Impact of climate change on waterborne diseases

Factors Influencing Microbial Contamination of Groundwater: A Systematic Review of Field-Scale Studies

Pathogenic microorganisms released onto the soil from point or diffuse sources represent a public health concern. They can be transported by rainwater that infiltrates into subsoil and reach the groundwater where they can survive for a long time and contaminate drinking water sources. As part of the SCA.Re.S. (Evaluation of Health Risk Related to the Discharge of Wastewater on the Soil) project, we reviewed a selection of field-scale studies that investigated the factors that influenced the fate of microorganisms that were transported from the ground surface to the groundwater. A total of 24 studies published between 2003 and 2022 were included in the review. These studies were selected from the PubMed and Web of Science databases. Microbial contamination of groundwater depends on complex interactions between human activities responsible for the release of contaminants onto the soil, and a range of environmental and biological factors, including the geological, hydraulic, and moisture characteristics of the media traversed by the water, and the characteristics and the viability of the microorganisms, which in turn depend on the environmental conditions and presence of predatory species. Enterococci appeared to be more resistant in the underground environment than thermotolerant coliforms and were suggested as a better indicator for detecting microbial contamination of groundwater.

Flood-Associated, Land-to-Sea Pathogens' Transfer: A One Health Perspective

Similarly to many other countries across the globe, several floods have been recorded in Italy throughout the last few decades, including those of catastrophic magnitude that occurred in the Emilia-Romagna and Tuscany regions last May and a few weeks ago, respectively [...].

Performance of regional water purification plants during extreme weather events: three case studies from New South Wales, Australia

Climate change is altering weather patterns, which affects water supply systems globally. More frequent extreme weather events like floods, droughts, and heatwaves are impacting the availability of raw water sources that supply cities. These events can lead to less water, higher demand, and potential infrastructure damage. Water agencies and utilities must develop resilient and adaptable systems to withstand shocks and stresses. Case studies demonstrating the impact of extreme weather on water quality are important for developing resilient water supply systems. This paper documents the challenges faced by regional New South Wales (NSW) in managing water quality and supply during extreme weather events. Effective treatment processes, such as ozone treatment and adsorption, are used to maintain drinking water standards during extreme weather. Water-efficient alternatives are provided, and critical water networks are inspected to identify leaks and reduce system demand. Local government areas must collaborate and share resources to ensure that towns can cope with future extreme weather events. Systematic investigation is needed to understand system capacity and identify surplus resources to be shared when demand cannot be met. Pooling resources could benefit regional towns experiencing both floods and droughts. With expected population growth in the area, regional NSW councils will require a significant increase in water filtration infrastructure to handle increased system loading. Continuous research, regular strategy reviews, and innovative approaches are essential to ensure a secure and reliable water supply during future extreme weather events.

The Minus Approach Can Redefine the Standard of Practice of Drinking Water Treatment

Chlorine-based disinfection for drinking water treatment (DWT) was one of the 20th century's great public health achievements, as it substantially reduced the risk of acute microbial waterborne disease. However, today's chlorinated drinking water is not unambiguously safe; trace levels of regulated and unregulated disinfection byproducts (DBPs), and other known, unknown, and emerging contaminants (KUECs), present chronic risks that make them essential removal targets. Because conventional chemical-based DWT processes do little to remove DBPs or KUECs, alternative approaches are needed to minimize risks by removing DBP precursors and KUECs that are ubiquitous in water supplies. We present the "Minus Approach" as a toolbox of practices and technologies to mitigate KUECs and DBPs without compromising microbiological safety. The Minus Approach reduces problem-causing chemical addition treatment (i.e., the conventional "Plus Approach") by producing biologically stable water containing pathogens at levels having negligible human health risk and substantially lower concentrations of KUECs and DBPs. Aside from ozonation, the Minus Approach avoids primary chemical-based coagulants, disinfectants, and advanced oxidation processes. The Minus Approach focuses on bank filtration, biofiltration, adsorption, and membranes to biologically and physically remove DBP precursors, KUECs, and pathogens; consequently, water purveyors can use ultraviolet light at key locations in conjunction with smaller dosages of secondary chemical disinfectants to minimize microbial regrowth in distribution systems. We describe how the Minus Approach contrasts with the conventional Plus Approach, integrates with artificial intelligence, and can ultimately improve the sustainability performance of water treatment. Finally, we consider barriers to adoption of the Minus Approach.

