus spp.), have accompanied the human species since its origin and their spread has often increased due to their behavior. Since both domesticated and wild animals play an important role as reservoirs of these pathogens the increase/decrease of their biomasses, migration, and passive introduction by humans can change their epidemiological patterns. It follows that globalization and climate change will have a tremendous impact on these pathogens modifying their epidemiological patterns and ecosystems due to the changes of biotic and abiotic parameters. The consequences of these changes on foodborne parasites cannot be foreseen as a whole due to their complexity, but it is important that biologists, epidemiologists, physicians and veterinarians evaluate/address the problem within a one health approach. This opinion, based on the author's experience of over 40 years in the parasitology field, takes into consideration the direct and indirect effects on the transmission of foodborne parasites to humans.

Public Health and Epidemiology Informatics: Can Artificial Intelligence Help Future Global Challenges? An Overview of Antimicrobial Resistance and Impact of Climate Change in Disease Epidemiology

OBJECTIVES

To provide an oveiview of the current application of artificial intelligence (AI) in the field of public health and epidemiology, with a special focus on antimicrobial resistance and the impact of climate change in disease epidemiology. Both topics are of vital importance and were included in the "Ten threats to global health in 2019" report published by the World Health Organization.

METHODS

We analysed publications that appeared in the last two years, between January 2017 and October 2018. Papers were searched using Google Scholar with the following keywords: public health, epidemiology, machine learning, data analytics, artificial intelligence, disease surveillance, climate change, antimicrobial resistance, and combinations thereof. Selected articles were organised by theme.

RESULTS

In spite of a large interest in AI generated both within and outside the scientific community, and of the many opinions pointing towards the importance of a better use of data in public health, few papers have been published on the selected topics in the last two years. We identify several potential reasons, including the complexity of the integration of heterogeneous data, and the lack of sound and unbiased validation procedures.

CONCLUSIONS

As there is a better comprehension of AI and more funding available, artificial intelligence will become not only the centre of attention in informatics, but more importantly the source of innovative solutions for public health.

How will climate change impact microbial foodborne disease in Canada?

Foodborne disease is a major concern in Canada and represents a significant climate change-related threat to public health. Climate variables, including temperature and precipitation patterns, extreme weather events and ocean warming and acidification, are known to exert significant, complicated and interrelated effects along the entire length of the food chain. Foodborne diseases are caused by a range of bacteria, fungi, parasites and viruses, and the prevalence of these diseases is modified by climate change through alterations in the abundance, growth, range and survival of many pathogens, as well as through alterations in human behaviours and in transmission factors such as wildlife vectors. As climate change continues and/or intensifies, it will increase the risk of an adverse effect on food safety in Canada ranging from increased public health burden to the emergence of risks not currently seen in our food chain. Clinical and public health practitioners need to be aware of the existing and emerging risks to respond accordingly.

Salmonella and the changing environment: systematic review using New York State as a model

Salmonella is a public health concern, for which a complex interplay between host, agent, and environment exists. An improved understanding of causal processes can be used to better gauge the causes and trajectory of Salmonella in a changing environment. This would be useful in determining the impact of climate change on the New York State (NYS) environment, the effect of climate change on Salmonella in NYS, factors contributing to Salmonella vulnerability in humans, and aspects of climate change and Salmonella which necessitate further research. A systematic review was conducted to study associations between Salmonella and the environment. Using the search criteria, a total of 91 relevant articles were identified from four electronic databases. Key information was abstracted, organized, and synthesized to identify causal processes and linkages between climate change, the environment of NYS, and Salmonella-related outcomes, as well as risk factors to characterize Salmonella vulnerabilities. Three inter-related domains were identified for consideration and application to epidemiological research to confirm and extrapolate disease patterns using climate change scenarios: improved quantification of causal relationships, inclusion of factors linked to sectors not immediately associated with the exposure and outcome, and increased capacity to validate models in diverse settings.

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.

