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El Niño en las Américas: Proteger la salud y promover la resiliencia

Guidance Notes on Prevention of Heat Stroke at Work

Climate change and health resilience actions in São Tomé and Príncipe

EU/CARIFORUM Caribbean Climate Change and Health Leaders Fellowship Training Program

Human Climate Horizons (HCH)

The impact of climate change on neglected tropical diseases: A systematic review

Neglected tropical diseases (NTDs) are a diverse group of diseases that continue to affect >1 billion people, with these diseases disproportionately impacting vulnerable populations and territories. Climate change is having an increasing impact on public health in tropical and subtropical areas and across the world and can affect disease distribution and transmission in potentially diverse ways. Improving our understanding of how climate change influences NTDs can help identify populations at risk to include in future public health interventions. Articles were identified by searching electronic databases for reports of climate change and NTDs between 1 January 2010 and 1 March 2020. Climate change may influence the emergence and re-emergence of multiple NTDs, particularly those that involve a vector or intermediate host for transmission. Although specific predictions are conflicting depending on the geographic area, the type of NTD and associated vectors and hosts, it is anticipated that multiple NTDs will have changes in their transmission period and geographic range and will likely encroach on regions and populations that have been previously unaffected. There is a need for improved surveillance and monitoring to identify areas of NTD incursion and emergence and include these in future public health interventions.

Towards the comprehension of fasciolosis (re-)emergence: An integrative overview

The increasing distribution and prevalence of fasciolosis in both human and livestock are concerning. Here, we examine the various types of factors influencing fasciolosis transmission and burden and the interrelations that may exist between them. We present the arsenal of molecules, ‘adjusting’ capabilities and parasitic strategies of Fasciola to infect. Such features define the high adaptability of Fasciola species for parasitism that facilitate their transmission. We discuss current environmental perturbations (increase of livestock and land use, climate change, introduction of alien species and biodiversity loss) in relation to fasciolosis dynamics. As Fasciola infection is directly and ultimately linked to livestock management, living conditions and cultural habits, which are also changing under the pressure of globalization and climate change, the social component of transmission is also discussed. Lastly, we examine the implication of increasing scientific and political awareness in highlighting the current circulation of fasciolosis and boosting epidemiological surveys and novel diagnostic techniques. From a joint perspective, it becomes clear that factors weight differently at each place and moment, depending on the biological, environmental, social and political interrelating contexts. Therefore, the analyses of a disease as complex as fasciolosis should be as integrative as possible to dissect the realities featuring each epidemiological scenario. Such a comprehensive appraisal is presented in this review and constitutes its main asset to serve as a fresh integrative understanding of fasciolosis.

Temperature dependent viral tropism: Understanding viral seasonality and pathogenicity as applied to the avoidance and treatment of endemic viral respiratory illnesses

This review seeks to explain three features of viral respiratory illnesses that have perplexed generations of virologists: (1) the seasonal timing of respiratory illness and the rapid response of outbreaks to weather, specifically temperature; (2) the common viruses causing respiratory illness worldwide, including year-round disease in the Tropics; (3) the rapid arrival and termination of epidemics caused by influenza and other viruses. The inadequacy of the popular explanations of seasonality is discussed, and a simple hypothesis is proposed, called temperature dependent viral tropism (TDVT), that is compatible with the above features of respiratory illness. TDVT notes that viruses can spread more effectively if they moderate their pathogenicity (thereby maintaining host mobility) and suggests that endemic respiratory viruses accomplish this by developing thermal sensitivity within a range that supports organ-specific viral tropism within the human body, whereby they replicate most rapidly at temperatures below body temperature. This can confine them to the upper respiratory tract and allow them to avoid infecting the lungs, heart, gut etc. Biochemical and tissue-culture studies show that ‘wild’ respiratory viruses show such natural thermal sensitivity. The typical early autumn surge of colds and the occurrence of respiratory illness in the Tropics year-round at intermediate levels are explained by the tendency for strains to adapt their thermal sensitivity to their local climate and season. TDVT has important practical implications for preventing and treating respiratory illness including Covid-19. It is testable with many options for experiments to increase our understanding of viral seasonality and pathogenicity.

Lymphatic filariasis in Asia: A systematic review and meta-analysis

Lymphatic filariasis (LF) is an important neglected parasitic disease according to the World Health Organization. In this study, we aimed to determine the prevalence of human LF in Asia using a systematic review and meta-analysis approach. Records from 1990 to 2018 in reputable databases including PubMed, Science Direct, Embase, and Cochrane Library were searched using a panel of related keywords. All 48 countries of Asia were searched one by one in combination with the keywords. In all, 41,742 cases identified in this study were included in the analysis. According to our findings, the pooled prevalence of LF in Asia was estimated at 3% (95% CI: [1.7, 5.2]). There was no major trend in the cumulative prevalence of LF over time. Some countries in Asia including China, Japan, Vietnam, and South Korea succeeded in eliminating LF as a public health problem, but others still need to monitor the disease. Based on the initiative of the WHO starting in 2000, some countries in Asia succeeded in eliminating LF as a public health problem. Other countries have taken steps to eliminate the disease with variable degrees of success. These efforts might be affected by issues such as climate change.

Minireview: Epidemiological impact of arboviral diseases in Latin American countries, arbovirus-vector interactions and control strategies

Mosquitoes are the most crucial insects in public health due to their vector capacity and competence to transmit pathogens, including arboviruses, bacterias and parasites. Re-emerging and emerging arboviral diseases, such as yellow fever virus (YFV), dengue virus (DENV), zika virus (ZIKV), and chikungunya virus (CHIKV), constitute one of the most critical health public concerns in Latin America. These diseases present a significant incidence within the human settlements increasing morbidity and mortality events. Likewise, among the different genus of mosquito vectors of arboviruses, those of the most significant medical importance corresponds to Aedes and Culex. In Latin America, the mosquito vector species of YFV, DENV, ZIKV, and CHIKV are mainly Aedes aegypti and Ae. Albopictus. Ae. aegypti is recognized as the primary vector in urban environments, whereas Ae. albopictus, recently introduced in the Americas, is more prone to rural settings. This minireview focuses on what is known about the epidemiological impact of mosquito-borne diseases in Latin American countries, with particular emphasis on YFV, DENV, ZIKV and CHIKV, vector mosquitoes, geographic distribution, and vector-arbovirus interactions. Besides, it was analyzed how climate change and social factors have influenced the spread of arboviruses and the control strategies developed against mosquitoes in this continent.

Climate beast: A potential threat for repercussions of disease status in Pakistan

Pakistan is amongst the developing countries, which have been strongly affected by several emerging and re-emerging disease outbreaks as a consequence of climate change. Various studies have clearly demonstrated the impact of climate change on human health in Pakistan. This has increased the rate of morbidity and mortality, related not only to vector-borne, water-borne and food-borne diseases but has also contributed to the prevalence of neurological, cardiovascular and respiratory disorders. It is therefore important to take adequate measurements for water management and improve sanitary conditions especially in case of natural disasters. In order to effectively control the emerging and re-emerging infections in the country, an early, more Rigorous response is required, by the national health department, to monitor and evaluate the spread of infections in future. Therefore, precise planning and management strategies should be defined in order to circumvent the damage caused by the natural disasters associated with climate changes. This mini-review gives an overview about the public health issues associated with environmental change with special reference to Pakistan. This will provide a baseline for policymakers to develop public health surveillance programs in Pakistan.

Arbovirus rash in the febrile returning traveler as a diagnostic clue

PURPOSE OF REVIEW: This review aims to describe briefly the general information of arboviruses dengue, Zika, and chikungunya infections and emphasize the clinical manifestations of each, to help identify and make a quick diagnosis of each. RECENT FINDINGS: The most relevant advances in the study of these arboviruses’ infections have been in the epidemiological distribution, mainly due to international travel, migration, and climate change; in the clinical manifestations of these diseases, the development of clinical decision-making software, which can help improve the management and outcomes of these patients; and in the prevention of this disease. SUMMARY: Although arboviruses infections constitute a clinical challenge for the attending physician in the scope of a febrile returning traveler, a thorough clinical history and exam can help to aid diagnostic reasoning. The characteristics of the rash are a very helpful clue in the evaluation of these patients. Currently, there are clinical decision aid tools that help to get the diagnosis more quickly.

Association between floods and the risk of dysentery in China: A meta-analysis

The association between floods and the risk of dysentery remain controversial. Therefore, we performed a meta-analysis to clarify this relationship. A literature search was performed in PubMed, Web of science, and Embase for relevant articles published up to November 2019. Random-effects model was used to pool relative risks with 95% confidence intervals. The sensitivity analysis was carried out to evaluate the stability of the results. Publication bias was estimated using Egger’s test. Eleven studies from 10 articles evaluated the association between floods and the risk of dysentery in China. The pooled RR (95% CI) of dysentery for the flooded time versus non-flooded period was 1.48 (95% CI: 1.14-1.91). Significant association was found in subgroup analysis stratified by dysentery styles [dysentery: 1.61 (95% CI: 1.34-1.93) and bacillary dysentery: 1.46 (95% CI: 1.06-2.01)]. The pooled RR (95%CI) of sensitivity analysis for dysentery was 1.26 (95% CI: 1.05-1.52). No significant publication bias was found in our meta-analysis. This meta-analysis confirms that floods have significantly increased the risk of dysentery in China. Our findings will provide more evidence to reduce negative health outcomes of floods in China.

When climate turns nasty, what are recent and future implications? Ecological and human health review of climate change impacts

Purpose of Review The impacts of climate change on biodiversity in the last three decades have increasingly assumed from significant to threatening proportions and this causes major global concerns. This study aims at examining the recent and future impacts of global climate change on both ecological resources and human well-being. This review study is based on the general concept of ecological resilience: that coping with climate change stresses and disturbances depends on social resilience, political and environmental strategies accessible in a community. The study assessed over 300 peer-reviewed publications, both articles and books, which linked climate change impacts on ecosystems to social/health resilience of people in the specific regions. Publications on that were focused on general impacts of climate change on global ecology, ecosystem distribution shifts and phenology change; the ecological and social/health resilience, in the tropic and polar regions, were reviewed. Recent Findings The major finding of this study is that there is considerable variation in magnitudes and patterns of responses to climate change in different regions, even with an overall review of scientific studies on the global ecosystem and human health. Despite this, what is obvious is that change in the ecosystem in Polar Regions will continue to have significant impacts on the global environment, flora, fauna and ultimately human well-being. There are many uncertainties, though, on the possible effects of climate change ecosystem and soils and their severe biological, social, cultural and economic consequences. Notwithstanding these uncertainties, the impacts of climate change on both ecosystem and human socio-cultural activities are very likely to become even more widespread in the near future.

The rise or fall of neglected tropical diseases in East Asia Pacific

While the East Asia Pacific (EAP) region has experienced tremendous economic growth and development, the resulting public health gains from reductions in its neglected tropical diseases (NTDs) have been less than expected due to opposing forces of urbanization, political instability, food insecurity, and climate change, together with co-morbidities with non-communicable diseases, including diabetes and hypertension. To be sure there’s been progress towards the elimination of lymphatic filariasis and trachoma through mass drug administration, and there are opportunities to extend MDA to yaws and scabies, but for most of the other NTDs we’ll require new biotechnologies. So far, EAP’s major technology hubs in China, Japan, Malaysia, Singapore, South Korea, and Taiwan have mostly failed to shift their attention towards new innovations for the NTDs, including new drugs, diagnostics, and vaccines, and vector control. Unless this situation changes the EAP could be facing a new grim reality of unhealthy megacities beset by emerging arbovirus infections, widespread antimicrobial resistance, and urban helminth infections.

Transmission dynamics of dengue and chikungunya in a changing climate: Do we understand the eco-evolutionary response?

INTRODUCTION: We are witnessing an alarming increase in the burden and range of mosquito-borne arboviral diseases. The transmission dynamics of arboviral diseases is highly sensitive to climate and weather and is further affected by non-climatic factors such as human mobility, urbanization, and disease control. As evidence also suggests, climate-driven changes in species interactions may trigger evolutionary responses in both vectors and pathogens with important consequences for disease transmission patterns. AREAS COVERED: Focusing on dengue and chikungunya, we review the current knowledge and challenges in our understanding of disease risk in a rapidly changing climate. We identify the most critical research gaps that limit the predictive skill of arbovirus risk models and the development of early warning systems, and conclude by highlighting the potentially important research directions to stimulate progress in this field. EXPERT OPINION: Future studies that aim to predict the risk of arboviral diseases need to consider the interactions between climate modes at different timescales, the effects of the many non-climatic drivers, as well as the potential for climate-driven adaptation and evolution in vectors and pathogens. An important outcome of such studies would be an enhanced ability to promulgate early warning information, initiate adequate response, and enhance preparedness capacity.

Urban design parameters for heat mitigation in tropics

According to United Nations, cities situated in the tropical belt occupy only 36% of the Earth’s surface yet account for 1/3 of the entire global population. The increasing number of compact dense cities and the rapid population growth in the tropics have also been accompanied by increased urban air temperature. Increased air temperature is often associated with heat waves, and increased energy consumption. Therefore, the urban heat island (UHI) phenomenon and thermal stress have received much research attention and, as a result, the establishment of heat mitigation technologies has become critical. Although studies on urban climate in the tropics have shown progress, the situation in these areas remains complex and warrants further investigation. Accordingly, this paper examines the available heat mitigation techniques and their effectiveness in tropical areas from five perspectives, namely, shading (modifications in urban geometry), urban ventilation (street orientation, sun, and wind), urban greening (green roofs, trees, parks, and walls), albedo, and water bodies. This review paper showed that adopting a combination of mitigation approaches is the most effective method in reducing temperature in tropical cities. The use of shading and/or urban ventilation has also been proven to be more promising than the extensive use of vegetation, water bodies, or albedo modifications in reducing air temperature in tropical cities, where there is already a high level of humidity exists. Some key planning actions to combat UHI and thermal discomfort in tropical areas are eventually provided that can help urban planners integrate urban climatic knowledge into their practices.

The effect of climate change and the Snail-Schistosome Cycle in transmission and bio-control of Schistosomiasis in Sub-Saharan Africa

In the next century, global warming, due to changes in climatic factors, is expected to have an enormous influence on the interactions between pathogens and their hosts. Over the years, the rate at which vector-borne diseases and their transmission dynamics modify and develop has been shown to be highly dependent to a certain extent on changes in temperature and geographical distribution. Schistosomiasis has been recognized as a tropical and neglected vector-borne disease whose rate of infection has been predicted to be elevated worldwide, especially in sub-Saharan Africa; the region currently with the highest proportion of people at risk, due to changes in climate. This review not only suggests the need to develop an efficient and effective model that will predict Schistosoma spp. population dynamics but seeks to evaluate the effectiveness of several current control strategies. The design of a framework model to predict and accommodate the future incidence of schistosomiasis in human population dynamics in sub-Saharan Africa is proposed. The impact of climate change on schistosomiasis transmission as well as the distribution of several freshwater snails responsible for the transmission of Schistosoma parasites in the region is also reviewed. Lastly, this article advocates for modelling several control mechanisms for schistosomiasis in sub-Saharan Africa so as to tackle the re-infection of the disease, even after treating infected people with praziquantel, the first-line treatment drug for schistosomiasis.

Schistosomiasis and climate change

Reviewing estimates of the basic reproduction number for dengue, Zika and chikungunya across global climate zones

BACKGROUND: Globally, dengue, Zika virus, and chikungunya are important viral mosquito-borne diseases that infect millions of people annually. Their geographic range includes not only tropical areas but also sub-tropical and temperate zones such as Japan and Italy. The relative severity of these arboviral disease outbreaks can vary depending on the setting. In this study we explore variation in the epidemiologic potential of outbreaks amongst these climatic zones and arboviruses in order to elucidate potential reasons behind such differences. METHODOLOGY: We reviewed the peer-reviewed literature (PubMed) to obtain basic reproduction number (R(0)) estimates for dengue, Zika virus, and chikungunya from tropical, sub-tropical and temperate regions. We also computed R(0) estimates for temperate and sub-tropical climate zones, based on the outbreak curves in the initial outbreak phase. Lastly we compared these estimates across climate zones, defined by latitude. RESULTS: Of 2115 studies, we reviewed the full text of 128 studies and included 65 studies in our analysis. Our results suggest that the R(0) of an arboviral outbreak depends on climate zone, with lower R(0) estimates, on average, in temperate zones (R(0) = 2.03) compared to tropical (R(0) = 3.44) and sub-tropical zones (R(0) = 10.29). The variation in R(0) was considerable, ranging from 0.16 to 65. The largest R(0) was for dengue (65) and was estimated by the Ross-Macdonald model in the tropical zone, whereas the smallest R(0) (0.16) was for Zika virus and was estimated statistically from an outbreak curve in the sub-tropical zone. CONCLUSIONS: The results indicate climate zone to be an important determinant of the basic reproduction number, R(0), for dengue, Zika virus, and chikungunya. The role of other factors as determinants of R(0), such as methods, environmental and social conditions, and disease control, should be further investigated. The results suggest that R(0) may increase in temperate regions in response to global warming, and highlight the increasing need for strengthening preparedness and control activities.

NTDs in the age of urbanization, climate change, and conflict: Karachi, Pakistan as a case study

Mosquito-borne viral diseases in the Democratic Republic of the Congo: A review

BACKGROUND: Mosquito-borne viral infections have in recent years, become a public health threat globally. This review aimed to provide an overview of the ecological and epidemiological profiles of mosquito-borne viral infections in the Democratic Republic of the Congo (DRC). METHODS: A search of literature was conducted using Google Scholar, PubMed and the WHO website using the following keywords: “Democratic Republic of the Congo”, “Zaire”, “Belgian Congo” and either of the following: “mosquito-borne virus”, “arbovirus”, “yellow fever”, “dengue”, “chikungunya”, “West Nile”, “Rift Valley fever”, “O’nyong’nyong”, “Zika”, “epidemiology”, “ecology”, “morbidity”, “mortality”. Published articles in English or French covering a period between 1912 and October 2018 were reviewed. RESULTS: A total of 37 articles were included in the review. The findings indicate that the burden of mosquito-borne viral infections in DRC is increasing over time and space. The north-western, north-eastern, western and central regions have the highest burden of mosquito-borne viral infections compared to south and eastern highland regions. Yellow fever, chikungunya, dengue, Zika, Rift Valley fever, West Nile and O’nyong’nyong have been reported in the country. These mosquito-borne viruses were found circulating in human, wildlife and domestic animals. Yellow fever and chikungunya outbreaks have been frequently reported. Aedes aegypti and Ae. simpsoni were documented as the main vectors of most of the mosquito-borne viral infections. Heavy rains, human movements, forest encroachment and deforestation were identified as drivers of mosquito-borne viruses occurrence in DRC. CONCLUSIONS: Mosquito-borne viral infections are becoming common and a serious public health problem in DRC. In the current context of climate change, there is urgent need to improve understanding on ecological and epidemiology of the diseases and strengthen surveillance systems for prompt response to epidemics in DRC.

Narrative review on health-EDRM primary prevention measures for vector-borne diseases

Climate change is expanding the global at-risk population for vector-borne diseases (VBDs). The World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework emphasises the importance of primary prevention of biological hazards and its value in protecting against VBDs. The framework encourages stakeholder coordination and information sharing, though there is still a need to reinforce prevention and recovery within disaster management. This keyword-search based narrative literature review searched databases PubMed, Google Scholar, Embase and Medline between January 2000 and May 2020, and identified 134 publications. In total, 10 health-EDRM primary prevention measures are summarised at three levels (personal, environmental and household). Enabling factor, limiting factors, co-benefits and strength of evidence were identified. Current studies on primary prevention measures for VBDs focus on health risk-reduction, with minimal evaluation of actual disease reduction. Although prevention against mosquito-borne diseases, notably malaria, has been well-studied, research on other vectors and VBDs remains limited. Other gaps included the limited evidence pertaining to prevention in resource-poor settings and the efficacy of alternatives, discrepancies amongst agencies’ recommendations, and limited studies on the impact of technological advancements and habitat change on VBD prevalence. Health-EDRM primary prevention measures for VBDs require high-priority research to facilitate multifaceted, multi-sectoral, coordinated responses that will enable effective risk mitigation.

Neglected tropical diseases in the context of climate change in East Africa: A systematic scoping review

East Africa is highly affected by neglected tropical diseases (NTDs), which are projected to be exacerbated by climate change. Consequently, understanding what research has been conducted and what knowledge gaps remain regarding NTDs and climate change is crucial to informing public health interventions and climate change adaptation. We conducted a systematic scoping review to describe the extent, range, and nature of publications examining relationships between NTDs and climatic factors in East Africa. We collated all relevant English and French publications indexed in PubMed(®), Web of Science™ Core Collection, and CAB Direct(©) databases published prior to 2019. Ninety-six publications were included for review. Kenya, Tanzania, and Ethiopia had high rates of publication, whereas countries in the Western Indian Ocean region were underrepresented. Most publications focused on schistosomiasis (n = 28, 29.2%), soil-transmitted helminthiases (n = 16, 16.7%), or human African trypanosomiasis (n = 14, 14.6%). Precipitation (n = 91, 94.8%) and temperature (n = 54, 56.3%) were frequently investigated climatic factors, whereas consideration of droughts (n = 10, 10.4%) and floods (n = 4, 4.2%) was not prominent. Publications reporting on associations between NTDs and changing climate were increasing over time. There was a decrease in the reporting of Indigenous identity and age factors over time. Overall, there were substantial knowledge gaps for several countries and for many NTDs. To better understand NTDs in the context of a changing climate, it would be helpful to increase research on underrepresented diseases and regions, consider demographic and social factors in research, and characterize how these factors modify the effects of climatic variables on NTDs in East Africa.

Leptospirosis: A neglected tropical zoonotic infection of public health importance-an updated review

Leptospirosis is a zoonotic and waterborne disease worldwide. It is a neglected, reemerging disease of global public health importance with respect to morbidity and mortality both in humans and animals. Due to negligence, rapid, unplanned urbanization, and poor sanitation, leptospirosis emerges as a leading cause of acute febrile illness in many of the developing countries. Every individual has a risk of getting infected as domestic and wild animals carry leptospires; the at-risk population varies from the healthcare professionals, animal caretakers, farmers and agricultural workers, fishermen, rodent catchers, water sports people, National Disaster Response Force (NDRF) personnel, people who volunteer rescue operations in flood-affected areas, sanitary workers, sewage workers, etc. The clinical manifestations of leptospirosis range from flu-like illness to acute kidney failure (AKF), pneumonia, jaundice, pulmonary hemorrhages, etc. But many rare and uncommon clinical manifestations are being reported worldwide. This review will cover all possible updates in leptospirosis from occurrence, transmission, rare clinical manifestations, diagnosis, treatment, and prophylactic measures that are currently available, their advantages and the future perspectives, elaborately. There are less or very few reviews on leptospirosis in recent years. Thus, this work will serve as background knowledge for the current understanding of leptospirosis for researchers. This will provide a detailed analysis of leptospirosis and also help in finding research gaps and areas to focus on regarding future research perspectives.