Cyanobacteria and Their Metabolites in Mono- and Polidominant Shallow Eutrophic Temperate Lakes

Monodominant (one species dominates) or polidominant (multiple species dominate) cyanobacterial blooms are pronounced in productive freshwater ecosystems and pose a potential threat to the biota due to the synthesis of toxins. Seasonal changes in cyanobacteria species and cyanometabolites composition were studied in two shallow temperate eutrophic lakes. Data on cyanobacteria biomass and diversity of dominant species in the lakes were combined with chemical and molecular analyses of fifteen potentially toxin-producing cyanobacteria species (248 isolates from the lakes). Anatoxin-a, saxitoxin, microcystins and other non-ribosomal peptides formed the diverse profiles in monodominant (Planktothrix agardhii) and polidominant (Aphanizomenon gracile, Limnothrix spp. and Planktolyngbya limnetica) lakes. However, the harmfulness of the blooms depended on the ability of the dominant species to synthesize cyanometabolites. It was confirmed that P. agardhii produced a greater amount and diverse range of MCs and other NRPs. In the polidominant lake, isolates of the co-dominant A. gracile, L. planctonica and P. limnetica synthesized no or only small amounts of cyanometabolites. In general, the profile of cyanometabolites was greater in cyanobacteria isolates than in environmental samples, indicating a high potential for toxic cyanobacteria bloom.

A hot topic at the environment-health nexus: investigating the impact of climate change on infectious diseases

CLIMATE CHANGE - THE ULTIMATE CHALLENGE OF OUR TIME

COVID-19 pandemic aside, climate change is the ultimate challenge of our time. However, to date, there has been insufficient political thrust to make that much-needed climate action a reality.

CLIMATE CHANGE AND INFECTIOUS DISEASES

Infectious diseases represent only one facet of the threats arising from climate change. Direct impacts from climate change include the more frequent occurrence and increased magnitude of extreme weather events, as well as changing temperatures and precipitation patterns. For climate-sensitive infectious diseases, these changes implicate a shift in geographical and temporal distribution, seasonality, and transmission intensity.

SIZING UP THE PROBLEM

Susceptibility to the deleterious effects of climate change is a net result of the interplay of not only environmental factors, but also human, societal, and economic factors, with social inequalities being a major determinant of vulnerability. The global South is already disproportionately affected by the climate crisis. The financial capacity to pursue adaptation options is also limited and unevenly distributed.

CONCLUSIONS

Climate change-induced mortality and morbidity from both infectious and non-infectious diseases, among other adverse scenarios, are expected to rise globally in the future. The coming decade will be crucial for using all remaining opportunities to develop and implement adequate mitigation and adaptation strategies.

SARS-CoV-2, a Threat to Marine Mammals? A Study from Italian Seawaters

Zoonotically transmitted coronaviruses were responsible for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), causing the dramatic Coronavirus Disease-2019 (CoViD-19) pandemic, which affected public health, the economy, and society on a global scale. The impact of the SARS-CoV-2 pandemic permeated into our environment and wildlife as well; in particular, concern has been raised about the viral occurrence and persistence in aquatic and marine ecosystems. The discharge of untreated wastewaters carrying infectious SARS-CoV-2 into natural water systems that are home to sea mammals may have dramatic consequences on vulnerable species. The efficient transmission of coronaviruses raises questions regarding the contributions of virus-receptor interactions. The main receptor of SARS-CoV-2 is Angiotensin Converting Enzyme-2 (ACE-2), serving as a functional receptor for the viral spike (S) protein. This study aimed, through the comparative analysis of the ACE-2 receptor with the human one, at assessing susceptibility to SARS-CoV-2 for different species of marine mammals living in Italian waters. We also determined, by means of immunohistochemistry, ACE-2 receptor localization in the lung tissue from different cetacean species, in order to provide a preliminary characterization of ACE-2 expression in the marine mammal respiratory tracts. Furthermore, to evaluate if and how Italian wastewater management and coastal exposition to extreme weather events may led to susceptible marine mammal populations being exposed to SARS-CoV-2, geomapping data were carried out and overlapped. The results showed the potential SARS-CoV-2 exposure for marine mammals inhabiting Italian coastal waters, putting them at risk when swimming and feeding in specific risk areas. Thus, we highlighted the potential hazard of the reverse zoonotic transmission of SARS-CoV-2 infection, along with its impact on marine mammals regularly inhabiting the Mediterranean Sea, while also stressing the need for appropriate action in order to prevent further damage to specific vulnerable populations.