Interrelationships between Multiple Climatic Factors and Incidence of Foodborne Diseases

Climatic factors can affect the incidence of foodborne diseases (FBDs). Moreover, microbial network inference is useful for predicting the interrelationships between the incidence of FBDs and climatic factors. However, the interrelationships between FBD pathogens and most climatic factors are unknown. Using principal component analysis (PCA) and partial correlation coefficient matrices (PCCMs), we determined the intra-ecosystem interrelationship network of the multiple combined effects of 5 climatic factors (temperature, relative humidity, rainfall, insolation, and cloudiness) and the monthly incidences of 12 bacterial FBDs. Many FBD pathogens are interrelated with multiple combined factors. Salmonellosis has strong positive interrelationships with Vibrio parahaemolyticus and enterohemorrhagic Escherichia coli, and the interrelationships between Staphylococcus aureus/enteropathogenic E. coli/enterotoxigenic E. coli exhibits a typical triangular pattern with the combined effects of all 5 climatic factors. Meanwhile, campylobacteriosis and Clostridium perfringens infections are negatively interrelated with insolation and cloudiness. Enteroinvasive E. coli, Bacillus cereus, Listeria spp., and Yersinia enterocolitica are significantly interrelated with any climatic factor combination. The interrelationships or higher-order interrelationships among these climatic factors play an important role in the incidence of FBDs, although the underlying mechanisms remain unclear. Our results will serve as a foundation for more sophisticated models of future FBD patterns with regard to climate change.

Synthesizing water quality indicators from standardized geospatial information to remedy water security challenges: A review

Water is vital not only for food, energy and sanitation but also for ecosystem functioning, human health, socio-economic progress and poverty reduction. Water security exists when all people have physical and economical access to sufficient, safe, and clean water that meets basic needs. However, water security is threatened by growing human population, episodic environmental disasters, indiscriminate land management practices, contaminants, and escalation in geopolitical conflicts. <3% of the estimated 1.4 billion cubic kilometers of water on earth is available for consumption. Although there exist a range of laboratory and field methods for measuring the chemical, physical and biological properties of water, the information available to the public remains inconsistent and patchy. To this end, we advance a new theory of a single-value objective water quality index (WQI) that considers the interaction between the above properties, to provide concise information for source water quality surveillance and monitoring. Although geospatial technologies such as remote sensing is credited as a high frequency spatiotemporal mapping tool, exiguous information is available on its application for constructing single-value WQIs. Besides, no remote sensing device exists that directly measures water quality, which must indirectly be inferred through modeling sensed remote sensing signals with measured water properties. This review not only highlights the water security conundrum but also provides an overview of methods for integrating geolocated qualitative (e.g., management data) with quantitative (i.e., measured water constituent properties) into a WQI.

Combined influence of multiple climatic factors on the incidence of bacterial foodborne diseases

Information regarding the relationship between the incidence of foodborne diseases (FBD) and climatic factors is useful in designing preventive strategies for FBD based on anticipated future climate change. To better predict the effect of climate change on foodborne pathogens, the present study investigated the combined influence of multiple climatic factors on bacterial FBD incidence in South Korea. During 2011-2015, the relationships between 8 climatic factors and the incidences of 13 bacterial FBD, were determined based on inpatient stays, on a monthly basis using the Pearson correlation analyses, multicollinearity tests, principal component analysis (PCA), and the seasonal autoregressive integrated moving average (SARIMA) modeling. Of the 8 climatic variables, the combination of temperature, relative humidity, precipitation, insolation, and cloudiness was significantly associated with salmonellosis (P<0.01), vibriosis (P<0.05), and enterohemorrhagic Escherichia coli O157:H7 infection (P<0.01). The combined effects of snowfall, wind speed, duration of sunshine, and cloudiness were not significant for these 3 FBD. Other FBD, including campylobacteriosis, were not significantly associated with any combination of climatic factors. These findings indicate that the relationships between multiple climatic factors and bacterial FBD incidence can be valuable for the development of prediction models for future patterns of diseases in response to changes in climate.

Detecting and Attributing Health Burdens to Climate Change

BACKGROUND

Detection and attribution of health impacts caused by climate change uses formal methods to determine a) whether the occurrence of adverse health outcomes has changed, and b) the extent to which that change could be attributed to climate change. There have been limited efforts to undertake detection and attribution analyses in health.

OBJECTIVE

Our goal was to show a range of approaches for conducting detection and attribution analyses.