Living in a State of Filth and Indifference to … Their Health’: Weather, public health and urban governance in colonial George Town, Penang

This article explores the development of public health infrastructure in George Town, Penang, before the 1930s. It argues that the extreme weather of the tropical climate led to a unique set of health challenges for George Town’s administrators, as the town grew from a small British base to a multi-cultural and thriving port. Weather and public health were (and still are) integrally connected, although the framing of this relationship has undergone significant shifts in thinking and appearance over time. One lens into this association is the situation and expression of these elements within municipal structures. During the nineteenth century, government departments were fewer and shared roles and responsibilities. The Medical Department, for example, observed the weather. making connections between rain. drought and the incidence of disease. Engineers asked critical questions about mortality rates from disease after floods. As ideas about climate and health developed and changed, the shift became evident in the style, concerns and proliferation of governmental departments. This article thus considers the different ways in which weather, public health, and town planning were understood, managed and enacted by the Straits Settlements’ administration until the 1930s. It will start by exploring the situation facing the settlement’s inhabitants, in terms of specific climate and health challenges. It will then consider how these challenges were understood and addressed, why and by whom, and how these elements were repositioned over the period in question.

Melioidosis: A neglected cause of community-acquired Pneumonia

Melioidosis, caused by the facultative intracellular gram-negative pathogen Burkholderia pseudomallei, is an emerging cause of community-acquired pneumonia across the tropics. The majority of patients present with pneumonia with or without sepsis, but localized and asymptomatic infection is also well recognized. Recent modeling and epidemiological studies have demonstrated the widespread presence of B. pseudomallei in otherwise unrecognized regions with a predicted mortality of 90,000 deaths worldwide. Innovative environmental studies are also uncovering how hydrodynamic, pedology, fauna, and weather events influence geographic distribution and incidence of melioidosis cases. Of concern is the changes associated with global warming, which will be conducive to B. pseudomallei in combination with the global diabetes pandemic. In fact, over 80% of patient developing melioidosis have underlying comorbidities. For this great mimicker, culture remains the mainstay of diagnosis and despite availability of other assays, challenges still remain in reducing time to diagnosis and avoiding misdiagnosis. With institution of timely antimicrobials such as ceftazidime and supportive intensive care, overall mortality can be reduced to 10%, although this can still be as high as 50% in poorly resourced areas. Promise is on the horizon with the first human vaccine trials being planned for 2021. Meanwhile new multiomics techniques are giving us a better understanding of the role of virulence and host-pathogen interactions on patient outcomes.

Impacts of climate change on the public health of the Mediterranean Basin population – Current situation, projections, preparedness and adaptation

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk – the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are “win-win situation” from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

Yellow fever virus outbreak in Brazil under current and future climate

INTRODUCTION: Yellow fever (YF) is primarily transmitted by Haemagogus species of mosquitoes. Under climate change, mosquitoes and the pathogens that they carry are expected to develop faster, potentially impacting the case count and duration of YF outbreaks. The aim of this study was to determine how YF virus outbreaks in Brazil may change under future climate, using ensemble simulations from regional climate models under RCP4.5 and RCP8.5 scenarios for three time periods: 2011-2040 (short-term), 2041-2070 (mid-term), and 2071-2100 (long-term). METHODS: A compartmental model was developed to fit the 2017/18 YF outbreak data in Brazil using least squares optimization. To explore the impact of climate change, temperature-sensitive mosquito parameters were set to change over projected time periods using polynomial equations fitted to their relationship with temperature according to the average temperature for years 2011-2040, 2041-2070, and 2071-2100 for climate change scenarios using RCP4.5 and RCP8.5, where RCP4.5/RCP8.5 corresponds to intermediate/high radiative forcing values and to moderate/higher warming trends. A sensitivity analysis was conducted to determine how the temperature-sensitive parameters impacted model results, and to determine how vaccination could play a role in reducing YF in Brazil. RESULTS: Yellow fever case projections for Brazil from the models varied when climate change scenarios were applied, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the outbreak duration. Overall, a decrease in YF cases and outbreak duration was observed. Comparing the observed incidence in 2017/18 to the projected incidence in 2070-2100, for RCP4.5, the cumulative case incidence decreased from 184 to 161, and the outbreak duration decreased from 21 to 20 weeks. For RCP8.5, the peak case incidence decreased from 184 to 147, and the outbreak duration decreased from 21 to 17 weeks. The observed decrease was primarily due to temperature increasing beyond that suitable for Haemagogus mosquito survival. CONCLUSIONS: Climate change is anticipated to have an impact on mosquito-borne diseases. We found outbreaks of YF may reduce in intensity as temperatures increase in Brazil; however, temperature is not the only factor involved with disease transmission. Other factors must be explored to determine the attributable impact of climate change on mosquito-borne diseases.

Building resilience to mosquito-borne diseases in the Caribbean

Small island developing states in the Caribbean are among the most vulnerable countries on the planet to climate variability and climate change. In the last 3 decades, the Caribbean region has undergone frequent and intense heat waves, storms, floods, and droughts. This has had a detrimental impact on population health and well-being, including an increase in infectious disease outbreaks. Recent advances in climate science have enhanced our ability to anticipate hydrometeorological hazards and associated public health challenges. Here, we discuss progress towards bridging the gap between climate science and public health decision-making in the Caribbean to build health system resilience to extreme climatic events. We focus on the development of climate services to help manage mosquito-transmitted disease epidemics. There are numerous areas of ongoing biological research aimed at better understanding the direct and indirect impacts of climate change on the transmission of mosquito-borne diseases. Here, we emphasise additional factors that affect our ability to operationalise this biological understanding. We highlight a lack of financial resources, technical expertise, data sharing, and formalised partnerships between climate and health communities as major limiting factors to developing sustainable climate services for health. Recommendations include investing in integrated climate, health and mosquito surveillance systems, building regional and local human resource capacities, and designing national and regional cross-sectoral policies and national action plans. This will contribute towards achieving the Sustainable Development Goals (SDGs) and maximising regional development partnerships and co-benefits for improved health and well-being in the Caribbean.

Understanding heat vulnerability in the subtropics: Insights from expert judgements

Risk to health from extreme heat is gaining attention in scholarship and policy. Demographic and socio-economic factors affect the extent to which a person is at risk from extreme heat, whilst empirical research of social vulnerability to heat outside a ‘Western’ context is relatively limited. Many countries still rely on expert judgements to draw locally specific context for heat vulnerability assessment. Yet, their view might not be evidence-informed and the result is influenced by who are involved. This paper reflects this point by eliciting expert views of social heat vulnerability in Taiwan through an expert questionnaire survey using the Analytic Hierarchy Process method, and the result was compared to existing empirical research. Our study finds that experts consider factors related to adaptive capacity, especially societal support, as the most important; but rate gender and ethnicity as the least important. Although experts point to the importance of adaptive capacity, there are relatively few empirical studies to date in societal support, and the low priority given to gender and ethnicity also contradicts prior empirical research. For heat risk assessment, our findings show that whilst systematic elicitation of expert judgement may help to fill gaps in empirical evidence specific to the local context, caution should be paid to the significant divergence with existing empirical data and expert opinions depending on who are selected to involve.

The effects of extreme temperatures on emergency room visits – A population-based analysis by age, sex, and comorbidity

This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan’s metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.

The impacts of precipitation patterns on dengue epidemics in Guangzhou city

Some studies have demonstrated that precipitation is an important risk factor of dengue epidemics. However, current studies mostly focused on a single precipitation variable, and few studies focused on the impact of precipitation patterns on dengue epidemics. This study aims to explore optimal precipitation patterns for dengue epidemics. Weekly dengue case counts and meteorological data from 2006 to 2018 in Guangzhou of China were collected. A generalized additive model with Poisson distribution was used to investigate the association between precipitation patterns and dengue. Precipitation patterns were defined as the combinations of three weekly precipitation variables: accumulative precipitation (Pre_A), the number of days with light or moderate precipitation (Pre_LMD), and the coefficient of precipitation variation (Pre_CV). We explored to identify optimal precipitation patterns for dengue epidemics. With a lead time of 10 weeks, minimum temperature, relative humidity, Pre_A, and Pre_LMD were positively associated with dengue, while Pre_CV was negatively associated with dengue. A precipitation pattern with Pre_A of 20.67-55.50 mm per week, Pre_LMD of 3-4 days per week, and Pre_CV less than 1.41 per week might be an optimal precipitation pattern for dengue epidemics in Guangzhou. The finding may be used for climate-smart early warning and decision-making of dengue prevention and control.

The abundance of Culex mosquito vectors for West Nile virus and other flaviviruses: A time-series analysis of rainfall and temperature dependence in Singapore

Culex mosquitoes are important vectors of West Nile Virus (WNV), St. Louis Encephalitis Virus (SLEV) and Japanese Encephalitis Virus (JEV). Climate change is expected to alter their ability to spread diseases in human populations. Studies examining the influence of climate variability on Culex mosquitoes in South East Asia are scarce. We examined the influence of climate variability on reported Culex mosquito larval habitats from 2009 to 2018 in Singapore. We analysed the non-linear immediate and lagged weather dependence of Culex habitats over 5 weeks in negative binomial regression models using nationally representative data. We adjusted for the effects of long-term trend, seasonality, public holidays and autocorrelation. There were 41,170 reported Culex larval habitats over the study period. Non-residential premises were associated with more reports of habitats compared to residential premises [Rate Ratio (RR): 113.9, 95% CI: 110.9, 116.9]. Larvae in more than 90% of these habitats were entomologically identified as Culex quinquefasciatus. In residences, every 10 mm increase in rainfall above a 90 mm threshold was associated with a 10.1% [Incidence Rate Ratio (IRR): 0.899, 95% CI: 0.836, 0.968] cumulative decline in larval habitats. Public holidays were not significantly included in the model analysing larval habitats in residences. In non-residences, a 1 °C increase in the ambient air temperature with respect to the mean was associated with a 36.0% (IRR: 1.360, 95% CI: 1.057, 1.749) cumulative increase in Culex larval habitats. Public holidays were associated with a decline in Culex larval habitats in the same week. Our study provides evidence of how ambient air temperature and rainfall variability influences the abundance of Culex mosquito larval habitats. Our findings support the utility of using weather data in predictive models to inform the timing of vector control measures aimed at reducing the risk of WNV and other Culex-borne flavivirus transmission in urban areas.

The contrasting relationships of relative humidity with influenza A and B in a humid subtropical region

Influenza is an acute respiratory disease that seriously threatens public health. The occurrence of influenza has been proved to be related to a variety of meteorological factors. However, less attention has been paid to the effect of relative humidity (RH) on different types of influenza, especially in subtropical regions. Daily data on laboratory-confirmed influenza cases, weather variables, and air pollutants in Hefei covering the 2014-2019 period were collected. The seasonality and trend of daily influenza cases were explored by the time series seasonal decomposition method. Generalized linear model was fitted in conjunction with distributed lag nonlinear model to quantify the associations of RH with influenza A and influenza B. Subgroup analyses were conducted by sex, age (0-4, 5-17, and ?18 years), and season (cold and warm seasons). A total of 5238 influenza cases including 2847 influenza A cases and 2391 influenza B cases were recorded. The epidemic of influenza presented a distinct seasonal pattern, and the number of daily influenza cases increased steadily since 2016. High RH was related to an increased risk of influenza A (maximum RR = 1.683, 95%CI: 1.365-2.076), especially among males, females, and school-age children. Low RH was associated with an increased risk of influenza B (maximum RR = 1.252, 95%CI: 1.169-1.340). The contrasting relationships of RH with influenza A and B remained significant in cold seasons. High RH and low RH were significantly associated with the increased risk of influenza A and B, respectively. The findings of our study may provide clues for proposing new effective interventions.

Temperature and photoperiod effects on dormancy status and life cycle parameters in Aedes albopictus and Aedes aegypti from subtropical Argentina

Aedes albopictus (Diptera: Culicidae) distribution is bounded to a subtropical area in Argentina, while Aedes aegypti (Diptera: Culicidae) covers both temperate and subtropical regions. We assessed thermal and photoperiod conditions on dormancy status, development time and mortality for these species from subtropical Argentina. Short days (8 light : 16 dark) significantly increased larval development time for both species, an effect previously linked to diapause incidence. Aedes albopictus showed higher mortality than Ae. aegypti at 16?°C under long day treatments (16 light : 8 dark), which could indicate a lower tolerance to a sudden temperature decrease during the summer season. Aedes albopictus showed a slightly higher percentage of dormant eggs from females exposed to a short day, relative to previous research in Brazilian populations. Since we employed more hours of darkness, this could suggest a relationship between day-length and dormancy intensity. Interestingly, local Ae. aegypti presented dormancy similar to Ae. albopictus, in accordance with temperate populations. The minimum dormancy in Ae. albopictus would not be sufficient to extend its bounded distribution. We believe that these findings represent a novel contribution to current knowledge about the ecophysiology of Ae. albopictus and Ae. aegypti, two species with great epidemiological relevance in this subtropical region.

Short-term effects of ambient temperature on preterm birth: A time-series analysis in Xuzhou, China

To date, research evidence suggests that extreme ambient temperatures may lead to preterm birth. Since the results of studies in subtropical humid monsoon climate are inconclusive, we investigated the association between extreme ambient temperatures and the risk of preterm birth in Xuzhou, China. We analyzed the association between the birth data of 103,876 singleton deliveries (from July 1, 2016 to June 30, 2019) and ambient temperature. We used a quasi-Poisson model with distributed lag nonlinear models (DLNM) to investigate the delay and nonlinear effects of temperature, taking into account the effects of air pollutants and relative humidity. During the study period, the number of hospitalizations for preterm birth was 4623. Taking the median temperature (16.8 °C) as a reference, the highest risk estimate at extreme cold temperature (- 2.8 °C, 1st percentile) was found at lag 0-1 days. Exposure to extreme cold (- 2.8 °C, 1st percentile), or moderate cold (6.8 °C, 25th percentile) were associated with 1.659 (95% confidence interval [CI] 1.177-2.338) and 1.456 (95% CI 1.183-1.790) increased risks of preterm birth, respectively. In the further stratified analysis of the age of pregnant women, we found that there were significant associations between cold temperatures and preterm birth in both groups (older group ? 35; younger group < 35). In a subtropical humid monsoon climate, low ambient temperatures may lead to preterm birth, suggesting that women should stay away from low temperatures during pregnancy.

Spatiotemporal dynamics of urban climate during the wet-dry season transition in a tropical African city

The Urban Heat Island effect has been the focus of several studies concerned with the effects of urbanisation on human and ecosystem health. Humidity, however, remains much less studied, although it is useful for characterising human thermal comfort, the Urban Dryness Island effect and vegetation development. Furthermore, variability in microscale climate due to differences in land cover is increasingly crucial for understanding urbanisation effects on the health and wellbeing of living organisms. We used regression analysis to investigate the spatial and temporal dynamics of temperature, humidity and heat index in the tropical African city of Kampala, Uganda. We gathered data during the wet to dry season transition from 22 locations that represent the wide range of urban morphological differences in Kampala. Our analysis showed that the advancement of the dry season increased variability of climate in Kampala and that the most built-up locations experienced the most profound seasonal changes in climate. This work stresses the need to account for water availability and humidity to improve our understanding of human and ecosystem health in cities.

Real-time forecasting and early warning of bacillary dysentery activity in four meteorological and geographic divisions in China

BACKGROUND: Accurate and timely forecasts of bacillary dysentery (BD) incidence can be used to inform public health decision-making and response preparedness. However, our ability to detect BD dynamics and outbreaks remains limited in China. OBJECTIVES: This study aims to explore the impacts of meteorological factors on BD transmission in four representative regions in China and to forecast weekly number of BD cases and outbreaks. METHODS: Weekly BD and meteorological data from 2014 to 2016 were collected for Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China). A boosted regression tree (BRT) model was conducted to assess the impacts of meteorological factors on BD transmission. Then a real-time forecast and early warning model based on BRT was developed to track the dynamics of BD and detect the outbreaks. The forecasting methodology was compared with generalized additive model (GAM) and seasonal autoregressive integrated moving average model (SARIMA) that have been used to model the BD case data previously. RESULTS: Ambient temperature was the most important meteorological factor contributing to the transmission of BD (80.81%-92.60%). A positive effect of temperature was observed when weekly mean temperature exceeded 4 °C, -3 °C, 9 °C and 16 °C in Beijing (Northern China), Shenyang (Northeast China), Chongqing (Southwest China) and Shenzhen (Southern China), respectively. BD incidence (Beijing and Shenyang) in temperate cities was more sensitive to high temperature than that in subtropical cities (Chongqing and Shenzhen). The dynamics and outbreaks of BD can be accurately forecasted and detected by the BRT model. Compared to GAM and SARIMA, BRT model showed more accurate forecasting for 1-, 2-, 3-weeks ahead forecasts in Beijing, Shenyang and Shenzhen. CONCLUSIONS: Temperature plays the most important role in weather-attributable BD transmission. The BRT model achieved a better performance in comparison with GAM and SARIMA in most study cities, which could be used as a more accurate tool for forecasting and outbreak alert of BD in China.

Potential geographic distribution of the tiger mosquito Aedes albopictus (Skuse, 1894) (Diptera: Culicidae) in current and future conditions for Colombia

In Colombia, little is known on the distribution of the Asian mosquito Aedes albopictus, main vector of dengue, chikungunya, and Zika in Asia and Oceania. Therefore, this work sought to estimate its current and future potential geographic distribution under the Representative Concentration Paths (RCP) 2.6 and 8.5 emission scenarios by 2050 and 2070, using ecological niche models. For this, predictions were made in MaxEnt, employing occurrences of A. albopictus from their native area and South America and bioclimatic variables of these places. We found that, from their invasion of Colombia to the most recent years, A. albopictus is present in 47% of the country, in peri-urban (20%), rural (23%), and urban (57%) areas between 0 and 1800 m, with Antioquia and Valle del Cauca being the departments with most of the records. Our ecological niche modelling for the currently suggests that A. albopictus is distributed in 96% of the Colombian continental surface up to 3000 m (p < 0.001) putting at risk at least 48 million of people that could be infected by the arboviruses that this species transmits. Additionally, by 2050 and 2070, under RCP 2.6 scenario, its distribution could cover to nearly 90% of continental extension up to 3100 m (?55 million of people at risk), while under RCP 8.5 scenario, it could decrease below 60% of continental extension, but expand upward to 3200 m (< 38 million of people at risk). These results suggest that, currently in Colombia, A. albopictus is found throughout the country and climate change could diminish eventually its area of distribution, but increase its altitudinal range. In Colombia, surveillance and vector control programs must focus their attention on this vector to avoid complications in the national public health setting.

Prevalence and trend of emerging and re-emerging arboviral infections in the state of Odisha

Newly emerging or re-emerging infections are posing continuous threat to both public health system and clinical care globally. The emergence of infections especially caused by arboviruses can be linked to several mechanisms which include geographical expansion linked to human development and transportation, global warming, enhanced transmission in peridomestic area and close proximity of human habitations to domestic as well as wild animals. The co-circulation of Dengue, Chikungunya and Zika is a matter of public health priority due to the fact that they are transmitted by the same vector as well as increase in the number of reported cases of severe dengue, post-chikungunya chronic joint disease and microcephaly related to Zika virus disease. The study was designed to estimate the prevalence of these arboviral infections in Odisha. About 5198 cases presenting with common clinical symptoms of fever, arthralgia, headache, myalgia and malaise were screened during 2016-2019. A total of 42.2% patients tested positive for dengue NS1 antigen (n?=?4154), 30.2% for dengue IgM (n?=?2161) and 14.3% for chikungunya IgM (n?=?1816). A total of 1684 samples were subjected to Zika RT-PCR and none was tested positive. Peak in the numbers of dengue/ chikungunya cases was evident in the post-monsoon months of July – October. Circulation of all four serotypes of dengue i.e. DEN 1, 2, 3, and 4 was noticed in the state. Molecular investigation of suspected Chik cases in early phases showed circulation of Eastern Central Southern African genotype (E1:226A). There is dearth of knowledge about disease severity during arbovirus co-infections and importance of adequate management of patients at an early stage residing in risk areas. It is the first study in Odisha to study the pattern and status of these three arboviral diseases Dengue, Chikungunya and Zika. The outcome of this study will help in focusing and improvement of existing surveillance systems and vector control tools, as well as on the development of suitable antiviral agents and formulating candidate vaccine.

Patterns of dengue in Nepal from 2010-2019 in relation to elevation and climate

BACKGROUND: Understanding and describing the regional and climatic patterns associated with increasing dengue epidemics in Nepal is critical to improving vector and disease surveillance and targeting control efforts. METHODS: We investigated the spatial and temporal patterns of annual dengue incidence in Nepal from 2010 to 2019, and the impacts of seasonal meteorological conditions (mean maximum, minimum temperature and precipitation) and elevation on those patterns. RESULTS: More than 25 000 laboratory-confirmed dengue cases were reported from 2010 to 2019. Epidemiological trends suggest that dengue epidemics are cyclical with major outbreaks occurring at 2- to 3-y intervals. A significant negative relationship between dengue incidence and increasing elevation (metres above sea level) driven by temperature was observed (p<0.05) with dengue risk being greatest below 500 m. Risk was moderate between 500 and 1500 m and decreased substantially above 1500 m. Over the last decade, increased nightly temperatures during the monsoon months correlated with increased transmission (p<0.05). No other significant relationship was observed between annual dengue cases or incidence and climatological factors. CONCLUSIONS: The spatial analysis and interpretation of dengue incidence over the last decade in Nepal confirms that dengue is now a well-established public health threat of increasing importance, particularly in low elevation zones and urbanised areas with a tropical or subtropical climate. Seasonal variations in temperature during the monsoon months are associated with increased transmission.

Mitigating trafficking of migrants and children through disaster risk reduction: Insights from the Thailand flood

Low ambient temperature increases hospital re-admissions for systemic lupus erythematosus in humid subtropical region: A time series study

Currently, the correlation between ambient temperature and systemic lupus erythematosus (SLE) hospital admissions remains not determined. The aim of this study was to explore the correlation between ambient temperature and SLE hospital admissions in Hefei City, China. An ecological study design was adopted. Daily data on SLE hospital admissions in Hefei City, from January 1, 2007, to December 31, 2017, were obtained from the two largest tertiary hospitals in Hefei, and the daily meteorological data at the same period were retrieved from China Meteorological Data Network. The generalized additive model (GAM) combined with distributed lag nonlinear model (DLNM) with Poisson link was applied to evaluate the influence of ambient temperature on SLE hospital admissions after controlling for potential confounding factors, including seasonality, relative humidity, day of week, and long-term trend. There were 1658 SLE hospital admissions from 2007 to 2017, including 370 first admissions and 1192 re-admissions (there were 96 admissions with admission status not stated). No correlation was observed between ambient temperature and SLE first admissions, but a correlation was found between low ambient temperature and SLE re-admissions (RR: 2.53, 95% CI: 1.11, 5.77) (3.5 °C vs 21 °C). The effect of ambient temperature on SLE re-admissions remained for 2 weeks but disappeared in 3 weeks. Exposure to low ambient temperature may increase hospital re-admissions for SLE, and thus it is important for SLE patients to maintain a warm living environment and avoid exposure to lower ambient temperature.