In Vivo and In Vitro Toxicity Testing of Cyanobacterial Toxins: A Mini-Review

Harmful cyanobacterial blooms are increasing and becoming a worldwide concern as many bloom-forming cyanobacterial species can produce toxic metabolites named cyanotoxins. These include microcystins, saxitoxins, anatoxins, nodularins, and cylindrospermopsins, which can adversely affect humans, animals, and the environment. Different methods to assess these classes of compounds in vitro and in vivo include biological, biochemical, molecular, and physicochemical techniques. Furthermore, toxic effects not attributable to known cyanotoxins can be observed when assessing bloom material. In order to determine exposures to cyanotoxins and to monitor compliance with drinking and bathing water guidelines, it is necessary to have reliable and effective methods for the analysis of these compounds. Many relatively simple low-cost methods can be employed to rapidly evaluate the potential hazard. The main objective of this mini-review is to describe the assessment of toxic cyanobacterial samples using in vitro and in vivo bioassays. Newly emerging cyanotoxins, the toxicity of analogs, or the interaction of cyanobacteria and cyanotoxins with other toxicants, among others, still requires bioassay assessment. This review focuses on some biological and biochemical assays (MTT assay, Immunohistochemistry, Micronucleus Assay, Artemia salina assay, Daphnia magna test, Radionuclide recovery, Neutral red cytotoxicity and Comet assay, Enzyme-Linked Immunosorbent Assay (ELISA), Annexin V-FITC assay and Protein Phosphatase Inhibition Assay (PPIA)) for the detection and measurement of cyanotoxins including microcystins, cylindrospermopsins, anatoxin-a, saxitoxins, and nodularins. Although most bioassay analyses often confirm the presence of cyanotoxins at low concentrations, such bioassays can be used to determine whether some strains or blooms of cyanobacteria may produce other, as yet unknown toxic metabolites. This review also aims to identify research needs and data gaps concerning the toxicity assessment of cyanobacteria.

Influence of weather and climate on cryptosporidiosis-A review

Studies have shown that climatic factors can significantly influence transmission of many waterborne diseases. However, knowledge of the impact of climate variability on cryptosporidiosis is much less certain. Associations between the incidence of cryptosporidiosis and climatic variables have been reported in several countries. Given that the identified relationships were not consistently reported across studies, it is not known whether these were country-specific observations or can be considered more globally. Variation in the disease risk in both low- and middle-income countries and high-income countries presents new challenges and opportunities to enact responsive changes in research and public health policies. Available epidemiological evidence of the influence of weather and climate on cryptosporidiosis is reviewed. Fourteen studies met the inclusion criteria, and most studies showed that the incidence of cryptosporidiosis is highly sensitive to climatic conditions, especially temperature, rainfall and relative humidity. The identified associations varied across studies, with different conditions of importance and lag times across different locations. Therefore, there is a need for countries at risk to assess Cryptosporidium transmission routes based on the spatiotemporal patterns of the disease and what role climate and other socio-ecological changes play in the transmission. Information gathering will then allow us to provide information for evidence-based control strategies and mitigation of transmission. This review offers new perspectives on the role of climate variability on Cryptosporidium transmission. It highlights different epidemiological approaches adopted and provides the potential for future research and surveillance to reduce the disease burden. By evaluating the epidemiological transmission of this organism in high-income countries, all mitigation strategies, for example filtration and water catchment management, can be used as exemplars of preventing infection in low- to middle-income countries.