RESULTS

Case studies for heatwaves, Lyme disease in Canada, and Vibrio emergence in northern Europe highlight evidence that climate change is adversely affecting human health. Changes in rates and geographic distribution of adverse health outcomes were detected, and, in each instance, a proportion of the observed changes could, in our judgment, be attributed to changes in weather patterns associated with climate change.

CONCLUSIONS

The results of detection and attribution studies can inform evidence-based risk management to reduce current, and plan for future, changes in health risks associated with climate change. Gaining a better understanding of the size, timing, and distribution of the climate change burden of disease and injury requires reliable long-term data sets, more knowledge about the factors that confound and modify the effects of climate on health, and refinement of analytic techniques for detection and attribution. At the same time, significant advances are possible in the absence of complete data and statistical certainty: there is a place for well-informed judgments, based on understanding of underlying processes and matching of patterns of health, climate, and other determinants of human well-being. https://doi.org/10.1289/EHP1509.

Preharvest Food Safety Under the Influence of a Changing Climate

Ensuring food safety and addressing the impact of climate change are both immense concepts. Food production systems must continue to evolve in order to develop food safety management programs and identify emerging risks linked to climate change. There are an infinite number of crosscutting issues regarding climate change and health. The changing climate of the globe manifests itself in fluctuating temperatures, intense storms, droughts, and fluctuating sea levels. These environmental variables in turn may increase the risk of foodborne disease transmission through our foods and increase the need for vigilance and risk mitigation at the preharvest level. While the influence of climate change is untold, four cases are discussed here, including waterborne disease, seafood, production of fruits and vegetables, and mycotoxins. Changes relative to climate have been documented at the preharvest level for these issues. Change must be addressed alongside education and research to safeguard the human health effects of climate change.

Vibrio alginolyticus infections in the USA, 1988-2012

Vibrio alginolyticus causes soft tissue and bloodstream infection; little systematically collected clinical and epidemiological information is available. In the USA, V. alginolyticus infections are reported to the Cholera and Other Vibrio Illness Surveillance system. Using data from 1988 to 2012, we categorised infections using specimen source and exposure history, analysed case characteristics, and calculated incidence rates using US Census Bureau data. Most (96%) of the 1331 V. alginolyticus infections were from coastal states. Infections of the skin and ear were most frequent (87%); ear infections occurred more commonly in children, lower extremity infections more commonly in older adults. Most (86%) infections involved water activity. Reported incidence of infections increased 12-fold over the study period, although the extent of diagnostic or surveillance bias is unclear. Prevention efforts should target waterborne transmission in coastal areas and provider education to promote more rapid diagnosis and prevent complications.

Analytical studies assessing the association between extreme precipitation or temperature and drinking water-related waterborne infections: a review

Determining the role of weather in waterborne infections is a priority public health research issue as climate change is predicted to increase the frequency of extreme precipitation and temperature events. To document the current knowledge on this topic, we performed a literature review of analytical research studies that have combined epidemiological and meteorological data in order to analyze associations between extreme precipitation or temperature and waterborne disease.A search of the databases Ovid MEDLINE, EMBASE, SCOPUS and Web of Science was conducted, using search terms related to waterborne infections and precipitation or temperature. Results were limited to studies published in English between January 2001 and December 2013.Twenty-four articles were included in this review, predominantly from Asia and North-America. Four articles used waterborne outbreaks as study units, while the remaining articles used number of cases of waterborne infections. Results presented in the different articles were heterogeneous. Although most of the studies identified a positive association between increased precipitation or temperature and infection, there were several in which this association was not evidenced. A number of articles also identified an association between decreased precipitation and infections. This highlights the complex relationship between precipitation or temperature driven transmission and waterborne disease. We encourage researchers to conduct studies examining potential effect modifiers, such as the specific type of microorganism, geographical region, season, type of water supply, water source or water treatment, in order to assess how they modulate the relationship between heavy rain events or temperature and waterborne disease. Addressing these gaps is of primary importance in order to identify the areas where action is needed to minimize negative impact of climate change on health in the future.