Migration rate estimation in an epidemic network

Most of the recent epidemic outbreaks in the world have as a trigger, a strong migratory component as has been evident in the recent Covid-19 pandemic. In this work we address the problem of migration of human populations and its effect on pathogen reinfections in the case of Dengue, using a Markov-chain susceptible-infected-susceptible (SIS) metapopulation model over a network. Our model postulates a general contact rate that represents a local measure of several factors: the population size of infected hosts that arrive at a given location as a function of total population size, the current incidence at neighboring locations, and the connectivity of the network where the disease spreads. This parameter can be interpreted as an indicator of outbreak risk at a given location. This parameter is tied to the fraction of individuals that move across boundaries (migration). To illustrate our model capabilities, we estimate from epidemic Dengue data in Mexico the dynamics of migration at a regional scale incorporating climate variability represented by an index based on precipitation data.

Influence of the meteorological conditions and some pollutants on PM(10) concentrations in Lamphun, Thailand

Particulate matter (PM) has been occurring regularly during the dry season in the upper north of Thailand including Lamphun Province that might be influenced by various factors including climatologic and other pollutants. This paper aims to investigate the climatologic and gaseous factors influencing the occurrence of PM(10) concentration using Pollution Control Department (PCD) data. The secondary data of 2009 to 2017 obtained from the PCD was used for analysis. We used descriptive statistics, Pearson’s correlation coefficient, multiple regression and graphic presentation using R program (R packages of ‘open air’ and ‘ncdf4’) and Microsoft Excel Spreadsheet®. In addition, the periodic measurement of PM(2.5) and PM(10) were investigated to determine the ratio of PM(2.5)/PM(10). The results indicated that haze episodes (daily PM(10) concentration always over the PCD standard) normally occur during the dry season from February to April. The maximum concentration was always found in March. The PM(10) concentration was negatively associated with relative humidity and temperature while the PM(10) concentration showed a strongly positive association with CO and NO(2) concentration with correlation values of 0.70 and 0.57, respectively. Furthermore, we found CO and PM(10) concentration was associated with ozone concentration. This finding will benefit local communities and the public health sector to provide a warning system for preparation and response plans to react to PM(10) episodes in their responsible areas.

Influence of the seasonality and of urban variables in the BTEX and PM(2.5) atmospheric levels and risks to human health in a tropical coastal city (Fortaleza, CE, Brazil)

The International Agency for Research on Cancer (IARC) classifies benzene in group 1 (carcinogenic to humans). Particulate matter (PM) has recently also been classified in this category. This was an advance toward prioritizing the monitoring of particles in urban areas. The aim of the present study was to assess levels of PM(2.5) and BTEX (benzene, toluene, ethylbenzene, and xylene), the influence of meteorological variables, the planetary boundary layer (PBL), and urban variables as well as risks to human health in the city of Fortaleza, Brazil, in the wet and dry periods. BTEX compounds were sampled using the 1501 method of NIOSH and determined by GC-HS-PID/FID. PM(2.5) was monitored using an air sampling pump with a filter holder and determined by the gravimetric method. Average concentrations of BTEX ranged from 1.6 to 45.5 ?g m(-3), with higher values in the wet period, which may be explained by the fact that annual distribution is influenced by meteorological variables and the PBL. PM(2.5) levels ranged from 4.12 to 33.0 ?g m(-3) and 4.18 to 86.58 ?g m(-3) in the dry and wet periods, respectively. No seasonal pattern was found for PM(2.5), probably due to the influence of meteorological variables, the PBL, and urban variables. Cancer risk ranged from 2.46E(-04) to 4.71E(-03) and 1.72E(-04) to 2.01E(-03) for benzene and from 3.07E(-06) to 7.04E(-05) and 3.08E(-06) to 2.85E(-05) for PM(2.5) in the wet and dry periods, respectively. Cancer risk values for benzene were above the acceptable limit established by the international regulatory agency in both the dry and wet periods. The results obtained of the noncarcinogenic risks for the compounds toluene, ethylbenzene, and xylene were within the limits of acceptability. The findings also showed that the risk related to PM is always greater among smokers than nonsmokers.

Identification of thermal hotspots through heat index determination and urban heat island mitigation using ENVImet numerical micro climate model

Achieving environmental sustainability by improving the urban microclimate is a key principle in mitigating the urban heat island (UHI) effect. This study aimed to (a) investigate the outdoor thermal comfort by establishing Heat Index (HI) values to identify thermal hot spots and (b) model green infrastructure possibilities to alleviate UHI in Colombo urban metropolitan in Sri Lanka using ENVImet climate model. Daytime temperature and humidity values of 14 urban locations were collected to determine HI to recognize thermal urban hotspots in Colombo area. A pretested comprehensive random-stratified questionnaire survey has been conducted to appraise the thermal discernment of the general public. ENVImet microclimate model was accompanied to test the temperature reduction levels in different bioclimatic green infrastructure scenarios [Two belts (R-1), three belts (R-2), four belts (R-3), five belts (R-4)] in the selected study site. Five sites (Borella, Colombo Fort, Maradana, Wellawaththa, Liberty junction) were identified as thermal hotspots in Colombo metropolitan. HI values were fluctuated within 33.82-40.35 degrees C range and the highest average day time HI value was observed at Maradana (40.35 degrees C) and the lowest HI was observed at Thummulla (33.82 degrees C). Survey results revealed that 89.3% people are affected with thermal uncomfortability and 5% were affected with heat-related skin diseases. Inserting trees into curbsides (R-4) reduced temperature remarkably by 2.07 degrees C in the urban metropolitan. Therefore, the proposed green infrastructure scenario has proved to be the most suitable way to improve the thermal comfort conditions of urban environment, as it can reduce the UHI effects.

Impact of meteorological conditions at multiple scales on ozone concentration in the Yangtze River Delta

Tropospheric ozone is known to have adverse effects on human health. Ozone pollution events are often associated with specific atmospheric circulation conditions. Therefore, studying the relationship between atmospheric circulation and ozone is particularly important for early warning and forecasting of ozone pollution events. Focusing on the Yangtze River Delta region, particularly in four important large industrial cities (Xuzhou, Nanjing, Shanghai, and Hangzhou) in the Yangtze River Delta, the T-mode objective classification method was applied to classify the weather circulation that mainly affects the Yangtze River Delta region into nine types. Local wind fields for the four industrial cities were classified according to their propensity for ventilation, stagnation, and recirculation based on the Allwine and Whiteman method. Based on the analysis of large-scale atmospheric circulation, we concluded that certain circulation patterns correspond to excessive ozone concentrations, while other circulation patterns correspond to good air quality. Moreover, ozone pollution was not closely related to local regional transmission. The importance of high temperatures in potentiating ozone pollution was also identified in the study area, whereas the effect of relative humidity was negligible. Finally, the importance of the different scale atmospheric motions was analyzed by studying two specific ozone pollution events in Xuzhou area (March, 2019) and Nanjing area (July-August, 2017). This analysis was complemented by HYSPLIT model’s outputs to simulate the pollutant diffusion path. Regarding the first episode, ozone concentration is often closely related to the slowly approaching thermal high-pressure system. In the second episode, local transmission had little effect on the generation and spread of ozone pollution. Furthermore, and comparing the circulation conditions with local meteorological factors, it was found that the increase in ozone concentration was often accompanied by higher temperature, and the response to humidity was not clear.

Impact of temperature on hospital admission for acute lower respiratory infection (ALRI) among pre-school children in Ho Chi Minh City, Vietnam

Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.

Health impacts of climate change on smallholder farmers

The health of smallholder farmers is crucial for ensuring food and nutritional security for two billion people. However, their health is in jeopardy for several reasons including challenges from climate change impacts. Using a narrative literature review supported by field observations and informal interviews with key informants in India, Bangladesh and Malawi, this paper identifies and discusses the health impacts of climate change under four categories: (i) communicable diseases, (ii) non-communicable diseases, (iii) mental health, and (iv) occupational health, safety and other health issues. The health impacts of climate change on smallholder farmers will hamper the realization of many of the United Nations’ Sustainable Development Goals, and a series of recommendations are made to regional and country governments to address the increasing health impacts of accelerating climate change among smallholder farmers.

Gaps in awareness of climate variability and its impacts on society among health professionals and community workers in Vietnam: Implications for COVID-19 and other epidemic response systems

Field study of pedestrians’ comfort temperatures under outdoor and semi-outdoor conditions in Malaysian university campuses

Difficulties in controlling the effects of outdoor thermal environment on the human body are attracting considerable research attention. This study investigated the outdoor thermal comfort of urban pedestrians by assessing their perceptions of the tropical, micrometeorological, and physical conditions via a questionnaire survey. Evaluation of the outdoor thermal comfort involved pedestrians performing various physical activities (sitting, walking, and standing) in outdoor and semi-outdoor spaces where the data collection of air temperature, globe temperature, relative humidity, wind speed, solar radiation, metabolic activity, and clothing insulation data was done simultaneously. A total of 1011 participants were interviewed, and the micrometeorological data were recorded under outdoor and semi-outdoor conditions at two Malaysian university campuses. The neutral temperatures obtained which were 28.1 °C and 30.8 °C were within the biothermal acceptable ranges of 24-34 °C and 26-33 °C of the PET thermal sensation ranges for the outdoor and semi-outdoor conditions, respectively. Additionally, the participants’ thermal sensation and preference votes were highly correlated with the PET and strongly related to air and mean radiant temperatures. The findings demonstrated the influence of individuals’ thermal adaptation on the outdoor thermal comfort levels. This knowledge could be useful in the planning and designing of outdoor environments in hot and humid regions to create better thermal environments.

Future changes in climatic variables due to greenhouse warming increases dengue incidence in the region of the Tucurui hydroelectric dam in the Amazon

This study investigates the impact of future changes in climatic variables on dengue incidence in the region of the Tucurui dam in the Amazon. Tucurui dam is the one of the largest hydroelectric power stations in the Amazon. Correlations and regression analysis through least squares fitting between dengue cases and temperature, precipitation, and humidity are obtained. Positive correlations between dengue incidence and temperature are found for lags from 4 to 5 months (higher correlation for lag 5), dengue and precipitation for lags 0 up to 1, and dengue and humidity for lag 0. The positive correlations between dengue and precipitation and between dengue and humidity are higher for the simultaneous correlation. To investigate the impact of the future changes in these climatic variables in the region, projections of RegCM4 model simulations under the RCP 8.5 scenario are obtained. The model projections indicate a warming and moisture increase in the region near the dam at the end of the twenty-first century. Regression analysis using the model projections indicates that the dengue incidence may increase substantially in future climate scenarios in this region (more than fivefold compared with the present climate). This increase is between two and three times higher than the global estimates of dengue incidence in the future. It is suggested that the incidence of dengue cases is more sensitive to changes in temperature. Vector parameters increase with temperature in the future, indicating that the temperature conditions are highly favorable for the spread of the disease in the region. The results indicate that cities in the area surrounding the Tucurui hydroelectric dam are areas of potential dengue incidence in the future. These findings may be applied to hydroelectric dams in other areas of the world. However, future studies involving additional dams are necessary. The results suggest an increase in climate-driven risk of transmission from Aedes aegypti throughout the entire Amazon, and especially the eastern and southern parts.

Extreme heat vulnerability assessment in tropical region: A case study in Malaysia

Environmental heat-related health symptoms among community in a tropical city

Estimating the magnitude and risk associated with heat exposure among Ghanaian mining workers

Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers’ gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.

Do women farmers cope or adapt to strategies in response to climate extreme events? Evidence from rural Ghana

Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information.Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information.

Effect of ambient temperatures on category C notifiable infectious diarrhea in China: An analysis of national surveillance data

BACKGROUND: Many studies have explored the association between meteorological factors and infectious diarrhea (ID) transmission but with inconsistent results, in particular the roles from temperatures. We aimed to explore the effects of temperatures on the transmission of category C ID, to identify its potential heterogeneity in different climate zones of China, and to provide scientific evidence to health authorities and local communities for necessary public health actions. METHODS: Daily category C ID counts and meteorological variables were collected from 270 cities in China over the period of 2014-16. Distributed lag non-linear models (DLNMs) were applied in each city to obtain the city-specific temperature-disease associations, then a multivariate meta-analysis was implemented to pool the city-specific effects. Multivariate meta-regression was conducted to explore the potential effect modifiers. Attributable fraction was calculated for both low and high temperatures, defined as temperatures below the 5th percentile of temperature or above the 95th percentile of temperature. RESULTS: A total of 2,715,544 category C ID cases were reported during the study period. Overall, a M-shaped curve relationship was observed between temperature and category C ID, with a peak at the 81st percentile of temperatures (RR = 1.723, 95% CI: 1.579-1.881) compared to 50th percentile of temperatures. The pooled associations were generally stronger at high temperatures compared to low ambient temperatures, and the attributable fraction due to heat was higher than cold. Latitude was identified as a possible effect modifier. CONCLUSIONS: The overall positive pooled associations between temperature and category C ID in China suggest the increasing temperature could bring about more category C infectious diarrhea cases, which warrants further public health measurements.

Coping and adaptation in response to environmental and climatic stressors in Caribbean coastal communities

Cumulative and synergistic impacts from environmental pressures, particularly in low-lying tropical coastal regions, present challenges for the governance of ecosystems, which provide natural resource-based livelihoods for communities. Here, we seek to understand the relationship between responses to the impacts of El Niño and La Niña events and the vulnerability of mangrove-dependent communities in the Caribbean region of Colombia. Using two case study sites, we show how communities are impacted by, and undertake reactive short-term responses to, El Niño and La Niña events, and how such responses can affect their adaptive capacity to progressive environmental deterioration. We show that certain coping measures to climate variability currently deliver maladaptive outcomes, resulting in circumstances that could contribute to system ‘lock-in’ and engender undesirable ecological states, exacerbating future livelihood vulnerabilities. We highlight the significant role of social barriers on vulnerabilities within the region, including perceptions of state abandonment, mistrust and conflicts with authorities. Opportunities to reduce vulnerability include enhancing the communities’ capacity to adopt more positive and preventative responses based on demonstrable experiential learning capacity. However, these will require close cooperation between formal and informal organisations at different levels, and the development of shared coherent adaptation strategies to manage the complexity of multiple interacting environmental and climatic pressures.

Climate warming and occupational heat and hot environment standards in Thailand

BACKGROUND: During the period 2001 to 2016, the maximum temperatures in Thailand rose from 38-41(o)C to 42-44(o)C. The current occupational heat exposure standard of Thailand issued in 2006 is based on wet bulb globe temperature (WBGT) defined for three workload levels without a work-rest regimen. This study examined whether the present standard still protects most workers. METHODS: The sample comprised 168 heat acclimatized workers (90 in construction sites, 78 in foundries). Heart rate and auditory canal temperature were recorded continuously for 2 hours. Workplace WBGT, relative humidity, and wind velocity were monitored, and the participants’ workloads were estimated. Heat-related symptoms and signs were collected by a questionnaire. RESULTS: Only 55% of the participants worked in workplaces complying with the heat standard. Of them, 79% had auditory canal temperature ? 38.5(o)C, compared with only 58% in noncompliant workplaces. 18% and 43% of the workers in compliant and noncompliant workplaces, respectively, had symptoms from heat stress, the trend being similar across all workload levels. An increase of one degree (C) in WBGT was associated with a 1.85-fold increase (95% confidence interval: 1.44-2.48) in odds for having symptoms. CONCLUSION: Compliance with the current occupational heat standard protects 4/5 of the workers, whereas noncompliance reduces this proportion to one half. The reasons for noncompliance include the gaps and ambiguities in the law. The law should specify work/rest schedules; outdoor work should be identified as an occupational heat hazard; and the staff should include occupational personnel to manage heat stress in establishments involving heat exposure.

Climate-based dengue model in Semarang, Indonesia: Predictions and descriptive analysis

BACKGROUND: Dengue is one of the most rapidly spreading vector-borne diseases, which is considered to be a major health concern in tropical and sub-tropical countries. It is strongly believed that the spread and abundance of vectors are related to climate. Construction of climate-based mathematical model that integrates meteorological factors into disease infection model becomes compelling challenge since the climate is positively associated with both incidence and vector existence. METHODS: A host-vector model is constructed to simulate the dynamic of transmission. The infection rate parameter is replaced with the time-dependent coefficient obtained by optimization to approximate the daily dengue data. Further, the optimized infection rate is denoted as a function of climate variables using the Autoregressive Distributed Lag (ARDL) model. RESULTS: The infection parameter can be extended when updated daily climates are known, and it can be useful to forecast dengue incidence. This approach provides proper prediction, even when tested in increasing or decreasing prediction windows. In addition, associations between climate and dengue are presented as a reversed slide-shaped curve for dengue-humidity and a reversed U-shaped curves for dengue-temperature and dengue-precipitation. The range of optimal temperature for infection is 24.3-30.5 °C. Humidity and precipitation are positively associated with dengue upper the threshold 70% at lag 38 days and below 50 mm at lag 50 days, respectively. CONCLUSION: Identification of association between climate and dengue is potentially useful to counter the high risk of dengue and strengthen the public health system and reduce the increase of the dengue burden.

Changes in climatic patterns and tourism and their concomitant effect on drinking water transfers into the region of South Aegean, Greece

Global warming is already having a negative impact on vital sectors on which human development depends, such as water resource availability. In this study, the changes and abrupt change timing of climatic extreme indices, aridity and drought over the Region of South Aegean are captured using the Mann-Kendall and Pettitt tests, while the latter variables are correlated with the water volume transported by ships to the region as well as the relevant costs. The region’s climate is shifting to warmer conditions with less precipitation, since significantly positive trends were noted with regard to the number of tropical nights, warm nights, warm days, the warm spell duration index and the diurnal temperature range; significant negative trends were observed in relation to the number of cool nights, cool days and the cold spell duration index, with the change-point year for the latter variables being 2006. Inaddition, 7/11 precipitation related indices exhibited a downward trend, while significantly negative trends were observed with regard to the number of consecutive dry days, with the timing of the abrupt change being 2001. The Aridity Index (AI) reveals that the region’s climate characterization is changing from dry and sub-humid to semi-arid conditions, whilst the Reconnaissance Drought Index standardized (RDI(st)) and the Standardized Precipitation Index (SPI) indices suggests an amplification of drought phenomena over the Region. The tourism variables illustrated a significant positive trend, with the timing of the abrupt change being registered during 2006-2009, whilst the correlation analysis between tourism variables and water transfers implies that the surge on water transfer by ships to the Region occurred between 1998 and 2008. This can be mainly attributed to the changes in climate patterns. The correlation analysis documents a strong positive correlation between the water transfer dataset and the diurnal temperature range, and a moderately negative association with the precipitation related indices, annual precipitation, drought phenomena and aridity with 7/11.

Climate change and risk of arboviral diseases in the state of Rio de Janeiro (Brazil)

Arboviral diseases are a theme of high interest in the field of public and collective health worldwide. Dengue, Zika, and Chikungunya, in particular, have shown significant expansion in terms of morbidity and mortality in different portions of the ecumene. These diseases are of great interest in geographic studies due to the characteristics of their vector (Aedes aegypti), adapted to the environmental and unequal context of the urbanization process. Given this background, this study assesses the relationship between global climate change and the risk of arboviral diseases for the state of Rio de Janeiro. To this end, the characteristics of future climate susceptibility to vector proliferation in the scenarios RCP 4.5 and 8.5 (2011-2040 and 2041-2070) were assessed using two models: Eta HadGEM2-ES and Eta MIROC5, as well as the vulnerability conditions that favor the spread of arboviruses. The results indicate that the tendency of thermal and hygrometric elevation, in association with vulnerability, may have repercussions on the intensification and spatial expansion of the risk of arboviral diseases in the state of Rio de Janeiro, since there is a spatial and temporal expansion of the optimal environmental conditions for the development of the vector.

Climate change impacts on Anopheles (K.) cruzii in urban areas of Atlantic Forest of Brazil: Challenges for malaria diseases

Around 27% of South Americans live in central and southern Brazil. Of 19,400 human malaria cases in Brazil in 2018, some were from the southern and southeastern states. High abundance of malaria vectors is generally positively associated with malaria incidence. Expanding geographic distributions of Anopheles vector mosquito species (e.g. A. cruzii) in the face of climate change processes would increase risk of such malaria transmission; such risk is of particular concern in regions that hold human population concentrations near present limits of vector species’ geographic distributions. We modeled effects of likely climate changes on the distribution of A. cruzii, evaluating two scenarios of future greenhouse gas emissions for 2050, as simulated in 21 general circulation models and two greenhouse gas scenarios (RCP 4.5 and RCP 8.5) for 2050. We tested 1305 candidate models, and chose among them based on statistical significance, predictive performance, and complexity. The models closely approximated the known geographic distribution of the species under current conditions. Under scenarios of future climate change, we noted increases in suitable area for the mosquito vector species in São Paulo and Rio de Janeiro states, including areas close to 30 densely populated cities. Under RCP 8.5, our models anticipate areal increases of >75% for this important malaria vector in the vicinity of 20 large Brazilian cities. We developed models that anticipate increased suitability for the mosquito species; around 50% of Brazilians reside in these areas, and ?89% of foreign tourists visit coastal areas in this region. Under climate change thereefore, the risk and vulnerability of human populations to malaria transmission appears bound to increase.

Associations between floods and bacillary dysentery cases in main urban areas of Chongqing, China, 2005-2016: A retrospective study

BACKGROUND: Understanding the association between floods and bacillary dysentery (BD) incidence is necessary for us to assess the health risk of extreme weather events. This study aims at exploring the association between floods and daily bacillary dysentery cases in main urban areas of Chongqing between 2005 and 2016 as well as evaluating the attributable risk from floods. METHODS: The association between floods and daily bacillary dysentery cases was evaluated by using distributed lag non-linear model, controlling for meteorological factors, long-term trend, seasonality, and day of week. The fraction and number of bacillary dysentery cases attributable to floods was calculated. Subgroup analyses were conducted to explore the association across age, gender, and occupation. RESULTS: After controlling the impact of temperature, precipitation, relative humidity, long-term trend, and seasonality, a significant lag effect of floods on bacillary dysentery cases was found at 0-day, 3-day, and 4-day lag, and the cumulative relative risk (CRR) over a 7-lag day period was 1.393 (95%CI 1.216-1.596). Male had higher risk than female. People under 5?years old and people aged 15-64?years old had significantly higher risk. Students, workers, and children had significantly higher risk. During the study period, based on 7-lag days, the attributable fraction of bacillary dysentery cases due to floods was 1.10% and the attributable number was 497 persons. CONCLUSIONS: This study confirms that floods can increase the risk of bacillary dysentery incidence in main urban areas of Chongqing within an accurate time scale, the risk of bacillary dysentery caused by floods is still serious. The key population includes male, people under 5?years old, students, workers, and children. Considering the lag effect of floods on bacillary dysentery, the government and public health emergency departments should advance to the emergency health response in order to minimize the potential risk of floods on public.