Climate Change, Water Quality and Water-Related Challenges: A Review with Focus on Pakistan

Climate variability is heavily impacting human health all around the globe, in particular, on residents of developing countries. Impacts on surface water and groundwater resources and water-related illnesses are increasing, especially under changing climate scenarios such as diversity in rainfall patterns, increasing temperature, flash floods, severe droughts, heatwaves and heavy precipitation. Emerging water-related diseases such as dengue fever and chikungunya are reappearing and impacting on the life of the deprived; as such, the provision of safe water and health care is in great demand in developing countries to combat the spread of infectious diseases. Government, academia and private water bodies are conducting water quality surveys and providing health care facilities, but there is still a need to improve the present strategies concerning water treatment and management, as well as governance. In this review paper, climate change pattern and risks associated with water-related diseases in developing countries, with particular focus on Pakistan, and novel methods for controlling both waterborne and water-related diseases are discussed. This study is important for public health care, particularly in developing countries, for policy makers, and researchers working in the area of climate change, water quality and risk assessment.

Hygienic Condition of Different Water Sources in the Kharaa River Basin, Mongolia in the Light of a Rapid Warming Trend

Mongolia is a water-scarce land-locked country, and available water resources are utilized for multiple purposes including irrigation, food preparation, drinking water for livestock and people. Limited data availability on water hygiene means that the related risks to public health are only partially understood. This is particularly problematic due to the widespread use of unimproved water sources such as surface water and water from simple shallow wells. Based on two field surveys in the Kharaa River Basin in spring 2017 and 2018, we assessed the presence and quantity of total coliforms (TC), fecal coliforms (FC), and E. coli bacteria in surface waters and wells and investigated potential linkages between temperature and hygiene. In the Kharaa River and its tributaries, TC concentrations averaged at a most probable number of (MPN) of 754 ± 761 per 100 mL and FC concentrations at an MPN of 31 ± 33. Only small and non-significant correlations between coliform concentrations and temperature were identified. Coliforms concentrations in wells were lower (average MPN for TC: 550 ± 1286, and for FC 58 ± 253). There was considerable variation between wells, with moderate but significant correlations between temperature and bacterial counts. Low water temperatures in April and May (just above freezing to less than 6.5 °C in wells and 7.5 °C to 14.5 °C in the river system) and the positive correlations between temperature and coliform concentrations particularly for well samples indicate that further warming is likely to increase the risks of microbiological water pollution. In the future, this should be complemented by modeling at a watershed scale. This should include the consideration of a trend towards stronger rainfall events, changes in livestock density, and urban sewage treatment and discharge, which are other likely drivers of changes in water hygiene.

Are There Seasonal Variations in Faecal Contamination of Exposure Pathways? An Assessment in a Low-Income Settlement in Uganda

Sanitation infrastructure are not able to cope with the increasing population in low-income countries, which leaves populations exposed to faecal contamination from multiple pathways. This study evaluated public health risk (using SaniPath) in a low-income community during the dry season, to identify the dominant exposure pathways, and compare this data to existing data for the rainy season, questioning the assumption that risk of faecal contamination is higher in the rainy season. SaniPath was used to collect and assess exposure and environmental data, and to generate risk profiles for each pathway. In the dry season the highest exposure frequency was for bathing and street food, exposure frequency generally increased, and seasonal variation was found in five pathways. The highest hazards in the dry season were through contact with drains, soil, and street food. Seasonal variation was found in the contamination of open drains and street food, with higher levels of Escherichia coli (E. coli) in the dry season. Open drains were identified as the most dominant risk pathway in both seasons, but risk was higher in the dry season. This highlights the complex nature of seasonal variation of faecal risk, and questions the assumption that risk is higher in the rainy season.

