Assessment of Climate-sensitive Infectious Diseases in the Federated States of Micronesia

Baseline conditions and land-based drivers of nearshore water quality in Pohnpei, Federated States of Micronesia

Pohnpei, Federated States of Micronesia, is a coral reef biodiversity hotspot. However, little water quality data are available, especially for nearshore waters. Identifying land-based pollution sources for watershed management is a priority of the government to improve water quality for their people and reefs, and it is needed before further development and climate change exacerbate conditions. We conducted an island-wide nearshore water quality survey in 2018 and 2019 to establish current conditions through nutrients, fecal indicator bacteria, stable nitrogen isotopes in nitrate and macroalgal tissue measurements. Relationships among water quality parameters and land cover were examined to identify drivers of water pollution. Sewage pollution from wastewater treatment plant infrastructure and onsite sewage disposal systems, piggeries, and dredge sites all contributed to poor water quality largely in the municipalities of Kolonia and Sokehs. NO3- + NO2-, Enterococcus spp., and δ15N-NO3- were the best indicators of sewage pollution, and the former two were positively related to urban cover. δ15N in macroalgae tissue was not a good indicator of sewage pollution because of high coastal NH4+ concentrations from mangroves. Our results will inform management actions to improve water quality, but more explicit measurements relative to pollution sources, transport mechanisms, and watershed information are needed. Our study's approach will be useful for other locations in the region grappling with nearshore water quality issues.

Investigation of the impacts of climate change and rising temperature on food poisoning cases in Malaysia

This study is an attempt to investigate climate-induced increases in morbidity rates of food poisoning cases. Monthly food poisoning cases, average monthly meteorological data, and population data from 2004 to 2014 were obtained from the Malaysian Ministry of Health, Malaysian Meteorological Department, and Department of Statistics Malaysia, respectively. Poisson generalised linear models were developed to assess the association between climatic parameters and the number of reported food poisoning cases. The findings revealed that the food poisoning incidence in Malaysia during the 11 years study period was 561 cases per 100 000 population for the whole country. Among the cases, females and the ethnic Malays most frequently experienced food poisoning with incidence rates of 313 cases per 100,000 and 438 cases per 100,000 population over the period of 11 years, respectively. Most of the cases occurred within the active age of 13 to 35 years old. Temperature gave a significant impact on the incidence of food poisoning cases in Selangor (95% CI: 1.033-1.479; p = 0.020), Melaka (95% CI: 1.046-2.080; p = 0.027), Kelantan (95% CI: 1.129-1.958; p = 0.005), and Sabah (95% CI: 1.127-2.690; p = 0.012) while rainfall was a protective factor in Terengganu (95% CI: 0.996-0.999; p = 0.034) at lag 0 month. For a 1.0°C increase in temperature, the excess risk of food poisoning in each state can increase up to 74.1%, whereas for every 50 mm increase in rainfall, the risk of getting food poisoning decreased by almost 10%. The study concludes that climate does affect the distribution of food poisoning cases in Selangor, Melaka, Kelantan, Sabah, and Terengganu. Food poisoning cases in other states are not directly associated with temperature but related to monthly trends and seasonality.

A Historical and Contemporary Review of the Contextualization and Social Determinants of Health of Micronesian Migrants in the United States

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.

The Vulnerability of Health Infrastructure to the Impacts of Climate Change and Sea Level Rise in Small Island Countries in the South Pacific

Anthropogenic climate change and related sea level rise will have a range of impacts on populations, particularly in the low lying Pacific island countries (PICs). One of these impacts will be on the health and well-being of people in these nations. In such cases, access to medical facilities is important. This research looks at the medical facilities currently located on 14 PICs and how climate change related impacts such as sea level rise may affect these facilities. The medical infrastructure in each country were located using information from a range of sources such as Ministry of Health (MoH) websites, World Health Organization, Doctors Assisting in South Pacific Islands (DAISI), Commonwealth Health Online, and Google Maps. A spatial analysis was undertaken to identify medical infrastructure located within 4 zones from the coastline of each country: 0 to 50 m, 50 to 100 m, 100 to 200 m, and 200 to 500 m. The findings indicate that 62% of all assessed medical facilities in the 14 PICs are located within 500 m of the coast. The low-lying coral atoll countries of Kiribati, Marshall Islands, Nauru, Palau, Tokelau, and Tuvalu will be highly affected as all medical facilities in these countries fall within 500 m of the coast. The results provide a baseline analysis of the threats posed by sea-level rise to existing critical medical infrastructure in the 14 PICs and could be useful for adaptive planning. These countries have limited financial and technical resources which will make adaptation challenging.

Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis

BACKGROUND

Projected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence.

OBJECTIVES

In this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature.

METHODS

To this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness.

RESULTS

A total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio ( IRR ) = 1.26 ; 95% confidence interval (CI): 1.05, 1.51], with a tendency toward an inverse association for extreme rain following wet periods, albeit nonsignificant, with one of four relevant studies showing a significant inverse association (IRR = 0.911 ; 95% CI: 0.771, 1.08). Incidences of bacterial and parasitic diarrhea were more common during rainy seasons, providing pathogen-specific support for a concentration mechanism, but rotavirus diarrhea showed the opposite association. Information on timing of cases within the rainy season (e.g., early vs. late) was lacking, limiting further analysis. We did not find a linear association between nonextreme rain exposures and diarrheal disease, but several studies found a nonlinear association with low and high rain both being associated with diarrhea.

DISCUSSION

Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.

Climate and climate-sensitive diseases in semi-arid regions: a systematic review

OBJECTIVES

We aim to describe the relationships between climate variables and climate-sensitive diseases (CSDs) in semi-arid regions, highlighting the different main groups of CSDs and their climate patterns.

METHODS

This systematic review considered Medline, Science Direct, Scopus and Web of Science. The data collection period was August and September 2019 and included studies published between 2008 and 2019. This study followed a protocol based on the PRISMA statement. Data analysis was done in a qualitative way.

RESULTS

The most of works were from Africa, Asia and Iran (71%), where temperature was the main climatic variable. Although the studies provide climatic conditions that are more favorable for the incidence of vector-borne and respiratory diseases, the influence of seasonal patterns on the onset, development and end of CSDs is still poorly understood, especially for gastrointestinal disorders. Moreover, little is known about the impact of droughts on CSDs.

CONCLUSIONS

This review summarized the state of art of the relationship between climate and CSDs in semi-arid regions. Moreover, a research agenda was provided, which is fundamental for health policy development, priority setting and public health management.

[Climate-sensitive diseases in Brazil and the world: systematic reviewEnfermedades sensibles al clima en Brasil y el mundo: revisión sistemática]

OBJECTIVE

To survey the literature regarding climate-sensitive diseases (CSD) and the impacts of climate changes on health.

METHOD

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The Lilacs, SciELO, Scopus, and PubMed databases were searched in July 2017 without temporal restrictions for articles published in in Portuguese, English and Spanish. The following search strategy was used in all databases: (climate) AND (disease) AND (sensitive).

RESULTS

The systematic review included 106 articles, most of which focused on dengue, malaria, and respiratory and cardiovascular diseases. The most commonly studied climate variables were temperature and precipitation. The studies revealed a relationship between the incidence of certain diseases, especially cardiovascular and respiratory diseases, dengue, malaria, and arboviral diseases, and climate conditions in different regions of the world. This relationship was analyzed considering both past data on the incidence of diseases and climate variables and projections regarding the future incidence of diseases according to expected climate variations. A greater number of studies was performed by authors originating from developed countries. The world regions most often studied were China, the United States, Australia, and Brazil.

CONCLUSIONS

Despite the increase in the number of published articles on this theme, a greater number of climate and environmental variables must be studied, with expansion of studies to additional regions in the world.

A systematic review of human and animal leptospirosis in the Pacific Islands reveals pathogen and reservoir diversity

BACKGROUND

The Pacific Islands have environmental conditions highly favourable for transmission of leptospirosis, a neglected zoonosis with highest incidence in the tropics, and Oceania in particular. Recent reports confirm the emergence and outbreaks of leptospirosis in the Pacific Islands, but the epidemiology and drivers of transmission of human and animal leptospirosis are poorly documented, especially in the more isolated and less developed islands.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a systematic review of human and animal leptospirosis within 25 Pacific Islands (PIs) in Polynesia, Melanesia, Micronesia, as well as Easter Island and Hawaii. We performed a literature search using four international databases for articles published between January 1947 and June 2017. We further included grey literature available on the internet. We identified 148 studies describing leptospirosis epidemiology, but the number of studies varied significantly between PIs. No data were available from four PIs. Human leptospirosis has been reported from 13 PIs, with 63% of all studies conducted in Hawaii, French Polynesia and New Caledonia. Animal leptospirosis has been investigated in 19 PIs and from 14 host species, mainly pigs (18% of studies), cattle (16%) and dogs (11%). Only 13 studies provided information on both human and animal leptospirosis from the same location. Serology results were highly diverse in the region, both in humans and animals.