Atmospheric tropical modes are important drivers of Sahelian springtime heatwaves

Heatwaves pose a serious threat to human health worldwide but remain poorly documented over Africa. This study uses mainly the ERA5 dataset to investigate their large-scale drivers over the Sahel region during boreal spring, with a focus on the role of tropical modes of variability including the Madden-Julian Oscillation (MJO) and the equatorial Rossby and Kelvin waves. Heatwaves were defined from daily minimum and maximum temperatures using a methodology that retains only intraseasonal scale events of large spatial extent. The results show that tropical modes have a large influence on the occurrence of Sahelian heatwaves, and, to a lesser extent, on their intensity. Depending on their convective phase, they can either increase or inhibit heatwave occurrence, with the MJO being the most important of the investigated drivers. A certain sensitivity to the geographic location and the diurnal cycle is observed, with nighttime heatwaves more impacted by the modes over the eastern Sahel and daytime heatwaves more affected over the western Sahel. The examination of the physical mechanisms shows that the modulation is made possible through the perturbation of regional circulation. Tropical modes thus exert a control on moisture and the subsequent longwave radiation, as well as on the advection of hot air. A detailed case study of a major event, which took place in April 2003, further supports these findings. Given the potential predictability offered by tropical modes at the intraseasonal scale, this study has key implications for heatwave risk management in the Sahel.

Calibrating UTCI’S comfort assessment scale for three Brazilian cities with different climatic conditions

Both global climate change and urbanization trends will demand adaptation measures in cities. Large agglomerations and impacts on landscape and natural environments due to city growth will require guided densification schemes in urban areas, particularly in developing countries. Human biometeorological indices such as the Universal Thermal Climate Index (UTCI) could guide this process, as they provide a clear account of expected effects on thermal sensation from a given change in outdoor settings. However, an earlier step should optimally include an adequacy test of suggested comfort and thermal stress ranges with calibration procedures based on surveys with the target population. This paper compares obtained thermal comfort ranges for three different locations in Brazil: Belo Horizonte, 20° S, Aw climate type; Curitiba, 25.5° S, Cfb subtropical climate, both locations in elevation (above 900 m a.s.l.); and Pelotas, at sea level, latitude 32° S, with a Cfa climate type. In each city, a set of outdoor comfort field campaigns has been carried out according to similar procedures, covering a wide range of climatic conditions over different seasons of the year. Obtained results indicate a variation of neutral temperatures up to 3 °C (UTCI units) as a possible latitude and local climate effect between the southern locations relative to the northernmost location. Low UTCI values were found in the two subtropical locations for the lower threshold of the thermal comfort band as compared with the original threshold. A possible explanation for that is a longer exposure to cold conditions as buildings are seldom provided with heating systems.

Association of heat exposure and emergency ambulance calls: A multi-city study

Evidence of the impact of ambient temperatures on emergency ambulance calls (EACs) in developing countries contributes to the improvement and complete understanding of the acute health effects of temperatures. This study aimed to examine the impacts and burden of heat on EACs in China, quantify the contributions of regional modifiers, and identify the vulnerable populations. A semi-parametric generalized additive model with a Poisson distribution was used to analyze the city-specific impacts of the daily maximum temperature (T-ma(x)) on EACs in June-August in 2014-2017. Stratified analyses by sex and age were performed to identify the vulnerable sub-populations. Meta-analysis was undertaken to illustrate the pooled associations. Further subgroup analysis, stratified by climate, latitude, and per capita disposable income (PCDI), and meta-regression analysis were conducted to explore the regional heterogeneity and quantify the contributions of possible modifiers. The city- and region-specific attributable fractions of EACs attributable to heat were calculated. Strong associations were observed between the daily T-max and total EACs in all cities. A total of 11.7% (95% confidence interval (CI): 11.2%-12.3%) of EACs were attributed to high temperatures in ten Chinese cities, and the central region with a low level of PCDI had the highest attributable fraction of 17.8% (95% CI: 17.2%-18.4%). People living in the central region with lower PCDI, and those aged 18-44 and 0-6 years were more vulnerable to heat than the others. The combined effects of PCDI, temperature, and latitude contributed 88.6% of the regional heterogeneity. The results complemented the understanding of the burden of EACs attributable to heat in developing countries and the quantitative contribution of regional modifiers.

An epidemiological index for drought vulnerability in the Rio Grande do Norte State, Brazil

In the Northeast Brazil (NEB), the impacts of climate extreme events such as severe droughts are aggravated by poverty and poor socioeconomic conditions. In this region, such events usually result in the spread of endemic diseases, problems in water distribution, and agricultural losses, often leading to an increase in the population’s vulnerability. Thus, this study aims to evaluate the microregions of the Rio Grande do Norte (RN) state, in the NEB, according to the Epidemiological Index for Drought Vulnerability (EIDV). We mapped and classified the microregions according to three dimensions of vulnerability: risk, susceptibility, and adaptive capacity. We also verified potential associations between drought risk and epidemiological vulnerability. The EIDV was calculated by considering the three dimensions of vulnerability as mutually exclusive events and applying the third axiom of probability. Then we carried out a cluster analysis in order to classify the microregions according to similarities in the EIDV. Odds ratio were also calculated in order to evaluate the odds of microregions having a high susceptibility to diseases and high vulnerability given the drought risk. Results showed that the Pau dos Ferros, Seridó Ocidental, Seridó Oriental, and Umarizal microregions were the most vulnerable, while Natal and Litoral Sul were the least vulnerable. Regarding the dimensions of vulnerability, we observed that almost the entire RN state exhibited high drought risk. Pau dos Ferros and Umarizal had the highest susceptibility and Litoral Nordeste presented the worst adaptive capacity to the effects of drought on health. The EIDV revealed that the population of the RN state needs improvements in living conditions and health, since socioeconomic status is one of the factors that most influence the vulnerability of microregions, which in turn is aggravated by drought risk.

Analysis of indoor human thermal comfort in Pelotas municipality, extreme southern Brazil

The indoor human thermal comfort (HTC) was investigated in residences located in the Pelotas City, southern Brazil, by the effective temperature index (ETI). In this study, temperature and relative humidity were measured inside 429 houses, located in different regions of Pelotas city, from January 11 to August 27, 2019. Samples were obtained using HOBO data loggers, indoor sensors, installed in different regions of the municipality, in the context of a cohort study of children between 2 and 4 years old and their respective mothers, led by Epidemiological Research Center of the Federal University of Pelotas (UFPEL). In general, all regions had average hourly values of effective temperature index above the comfort zone in summer and below the comfort zone in the winter. In terms of spatial variability, the indoor HTC was dependent on environmental factors such as lake breeze and indoor behavior factors, such as the use of air conditioning system in the downtown buildings.

Analysis of the association between meteorological variables and mortality in the elderly applied to different climatic characteristics of the state of Sao Paulo, Brazil

With the rising trends in elderly populations around the world, there is a growing interest in understanding how climate variability is related to the health of this population group. Therefore, we analyzed the associations between mortality in the elderly due to cardiovascular (CVD) and respiratory diseases (RD) and meteorological variables, for three cities in the State of Sao Paulo, Brazil: Campos do Jordao, Ribeirao Preto, and Santos, all in different subtropical regions, from 1996 to 2017. The main objective was to verify how these distinct subtropical climates impact elderly mortality differently. We applied the autoregressive model integrated with moving average (ARIMA) and the principal component analysis (PCA), in order to evaluate statistical associations. Results showed CVD as a major cause of mortality, particularly in the cold period, when a high mortality rate is also observed due to RD. The mortality rate was higher in Campos do Jordao and lower in Santos. In Campos do Jordao, results indicate an increased probability of mortality from CVD and RD due to lower temperatures. In Ribeirao Preto, the lower relative humidity may be related to the increase in CVD and RD deaths. This study emphasizes that, even among subtropical climates, there are significant differences on how climate impacts human health, which can assist decision-makers in the implementation of mitigating and adaptive measures.

A vulnerability curve method to assess risks of climate-related hazards at county level

A comprehensive risk assessment of different types of natural disasters at the county level can promote quantitative disaster risk assessment and can provide a scientific basis for the formulation of disaster prevention measures. Focusing on climate-related hazards and based on natural disaster risk assessment theories and methods, this study integrates disaster statistics, meteorological data, geographic information, and other multivariate data to quantify the hazards of various disasters and the vulnerability and exposure of hazard-bearing bodies and conducts an integrated assessment of comprehensive risks of multiple climate-related hazards in Cangnan County, Zhejiang Province. Typhoon disaster risk is high in the central and northern parts of this county and low in its surroundings, with high-risk areas mainly distributed in Lingxi Town to the north. The comprehensive risk distribution patterns of drought and flood disasters in Cangnan County are similar: low in the south and high in the north. With the method of standard deviation, the comprehensive risk of multiple climate-related hazards in Cangnan County shows a distribution pattern of being low in the south and high in the north, with high risk in the northeast and low risk in the northwest and south.

Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China

Ambient air pollutants have been linked to adverse health outcomes, but evidence is still relatively rare in college students. Upper respiratory tract infection (URTI) is a common disease of respiratory system among college students. In this study, we assess the acute effect of air pollution on clinic visits of college students for URTI in Wuhan, China. Data on clinic visits due to URTI were collected from Wuhan University Hospital, meteorological factors (including daily temperature and relative humidity) provided by Wuhan Meteorological Bureau, and air pollutants by Wuhan Environmental Protection Bureau. In the present study, generalized additive model with a quasi-Poisson distribution link function was used to examine the association between ambient air pollutants (fine particulate matter (PM(2.5)), particulate matter (PM(10)), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and ozone (O(3))) and the daily number of clinic visits of college students for URTI at Wuhan University Hospital in Wuhan, China. In the meantime, the model was adjusted for the confounding effects of long-term trends, seasonality, day of the week, public holidays, vacation, and meteorological factors. The best degrees of free in model were selected based on AIC (Akaike Information Criteria). The effect modification by gender was also examined. A total of 44,499 cases with principal diagnosis of URTI were included from January 1, 2016, to December 31, 2018. In single-pollutant models, the largest increment of URTI visits were found at lag 0 day in single-day lags, and the effect values in cumulative lags were greater than those in single-day lags. PM(2.5) (0.74% (95%CI: 0.05, 1.44)) at lag 0 day, PM(10) (0.61% (95%CI: 0.12, 1.11)) and O(3) (1.01% (95%CI: 0.24, 1.79)) at lag 0-1 days, and SO(2) (9.18% (95%CI: 3.27, 15.42)) and NO(2) (3.40% (95% CI:1.64, 5.19)) at lag 0-3 days were observed to be strongly and significantly associated with clinic visits for URTI. PM(10) and NO(2) were almost still significantly associated with URTI after controlling for the other pollutants in our two-pollutant models, where the effect value of SO(2) after inclusion of O(3) appeared to be the largest and the effects of NO(2) were also obvious compared with the other pollutants. Subgroups analysis demonstrated that males were more vulnerable to PM(10) and O(3), while females seemed more vulnerable to exposure to SO(2) and NO(2). This study implied that short-term exposure to ambient air pollution was associated with increased risk of URTI among college students at Wuhan University Hospital in Wuhan, China. And gaseous pollutants had more negative health impact than solid pollutants. SO(2) and NO(2) were the major air pollutants affecting the daily number of clinic visits on URTI, to which females seemed more vulnerable than males.

Zika virus transmission by Brazilian Aedes aegypti and Aedes albopictus is virus dose and temperature-dependent

BACKGROUND: Zika virus (ZIKV) emerged in the Pacific Ocean and subsequently caused a dramatic Pan-American epidemic after its first appearance in the Northeast region of Brazil in 2015. The virus is transmitted by Aedes mosquitoes. We evaluated the role of temperature and infectious doses of ZIKV in vector competence of Brazilian populations of Ae. aegypti and Ae. albopictus. METHODOLOGY/PRINCIPAL FINDINGS: Two Ae. aegypti (Rio de Janeiro and Natal) and two Ae. albopictus (Rio de Janeiro and Manaus) populations were orally challenged with five viral doses (102 to 106 PFU / ml) of a ZIKV strain (Asian genotype) isolated in Northeastern Brazil, and incubated for 14 and 21 days in temperatures mimicking the spring-summer (28°C) and winter-autumn (22°C) mean values in Brazil. Detection of viral particles in the body, head and saliva samples was done by plaque assays in cell culture for determining the infection, dissemination and transmission rates, respectively. Compared with 28°C, at 22°C, transmission rates were significantly lower for both Ae. aegypti populations, and Ae. albopictus were not able to transmit the virus. Ae. albopictus showed low transmission rates even when challenged with the highest viral dose, while both Ae. aegypti populations presented higher of infection, dissemination and transmission rates than Ae. albopictus. Ae. aegypti showed higher transmission efficiency when taking virus doses of 105 and 106 PFU/mL following incubation at 28°C; both Ae. aegypti and Ae. albopictus were unable to transmit ZIKV with virus doses of 102 and 103 PFU/mL, regardless the incubation temperature. CONCLUSIONS/SIGNIFICANCE: The ingested viral dose and incubation temperature were significant predictors of the proportion of mosquito’s biting becoming infectious. Ae. aegypti and Ae. albopictus have the ability to transmit ZIKV when incubated at 28°C. However Brazilian populations of Ae. aegypti exhibit a much higher transmission potential for ZIKV than Ae. albopictus regardless the combination of infection dose and incubation temperature.

Wet bulb globe temperature and recorded occupational injury rates among sugarcane harvesters in southwest Guatemala

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.

Urban heat island mitigation in Singapore: Evaluation using WRF/multilayer urban canopy model and local climate zones

Mitigation and adaption measures must be designed strategically by urban planners, designers, and decision-makers to reduce urban heat island (UHI) related risks. We employed the Weather Research and Forecasting (WRF) model to assess UHI mitigation scenarios for the tropical city of Singapore during April 2016, including two heat wave periods. The local climate zones for Singapore were used as the land use/land cover data to account for the intra-urban variability. The simulations show that the canopy layer UHI intensity in Singapore can reach up to 5 degrees C in compact areas during nighttime. The results reveal that city-scale deployment of cool roofs can provide an overall reduction of 1.3 degrees C in the near-surface daytime air temperature in large lowrise areas. Increasing the thermostat set temperature to 25 degrees C from 21 degrees C in city-wide buildings can potentially reduce the air temperature due to less (similar to 20%) waste heat discharge from airconditioning units. A densification scenario considering an increase from approximately 7 841 people/km(2) (2016) to 9040-9,600 people/km(2) (2030) under the current climate leads to air temperature increase of 1.4 degrees C, which demonstrates the importance of limiting the densification of less compact areas in maintaining thermal comfort in the future.

Warming temperatures could expose more than 1.3 billion new people to Zika virus risk by 2050

In the aftermath of the 2015 pandemic of Zika virus, concerns over links between climate change and emerging arboviruses have become more pressing. Given the potential that much of the world might remain at risk from the virus, we used a previously established temperature-dependent transmission model for Zika virus (ZIKV) to project climate change impacts on transmission suitability risk by mid-century (a generation into the future). Based on these model predictions, in the worst-case scenario, over 1.3 billion new people could face suitable transmission temperatures for ZIKV by 2050. The next generation will face substantially increased ZIKV transmission temperature suitability in North America and Europe, where naïve populations might be particularly vulnerable. Mitigating climate change even to moderate emissions scenarios could significantly reduce global expansion of climates suitable for ZIKV transmission, potentially protecting around 200 million people. Given these suitability risk projections, we suggest an increased priority on research establishing the immune history of vulnerable populations, modeling when and where the next ZIKV outbreak might occur, evaluating the efficacy of conventional and novel intervention measures, and increasing surveillance efforts to prevent further expansion of ZIKV.

Time-lagged inverse-distance weighting for air temperature analysis in an equatorial urban area (Guayaquil, Ecuador)

It is well known that sudden variations of air temperature have the potential to cause severe impacts on human health. Therefore, it becomes necessary to provide information capable of quantifying the severity of the problem, considering that the continuous increase of temperature due to global warming and urban development will cause more intense effects in heavily populated areas. Due to its geographical location and local characteristics, Ecuador, a country located on the western coast of South America, is characterized by a high vulnerability to climatic extremes. The present research develops an evaluation of urban climate change effects through the analysis of extreme temperature indices using four meteorological stations situated in the city of Guayaquil (southwest Ecuador). Since the available data are not adequate for extreme temperature indices criteria, it was necessary to employ an infilling method for times series in an innovative way that can be applicable at the small scale. Thus, a cross-correlation-enhanced inverse distance weighting (CC-IDW) method was proposed. The method entails a spatial interpolation based on data of urban stations situated outside of Guayaquil by taking into account cross-correlation among times series at precise lags that leads to an improvement in the way of estimating the missing values. Subsequently, a homogeneity test, data quality control and the calculation of extreme temperature indices chosen from those proposed by the World Meteorological Organization (WMO) were implemented. The results show that there is a general tendency of warming with quite homogenous temperatures for all considered stations. However, it should be recognized that the climate pattern of this region is strongly modulated by the El Nino Southern Oscillation (ENSO) cycle. Only for two extreme indices: the highest maximum temperature (TXx) and the warm days (TX90p), are the resulting trend co-efficients statistically significant. The study suggests a deteriorated climatic condition due to heat stress that warrants further study using the available database for the city of Guayaquil.

Understanding the preferences of rural communities for adaptation to 21st-century sea-level rise: A case study from the Samoan islands

This paper explores the perceived adaptation preference of rural island communities in addressing future climate change risks, particularly those concerning sea-level rise. The research explores the role of culture and local politics, and differences among various age and gender groups within the community regarding preferred adaptation pathways for coping with the impacts of future sea-level rise. A participatory action approach, in the form of a community workshop, was employed, which separated participants into community identified groupings. Differences in community groups’ adaptation preferences emerged, though the range of adaptation measures considered were limited, probably due to the participants’ limited exposure to adaptation mechanisms in their immediate surroundings. Overall, the communities surveyed tended to be conservative, especially in their attitudes towards western adaptation solutions developed in non-island contexts.

Thermal comfort and cooling strategies in the Brazilian Amazon. An assessment of the concept of fuel poverty in tropical climates

Fuel poverty has increasingly been associated with thermal discomfort, health related issues and winter deaths in the Global North because it can force families to choose between food and a warmer environment. Juxtaposing the concept of fuel poverty in rural tropical areas of the Global South, it is likely that a similar pattern between fuel poverty and heat related illnesses can be found. A recent study shows that between 1.8 and 4.1 billion people, especially in India, Southeast Asia and Sub-Saharan Africa will need indoor cooling to avoid heat related health issues. This paper aims to address a blind spot in the literature on the links between fuel poverty, thermal comfort and cooling strategies in the Brazilian Amazon. This study draws from current definitions and indicators of fuel poverty in the Global North and juxtaposes it in the context of tropical areas to understand how fuel poverty affects human health, livelihood strategies and social justice in rural communities that live in hot climates. To do so, this paper uses qualitative methods and a conceptual framework to guide the analysis. I call the intersection between vernacular architecture and sustainable cooling practices ‘energy relief.

The potential impacts of climate factors and malaria on the Middle Palaeolithic population patterns of ancient humans

Previous studies that observed the fact that Middle Palaeolithic sites mainly were concentrated in arid and semi-arid areas in Africa and Southwest Asia, concluded that climate factors determined the distribution patterns. We argue that biological factors could have been equally important. In present-day sub-Saharan Africa, mosquito borne diseases and especially falciparum malaria have a serious impact on human populations. This study was aimed to investigate the possible former effect of falciparum malaria on Middle Palaeolithic site distribution patterns and explain why ancient humans avoided the humid areas in the tropical and subtropical regions. It was found that the early human settlements situated in those regions of Africa and Southwest Asia where the potential annual development period of falciparum parasites was short in the mosquitoes, the area was not too humid, and the potential falciparum malaria incidence values were low or moderate. In the Indian Peninsula, precipitation played a less significant role in determining human settlements. The number of the months when the extrinsic development of Plasmodium falciparum parasites was possible showed the strongest structural overlap with the modelled malaria incidences according to the spatial occurrence of the Middle Paleolithic archaeological sites in the case of Africa and in Southwest Asia. In the Indian Peninsula, climatic factors showed the strongest structural overlap with the modelled malaria incidences according to the occurrence patterns of the Middle Palaeolithic archaeological sites.

The impact of climatic variables on the population dynamics of the main malaria vector, Anopheles stephensi Liston (Diptera: Culicidae), in southern Iran

Objective: To determine the significance of temperature, rainfall and humidity in the seasonal abundance of Anopheles stephensi in southern Iran. Methods: Data on the monthly abundance of Anopheles stephensi larvae and adults were gathered from earlier studies conducted between 2002 and 2019 in malaria prone areas of southeastern Iran. Climatic data for the studied counties were obtained from climatology stations. Generalized estimating equations method was used for cluster correlation of data for each study site in different years. Results: A significant relationship was found between monthly density of adult and larvae of Anopheles stephensi and precipitation, max temperature and mean temperature, both with simple and multiple generalized estimating equations analysis (P<0.05). But when analysis was done with one month lag, only relationship between monthly density of adults and larvae of Anopheles stephensi and max temperature was significant (P<0.05). Conclusions: This study provides a basis for developing multivariate time series models, which can be used to develop improved appropriate epidemic prediction systems for these areas. Long-term entomological study in the studied sites by expert teams is recommended to compare the abundance of malaria vectors in the different areas and their association with climatic variables.

The impact of extreme heat and heat waves on emergency ambulance dispatches due to external cause in Shenzhen, China

BACKGROUND: Compared to hospital admissions (HAs), emergency ambulance dispatches (EADs) can be considered a real-time outcome for evaluating the public health impacts of ambient temperature. OBJECTIVES: This study aimed to assess if temperature has a causal effect on cause-specific EADs and its potential main and added effect in Shenzhen from 2013 to 2017. METHODS: A distributed lag nonlinear model (DLNM) with quasi-Poisson distribution was applied to quantify the association between temperature and EADs. Likewise, the fraction of EADs attributable to different temperature ranges was calculated to identify extreme temperature ranges affecting population health. We then explored the main and added wave effects of heatwaves. RESULTS: Ambient temperature showed a U-shaped association with EADs. The minimum risk temperature was 17 °C (16th percentile of the daily mean temperature). Compared with the cold, the relative risk (RR) of heat on EADs presented smaller but the attributable risk larger. The main effects of heatwaves on EADs varied with external causes; and the peak RR of heat on EADs was observed in suicidal behaviors with heatwaves defined as 3 or more days with temperatures above the 75th percentile (RR = 4.53, 95% CI: 1.23-16.68), followed by assault (RR = 2.36, 95% CI: 1.25-4.48) and accidents (RR = 1.72, 95% CI: 1.30-2.28), while the added wave effect was negligible. CONCLUSIONS: Heat was responsible for a higher proportion of EADs than cold. Most of the increase in health risk during warm season can be simply ascribed to the independent effects of daily temperature occurrences whether it is or not on the heat-wave day. And the main effects of heatwaves on cause-specific EADs showed varied change trends, of which the incidence of suicides seems more susceptible, followed by assault and accidents.