Climate change on YouTube: A potential platform for youth learning

Background: Climate change is one of the most critical threats to our society. The purpose of this cross-sectional study was to describe the content of the most viewed climate change videos on YouTube.

Methods: The term "climate change" was used to search on YouTube to garner a sample of the 100most widely-viewed videos. Videos in a language other than English, or considered irrelevant, were excluded. Using a fact sheet from National Aeronautics and Space Administration, content categories were created and successively coded.

Results: The mean number of views for the 100 videos evaluated was 231,140.2 views (SD=718, 399.5) and the mean length was 12.1 minutes (SD= 24.1). Most videos were uploaded by a news source (77.0%), included a belief that climate change is happening (77.0%), and mentioned the impact of climate change on the environment (71.0%). Only one-third of the videos mentioned how to prevent climate change (33.0%). More than half focused on a specific environment and, of those, 47.2% specifically focused on cities. Compared to videos that did not focus on a specific environment, the videos with an environmental focus were more often intended for adults (87.3% vs. 53.3%, P≤0.001).

Conclusion: This study highlights the need for climate change YouTube videos intended for youth. Targeting youth may lead to engagement of younger generations in climate change discourse and inspire climate action. Further research is needed to determine the effectiveness of YouTube as a platform for educational videos on climate change.

A REVIEW OF WATER QUALITY RESPONSES TO AIR TEMPERATURE AND PRECIPITATION CHANGES 1: FLOW, WATER TEMPERATURE, SALTWATER INTRUSION

Anticipated future increases in air temperature and regionally variable changes in precipitation will have direct and cascading effects on U.S. water quality. In this paper, and a companion paper by Coffey et al. (2019), we review technical literature addressing the responses of different water quality attributes 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. Here we focus on potential changes in streamflow, water temperature, and salt water intrusion (SWI). Projected changes in the volume and timing of streamflow vary regionally, with general increases in northern and eastern regions of the U.S., and decreases in the southern Plains, interior Southwest and parts of the Southeast. Water temperatures have increased throughout the U.S. and are expected to continue to increase in the future, with the greatest changes in locations where high summer air temperatures occur together with low streamflow volumes. In coastal areas, especially the mid-Atlantic and Gulf coasts, SWI to rivers and aquifers could be exacerbated by sea level rise, storm surges, and altered freshwater runoff. Management responses for reducing risks to water quality should consider strategies and practices robust to a range of potential future conditions.

First report of Salmonella 1,4,[5],12:i:- in free-ranging striped dolphins (Stenella coeruleoalba), Italy

Between 2015 and the beginning of 2018 (January-March), 30 cetaceans were found stranded along the Ligurian Sea coast of Italy. Necropsies were performed in 22 cases and infectious diseases resulted the most common cause of death. Three striped dolphins, showed a severe coinfection involving the monophasic variant of Salmonella Typhimurium (Salmonella 1,4,[5],12:i:-). The isolates were characterized based on antimicrobial resistance, Multiple-Locus Variable-number tandem-repeat Analysis (MLVA) and whole-genome sequencing (WGS). All isolates demonstrated the same multidrug resistant genotype (ASSuT isolates), showed three different MLVA profiles, two of which closely related, and were identified as Sequence Type 34. Moreover, Single nucleotide polymorphisms (SNP) analysis confirmed strong correlations between two out of the three isolates. To our knowledge, S. 1,4,[5],12:i:-, one of the most common serovars in cases of human infection and food sources worldwide, has not previously been described in marine mammals, and reports of Salmonella-associated disease in free-ranging cetaceans are rare. These results highlight the role of cetaceans as sentinel species for zoonotic and terrestrial pathogens in the marine environment, suggest a potential risk for cetaceans and public health along the North Western Italian coastline and indicate cetaceans as a novel potential reservoir for one of the most widespread Salmonella serovars.