CONCLUSIONS/SIGNIFICANCE

Our study suggests that, as in other tropical regions, leptospirosis is widespread in the PIs while showing some epidemiological heterogeneity. Data are scarce or absent from many PIs. Rodents, cattle, pigs and dogs are all likely to be important carriers, but the relative importance of each animal species in human infection needs to be clarified. Epidemiological surveys with appropriate sampling design, pathogen typing and data analysis are needed to improve our understanding of transmission patterns and to develop effective intervention strategies.

Temperature Variability and Gastrointestinal Infections: A Review of Impacts and Future Perspectives

The objectives of this research are to review and assess the current state of knowledge of the association between environmental temperature and gastrointestinal (GI) infections. A review of the published literature was undertaken using standard approaches. Initially, four electronic databases including Embase, Medline, Scopus, and Web of Science were chosen to retrieve studies published from 1 January 2006 to 31 December 2017 based on selected keywords used in the primary search. After the elimination of duplicates, the titles were reviewed for relevance to the principal research question. Secondly, the abstracts of titles deemed to be relevant were reviewed for significance and finally the articles were reviewed in their entirety to identify their contribution to the principal research question. Initially, 8201 articles were identified, and eight studies finally met the inclusion criteria. A secondary phase involving scrutiny of the references of key identified articles found three further studies. Consequently, 11 papers were selected for the final review. Current literature confirms a significant association between temperature and infectious gastroenteritis worldwide. Also, a most-likely non-linear correlation between rainfall and GI infections has been identified in that the rate of such infections can be increased with either high or low precipitation. Finally, some studies suggest high relative humidity may not increase the rate of GI infections and some have found it may decrease it. These findings help inform predictions of risk, particularly under future climate change scenarios.

Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak

After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.

Health Impacts of Climate Change in Pacific Island Countries: A Regional Assessment of Vulnerabilities and Adaptation Priorities

BACKGROUND

Between 2010 and 2012, the World Health Organization Division of Pacific Technical Support led a regional climate change and health vulnerability assessment and adaptation planning project, in collaboration with health sector partners, in 13 Pacific island countries-Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu, and Vanuatu.

OBJECTIVE

We assessed the vulnerabilities of Pacific island countries to the health impacts of climate change and planned adaptation strategies to minimize such threats to health.

METHODS

This assessment involved a combination of quantitative and qualitative techniques. The former included descriptive epidemiology, time series analyses, Poisson regression, and spatial modeling of climate and climate-sensitive disease data, in the few instances where this was possible; the latter included wide stakeholder consultations, iterative consensus building, and expert opinion. Vulnerabilities were ranked using a "likelihood versus impact" matrix, and adaptation strategies were prioritized and planned accordingly.

RESULTS

The highest-priority climate-sensitive health risks in Pacific island countries included trauma from extreme weather events, heat-related illnesses, compromised safety and security of water and food, vector-borne diseases, zoonoses, respiratory illnesses, psychosocial ill-health, non-communicable diseases, population pressures, and health system deficiencies. Adaptation strategies relating to these climate change and health risks could be clustered according to categories common to many countries in the Pacific region.

CONCLUSION

Pacific island countries are among the most vulnerable in the world to the health impacts of climate change. This vulnerability is a function of their unique geographic, demographic, and socioeconomic characteristics combined with their exposure to changing weather patterns associated with climate change, the health risks entailed, and the limited capacity of the countries to manage and adapt in the face of such risks. Citation: McIver L, Kim R, Woodward A, Hales S, Spickett J, Katscherian D, Hashizume M, Honda Y, Kim H, Iddings S, Naicker J, Bambrick H, McMichael AJ, Ebi KL. 2016. Health impacts of climate change in Pacific island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect 124:1707-1714; http://dx.doi.org/10.1289/ehp.1509756.