The impact of weather and air pollution on viral infection and disease outcome among pediatric pneumonia patients in Chongqing, China from 2009 to 2018: A prospective observational study

BACKGROUND: For pediatric pneumonia, the meteorological and air pollution indicators had been frequently investigated for their association with viral circulation, however, not for their impact on disease severity. METHODS: We performed a 10-year prospective observational study in one hospital in Chongqing, China to recruit children with pneumonia. Eight commonly seen respiratory viruses were tested. Autoregressive distributed lag (ADL) and Random forest (RF) models were performed to fit monthly detection rates of each virus at population level and predict the possibility of severe pneumonia at individual level, respectively. RESULTS: Between 2009?2018, 6 611 pediatric pneumonia patients were included, and 4 846 (73.3%) tested positive for at least one respiratory virus. The median age of the patients was 9 (IQR: 4?20) months. ADL models demonstrated a decent fitting of detection rates of four viruses (R2 >0.7 for RSV, HRV, PIV, and HMPV). Based on the RF models, the AUC for host-related factors alone is 0.88 (95% CI: 0.87?0.89), 0.86 (95% CI: 0.85?0.88) for meteorological and air pollution indicators alone, and 0.62 (95% CI: 0.60?0.63) for viral infections alone. The final model indicated that nine weather and air pollution indicators were important determinants of severe pneumonia, with relative contribution of 62.53%, significantly higher than respiratory viral infections (7.36%). CONCLUSIONS: Meteorological and air pollution predictors contributed more to severe pneumonia in children than respiratory viruses. These meteorological data could help predict times when children would be at increased risk for severe pneumonia, and interventions such as reducing outdoor activities, may be warranted.

The impacts of climate variability on cholera cases in Malaysia

Introduction: Altered weather patterns and changes in precipitation, temperature and humidity resulting from climate change could affect the distribution and incidence of cholera. This study is to quantify climate-induced increase in morbidity rates of cholera. Material and Methods: Monthly cholera cases and monthly temperature, precipitation, and relative humidity data from 2004 to 2014 were obtained from the Malaysian Ministry of Health and Malaysian Meteorological Department, respectively. Poisson generalized linear models were developed to quantify the relationship between meteorological parameters and the number of reported cholera cases. Results: The findings revealed that the total number of cholera cases in Malaysia during the 11 year study period was 3841 cases with 32 deaths. Out of these, 45.1% of the cases were among children below 12 years old and 75% of the cases were from Sabah. Temperature and precipitation gave significant impact on the cholera cases in Sabah, (p<0.001) while precipitation were significant in Terengganu (p<0.001), and Sarawak (p=0.013). Monthly lag temperature data at Lag 0, 1, and 2 months were associated with the cholera cases in Sabah (p<0.001). The change in odds of having cholera cases were by the factor of 3.5 for every 1 degrees C increase in temperature. However, the contribution of rainfall was very mild, whereby an increase of 1 mm in precipitation will increase the excess risk of cholera by up to 0.8%. Conclusion: This study concludes that climate does influence the number of cholera cases in Malaysia.

The effect of temperature on cause-specific mental disorders in three subtropical cities: A case-crossover study in China

BACKGROUND: Little is known about the association between ambient temperature and cause-specific mental disorders, especially in subtropical areas. OBJECTIVE: To investigate the effect of ambient temperature on mental disorders in subtropical cities. METHOD: Daily morbidity data for mental disorders in three Chinese cities (Shenzhen, Zhaoqing, and Huizhou) were collected from medical record systems of local psychiatric specialist hospitals, covering patients of all ages. Case-crossover design combined with a distributed lag nonlinear model (DLNM) was used to assess the nonlinear and delayed effects of temperatures on five specific mental disorders (affective disorders, anxiety, depressive disorders, schizophrenia, and organic mental disorders), with analyses stratified by gender and age. The temperature of minimum effect was used as the reference value to calculate estimates. RESULTS: We observed inversed J-shaped exposure-response curves between temperature and mental morbidity and observed that low temperatures had a significant and prolonged effect on most types of mental disorders in the three cities. For example, the effect of the cold (2.5th percentile) on anxiety was consistently observed in the three cities with an odds ratio (OR) of 1.29 (95% CI: 1.06-1.57) in Zhaoqing, 1.26 (95% CI: 1.18-1.34) in Shenzhen, and 1.45 (95% CI: 1.17-1.81) in Huizhou. Low temperature was also associated with an increased risk of depressive disorders and schizophrenia. For the high temperature exposure (97.5th percentile), we only observed a significant, harmful effect on anxiety [OR = 1.30 (95% CI: 1.08, 1.58) in Shenzhen, OR = 1.16 (95% CI: 1.00, 1.34) in Zhaoqing], affective disorders [OR = 1.32 (95% CI: 1.08, 1.62) in Shenzhen], and schizophrenia [OR = 1.24 (95% CI: 1.03, 1.48) in Zhaoqing, OR = 1.03 (95% CI: 1.00, 1.06) in Huizhou]. CONCLUSIONS: Our study suggests that both low and high temperatures might be important drivers of morbidity from mental disorders, and low temperature may have a more general and wide-spread effect on this cause-specific morbidity than high temperature.

The effects of seasonal climate variability on dengue annual incidence in Hong Kong: A modelling study

In recent years, dengue has been rapidly spreading and growing in the tropics and subtropics. Located in southern China, Hong Kong’s subtropical monsoon climate may favour dengue vector populations and increase the chance of disease transmissions during the rainy summer season. An increase in local dengue incidence has been observed in Hong Kong ever since the first case in 2002, with an outbreak reaching historically high case numbers in 2018. However, the effects of seasonal climate variability on recent outbreaks are unknown. As the local cases were found to be spatially clustered, we developed a Poisson generalized linear mixed model using pre-summer monthly total rainfall and mean temperature to predict annual dengue incidence (the majority of local cases occur during or after the summer months), over the period 2002-2018 in three pre-defined areas of Hong Kong. Using leave-one-out cross-validation, 5 out of 6 observations of area-specific outbreaks during the major outbreak years 2002 and 2018 were able to be predicted. 42 out of a total of 51 observations (82.4%) were within the 95% confidence interval of the annual incidence predicted by our model. Our study found that the rainfall before and during the East Asian monsoon (pre-summer) rainy season is negatively correlated with the annual incidence in Hong Kong while the temperature is positively correlated. Hence, as mosquito control measures in Hong Kong are intensified mainly when heavy rainfalls occur during or close to summer, our study suggests that a lower-than-average intensity of pre-summer rainfall should also be taken into account as an indicator of increased dengue risk.

The effect of climate change on yellow fever disease burden in Africa

Yellow Fever (YF) is an arbovirus endemic in tropical regions of South America and Africa and it is estimated to cause 78,000 deaths a year in Africa alone. Climate change may have substantial effects on the transmission of YF and we present the first analysis of the potential impact on disease burden. We extend an existing model of YF transmission to account for rainfall and a temperature suitability index and project transmission intensity across the African endemic region in the context of four climate change scenarios. We use these transmission projections to assess the change in burden in 2050 and 2070. We find disease burden changes heterogeneously across the region. In the least severe scenario, we find a 93.0%[95%CI(92.7, 93.2%)] chance that annual deaths will increase in 2050. This change in epidemiology will complicate future control efforts. Thus, we may need to consider the effect of changing climatic variables on future intervention strategies.

Temperature and humidity associated with increases in tuberculosis notifications: A time-series study in Hong Kong

Previous studies have revealed associations of meteorological factors with tuberculosis (TB) cases. However, few studies have examined their lag effects on TB cases. This study was aimed to analyse nonlinear lag effects of meteorological factors on the number of TB notifications in Hong Kong. Using a 22-year consecutive surveillance data in Hong Kong, we examined the association of monthly average temperature and relative humidity with temporal dynamics of the monthly number of TB notifications using a distributed lag nonlinear models combined with a Poisson regression. The relative risks (RRs) of TB notifications were >1.15 as monthly average temperatures were between 16.3 and 17.3 °C at lagged 13-15 months, reaching the peak risk of 1.18 (95% confidence interval (CI) 1.02-1.35) when it was 16.8 °C at lagged 14 months. The RRs of TB notifications were >1.05 as relative humidities of 60.0-63.6% at lagged 9-11 months expanded to 68.0-71.0% at lagged 12-17 months, reaching the highest risk of 1.06 (95% CI 1.01-1.11) when it was 69.0% at lagged 13 months. The nonlinear and delayed effects of average temperature and relative humidity on TB epidemic were identified, which may provide a practical reference for improving the TB warning system.

Spatial-temporal distribution of human brucellosis in mainland China from 2004 to 2017 and an analysis of social and environmental factors

BACKGROUND: This study aimed to describe the changing distribution of human brucellosis between 2004 and 2017 in mainland China and seek scientific evidence of the relationship between socio-economic, environmental, and ecological factors and human brucellosis incidence. METHODS: The annual numbers of brucellosis cases and incidence rates from 31 provinces in mainland China between 2004 and 2017 were obtained from the Data-Center for China Public Health Science. The number of monthly brucellosis cases in 2018 was obtained from the Chinese Center for Disease Control and Prevention. The electronic map of the People’s Republic of China was downloaded from the National Earth System Science Data Sharing Platform. Human population density, gross domestic product (GDP), and an inventory of cattle and sheep at the end of each year from 2004 to 2017 were obtained from the National Bureau of Statistics of China. Annual rainfall data from 31 provinces in the People’s Republic of China from 2004 to 2017 were collected from the China Meteorological Data Service Center. The risk distribution and changing trends of human brucellosis were mapped with ArcGIS. A cluster analysis was employed to identify geographical areas and periods with statistically significant incidence rates. Multivariate linear regression was used to determine possible factors that were significantly correlated with the presence of human brucellosis cases. RESULTS: Human brucellosis cases have spread throughout the whole country. Human brucellosis cases occurred mostly from March to August and were concentrated from April to July. The inventory of sheep, GDP, and climate were significantly correlated with the presence of brucellosis cases in mainland China. CONCLUSIONS: The geographical expansion of human brucellosis in mainland China was observed, so did the high-incidence clusters between 2004 and 2017. Most of the cases were reported during the early spring to early summer (February-August). Results from the multivariate linear regression suggested that the inventory of sheep, GDP, and climate were significantly associated with the incidence of human brucellosis in mainland China.

Statistical modelling of the effects of weather factors on Malaria occurrence in Abuja, Nigeria

Background: despite the increase in malaria control and elimination efforts, weather patterns and ecological factors continue to serve as important drivers of malaria transmission dynamics. This study examined the statistical relationship between weather variables and malaria incidence in Abuja, Nigeria. Methodology/Principal Findings: monthly data on malaria incidence and weather variables were collected in Abuja from the year 2000 to 2013. The analysis of count outcomes was based on generalized linear models, while Pearson correlation analysis was undertaken at the bivariate level. The results showed more malaria incidence in the months with the highest rainfall recorded (June-August). Based on the negative binomial model, every unit increase in humidity corresponds to about 1.010 (95% confidence interval (CI), 1.005-1.015) times increase in malaria cases while the odds of having malaria decreases by 5.8% for every extra unit increase in temperature: 0.942 (95% CI, 0.928-0.956). At lag 1 month, there was a significant positive effect of rainfall on malaria incidence while at lag 4, temperature and humidity had significant influences. Conclusions: malaria remains a widespread infectious disease among the local subjects in the study area. Relative humidity was identified as one of the factors that influence a malaria epidemic at lag 0 while the biggest significant influence of temperature was observed at lag 4. Therefore, emphasis should be given to vector control activities and to create public health awareness on the proper usage of intervention measures such as indoor residual sprays to reduce the epidemic especially during peak periods with suitable weather conditions.

Spatial epidemiology of yellow fever: Identification of determinants of the 2016-2018 epidemics and at-risk areas in Brazil

Optimise control strategies of infectious diseases, identify factors that favour the circulation of pathogens, and propose risk maps are crucial challenges for global health. Ecological niche modelling, once relying on an adequate framework and environmental descriptors can be a helpful tool for such purposes. Despite the existence of a vaccine, yellow fever (YF) is still a public health issue. Brazil faced massive sylvatic YF outbreaks from the end of 2016 up to mid-2018, but cases in human and non-human primates have been recorded until the beginning of 2020. Here we used both human and monkey confirmed YF cases from two epidemic periods (2016/2017 and 2017/2018) to describe the spatial distribution of the cases and explore how biotic and abiotic factors drive their occurrence. The distribution of YF cases largely overlaps for humans and monkeys, and a contraction of the spatial extent associated with a southward displacement is observed during the second period of the epidemics. More contributive variables to the spatiotemporal heterogeneity of cases were related to biotic factors (mammal richness), abiotic factors (temperature and precipitation), and some human-related variables (population density, human footprint, and human vaccination coverage). Both projections of the most favourable conditions showed similar trends with a contraction of the more at-risk areas. Once extrapolated at a large scale, the Amazon basin remains at lower risk, although surrounding forest regions and notably the North-West region, would face a higher risk. Spatial projections of infectious diseases often relied on climatic variables only; here for both models, we instead highlighted the importance of considering local biotic conditions, hosts vulnerability, social and epidemiological factors to run the spatial risk analysis correctly: all YF cases occurring later on, in 2019 and 2020, were observed in the predicted at-risk areas.

Spatial patterns of health vulnerability to heatwaves in Vietnam

The increasing frequency and intensity of heat events have weighty impacts on public health in Vietnam, but their effects vary across regions. In this study, we have applied a vulnerability assessment framework (VAF) to systematically assess the spatial pattern of health vulnerability to heatwaves in Vietnam. The VAF was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity, with the indicators for each dimension derived from the relevant literature, consultation with experts, and available data. An analytic hierarchy process (AHP) was used to determine the weight of indicators. Each province in Vietnam’s vulnerability to the health impacts of heatwaves was evaluated by applying the vulnerability index, computed using 13 indicators (sensitivity index, 9; adaptive capacity index, 3; and exposure index, 1). As a result of this analysis, this study has identified heatwave vulnerability ‘hotspots’, primarily in the Southeast, Central Highlands, and South Central Coast of Vietnam. However, these hotspots are not necessarily the same as the area most vulnerable to climate change, because some areas that are more sensitive to heatwaves may have a higher capacity to adapt to them due to a host of factors including their population characteristics (e.g. rates of the elderly or children), socio-economic and geographical conditions, and the availability of air-conditioners. This kind of information, provided by the vulnerability index framework, allows policymakers to determine how to more efficiently allocate resources and devise appropriate interventions to minimise the impact of heatwaves with strategies tailored to each region of Vietnam.

Shifting transmission risk for malaria in Africa with climate change: A framework for planning and intervention

BACKGROUND: Malaria continues to be a disease of massive burden in Africa, and the public health resources targeted at surveillance, prevention, control, and intervention comprise large outlays of expense. Malaria transmission is largely constrained by the suitability of the climate for Anopheles mosquitoes and Plasmodium parasite development. Thus, as climate changes, shifts in geographic locations suitable for transmission, and differing lengths of seasons of suitability will occur, which will require changes in the types and amounts of resources. METHODS: The shifting geographic risk of malaria transmission was mapped, in context of changing seasonality (i.e. endemic to epidemic, and vice versa), and the number of people affected. A published temperature-dependent model of malaria transmission suitability was applied to continental gridded climate data for multiple future AR5 climate model projections. The resulting outcomes were aligned with programmatic needs to provide summaries at national and regional scales for the African continent. Model outcomes were combined with population projections to estimate the population at risk at three points in the future, 2030, 2050, and 2080, under two scenarios of greenhouse gas emissions (RCP4.5 and RCP8.5). RESULTS: Estimated geographic shifts in endemic and seasonal suitability for malaria transmission were observed across all future scenarios of climate change. The worst-case regional scenario (RCP8.5) of climate change predicted an additional 75.9 million people at risk from endemic (10-12 months) exposure to malaria transmission in Eastern and Southern Africa by the year 2080, with the greatest population at risk in Eastern Africa. Despite a predominance of reduction in season length, a net gain of 51.3 million additional people is predicted be put at some level of risk in Western Africa by midcentury. CONCLUSIONS: This study provides an updated view of potential malaria geographic shifts in Africa under climate change for the more recent climate model projections (AR5), and a tool for aligning findings with programmatic needs at key scales for decision-makers. In describing shifting seasonality, it was possible to capture transitions between endemic and epidemic risk areas, to facilitate the planning for interventions aimed at year-round risk versus anticipatory surveillance and rapid response to potential outbreak locations.

Short-term effects of diurnal temperature range on hospital admission in Bangkok, Thailand

Diurnal temperature range (DTR) is a key indicator reflecting climate stability. Many previous studies have examined the effects of ambient temperature, both hot and cold, on human morbidity and mortality, but few studies have evaluated health effects of DTR, especially those in developing countries. This study aimed to investigate the association between short-term exposure to DTR and hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand. We obtained daily meteorological variables from the Thai Meteorological Department from January 2006 through December 2014 and daily hospital admissions from the National Health Security Office during the same period. Quasi-Poisson generalized linear regression model combined with distributed lag non-linear model was used to examine the association between DTR and cardiovascular and respiratory hospital admissions controlling for daily average temperature, relative humidity, day of the week, public holiday, and seasonal and long-term trend. A J-shape relationship between DTR and hospital admissions was observed. With 7.8 °C DTR as a reference value, the relative risks for cardiovascular and respiratory hospital admission associated with extremely high DTR (11.6 °C) at cumulative lag 0-21 (21-day cumulative effects) were 1.206 (95% CI: 1.002-1.452) and 1.021 (95% CI: 0.856-1.218), respectively. The effects of extremely high DTR relative to a reference value did not significantly differ between males and females, as well as between young people (<65 years) and the elderly (?65 years) for both cardiovascular and respiratory admission. When stratifying the effects by season, the effect of extremely high DTR in winter was greater than that in summer and rainy season. This study showed that short-term exposure to extremely high DTR was significantly associated with increased risk of hospital admissions for cardiovascular disease in Bangkok, especially during winter. Results from this study could provide important scientific evidence for policy decision making to protect populations from adverse health effects of DTR.

Seasonal temperature and rainfall extremes 1911-2017 for northern Australian population centres: Challenges for human activity

More than 40% of the human population reside in global tropical zones despite the extreme climates that frequently approach the upper thermotolerance levels for human physical activity and societal flourishing. Many of these regions also regularly subject resident populations to extreme weather events. Australia’s tropical regions experience exceptionally high climatic variability, making it one of the world’s most challenging for human settlements. Adaptation planning, project management and health protection agencies working at local scales require localized analysis on long-term climatic trends and projections. Utility of existing large-scale analyses is constrained by climatic heterogeneity across expansive national scales. Here we track historical changes in seasonal climatic extremes for seven key population centres across Australia’s north between the periods 1911-1940 and 1988-2017 as measured against the 1961-1990 period. Shifts in daily minimum temperature (20 degrees C or more), maximum temperature (10th, 90th and 95th percentiles), trends in heatwaves (5 days or longer) and in 1- and 3-day heavy rainfall events (95th and 98th percentiles) are provided. Results indicate the greatest warming has occurred during the Dry season and in coastal locations. Rainfall extremes demonstrate a pattern of marked spatial non-uniformity. This location-centred approach to identifying shifts in climatic extremes has wide applicability for adaptation planning across diverse global climatic regions.

Respiratory syncytial virus infection trend is associated with meteorological factors

Respiratory syncytial virus (RSV) infects young children and causes influenza-like illness. RSV circulation and prevalence differ among countries and climates. To better understand whether climate factors influence the seasonality of RSV in Thailand, we examined RSV data from children???5 years-old who presented with respiratory symptoms from January 2012-December 2018. From a total of 8,209 nasopharyngeal samples, 13.2% (1,082/8,209) was RSV-positive, of which 37.5% (406/1,082) were RSV-A and 36.4% (394/1,082) were RSV-B. The annual unimodal RSV activity from July-November overlaps with the rainy season. Association between meteorological data including monthly average temperature, relative humidity, rainfall, and wind speed for central Thailand and the incidence of RSV over 7-years was analyzed using Spearman’s rank and partial correlation. Multivariate time-series analysis with an autoregressive integrated moving average (ARIMA) model showed that RSV activity correlated positively with rainfall (r?=?0.41) and relative humidity (r?=?0.25), but negatively with mean temperature (r?=?-?0.27). The best-fitting ARIMA (1,0,0)(2,1,0)(12) model suggests that peak RSV activity lags the hottest month of the year by 4 months. Our results enable possible prediction of RSV activity based on the climate and could help to anticipate the yearly upsurge of RSV in this region.

Risk assessment of temperature and air pollutants on hospitalizations for mental and behavioral disorders in Curitiba, Brazil

BACKGROUND: Extreme ambient temperatures and air quality have been directly associated with various human diseases from several studies around the world. However, few analyses involving the association of these environmental circumstances with mental and behavioral disorders (MBD) have been carried out, especially in developing countries such as Brazil. METHODS: A time series study was carried out to explore the associations between daily air pollutants (SO(2), NO(2), O(3), and PM(10)) concentrations and meteorological variables (temperature and relative humidity) on hospital admissions for mental and behavioral disorders for Curitiba, Brazil. Daily hospital admissions from 2010 to 2016 were analyzed by a semi-parametric generalized additive model (GAM) combined with a distributed lag non-linear model (DLNM). RESULTS: Significant associations between environmental conditions (10??g/m(3) increase in air pollutants and temperature °C) and hospitalizations by MBD were found. Air temperature was the environmental variable with the highest relative risk (RR) at 0-day lag for all ages and sexes analyzed, with RR values of 1.0182 (95% CI: 1.0009-1.0357) for men, and 1.0407 (95% CI: 1.0230-1.0587) for women. Ozone exposure was a risk for all women groups, being higher for the young group, with a RR of 1.0319 (95% CI: 1.0165-1.0483). Elderly from both sexes were more susceptible to temperature variability, with a RR of 1.0651 (95% CI: 1.0213-1.1117) for women, and 1.0215 (95% CI: 1.0195-1.0716) for men. CONCLUSIONS: This study suggests that temperatures above and below the thermal comfort threshold, in addition to high concentrations of air pollutants, present significant risks on hospitalizations by MBD; besides, there are physiological and age differences resulting from the effect of this exposure.