Neurotoxin BMAA and its isomeric amino acids in cyanobacteria and cyanobacteria-based food supplements

Cyanobacteria are photosynthetic microorganisms distributed globally in aquatic and terrestrial environments. They are also industrially cultivated to be used as dietary supplements, as they have a high nutritional value; however, they are also known to produce a wide range of toxic secondary metabolites, called cyanotoxins. BMAA (β-methylamino-l-alanine) and its most common structural isomers, DAB (2,4-diaminobutyric acid) and AEG (N-2-aminoethylglycine) produced by cyanobacteria, are non-proteinogenic amino acids that have been associated with neurodegenerative diseases. A possible route of exposure to those amino acids is through consumption of food supplements based on cyanobacteria. The review critically discusses existing reports regarding the occurrence of BMAA, DAB and AEG in cyanobacteria and cyanobacteria-based food supplements. It is shown that inconsistencies in reported results could be attributed to performance of different methods of extraction and analysis applied and in ambiguities regarding determination of soluble and bound fractions of the compounds. The critical aspect of this review aims to grow awareness of human intake of neurotoxic amino acids, while results presented in literature concerning dietary supplements aim to promote further research, quality control as well as development of guidelines for cyanotoxins in food products.

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.

Microcystin-leucine arginine (MC-LR) induces bone loss and impairs bone micro-architecture by modulating host immunity in mice: Implications for bone health

Osteoporosis or enhanced bone loss is one of the most commonly occurring bone conditions in the world, responsible for higher incidence of fractures leading to increased morbidity and mortality in adults. Bone loss is affected by various environmental factors including diet, age, drugs, toxins etc. Microcystins are toxins produced by cyanobacteria with microcystin-LR being the most abundantly found around the world effecting both human and animal health. The present study demonstrates that MC-LR treatment induces bone loss and impairs both trabecular and cortical bone microarchitecture along with decreasing the mineral density and heterogeneity of bones in mice. This effect of MC-LR was found due to its immunomodulatory effects on the host immune system, wherein MC-LR skews both T cell (CD4⁺ and CD8⁺ T cells) and B cell populations in various lymphoid tissues. MC-LR further was found to significantly enhance the levels of osteoclastogenic cytokines (IL-6, IL-17 and TNF-α) along with simultaneously decreasing the levels of anti-osteoclastogenic cytokines (IL-10 and IFN-γ). Taken together, our study for the first time establishes a direct link between MC-LR intake and enhanced bone loss thereby giving a strong impetus to the naïve field of "osteo-toxicology", to delineate the effects of various toxins (including cyanotoxins) on bone health.

Vulnerability of global food production to extreme climatic events

It is known that the frequency, intensity or duration of the extreme climatic events have been changing substantially. The ultimate goal of this study was to identify current vulnerabilities of global primary food production against extreme climatic events, and to discuss potential entry points for adaptation planning by means of an explorative vulnerability analysis. Outcomes of this analysis were demonstrated as a composite index where 118 country performances in maintaining safety of food production were compared and ranked against climate change. In order to better interpret the results, cluster analysis technique was used as a tool to group the countries based on their vulnerability index (VI) scores. Results suggested that one sixth of the countries analyzed were subject to high level of exposure (0.45-1), one third to high to very high level of sensitivity (0.41-1) and low to moderate level of adaptive capacity (0-0.59). Proper adaptation strategies for reducing the microbial and chemical contamination of food products, soil and waters on the field were proposed. Finally, availability of data on food safety management systems and occurrence of foodborne outbreaks with global coverage were proposed as key factors for improving the robustness of future vulnerability assessments.

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.

Understanding Perceptions of Climate Change, Priorities, and Decision-Making among Municipalities in Lima, Peru to Better Inform Adaptation and Mitigation Planning

Climate change poses multiple risks to the population of Lima, the largest city and capital of Peru, located on the Pacific coast in a desert ecosystem. These risks include increased water scarcity, increased heat, and the introduction and emergence of vector-borne and other climate sensitive diseases. To respond to these threats, it is necessary for the government, at every level, to adopt more mitigation and adaptation strategies. Here, focus groups were conducted with representatives from five Lima municipalities to determine priorities, perception of climate change, and decision-making processes for implementing projects within each municipality. These factors can affect the ability and desire of a community to implement climate change adaptation and mitigation strategies. The results show that climate change and other environmental factors are of relatively low priority, whereas public safety and water and sanitation services are of highest concern. Perhaps most importantly, climate change is not well understood among the municipalities. Participants had trouble distinguishing climate change from other environmental issues and did not fully understand its causes and effects. Greater understanding of what climate change is and why it is important is necessary for it to become a priority for the municipalities. Different aspects of increased climate change awareness seem to be connected to having experienced extreme weather events, whether related or not to climate change, and to higher socioeconomic status.