A systematic review and meta-analysis of the effects of extreme weather events and other weather-related variables on Cryptosporidium and Giardia in fresh surface waters

Global climate change is expected to impact drinking water quality through multiple weather-related phenomena. We conducted a systematic review and meta-analysis of the relationship between various weather-related variables and the occurrence and concentration of Cryptosporidium and Giardia in fresh surface waters. We implemented a comprehensive search in four databases, screened 1,228 unique citations for relevance, extracted data from 107 relevant articles, and conducted random-effects meta-analysis on 16 key relationships. The average odds of identifying Cryptosporidium oocysts and Giardia cysts in fresh surface waters was 2.61 (95% CI = 1.63-4.21; I² = 16%) and 2.87 (95% CI = 1.76-4.67; I² = 0%) times higher, respectively, during and after extreme weather events compared to baseline conditions. Similarly, the average concentration of Cryptosporidium and Giardia identified under these conditions was also higher, by approximately 4.38 oocysts/100 L (95% CI = 2.01-9.54; I(2) = 0%) and 2.68 cysts/100 L (95% CI = 1.08-6.55; I² = 48%). Correlation relationships between other weather-related parameters and the density of these pathogens were frequently heterogeneous and indicated low to moderate effects. Meta-regression analyses identified different study-level factors that influenced the variability in these relationships. The results can be used as direct inputs for quantitative microbial risk assessment. Future research is warranted to investigate these effects and potential mitigation strategies in different settings and contexts.

The interconnected and cross-border nature of risks posed by infectious diseases

Infectious diseases can constitute public health emergencies of international concern when a pathogen arises, acquires new characteristics, or is deliberately released, leading to the potential for loss of human lives as well as societal disruption. A wide range of risk drivers are now known to lead to and/or exacerbate the emergence and spread of infectious disease, including global trade and travel, the overuse of antibiotics, intensive agriculture, climate change, high population densities, and inadequate infrastructures, such as water treatment facilities. Where multiple risk drivers interact, the potential impact of a disease outbreak is amplified. The varying temporal and geographic frequency with which infectious disease events occur adds yet another layer of complexity to the issue. Mitigating the emergence and spread of infectious disease necessitates mapping and prioritising the interdependencies between public health and other sectors. Conversely, during an international public health emergency, significant disruption occurs not only to healthcare systems but also to a potentially wide range of sectors, including trade, tourism, energy, civil protection, transport, agriculture, and so on. At the same time, dealing with a disease outbreak may require a range of critical sectors for support. There is a need to move beyond narrow models of risk to better account for the interdependencies between health and other sectors so as to be able to better mitigate and respond to the risks posed by emerging infectious disease.

A decision support tool to compare waterborne and foodborne infection and/or illness risks associated with climate change

Climate change may impact waterborne and foodborne infectious disease, but to what extent is uncertain. Estimating climate-change-associated relative infection risks from exposure to viruses, bacteria, or parasites in water or food is critical for guiding adaptation measures. We present a computational tool for strategic decision making that describes the behavior of pathogens using location-specific input data under current and projected climate conditions. Pathogen-pathway combinations are available for exposure to norovirus, Campylobacter, Cryptosporidium, and noncholera Vibrio species via drinking water, bathing water, oysters, or chicken fillets. Infection risk outcomes generated by the tool under current climate conditions correspond with those published in the literature. The tool demonstrates that increasing temperatures lead to increasing risks for infection with Campylobacter from consuming raw/undercooked chicken fillet and for Vibrio from water exposure. Increasing frequencies of drought generally lead to an elevated infection risk of exposure to persistent pathogens such as norovirus and Cryptosporidium, but decreasing risk of exposure to rapidly inactivating pathogens, like Campylobacter. The opposite is the case with increasing annual precipitation; an upsurge of heavy rainfall events leads to more peaks in infection risks in all cases. The interdisciplinary tool presented here can be used to guide climate change adaptation strategies focused on infectious diseases.