Season-stratified effects of meteorological factors on childhood asthma in Shanghai, China

OBJECTIVES: There has been increasing interest in identifying the adverse effects of ambient environmental factors on asthma exacerbations (AE), but season-stratified effects of meteorological factors on childhood asthma remain unclear. We explored the season-stratified effects of meteorological factors on childhood AE in Shanghai, China. METHODS: Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to examine the lagged and nonlinear effects of meteorological factors on childhood AE after adjustment for putative confounders. We also performed a season-stratified analysis to determine whether the season modified the relationship between meteorological factors and childhood AE. RESULTS: There were 23,103 emergency department visits (EDVs) for childhood AE, including 15,466 boys and 7637 girls during 2008-2017. Most meteorological factors (e.g., temperature, diurnal temperature range (DTR), relative humidity (RH) and wind speed (WS)) were significantly associated with EDVs for childhood AE, even after adjustment for the confounding effects of air pollutants. In the whole year, extreme cold, moderate heat, higher DTR, lower RH and WS increased the relative risk (RR) for childhood AE. In the cold season, lower RH and wind speed increased the risks of childhood AE (RR(lag0-28) for the 5th percentile (p5) of RH: 9.744, 95% CI: 3.567, 26.616; RR(lag0-28) for the p5 of wind speed: 10.671, 95% CI: 1.096, 103.879). In the warm season, higher temperature and DTR, lower RH and WS increased the RR for childhood AE (RR(lag0-5) for the p95 of temperature: 1.871, 95% CI: 1.246, 2.810; RR(lag0-2) for the p95 of DTR: 1.146, 95% CI: 1.010, 1.300; RR(lag0-5) for the p5 of RH: 1.931, 95% CI: 1.191, 3.128; RR(lag0-2) for the p5 of WS: 1.311, 95% CI: 1.005, 1.709). CONCLUSIONS: Extreme meteorological factors appeared to be triggers of EDVs for childhood AE in Shanghai and the effects modified by season. These findings provide evidence for developing season-specific and tailored strategies to prevent and control childhood AE.

Relationship between COVID-19 and weather: Case study in a tropical country

This study aimed to evaluate the relationship between weather factors (temperature, humidity, solar radiation, wind speed, and rainfall) and COVID-19 infection in the State of Rio de Janeiro, Brazil. Solar radiation showed a strong (-0.609, p < 0.01) negative correlation with the incidence of novel coronavirus (SARS-CoV-2). Temperature (maximum and average) and wind speed showed negative correlation (p < 0.01). Therefore, in this studied tropical state, high solar radiation can be indicated as the main climatic factor that suppress the spread of COVID-19. High temperatures, and wind speed also are potential factors. Therefore, the findings of this study show the ability to improve the organizational system of strategies to combat the pandemic in the State of Rio de Janeiro, Brazil, and other tropical countries around the word.

Preliminary analysis of relationships between COVID19 and climate, morphology, and urbanization in the Lombardy Region (Northern Italy)

The coronavirus disease 2019 (COVID-19) pandemic is the most severe global health and socioeconomic crisis of our time, and represents the greatest challenge faced by the world since the end of the Second World War. The academic literature indicates that climatic features, specifically temperature and absolute humidity, are very important factors affecting infectious pulmonary disease epidemics – such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS); however, the influence of climatic parameters on COVID-19 remains extremely controversial. The goal of this study is to individuate relationships between several climate parameters (temperature, relative humidity, accumulated precipitation, solar radiation, evaporation, and wind direction and intensity), local morphological parameters, and new daily positive swabs for COVID-19, which represents the only parameter that can be statistically used to quantify the pandemic. The daily deaths parameter was not considered, because it is not reliable, due to frequent administrative errors. Daily data on meteorological conditions and new cases of COVID-19 were collected for the Lombardy Region (Northern Italy) from 1 March, 2020 to 20 April, 2020. This region exhibited the largest rate of official deaths in the world, with a value of approximately 1700 per million on 30 June 2020. Moreover, the apparent lethality was approximately 17% in this area, mainly due to the considerable housing density and the extensive presence of industrial and craft areas. Both the Mann-Kendall test and multivariate statistical analysis showed that none of the considered climatic variables exhibited statistically significant relationships with the epidemiological evolution of COVID-19, at least during spring months in temperate subcontinental climate areas, with the exception of solar radiation, which was directly related and showed an otherwise low explained variability of approximately 20%. Furthermore, the average temperatures of two highly representative meteorological stations of Molise and Lucania (Southern Italy), the most weakly affected by the pandemic, were approximately 1.5 °C lower than those in Bergamo and Brescia (Lombardy), again confirming that a significant relationship between the increase in temperature and decrease in virulence from COVID-19 is not evident, at least in Italy.

Past, present, and future vulnerability to Dengue in Jamaica: A spatial analysis of monthly variations

Over the years, Jamaica has experienced sporadic cases of dengue fever. Even though the island is vulnerable to dengue, there is paucity in the spatio-temporal analysis of the disease using Geographic Information Systems (GIS) and remote sensing tools. Further, access to time series dengue data at the community level is a major challenge on the island. This study therefore applies the Water-Associated Disease Index (WADI) framework to analyze vulnerability to dengue in Jamaica based on past, current and future climate change conditions using three scenarios: (1) WorldClim rainfall and temperature dataset from 1970 to 2000; (2) Climate Hazard Group InfraRed Precipitation with Station data (CHIRPS) rainfall and land surface temperature (LST) as proxy for air temperature from the Moderate Resolution Imaging Spectroradiometer (MODIS) for the period 2002 to 2016, and (3) maximum temperature and rainfall under the Representative Concentration Pathway (RCP) 8.5 climate change scenario for 2030 downscaled at 25 km based on the Regional Climate Model, RegCM4.3.5. Although vulnerability to dengue varies spatially and temporally, a higher vulnerability was depicted in urban areas in comparison to rural areas. The results also demonstrate the possibility for expansion in the geographical range of dengue in higher altitudes under climate change conditions based on scenario 3. This study provides an insight into the use of data with different temporal and spatial resolution in the analysis of dengue vulnerability.

Pattern of climate connectivity and equivalent niche of Triatominae species of the Phyllosoma complex

The Phyllosoma complex is a Triatominae (Hemiptera: Reduviidae) group of medical importance involved in Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) transmission. Most of the members of this group are endemic and sympatric species with distribution in Mexico and the southern U.S.A. We employed MaxEnt to construct ecological niche models of nine species of Triatominae to test three hypothesis: (a) whether species with a broad climatic niche breadth occupy a broader geographical range than species with a narrow climatic breadth, (b) whether species with broad distribution present high degree of climatic fragmentation/isolation, which was tested through landscape metrics; and (c) whether the species share the same climatic niche space (niche conservatism) considered through an equivalence test implemented in ENMtools. Overall, our results suggest that the geographical distribution of this complex is influenced mainly by temperature seasonality where all suitable areas are places of current and potential transmission of T. cruzi. Niche breadth in the Phyllosoma complex is associated with the geographical distribution range, and the geographical range affects the climatic connectivity. We found no strong evidence of niche climatic divergence in members of this complex. We discuss the epidemiological implications of these results.

Outdoor thermal comfort in different settings of a tropical planning region: A study on Sriniketan-Santiniketan Planning Area (SSPA), eastern India

Outdoor Thermal Comfort (OTC) is largely influenced by urban morphology and geometry of the urban landscape. In this study, the Local Climatic Zones (LCZs) approach was adopted to assess the OTC in different settings of Sriniketan-Santiniketan Planning Area (SSPA) during the summer season. The basic objective of this study is to assess OTC from both subjective and objective perspectives over eight LCZs. This study assessed OTC over LCZs using both field measurements and questionnaire survey. Non-parametric tests such as ANOVA and Kruskal-Wallis tests were also performed to find out the significant difference of perception across LCZs. The result of ANOVA and Krushkal-Walls test showed that subjective perception of OTC across LCZs varied due to diversified physical landscape settings. The result also showed that the maximum (above 40 degrees C) and minimum (28 degrees C) temperature was recorded in built types (particularly compact low rise) and natural land cover types (dense forest and water) respectively. Highest PET was also recorded over the built-up LCZs (about 50 degrees C) that led to this planning region thermally very hot or extreme heat stress. The respondents living in LCZ3 and LCZ6 were more sensitive to the thermal sensation as compared to those living in other LCZs.This study was probably the first attempt dealing with the assessment of OTC over the tropical planning region using LCZ approach from subjective and objective perspectives. Therefore, this research study has an immense potentiality to formulate strategies to deal with the outdoor thermal conditions as well to implement climate sensitive planning for urban sustainability in tropical cities.

Outdoor thermal comfort in various microentrepreneurial settings in hot humid tropical Kolkata: Human biometeorological assessment of objective and subjective parameters

Extreme heat and associated health risks increasingly become threats to urban populations, especially in developing countries of the tropics. Although human thermal exposure in cities has been studied across the globe, current narratives insufficiently discuss mixed-used spaces, informal economic activity settings, and informal settlements. This study assessed outdoor human thermal comfort in the tropical city of Kolkata, India where uncomfortable hot and humid climatic conditions prevail year-round. Thermal Comfort Perception Surveys (TCPS) and biometeorological observations were conducted during summer and winter in three microentrepreneurial neighborhoods (Kumartuli, Boipara, and Mallickghat). A one-way ANOVA was performed to investigate the variance in Physiologically Equivalent Temperature (PET) values of 318 survey samples across neighborhoods. Through multiple linear regression and ANCOVA, significant relationships were established between various climatic and non-climatic parameters. No respondent reported a neutral thermal sensation during the summer. Annual neutral PET across neighborhoods was 23.6 °C with a neutral PET range of 19.5 °C to 27.6 °C. Annual neutral PET was 22.7 °C and 26.5 °C in Mallickghat and Boipara, respectively. Respondents in Boipara were more sensitive towards warmer sensation than in Mallickghat. Even in the winter, people reported warmer sensation votes. PET was a better predictor of the mean Thermal Sensation Vote (mTSV) compared to air temperature. In a few cases, acclimatization and expectations improved thermal comfort. Results can be useful in formulating strategies towards improving outdoor microclimate and heat health in tropical cities.

Mortality risk of a future heat event across a subtropical city: Implications for community planning and health policy

In this study, we applied the Weather Research and Forecasting model to project 2050 urban and rural temperature. We applied a time-stratified analysis to compare it with mortality between 2001 and 2014 and between 2011 and 2014, to estimate the elevated risk of a 2050 heat event. We included change in daytime versus nighttime and urban versus rural temperatures as factors to project mortality, to evaluate the potential influence of climate change on mortality risk. Increases of 2.9 degrees C and 2.6 degrees C in maximum and minimum air temperature are projected in a 2050 heat event, with a day and a night that will have respective temperatures 9.8 degrees C and 4.9 degrees C higher than 2001-2014. Significantly higher mortality risk is forecasted in 2050 compared to 2001-2014 (IRR 1.721 [1.650, 1.796]) and 2011-2014 (IRR 1.622 [1.547, 1.701]) without consideration of temperature change. After consideration of changing temperature, change in maximum temperature in rural areas will induce the highest mortality risk during 2050, possibly due to rapid urbanization across the city, and with the second highest mortality risk induced by the change in minimum temperature in urbanized areas, possibly because local people in the city have been adapted to the maximum level of urban thermal stress during a summer day. Improvements to heat warning systems and sustainable planning protocols are urgently needed for climate change mitigation.

Nonlinear and threshold effect of meteorological factors on Japanese encephalitis transmission in southwestern China

Although previous studies have reported that meteorological factors might affect the risk of Japanese encephalitis (JE), the relationship between meteorological factors and JE remains unclear. This study aimed to evaluate the relationship between meteorological factors and JE and identify the threshold temperature. Daily meteorological data and JE surveillance data in Dazhou, Sichuan, were collected for the study period from 2005 to 2012 (restricting to May-October because of the seasonal distribution of JE). A distributed lag nonlinear model was used to analyze the lagged and cumulative effect of daily average temperature and daily rainfall on JE transmission. A total of 622 JE cases were reported over the study period. We found JE was positively associated with daily average temperature and daily rainfall with a 25-day lag and 30-day lag, respectively. The threshold value of the daily average temperature is 20°C. Each 5°C increase over the threshold would lead to a 13% (95% CI: 1-17.3%) increase in JE. Using 0 mm as the reference, a daily rainfall of 100 mm would lead to a 132% (95% CI: 73-311%) increase in the risk of JE. Japanese encephalitis is climate-sensitive; meteorological factors should be taken into account for the future prevention and control measure making, especially in a warm and rainy weather condition.

Occupational heat stress induced health impacts: A cross-sectional study from South Indian working population

Rising temperature and heat stress risks in the changing climate scenario might potentially affect workers globally, especially the ones with strenuous workload in tropical settings. We used a cross-sectional study design to profile the heat exposures of similar to 1900 workers from eight industrial sectors using a QuesTemp Wet Bulb Globe Temperature (WBGT) monitor, quantified select heat-strain indicators viz., rise in Core Body Temperature, Sweat Rate, and Urine Specific Gravity and evaluated the perceived health impacts of heat stress using a structured questionnaire. Heat exposures (average WBGT: 30.1 +/- 2.6 degrees C) exceeded the Threshold Limit Value for 67% workers and was positively associated with the rise in Core Body Temperature >1 degrees C in 13% and elevated Urine Specific Gravity >1.020 in 9% workers. Heat-related health concerns were reported by 86% workers, and the heat-exposed workers had 2.3 times higher odds of adverse health outcomes compared to unexposed workers (p < 0.0001). Exposure to higher WBGT and adverse renal health among salt-pan workers were significantly associated (p = 0.004), and steel workers had 9% prevalence of kidney stones. Evidence presented clearly points to heat stress as a health and productivity risk factor that could have long-term and irreversible health impacts. In-depth assessments are urgently needed to develop scientifically sound preventative interventions and protective labor policies to avert the adverse occupational health and productivity consequences for millions of workers globally, thereby aiding poverty reduction.

Modeling the time-lag effect of sea surface temperatures on ciguatera poisoning in the South Pacific: Implications for surveillance and response

Ciguatera poisoning (CP), arising from ciguatoxins produced by toxic dinoflagellate Gambierdiscus, is one of the most common food-borne diseases in the South Pacific. Climate change as well as its related events have been hypothesized to a higher abundance and wider presence of toxic dinoflagellates, hence a higher risk of the disease. Yet existing studies assessing the relationship between climate factors and CP are limited or based on old data. In this study, we used prewhitened cross-correlation analysis and auto-regressive integrated moving-average (ARIMA) modeling to develop predictive models of monthly CP incidence in Cook Islands and French Polynesia, two ciguatera-endemic regions in the South Pacific, utilizing the latest epidemiological data. Results reveal the significant time-lagged associations between the monthly CP incidence rate and several indicators relating to sea surface temperature (SST). In particular, SST anomaly is proven to be a strong positive predictor of an increased ciguatera incidence for both countries. If these time-lags can be supported by more investigations, it will allow health authorities to take appropriate actions, to limit or avoid an epidemic risk, especially on high-risk climate scenarios.

Modelling and analyzing spatial clusters of leptospirosis based on satellite-generated measurements of environmental factors in Thailand during 2013-2015

This study statistically identified the association of remotely sensed environmental factors, such as Land Surface Temperature (LST), Night Time Light (NTL), rainfall, the Normalised Difference Vegetation Index (NDVI) and elevation with the incidence of leptospirosis in Thailand based on the nationwide 7,495 confirmed cases reported during 2013-2015. This work also established prediction models based on empirical findings. Panel regression models with random-effect and fixed-effect specifications were used to investigate the association between the remotely sensed environmental factors and the leptospirosis incidence. The Local Indicators of Spatial Association (LISA) statistics were also applied to detect the spatial patterns of leptospirosis and similar results were found (the R2 values of the random-effect and fixed-effect models were 0.3686 and 0.3684, respectively). The outcome thus indicates that remotely sensed environmental factors possess statistically significant contribution in predicting this disease. The highest association in 3 years was observed in LST (random- effect coefficient = -9.787, P<0.001; fixed-effect coefficient = -10.340, P=0.005) followed by rainfall (random-effect coefficient = 1.353, P<0.001; fixed-effect coefficient = 1.347, P<0.001) and NTL density (random-effect coefficient = -0.569, P=0.004; fixed-effect coefficient = -0.564, P=0.001). All results obtained from the bivariate LISA statistics indicated the localised associations between remotely sensed environmental factors and the incidence of leptospirosis. Particularly, LISA’s results showed that the border provinces in the northeast, the northern and the southern regions displayed clusters of high leptospirosis incidence. All obtained outcomes thus show that remotely sensed environmental factors can be applied to panel regression models for incidence prediction, and these indicators can also identify the spatial concentration of leptospirosis in Thailand.

Monsoon weather and early childhood health in India

BACKGROUND: India is expected to experience an increase in the frequency and intensity of extreme weather events in the coming decades, which poses serious risks to human health and wellbeing in the country. OBJECTIVE: This paper aims to shed light on the possible detrimental effects of monsoon weather shocks on childhood undernutrition in India using the Demographic and Health Survey 2015-16, in combination with geo-referenced climate data. METHODS: Undernutrition is captured through measures of height-for-age, weight-for-height, stunting and wasting among children aged 0-59 months. The standardised precipitation and evapotranspiration index (SPEI) is used to measure climatic conditions during critical periods of child development. RESULTS: The results of a multivariate logistic regression model show that climate anomalies experienced in utero and during infancy are associated with an increased risk of child undernutrition; exposure to excessive monsoon precipitation during these early periods of life elevates the risk of stunting, particularly for children in the tropical wet and humid sub-tropical regions. In contrast, the risk of stunting is reduced for children residing in the mountainous areas who have experienced excessive monsoon precipitation during infancy. The evidence on the short-term effects of climate shocks on wasting is inconclusive. We additionally show that excessive precipitation, particularly during the monsoon season, is associated with an increased risk of contracting diarrhoea among children under five. Diseases transmitted through water, such as diarrhoea, could be one important channel through which excessive rainfall increases the risk of stunting. CONCLUSIONS: We find a positive association between childhood undernutrition and exposure to excessive monsoon precipitation in India. Pronounced differences across climate zones are found. The findings of the present analysis warn of the urgent need to provide health assistance to children in flood-prone areas.

More perceived but not faster evolution of heat stress than temperature extremes in the future

Global warming is projected to intensify during the twenty-first century. Yet, only few studies investigate how global warming could be perceived by future populations. Here, we propose an assessment of how climate change could be perceived by combining climatological indicators. We analyse extremes of temperature (T-99) and simplified Wet-Bulb Globe Temperature (WBGT(99)), a heat stress index assessing the combined effect of elevated temperature and humidity on the human body. The speed of change is defined for each year as the difference between the previous 20 years and the twenty upcoming years (i.e. with a moving baseline), and we assess how these speeds emerge from each last 20-year interannual variability. Using a set of 12 CMIP5 models, speeds of change ofT(99)and WBGT(99)in 2080 are both twice as fast compared with current speeds in mid-latitudes, and by up to four times faster in the tropics under the RCP8.5 scenario. Warming accelerations are thus similar forT(99)and WBGT(99). However, these speeds in tropical regions in 2080 are projected to be 2.3 times larger than the last 20-year interannual variability for WBGT(99), and only 1.5 to 1.8 times larger forT(99). According to the models, the WBGT(99)intensification will be more emergent from the recent year-to-year variability than theT(99)warming. This analysis suggests that the accelerated warming of heat extremes will be felt more strongly by populations than current changes for RCP8.5, and that this evolution will be more perceived in heat stress than in temperature, particularly within the tropics.

Model-based assessment of changes in the potential distribution of Solenopsis geminata (Hymenoptera: Formicidae) according to climate change scenarios

The tropical fire ant (TFA, Solenopsis geminata) is an aggressive fire ant species that can cause health problems in humans and damages ecosystems. The TFA can be found across the world, from North and South America to Africa, Asia, and Oceania; furthermore, it has been introduced into new areas by human transport or natural flights. In this study, species distribution modeling was applied to the TFA for the first time, and its potential distribution as a response to climate change was evaluated. This study used CLIMEX as the climate-specific species distribution modeling tool with the distribution data for TFA, current global meteorological data, and two types of climate change scenarios. Thus, although the climatic suitability of the TFA was assumed to decrease with climate change, its distribution limit was expected to increase. In addition, the difference between potential distributions predicted using Special Report on Emissions Scenarios A1 B and Special Report on Emissions Scenarios A2 increased over time. In conclusion, even with an overall decrease in climatic suitability, in the future, the TFA will still be able to invade a new area that it cannot inhabit under the current climatic scenario. As the first study that predicts TFA distribution using a species distribution model, we expect that this study will provide the basic information for further TFA modeling and for setting up quarantine and control measures. (C) 2020 National Science Museum of Korea (NSMK) and Korea National Arboretum (KNA), Publishing Services by Elsevier.

Modeling an association between malaria cases and climate variables for Keonjhar district of Odisha, India: A Bayesian approach

Malaria, a vector-borne disease, is a significant public health problem in Keonjhar district of Odisha (the malaria capital of India). Prediction of malaria, in advance, is an urgent need for reporting rolling cases of disease throughout the year. The climate condition do play an essential role in the transmission of malaria. Hence, the current study aims to develop and assess a simple and straightforward statistical model of an association between malaria cases and climate variates. It may help in accurate predictions of malaria cases given future climate conditions. For this purpose, a Bayesian Gaussian time series regression model is adopted to fit a relationship of the square root of malaria cases with climate variables with practical lag effects. The model fitting is assessed using a Bayesian version of R(2) (RsqB). Whereas, the predictive ability of the model is measured using a cross-validation technique. As a result, it is found that the square root of malaria cases with lag 1, maximum temperature, and relative humidity with lag 3 and 0 (respectively), are significantly positively associated with the square root of the cases. However, the minimum and average temperatures with lag 2, respectively, are observed as negatively (significantly) related. The considered model accounts for moderate amount of variation in the square root of malaria cases as received through the results for RsqB. We also present Absolute Percentage Errors (APE) for each of the 12 months (January-December) for a better understanding of the seasonal pattern of the predicted (square root of) malaria cases. Most of the APEs obtained corresponding to test data points is reasonably low. Further, the analysis shows that the considered model closely predicted the actual (square root of) malaria cases, except for some peak cases during the particular months. The output of the current research might help the district to develop and strengthen early warning prediction of malaria cases for proper mitigation, eradication, and prevention in similar settings.