Estimating the microbiological risks associated with inland flood events: Bridging theory and models of pathogen transport

Flooding is known to facilitate infectious disease transmission, yet quantitative research on microbiological risks associated with floods has been limited. Pathogen fate and transport models provide a framework to examine interactions between landscape characteristics, hydrology, and waterborne disease risks, but have not been widely developed for flood conditions. We critically examine capabilities of current hydrological models to represent unusual flow paths, non-uniform flow depths, and unsteady flow velocities that accompany flooding. We investigate the theoretical linkages between hydrodynamic processes and spatio-temporally variable suspension and deposition of pathogens from soils and sediments; pathogen dispersion in flow; and concentrations of constituents influencing pathogen transport and persistence. Identifying gaps in knowledge and modeling practice, we propose a research agenda to strengthen microbial fate and transport modeling applied to inland floods: 1) development of models incorporating pathogen discharges from flooded sources (e.g., latrines), effects of transported constituents on pathogen persistence, and supply-limited pathogen transport; 2) studies assessing parameter identifiability and comparing model performance under varying degrees of process representation, in a range of settings; 3) development of remotely sensed datasets to support modeling of vulnerable, data-poor regions; and 4) collaboration between modelers and field-based researchers to expand the collection of useful data in situ.

Association between climate factors and diarrhoea in a Mekong Delta area

The Mekong Delta is vulnerable to changes in climate and hydrological events which alter environmental conditions, resulting in increased risk of waterborne diseases. Research exploring the association between climate factors and diarrhoea, the most frequent waterborne disease in Mekong Delta region, is sparse. This study evaluated the climate-diarrhoea association in Can Tho city, a typical Mekong Delta area in Vietnam. Climate data (temperature, relative humidity, and rainfall) were obtained from the Southern Regional Hydro-Meteorological Centre, and weekly counts of diarrhoea visits were obtained from Can Tho Preventive Medicine Centre from 2004 to 2011. Analysis of climate and health variables was carried out using spline function to adjust for seasonal and long-term trends of variables. A distributed lag model was used to investigate possible delayed effects of climate variables on diarrhoea (considering 0-4 week lag periods), then the multivariate Poisson regression was used to examine any potential association between climate factors and diarrhoea. The results indicated that the diarrhoea incidence peaked within the period August-October annually. Significant positive associations were found between increased diarrhoea and high temperature at 4 weeks prior to the date of hospital visits (IRR = 1.07; 95 % CI = 1.04-1.08), high relative humidity (IRR = 1.13; 95 % CI = 1.12-1.15) and high (>90th percentile) cumulative rainfall (IRR = 1.05; 95 % CI = 1.05-1.08). The association between climate factors and diarrhoea was stronger in rural than urban areas. These findings in the context of the projected changes of climate conditions suggest that climate change will have important implications for residential health in Mekong Delta region.

Assessment of the health impacts of climate change in Kiribati

Kiribati-a low-lying, resource-poor Pacific atoll nation-is one of the most vulnerable countries in the World to the impacts of climate change, including the likely detrimental effects on human health. We describe the preparation of a climate change and health adaptation plan for Kiribati carried out by the World Health Organization and the Kiribati Ministry of Health and Medical Services, including an assessment of risks to health, sources of vulnerability and suggestions for highest priority adaptation responses. This paper identifies advantages and disadvantages in the process that was followed, lays out a future direction of climate change and health adaptation work in Kiribati, and proposes lessons that may be applicable to other small, developing island nations as they prepare for and adapt to the impacts of climate change on health.