Climate change and temperature rise: implications on food- and water-borne diseases

This study attempts to quantify climate-induced increases in morbidity rates associated with food- and water-borne illnesses in the context of an urban coastal city, taking Beirut-Lebanon as a study area. A Poisson generalized linear model was developed to assess the impacts of temperature on the morbidity rate. The model was used with four climatic scenarios to simulate a broad spectrum of driving forces and potential social, economic and technologic evolutions. The correlation established in this study exhibits a decrease in the number of illnesses with increasing temperature until reaching a threshold of 19.2 °C, beyond which the number of morbidity cases increases with temperature. By 2050, the results show a substantial increase in food- and water-borne related morbidity of 16 to 28% that can reach up to 42% by the end of the century under A1FI (fossil fuel intensive development) or can be reversed to ~0% under B1 (lowest emissions trajectory), highlighting the need for early mitigation and adaptation measures.

Climate Change Impact Assessment of Food- and Waterborne Diseases

The PubMed and ScienceDirect bibliographic databases were searched for the period of 1998-2009 to evaluate the impact of climatic and environmental determinants on food- and waterborne diseases. The authors assessed 1,642 short and concise sentences (key facts), which were extracted from 722 relevant articles and stored in a climate change knowledge base. Key facts pertaining to temperature, precipitation, water, and food for 6 selected pathogens were scrutinized, evaluated, and compiled according to exposure pathways. These key facts (corresponding to approximately 50,000 words) were mapped to 275 terminology terms identified in the literature, which generated 6,341 connections. These relationships were plotted on semantic network maps to examine the interconnections between variables. The risk of campylobacteriosis is associated with mean weekly temperatures, although this link is shown more strongly in the literature relating to salmonellosis. Irregular and severe rain events are associated with Cryptosporidium sp. outbreaks, while noncholera Vibrio sp. displays increased growth rates in coastal waters during hot summers. In contrast, for Norovirus and Listeria sp. the association with climatic variables was relatively weak, but much stronger for food determinants. Electronic data mining to assess the impact of climate change on food- and waterborne diseases assured a methodical appraisal of the field. This climate change knowledge base can support national climate change vulnerability, impact, and adaptation assessments and facilitate the management of future threats from infectious diseases. In the light of diminishing resources for public health this approach can help balance different climate change adaptation options.

Mapping climate change vulnerabilities to infectious diseases in Europe

BACKGROUND

The incidence, outbreak frequency, and distribution of many infectious diseases are generally expected to change as a consequence of climate change, yet there is limited regional information available to guide decision making.

OBJECTIVE

We surveyed government officials designated as Competent Bodies for Scientific Advice concerning infectious diseases to examine the degree to which they are concerned about potential effects of climate change on infectious diseases, as well as their perceptions of institutional capacities in their respective countries.

METHODS

In 2007 and 2009/2010, national infectious disease experts from 30 European Economic Area countries were surveyed about recent and projected infectious disease patterns in relation to climate change in their countries and the national capacity to cope with them.

RESULTS

A large majority of respondents agreed that climate change would affect vector-borne (86% of country representatives), food-borne (70%), water-borne (68%), and rodent-borne (68%) diseases in their countries. In addition, most indicated that institutional improvements are needed for ongoing surveillance programs (83%), collaboration with the veterinary sector (69%), management of animal disease outbreaks (66%), national monitoring and control of climate-sensitive infectious diseases (64%), health services during an infectious disease outbreak (61%), and diagnostic support during an epidemic (54%).

CONCLUSIONS

Expert responses were generally consistent with the peer-reviewed literature regarding the relationship between climate change and vector- and water-borne diseases, but were less so for food-borne diseases. Shortcomings in institutional capacity to manage climate change vulnerability, identified in this assessment, should be addressed in impact, vulnerability, and adaptation assessments.

Future infectious disease threats to Europe

We examined how different drivers of infectious disease could interact to threaten control efforts in Europe. We considered projected trends through 2020 for 3 broad groups of drivers: globalization and environmental change, social and demographic change, and health system capacity. Eight plausible infectious disease threats with the potential to be significantly more problematic than they are today were identified through an expert consultation: extensively drug-resistant bacteria, vector-borne diseases, sexually transmitted infections, food-borne infections, a resurgence of vaccine-preventable diseases, health care-associated infections, multidrug-resistant tuberculosis, and pandemic influenza. Preemptive measures to be taken by the public health community to counteract these threats were identified.