Machine learning and dengue forecasting: Comparing random forests and artificial neural networks for predicting dengue burden at national and sub-national scales in Colombia

The robust estimate and forecast capability of random forests (RF) has been widely recognized, however this ensemble machine learning method has not been widely used in mosquito-borne disease forecasting. In this study, two sets of RF models were developed at the national (pooled department-level data) and department level in Colombia to predict weekly dengue cases for 12-weeks ahead. A pooled national model based on artificial neural networks (ANN) was also developed and used as a comparator to the RF models. The various predictors included historic dengue cases, satellite-derived estimates for vegetation, precipitation, and air temperature, as well as population counts, income inequality, and education. Our RF model trained on the pooled national data was more accurate for department-specific weekly dengue cases estimation compared to a local model trained only on the department’s data. Additionally, the forecast errors of the national RF model were smaller to those of the national pooled ANN model and were increased with the forecast horizon increasing from one-week-ahead (mean absolute error, MAE: 9.32) to 12-weeks ahead (MAE: 24.56). There was considerable variation in the relative importance of predictors dependent on forecast horizon. The environmental and meteorological predictors were relatively important for short-term dengue forecast horizons while socio-demographic predictors were relevant for longer-term forecast horizons. This study demonstrates the potential of RF in dengue forecasting with a feasible approach of using a national pooled model to forecast at finer spatial scales. Furthermore, including sociodemographic predictors is likely to be helpful in capturing longer-term dengue trends.

Mapping heat-related risks in Northern Jiangxi Province of China based on two spatial assessment frameworks approaches

Heat-health risk is a growing concern in many regions of China due to the more frequent occurrence of extremely hot weather. Spatial indexes based on various heat assessment frameworks can be used for the assessment of heat risks. In this study, we adopted two approaches-Crichton’s risk triangle and heat vulnerability index (HVI) to identify heat-health risks in the Northern Jiangxi Province of China, by using remote sensing and socio-economic data. The Geographical Information System (GIS) overlay and principal component analysis (PCA) were separately used in two frameworks to integrate parameters. The results show that the most densely populated community in the suburbs, instead of city centers, are exposed to the highest heat risk. A comparison of two heat assessment mapping indicates that the distribution of HVI highlights the vulnerability differences between census tracts. In contrast, the heat risk index of Crichton’s risk triangle has a prominent representation for regions with high risks. The stepwise multiple linear regression zero-order correlation coefficient between HVI and outdoor workers is 0.715, highlighting the vulnerability of this particular group. Spearman’s rho nonparametric correlation and the mean test reveals that heat risk index is strongly correlated with HVI in most of the main urban regions in the study area, with a significantly lower value than the latter. The analysis of variance shows that the distribution of HVI exhibits greater variety across urban regions than that of heat risk index. Our research provides new insight into heat risk assessment for further study of heat health risk in developing countries.

La Niña weather impacts dietary patterns and dietary diversity among children in the Peruvian Amazon

OBJECTIVE: In 2011-2012, severe El Niño Southern Oscillation (ENSO) conditions (La Niña) led to massive flooding and temporarily displacement in the Peruvian Amazon. Our aims were to examine the impact of this ENSO exposure on child diets, in particular: (1) frequency of food consumption patterns, (2) the amount of food consumed (g/d), (3) dietary diversity (DD), (4) consumption of donated foods, among children aged 9-36 months living in the outskirts of City of Iquitos in the Amazonian Peru. DESIGN: This was a longitudinal study that used quantitative 24-h recall dietary data collection from children aged 9-36 months from 2010 to 2014 as part of the MAL-ED birth cohort study. SETTING: Iquitos, Loreto, Peru. PARTICIPANTS: Two hundred and fifty-two mother-child dyads. RESULTS: The frequency of grains, rice, dairy and sugar in meals reduced by 5-7 %, while the frequency of plantain in meals increased by 24 % after adjusting for covariates. ENSO exposure reduced girl’s intake of plantains and sugar. Despite seasonal fluctuations in the availability of fruits, vegetables and fish, DD remained constant across seasons and as children aged. However, DD was significantly reduced under moderate La Niña conditions by 0·32 (P < 0·05) food groups. Adaptive social strategies such as consumption of donated foods were significantly higher among households with girls. CONCLUSIONS: This is the first empirical study to show differential effect of the ENSO on the dietary patterns of children, highlighting differences by gender. Public health nutrition programmes should be climate- and gender-sensitive in their efforts to safeguard the diets of vulnerable populations.

Leptospirosis and its spatial and temporal relations with natural disasters in six municipalities of Santa Catarina, Brazil, from 2000 to 2016

Leptospirosis is a serious bacterial infection that occurs worldwide, with fatality rate of up to 40% in the most severe cases. The number of cases peaks during the rainy season and may reach epidemic proportions in the event of flooding. It is possible that people living in areas affected by natural disasters are at greater risk of contracting the disease. The aim of this study was to identify clusters of relatively higher risk for leptospirosis occurrence, both in space and time, in six municipalities of Santa Catarina, Brazil, which had the highest incidence of the disease between 2000 and 2016, and to evaluate if these clusters coincide with the occurrence of natural disasters. The cases were geocoded with the geographic coordinates of patients’ home addresses, and the analysis was performed using SaTScan software. The areas mapped as being at risk for hydrological and mass movements were compared with the locations of detected leptospirosis clusters. The disease was more common in men and in the age group from 15 to 69 years. In the scan statistics performed, only space-time showed significant results. Clusters were detected in all municipalities in 2008, when natural disasters preceded by heavy rainfall occurred. One of the municipalities also had clusters in 2011. In these clusters, most of the cases lived in urban areas and areas at risk for experiencing natural disasters. The interaction between time (time of disaster occurrence) and space (areas at risk of experiencing natural disasters) were the determining factors affecting cluster formation.

Leptospirosis trends in China, 2007-2018: A retrospective observational study

Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re-emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007-2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660-0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60-75), males, farmers, students and field workers were high-risk populations. During the 2007-2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re-emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China.

Japanese Encephalitis and associated environmental risk factors in Eastern Uttar Pradesh: A time series analysis from 2001 to 2016

India and other Southeast Asian countries are severely affected by Japanese encephalitis (JE), one of the deadliest vector-borne disease threat to human health. Several epidemiological observations suggest climate variables play a role in providing a favorable environment for mosquito development and virus transmission. In this study, generalized additive models were used to determine the association of JE admissions and mortality with climate variables in Gorakhpur district, India, from 2001-2016. The model predicted that every 1 unit increase in mean (Tmean;°C), and minimum (Tmin;°C) temperature, rainfall (RF; mm) and relative humidity (RH; %) would on average increase the JE admissions by 22.23 %, 17.83 %, 0.66 %, and 5.22 % respectively and JE mortality by 13.27 %, 11.77 %, 0.94 %, and 3.27 % respectively Conversely, every unit decrease in solar radiation (Srad; MJ/m(2)/day) and wind speed (WS; Kmph) caused an increase in JE admission by 17% and 11.42% and in JE mortality by 9.37% and 4.88% respectively suggesting a protective effect at higher levels. The seasonal analysis shows that temperature was significantly associated with JE in pre-monsoon and post-monsoon while RF, RH, Srad, and WS are associated with the monsoon. Effect modification due to age and gender showed an equal risk for both genders and increased risk for adults above 15 years of age, however, males and age groups under 15 years outnumbered females and adults. Sensitivity analysis results to explore lag effects in climate variables showed that climate variables show the strongest association at lag 1 to 1.5 months with significant lag effect up tp lag 0-60 days. The exposure-response curve for climate variables showed a more or less linear relationship, with an increase in JE admissions and mortality after a certain threshold and decrease were reported at extreme levels of exposure. The study concludes that climate variables could influence the JE vector development and multiplication and parasite maturation and transmission in the Gorakhpur region whose indirect impact was noted for JE admission and mortality. In response to the changing climate, public health interventions, public awareness, and early warning systems would play an unprecedented role to compensate for future risk.

Kerteszia cruzii and extra-Amazonian malaria in Brazil: Challenges due to climate change in the Atlantic Forest

Kerteszia cruzii is a sylvatic mosquito and the primary vector of Plasmodium spp., which can cause malaria in humans in areas outside the Amazon River basin in Brazil. Anthropic changes in the natural environments are the major drivers of massive deforestation and local climate change, with serious impacts on the dynamics of mosquito communities and on the risk of acquiring malaria. Considering the lack of information on the dynamics of malaria transmission in areas across the Atlantic Forest biome, where Ke. cruzii is the dominant vector, and the impact of climate drivers of malaria, the present study aimed to: (i) investigate the occurrence and survival rate of Ke. cruzii based on the distinct vegetation profiles found in areas across the coastal region of the Brazilian Atlantic Forest biome; (ii) estimate the extrinsic incubation period (EIP) and survival rates of P. vivax and P. falciparum parasites in Ke. cruzii under current and future scenarios. The potential distribution of Plasmodium spp. was estimated using simulation analyses under distinct scenarios of average temperature increases from 1 °C to 3.7 °C. Our results showed that two conditions are necessary to explain the occurrence and survival of Ke. cruzii: warm temperature and presence of the Atlantic Forest biome. Moreover, both Plasmodium species showed a tendency to decrease their EIP and increase their estimated survival rates in a scenario of higher temperature. Our findings support that the high-risk malaria areas may include the southern region of the distribution range of the Atlantic Forest biome in the coming years. Despite its limitations and assumptions, the present study provides robust evidence of areas with potential to be impacted by malaria incidence in a future scenario. These areas should be monitored in the next decades regarding the occurrence of the mosquito vector and the potential for malaria persistence and increased occurrence.

Increased temperatures reduce the vectorial capacity of Aedes mosquitoes for Zika virus

Rapid and significant range expansion of both Zika virus (ZIKV) and its Aedes vector species has resulted in ZIKV being declared a global health threat. Mean temperatures are projected to increase globally, likely resulting in alterations of the transmission potential of mosquito-borne pathogens. To understand the effect of diurnal temperature range on the vectorial capacity of Ae. aegypti and Ae. albopictus for ZIKV, longevity, blood-feeding and vector competence were assessed at two temperature regimes following feeding on infectious blood meals. Higher temperatures resulted in decreased longevity of Ae. aegypti [Log-rank test, ?2, df 35.66, 5, P < 0.001] and a decrease in blood-feeding rates of Ae. albopictus [Fisher's exact test, P < 0.001]. Temperature had a population and species-specific impact on ZIKV infection rates. Overall, Ae. albopictus reared at the lowest temperature regime demonstrated the highest vectorial capacity (0.53) and the highest transmission efficiency (57%). Increased temperature decreased vectorial capacity across groups yet more significant effects were measured with Ae. aegypti relative to Ae. albopictus. The results of this study suggest that future increases in temperature in the Americas could significantly impact vector competence, blood-feeding and longevity, and potentially decrease the overall vectorial capacity of Aedes mosquitoes in the Americas.

Independent association between meteorological factors, PM2.5, and seasonal influenza activity in Hangzhou, Zhejiang province, China

BACKGROUND: Due to variations in climatic conditions, the effects of meteorological factors and PM(2.5) on influenza activity, particularly in subtropical regions, vary in existing literature. In this study, we examined the relationship between influenza activity, meteorological parameters, and PM(2.5) . METHODS: A total of 20 165 laboratory-confirmed influenza cases in Hangzhou, Zhejiang province, were documented in our dataset and aggregated into weekly counts for downstream analysis. We employed a combination of the quasi-Poisson-generalized additive model and the distributed lag non-linear model to examine the relationship of interest, controlling for long-term trends, seasonal trends, and holidays. RESULTS: A hockey-stick association was found between absolute humidity and the risk of influenza infections. The overall cumulative adjusted relative risk (ARR) was statistically significant when weekly mean absolute humidity was low (<10 µg/m(3) ) and high (>17.5 µg/m(3) ). A slightly higher ARR was observed when weekly mean temperature reached over 30.5°C. A statistically significantly higher ARR was observed when weekly mean relative humidity dropped below 67%. ARR increased statistically significantly with increasing rainfall. For PM(2.5) , the ARR was marginally statistically insignificant. In brief, high temperature, wet and dry conditions, and heavy rainfall were the major risk factors associated with a higher risk of influenza infections. CONCLUSIONS: The present study contributes additional knowledge to the understanding of the effects of various environmental factors on influenza activities. Our findings shall be useful and important for the development of influenza surveillance and early warning systems.

Inference on dengue epidemics with Bayesian regime switching models

Dengue, a mosquito-borne infectious disease caused by the dengue viruses, is present in many parts of the tropical and subtropical regions of the world. All four serotypes of dengue viruses are endemic in Singapore, an equatorial city-state. Frequent outbreaks occur, sometimes leading to national epidemics. However, few studies have attempted to characterize breakpoints which precede large rises in dengue case counts. In this paper, Bayesian regime switching (BRS) models were employed to infer epidemic and endemic regimes of dengue transmissions, each containing regime specific autoregressive processes which drive the growth and decline of dengue cases, estimated using a custom built multi-move Gibbs sampling algorithm. Posterior predictive checks indicate that BRS replicates temporal trends in Dengue transmissions well and nowcast accuracy assessed using a post-hoc classification scheme showed that BRS classification accuracy is robust even under limited data with the AUC-ROC at 0.935. LASSO-based regression and bootstrapping was used to account for plausibly high dimensions of climatic factors affecting Dengue transmissions, which was then estimated using cross-validation to conduct statistical inference on long-run climatic effects on the estimated regimes. BRS estimates epidemic and endemic regimes of dengue in Singapore which are characterized by persistence across time, lasting an average of 20 weeks and 66 weeks respectively, with a low probability of transitioning away from their regimes. Climate analysis with LASSO indicates that long-run climatic effects up to 20 weeks ago do not differentiate epidemic and endemic regimes. Lastly, by fitting BRS to simulated disease data generated from a stochastic Susceptible-Infected-Recovered model, mechanistic links between infectivity and regimes classified using BRS were provided. The model proposed could be applied to other localities and diseases under minimal data requirements where transmission counts over time are collected.

Impact of meteorological factors on the occurrence of acute aortic dissection in Fujian Province, China: A single-center seven-year retrospective study

BACKGROUND: The aim of this study was to investigate the correlation between meteorological factors and the occurrence of acute aortic dissection (AAD) in Fujian Province, China. METHODS: The clinical data of 2004 patients diagnosed with AAD in our hospital and the relevant local meteorological data from January 2013 to November 2019 were retrospectively analyzed. RESULTS: The incidence of AAD had a clear tendency toward concentration, and the corresponding peak in terms of the occurrence date was from January 13 to 14. The average minimum temperature, the average maximum temperature, and the average daily temperature differences on the “day with AAD” were significantly lower than those on the “day without AAD”. From 5?days to 3?days before AAD onset, the average daily temperature difference showed a downward trend, but statistical analysis showed that the average minimum, average maximum and average daily temperature differences were not significantly different from the values 5?days to 0?days before AAD onset. CONCLUSIONS: The incidence of AAD is related to the season and month. The lowest average temperature may increase the incidence of AAD in patients with complicated cardiovascular diseases.

Impact of temperature variability on childhood allergic rhinitis in a subtropical city of China

BACKGROUND: Many studies have shown an association of childhood respiratory diseases with short-term temperature variability such as diurnal temperature range (DTR) and temperature change between two neighboring days (TCN). However, the impact of temperature variability on allergic rhinitis (AR) has not been investigated so far. This study sought to evaluate the short-term effect of temperature variability (i.e., TCN and DTR) on AR, as well as to identify vulnerable subpopulations. METHOD: We collected daily data on emergency room visits and outpatients for AR and weather variables in Hefei, China during 2014-2016. A distributed lag non-linear model that controlled for long-term trend and seasonality, mean temperature, relative humidity, day of week was used to fit the associations of AR with DTR and TCN. Stratified analyses by age, sex and occupation were also performed. RESULTS: During the study period, there were a total of 53,538 cases and the average values of DTR and TCN were 8.4?°C (range: 1.0?°C to 21.2?°C) and 0?°C (range: -?12.2?°C to 5.9?°C), respectively. While we did not observe an adverse effect of DTR on AR, TCN was significantly associated with increased risk of AR. Specifically, a large temperature drop between two adjacent days (3.8?°C, 5th percentile of TCN) has a delayed and short-lasting effect on AR, with the estimated relative risk of 1.02 (95% confidence interval: 1.01 to 1.04) at lag 12. Moreover, boys and children older than 15?years seemed to be more vulnerable to the effect of TCN. CONCLUSIONS: This study provided evidence of an adverse effect of large temperature drops between two adjacent days on childhood AR. Attention paid to boys and older children may help prevent AR attacks.

Impacts of low temperatures on Wolbachia (Rickettsiales: Rickettsiaceae)-infected Aedes aegypti (Diptera: Culicidae)

In recent decades, the occurrence and distribution of arboviral diseases transmitted by Aedes aegypti mosquitoes has increased. In a new control strategy, populations of mosquitoes infected with Wolbachia are being released to replace existing populations and suppress arboviral disease transmission. The success of this strategy can be affected by high temperature exposure, but the impact of low temperatures on Wolbachia-infected Ae. aegypti is unclear, even though low temperatures restrict the abundance and distribution of this species. In this study, we considered low temperature cycles relevant to the spring season that are close to the distribution limits of Ae. aegypti, and tested the effects of these temperature cycles on Ae. aegypti, Wolbachia strains wMel and wAlbB, and Wolbachia phage WO. Low temperatures influenced Ae. aegypti life-history traits, including pupation, adult eclosion, and fertility. The Wolbachia-infected mosquitoes, especially wAlbB, performed better than uninfected mosquitoes. Temperature shift experiments revealed that low temperature effects on life history and Wolbachia density depended on the life stage of exposure. Wolbachia density was suppressed at low temperatures but densities recovered with adult age. In wMel Wolbachia there were no low temperature effects specific to Wolbachia phage WO. The findings suggest that Wolbachia-infected Ae. aegypti are not adversely affected by low temperatures, indicating that the Wolbachia replacement strategy is suitable for areas experiencing cool temperatures seasonally.

Incidence and spatial distribution of cases of dengue, from 2010 to 2019: An ecological study

BACKGROUND: Dengue is an arbovirus that has caused serious problem in Brazil, putting the public health system under severe stress. Understanding its incidence and spatial distribution is essential for disease control and prevention. OBJECTIVE: To perform an analysis on dengue incidence and spatial distribution in a medium-sized, cool-climate and high-altitude city. DESIGN AND SETTING: Ecological study carried out in a public institution in the city of Garanhuns, Pernambuco, Brazil. METHODS: Secondary data provided by specific agencies in each area were used for spatial analysis and elaboration of kernel maps, incidence calculations, correlations and percentages of dengue occurrence. The Geocentric Reference System for the Americas (Sistema de Referência Geocêntrico para as Américas, SIRGAS), 2000, was the software of choice. RESULTS: The incidence rates were calculated per 100,000 inhabitants. Between 2010 and 2019, there were 6,504 cases and the incidence was 474.92. From 2010 to 2014, the incidence was 161.46 for a total of 1,069 cases. The highest incidence occurred in the period from 2015 to 2019: out of a total of 5,435 cases, the incidence was 748.65, representing an increase of 485.97%. Population density and the interaction between two climatic factors, i.e. atypical temperature above 31 °C and relative humidity above 31.4%, contributed to the peak incidence of dengue, although these variables were not statistically significant (P > 0.05). CONCLUSION: The dengue incidence levels and spatial distribution reflected virus and vector adjustment to the local climate. However, there was no correlation between climatic factors and occurrences of dengue in this city.

Increase in the risk of snakebites incidence due to changes in humidity levels: A time series study in four municipalities of the state of Rondônia

INTRODUCTION: Snakebites represent a serious global public health problem, especially in tropical countries. In Brazil, the incidence of snakebites ranges from 19 to 22 thousand cases per 100000 persons annually. The state of Rondônia, in particular, has had an increasing incidence of snakebites. METHODS: A retrospective cross-sectional study on snakebites was conducted from January 2007 to December 2018. Brazil’s Information System for Notifiable Diseases was queried for all snakebites reported in Porto Velho, Ariquemes, Cacoal, and Vilhena. Data on land surface temperatures during the day and night, precipitation, and humidity were obtained using the Google Earth Engine. A Bayesian time series model was constructed to describe the pattern of snakebites and their relationship with climate data. RESULTS: In total, 6326 snakebites were reported in Rondônia. Accidents were commonly caused by Bothrops sp. (n=2171, 81.80%). Snakebites most frequently occurred in rural areas (n=2271, 85.5%). Men, with a median age of 34 years (n=2101, 79.1%), were the most frequent bitten. Moderate clinical manifestation was the most common outcome of an accident (n=1101, 41.50%). There were clear seasonal patterns with respect to rainfall, humidity, and temperature. Rainfall and land surface temperature during the day or night did not increase the risk of snakebites in any city; however, changes in humidity increased the risk of snakebites in all cities. CONCLUSION: This study identified the population exposed to snakes and the influence of anthropic and climatic factors on the incidence of snakebites. According to climate data, changes in humidity increased the risk of snakebites.

Impact of climate variability and abundance of mosquitoes on Dengue Transmission in Central Vietnam

Dengue fever is an important arboviral disease in many countries. Its incidence has increased during the last decade in central Vietnam. Most dengue studies in Vietnam focused on the northern area (Hanoi) and southern regions but not on central Vietnam. Dengue transmission dynamics and relevant environmental risk factors in central Vietnam are not understood. This study aimed to evaluate spatiotemporal patterns of dengue fever in central Vietnam and effects of climatic factors and abundance of mosquitoes on its transmission. Dengue and mosquito surveillance data were obtained from the Department of Vector Control and Border Quarantine at Nha Trang Pasteur Institute. Geographic Information System and satellite remote sensing techniques were used to perform spatiotemporal analyses and to develop climate models using generalized additive models. During 2005-2018, 230,458 dengue cases were reported in central Vietnam. Da Nang and Khanh Hoa were two major hotspots in the study area. The final models indicated the important role of Indian Ocean Dipole, multivariate El Niño-Southern Oscillation index, and vector index in dengue transmission in both regions. Regional climatic variables and mosquito population may drive dengue transmission in central Vietnam. These findings provide important information for developing an early dengue warning system in central Vietnam.

Impact of environmental and climate factors on spatial distribution of Cutaneous Leishmaniasis in Northeastern Iran: Utilizing remote sensing

BACKGROUND: Cutaneous leishmaniasis (CL) is a dermal and parasitic disease.. The aim of this study was to determine the effect of environmental and climate factors on spatial distribution of CL in northeastern Iran by utilizing remote sensing from 20 March 2016 to 19 March 2017. METHODS: In this ecological study, the data were divided into two parts: The descriptive data on human CL cases were gathered from Communicable Diseases center of Iran. The remote sensing techniques and satellite imagery data (TRMM, MODIS-Aqua, MODIS-Terra and AMSR-2 with spatial resolution 0.25°, 0.05°, 5600m and 10km) of environmental and climate factors were used to determine the spatial pattern changes of cutaneous leishmaniasis incidence. RESULTS: The incidence of CL in North Khorasan, Razavi Khorasan, and South Khorasan was 35.80 per 100,000 people (309/863092), 34.14 per 100,000 people (2197/6,434,501) and 7.67 per 100,000 people (59/768,898), respectively. The incidence of CL had the highest correlation with soil moisture and evapotranspiration. Moreover, the incidence of disease was significantly correlated with Normalized Difference Vegetation Index (NDVI) and air humidity while it had the lowest correlation with rainfall. Furthermore, the CL incidence had an indirect correlation relation with the air temperature meaning that with an increase in the temperature, the incidence of disease decreased. CONCLUSION: As such, the incidence of disease was also higher in the northern regions; most areas of North Khorasan and northern regions of Razavi Khorasan; where the rainfall, vegetation, specific humidity, evapotranspiration, and soil moisture was higher than the southern areas.

Impact of long-term exposure wildfire smog on respiratory health outcomes

Background: Air pollution is a global problem and also linked to respiratory diseases. Wildfire smog is a major cause of air pollution in the upper northern area of Thailand. Thus, in the current study, we examined whether long-term exposure to wildfire smog induces lung function changes in a population from the upper northern area of Thailand. Methods: The lung function of 115 participants with long-term exposure smog was determined using peak flow meter. Results: Long-term smoke exposure participants decreased FEV1 (forced expiratory volume in 1 second)/FVC (forced vital capacity) ratio (56.49 +/- 23.88 in males and 56.29 +/- 28.23 in females) compared with general Thai population. Moreover, the reduction of FVC, FEV1, and peak expiratory flow rate (PEFR) values also showed in both male and female subjects. These results suggest that long-term smoke exposure induces obstructive lung abnormality. Moreover, itchy/watery nose, cough, phlegm, and chest pain also reported in these subjects. Conclusion: Wildfire smog could be induced respiratory pathway inflammation and easily collapsible respiratory airways.

Identification and seasonality of rhinovirus and respiratory syncytial virus in asthmatic children in tropical climate

INTRODUCTION: Asthma is a disease that has been associated with the presence of different genetic and socio-environmental factors. OBJECTIVE: To identify and evaluate the seasonality of respiratory syncytial virus (RSV) and human rhinovirus (RV) in asthmatic children and adolescents in tropical climate, as well as to assess the socioeconomic and environmental factors involved. METHODS: The study was conducted in a referral hospital, where a total of 151 children were recruited with a respiratory infection. The International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a questionnaire were applied, and a skin prick test was performed. The nasal swab was collected to detect RV and RSV through molecular assay. National Meteorological Institute (INMET) database was the source of climatic information. RESULTS: The socio-environmental characterization of asthmatic children showed the family history of allergy, disturbed sleep at night, dry cough, allergic rhinitis, individuals sensitized to at least one mite. We identified RV in 75% of children with asthma and 66.7% of RSV in children with asthma. There was an association between the presence of RV and the dry season whereas the presence of the RSV was associated with the rainy season. Contributing to these results, a negative correlation was observed between the RSV and the wind speed and the maximum temperature (T. Max) and a positive correlation with precipitation. CONCLUSIONS: The results suggest a high prevalence of RV and RSV in asthmatic children and the seasonality of these viruses were present in different climatic periods. This has significant implications for understanding short- and long-term clinical complications in asthmatic patients.

Heat-related mortality at the beginning of the twenty-first century in Rio de Janeiro, Brazil

Temperature record-breaking events, such as the observed more intense, longer-lasting, and more frequent heat waves, pose a new global challenge to health sectors worldwide. These threats are of particular interest in low-income regions with limited investments in public health and a growing urban population, such as Brazil. Here, we apply a comprehensive interdisciplinary climate-health approach, including meteorological data and a daily mortality record from the Brazilian Health System from 2000 to 2015, covering 21 cities over the Metropolitan Region of Rio de Janeiro. The percentage of absolute mortality increase due to summer extreme temperatures is estimated using a negative binomial regression modeling approach and maximum/minimum temperature-derived indexes as covariates. Moreover, this study assesses the vulnerability to thermal stress for different age groups and both genders and thoroughly analyzes four extremely intense heat waves during 2010 and 2012 regarding their impacts on the population. Results showed that the highest absolute mortality values during heat-related events were linked to circulatory illnesses. However, the highest excess of mortality was related to diabetes, particularly for women within the elderly age groups. Moreover, results indicate that accumulated heat stress conditions during consecutive days preferentially preceded by persistent periods of moderate-temperature, lead to higher excess mortality rather than sporadic single hot days. This work may provide directions in human health policies related to extreme climate events in large tropical metropolitan areas from developing countries, contributing to altering the historically based purely reactive response.

Heatwave-induced human health risk assessment in megacities based on heat stress-social vulnerability-human exposure framework

Assessing heatwave-induced human health risk is of critical importance in order to mitigate hazards caused by extreme environmental events. Air temperature or land surface temperature in previous studies was often used to characterize the severity of heatwaves, and human perception of the thermal environment was neglected as a key component in the heatwave-induced risk assessment. In order to redress this issue, in this study we applied the Universal Thermal Climate Index (UTCI) to represent human thermal comfort perception and embedded the measure within an assessment framework of heat stress-social vulnerability-human exposure. The heatwave-induced human health risk was then evaluated in Wuhan City, China across 177 blocks covering the entire city area and local risk governance measures were also explored based on risk zoning. The results showed that spatial patterns of heatwave-induced human health risk followed a decreasing trend from the city center towards the surrounding areas, with the average risk of the main urban area being 1.6 times that beyond the metropolitan development area. Through the heatwave-induced human health risk zoning, about 73.45% of the 177 blocks in Wuhan City demonstrated a positive relationship between heat stress and human exposure, and both were opposite with social vulnerability. Multiple linear regression between UTCI and the proportion of greenspace, water body and construction land indicated that, more blue or green infrastructure should be integrated within the urban fabric to help mitigate heat stress particularly in the main urban area, while in the metropolitan development area construction land dominating heat stress should be strictly regulated. Furthermore, protecting vulnerable groups such as left-behind children and elderly people should be a priority in rural areas that were generally associated with higher levels of social vulnerability. This study proposed a new heatwave-induced human health risk framework with a local evidence in Wuhan City, and further emphasized that risk zoning could be used as a basic yet important approach to facilitating more effective urban planning guidelines for risk governance.

Heatwaves and dengue outbreaks in Hanoi, Vietnam: New evidence on early warning

BACKGROUND: Many studies have shown associations between rising temperatures, El Niño events and dengue incidence, but the effect of sustained periods of extreme high temperatures (i.e., heatwaves) on dengue outbreaks has not yet been investigated. This study aimed to compare the short-term temperature-dengue associations during different dengue outbreak periods, estimate the dengue cases attributable to temperature, and ascertain if there was an association between heatwaves and dengue outbreaks in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS: Dengue outbreaks were assigned to one of three categories (small, medium and large) based on the 50th, 75th, and 90th percentiles of distribution of weekly dengue cases during 2008-2016. Using a generalised linear regression model with a negative binomial link that controlled for temporal trends, temperature variation, rainfall and population size over time, we examined and compared associations between weekly average temperature and weekly dengue incidence for different outbreak categories. The same model using weeks with or without heatwaves as binary variables was applied to examine the potential effects of extreme heatwaves, defined as seven or more days with temperatures above the 95th percentile of daily temperature distribution during the study period. This study included 55,801 dengue cases, with an average of 119 (range: 0 to 1454) cases per week. The exposure-response relationship between temperature and dengue risk was non-linear and differed with dengue category. After considering the delayed effects of temperature (one week lag), we estimated that 4.6%, 11.6%, and 21.9% of incident cases during small, medium, and large outbreaks were attributable to temperature. We found evidence of an association between heatwaves and dengue outbreaks, with longer delayed effects on large outbreaks (around 14 weeks later) than small and medium outbreaks (4 to 9 weeks later). Compared with non-heatwave years, dengue outbreaks (i.e., small, moderate and large outbreaks combined) in heatwave years had higher weekly number of dengue cases (p<0.05). Findings were robust under different sensitivity analyses. CONCLUSIONS: The short-term association between temperature and dengue risk varied by the level of outbreaks and temperature seems more likely affect large outbreaks. Moreover, heatwaves may delay the timing and increase the magnitude of dengue outbreaks.

Heatwaves intensification in Australia: A consistent trajectory across past, present and future

Heatwaves are defined as unusually high temperature events that occur for at least three consecutive days with major impacts to human health, economy, agriculture and ecosystems. This paper investigates: 1) changes in heatwave characteristics such as peak temperature, number of events, frequency and duration over a past 67-year period in Australia; 2) projected changes in heatwave characteristics for this century in Queensland, northeast Australia; and 3) the avoided heatwave impacts of limiting global warming by 1.5 °C, 2.0 °C and 3.0 °C. The results reveal that heatwaves have increased in intensity, frequency and duration across Australia over the past 67 years, such intensification was particularly higher on recent decades. Downscaled future climate projections for Queensland suggest that heatwaves will further intensify over the current century. The projections also highlight that distinct climatic regions within Queensland may have different heatwave responses under global warming, where tropical and equatorial heatwaves appear to be more sensitive to elevated atmospheric CO(2) concentrations than temperate and arid regions. The results offer new insights to support climate adaptation and mitigation at regional scales. These findings are already being used by health and emergency services to inform the development of statewide policies to mitigate heatwave impacts.

Heat exposure from tropical deforestation decreases cognitive performance of rural workers: An experimental study

The effect of tropical deforestation on heat exposure and subsequent human health outcomes remains understudied, especially among an increasingly vulnerable population-healthy, adult subsistence workers in rural industrializing tropical countries. We report on a field experiment that estimated the short-term effects of heat exposure from deforestation on cognitive performance. We randomly assigned rural, adult subsistence workers in East Kalimantan, Indonesia to deforested or forested settings, and standard or high incentive piece rate payments. Participants worked in forested or deforested settings for up to 90 min, where ambient and black globe temperatures in deforested areas were, on average, 2.1 degrees C and 10 degrees C higher. After completing the experimental task, participants were asked to take a validated general cognitive assessment test (CAT) and episodic memory test (EMT). We found participants in deforested settings had statistically significant lower scores on both CAT and EMT. Effects were largely driven by heat effects on male participants and those working after noon. Our results highlight how heat exposure from tropical deforestation may lead to declines in cognitive performance even in favorable work settings. Policymakers should consider how land use planning that takes into account the cooling services of trees can play a significant role in increasing resilience to heat from climate and land use change in the tropics.

Heat stress risk and vulnerability under climate change in Durban metropolitan, South Africa – Identifying urban planning priorities for adaptation

There is an urgent need to map the geographic location of climate change risks and vulnerability, especially for cities in sub-Saharan Africa, which are experiencing the greatest urban development challenges and vulnerability to climate change impacts. The aim of this study is to investigate current and projected future heat risk, expressed as a heat stress exposure index using high-resolution climate change projections, and a social vulnerability index, to identify areas of potential future heat stress risk in the Durban (eThekwini) metropolitan area, South Africa. Additionally, this is the first study to use high-resolution downscaled climate change projections under Representative Concentration (RCP) 8.5, to construct the heat exposure index using apparent temperature and increases in minimum temperature and a social vulnerability index, using demographic and socio-economic census and land use data to, derived from principal component analysis (PCA) to spatially characterize heat stress within a South African city. Results show that while heat stress is not a current concern, it is projected to increase and become a future concern, mainly as a function of social vulnerability due to household demographic and infrastructural characteristics, and will be experienced in both the rural and inner-city areas of the metro. This study contributes a heat risk framework to identify locations for specific research and adaptation activities on heat stress risk and for urban planning in sub-Saharan African cities, which are characterized by both rural and urban contexts, to address climate change adaptation targeting and priority setting.

Heat stress, physiological response, and heat-related symptoms among Thai Sugarcane workers

Prolonged or intense exposure to heat can lead to a range of health effects. This study investigated heat exposure and heat-related symptoms which sugarcane workers (90 sugarcane cutters and 93 factory workers) experienced during a harvesting season in Thailand. During the hottest month of harvesting season, wet bulb globe temperature was collected in the work environment, and workloads observed, to assess heat stress. Urine samples for dehydration test, blood pressure, heart rate, and body temperature were measured pre- and post-shift to measure heat strain. Fluid intake and heat-related symptoms which subjects had experienced during the harvesting season were gathered via interviews at the end of the season. From the results, sugarcane cutters showed high risk for heat stress and strain, unlike factory workers who had low risk based on the American Conference of Governmental Industrial Hygiene (ACGIH) threshold limit values (TLVs) for heat stress. Dehydration was observed among sugarcane cutters and significant physiological changes including heart rate, body temperature, and systolic blood pressure occurred across the work shift. Significantly more sugarcane cutters reported experiencing heat-related symptoms including weakness/fatigue, heavy sweating, headache, rash, muscle cramp, dry mouth, dizziness, fever, dry/cracking skin, and swelling, compared to sugarcane factory workers. We conclude that the heat stress experienced by sugarcane cutters working in extremely hot environments, with high workloads, is associated with acute health effects. Preventive and control measures for heat stress are needed to reduce the risk of heat strain.

Harmful algal blooms threaten the health of peri-urban fisher communities: A case study in Kisumu Bay, Lake Victoria, Kenya

Available guidance to mitigate health risks from exposure to freshwater harmful algal blooms (HABs) is largely derived from temperate ecosystems. Yet in tropical ecosystems, HABs can occur year-round, and resource-dependent populations face multiple routes of exposure to toxic components. Along Winam Gulf, Lake Victoria, Kenya, fisher communities rely on lake water contaminated with microcystins (MCs) from HABs. In these peri-urban communities near Kisumu, we tested hypotheses that MCs exceed exposure guidelines across seasons, and persistent HABs present a chronic risk to fisher communities through ingestion with minimal water treatment and frequent, direct contact. We tested source waters at eleven communities across dry and rainy seasons from September 2015 through May 2016. We measured MCs, other metabolites, physicochemical parameters, chlorophyll a, phytoplankton abundance and diversity, and fecal indicators. We then selected four communities for interviews about water sources, usage, and treatment. Greater than 30% of source water samples exceeded WHO drinking water guidelines for MCs (1?g/L), and over 60% of source water samples exceeded USEPA guidelines for children and immunocompromised individuals. 50% of households reported sole use of raw lake water for drinking and household use, with alternate sources including rain and boreholes. Household chlorination was the most widespread treatment utilized. At this tropical, eutrophic lake, HABs pose a year-round health risk for fisher communities in resource -limited settings. Community-based solutions and site-specific guidance for Kisumu Bay and similarly impacted regions is needed to address a chronic health exposure likely to increase in severity and duration with global climate change.

Enhancing fine-grained intra-urban dengue forecasting by integrating spatial interactions of human movements between urban regions

BACKGROUND: As a mosquito-borne infectious disease, dengue fever (DF) has spread through tropical and subtropical regions worldwide in recent decades. Dengue forecasting is essential for enhancing the effectiveness of preventive measures. Current studies have been primarily conducted at national, sub-national, and city levels, while an intra-urban dengue forecasting at a fine spatial resolution still remains a challenging feat. As viruses spread rapidly because of a highly dynamic population flow, integrating spatial interactions of human movements between regions would be potentially beneficial for intra-urban dengue forecasting. METHODOLOGY: In this study, a new framework for enhancing intra-urban dengue forecasting was developed by integrating the spatial interactions between urban regions. First, a graph-embedding technique called Node2Vec was employed to learn the embeddings (in the form of an N-dimensional real-valued vector) of the regions from their population flow network. As strongly interacting regions would have more similar embeddings, the embeddings can serve as “interaction features.” Then, the interaction features were combined with those commonly used features (e.g., temperature, rainfall, and population) to enhance the supervised learning-based dengue forecasting models at a fine-grained intra-urban scale. RESULTS: The performance of forecasting models (i.e., SVM, LASSO, and ANN) integrated with and without interaction features was tested and compared on township-level dengue forecasting in Guangzhou, the most threatened sub-tropical city in China. Results showed that models using both common and interaction features can achieve better performance than that using common features alone. CONCLUSIONS: The proposed approach for incorporating spatial interactions of human movements using graph-embedding technique is effective, which can help enhance fine-grained intra-urban dengue forecasting.

Ecological relationships of Haemagogus spegazzinii (Diptera: Culicidae) in a semiarid area of Brazil

INTRODUCTION: Haemagogus are mosquitoes with diurnal habits that live preferentially in forest areas. In Brazil, they are considered the primary vectors of wild yellow fever. METHODS: The ecological relationships between Haemagogus spegazzinii, the environment, and some of its activities in the semiarid region of Rio Grande do Norte were analyzed by collecting eggs with ovitraps, actively searching in tree holes, capturing adults in Shannon traps, and conducting an investigation for viral infections. RESULTS: A total of 2420 eggs, 271 immature specimens (larvae and pupae), and 206 adults were collected. Egg collection depended on rainfall and relative humidity, with oviposition occurring between January and May. Larvae were found in five plant species, including Tabebuia aurea (craibeira), with 160 larvae collected. We observed shared breeding sites between Hg. spegazzinii and the following species: Aedes albopictus, Aedes terrens, Culex spp., and Toxorhynchites theobaldi. Adults exhibited greater activity between 5 pm and 6 pm, when 191 (92.7%) specimens were captured, while only 1 (0.5%) was collected between 7 pm and 8 pm. The relationship between Hg. spegazzinii and rainfall was significant, with positive correlations with accumulated rainfall 5, 10, 15, 20, and 30 days before mosquito collection. We found that the species was infected with the DENV-2 virus. CONCLUSIONS: This work contributes new information on the bioecology of Hg. spegazzinii, with data on the main reproduction periods, oviposition, breeding sites, activity times, and the relationship between the species and meteorological variables in the Caatinga of northeastern Brazil.

Effects of mosquito biology on modeled Chikungunya virus invasion potential in Florida

Arboviruses transmitted by Aedes aegypti and Aedes albopictus have been introduced to Florida on many occasions. Infrequently, these introductions lead to sporadic local transmission and, more rarely, sustained local transmission. Both mosquito species are present in Florida, with spatio-temporal variation in population composition. We developed a two-vector compartmental, deterministic model to investigate factors influencing Chikungunya virus (CHIKV) establishment. The model includes a nonlinear, temperature-dependent mosquito mortality function based on minimum mortality in a central temperature region. Latin Hypercube sampling was used to generate parameter sets used to simulate transmission dynamics, following the introduction of one infected human. The analysis was repeated for three values of the mortality function central temperature. Mean annual temperature was consistently important in the likelihood of epidemics, and epidemics increased as the central temperature increased. Ae. albopictus recruitment was influential at the lowest central temperature while Ae. aegypti recruitment was influential at higher central temperatures. Our results indicate that the likelihood of CHIKV establishment may vary, but overall Florida is permissive for introductions. Model outcomes were sensitive to the specifics of mosquito mortality. Mosquito biology parameters are variable, and improved understanding of this variation will improve our ability to predict the outcome of introductions.

Changes in global and regional characteristics of heat stress waves in the 21st century

Wet bulb globe temperature (WBGT), a combined measure of temperature and humidity effects on thermal comfort, is used to define heat stress waves (HSWs). While emerging research has raised concerns on future changes in heat stress, for the first time, this study examines spatiotemporal changes in multiple HSW characteristics (intensity, duration, frequency, and cumulative mean intensity) in the 21st century under three emissions scenarios. It is the sustained nature of HSWs that impose more adverse impacts than extreme heat on a single day. HSWs are expected to be more intense, persistent, frequent, and influential due to anthropogenic influence. Models project the largest increases in multiple HSW characteristics will occur over the tropics and subtropics. The exception is maximum intensity, which displays a relative uniform increase over most global land areas. Analysis of regional population exposure to HSWs under different climate and socioeconomic scenarios emphasizes the importance of aggressive mitigation to minimize the potential impacts of HSWs. We further investigate how different regional HSW characteristics are projected to change relative to increasing global mean surface temperature (GMST). Our results confirm the varying rates and different trajectories at which regional HSWs change, independent of forcing pathway, strongly related to GMST. On both globally aggregated and regional scales, the maximum intensity and GMST are highly linearly associated, with an approximately 1:1 increase. However, the other three HSW characteristics are projected to change at a nonlinear rate per degree of GMST increase in general and display large regional variation in the rates of their changes. Plain Language Summary Besides air temperature, air humidity is another important factor in determining the impact of heat waves on humans. High humidity will reduce the efficiency of evaporative cooling and, when combined with high temperature, could pose a serious threat to human health or even life safety. Heat stress indices, taking into account both temperature and humidity effects, are considered to be better indicators of environmental conditions conducive to heat stress on human health. We here employ a widely used heat stress index, wet bulb globe temperature, to define heat waves, namely, heat stress waves (HSWs). Heat waves can be considered through a number of characteristics, and it is their distinctive characteristics that result in the vast array of adverse impacts. This also applies to HSWs. Our results show that more intense, longer-lasting, frequent, and influential HSWs are anticipated during the 21st century, and anthropogenic warming substantially increases the occurrence of HSWs. Except intensity, tropical regions will generally witness the largest increases in multiple HSW characteristics and the number of people that may be exposed to HSWs. Changes in HSW characteristics are confirmed not to depend on whether a particular warming is reached sooner or later; they are strongly related to global mean surface temperature.

Caribbean Action Plan on Health and Climate Change

The Brazilian Observatory of Climate and Health: Experience of organizing and disseminating climate and health information in Manaus, Amazon region

The complex associations of climate variability with seasonal influenza A and B virus transmission in subtropical Shanghai, China

Latitudes mediate the association between influenza activity and meteorological factors: A nationwide modelling analysis in 45 Japanese prefectures from 2000 to 2018

Individual- and community-level shifts in mortality patterns during the January 2016 East Asia cold wave associated with a super El Nino event: Empirical evidence in Hong Kong

Fungal assemblages on indoor surfaces with visible mold growth in homes after the 2016 flood disaster in Thailand

Explicit spatializing heat-exposure risk and local associated factors by coupling social media data and automatic meteorological station data

Evaluation of heat stress impacts and adaptations: Perspectives from smallholder rural farmers in Bawku East of Northern Ghana

Evidence that high temperatures and intermediate relative humidity might favor the spread of COVID-19 in tropical climate: A case study for the most affected Brazilian cities

Evaluating the effects of climate and environmental factors on Under-5 Children Malaria spatial distribution using Generalized Additive Models (GAMs)

Epidemiology of tsutsugamushi disease and its relationship with meteorological factors in Xiamen city, China

Epidemiological evidence from south Indian working population-the heat exposures and health linkage

Different responses of dengue to weather variability across climate zones in Queensland, Australia

Dengue incidence and sociodemographic conditions in Pucallpa, Peruvian Amazon: What role for modification of the Dengue-temperature relationship?

Demographic and climatic factors associated with dengue prevalence in a hyperendemic zone in Mexico: An empirical approach

Correlational study of climate factor, mobility and the incidence of Dengue Hemorrhagic Fever in Kendari, Indonesia

Coronavirus pandemic versus temperature in the context of Indian subcontinent: A preliminary statistical analysis

Climate-related displacement, impoverishment and healthcare accessibility in mainland Bangladesh

Climatic changes, water systems, and adaptation challenges in Shawi communities in the Peruvian Amazon

Climate factors influence seasonal influenza activity in Bangkok, Thailand

Climate variability and dengue fever in Makassar, Indonesia: Bayesian spatio-temporal modelling

Climate exposures and child undernutrition: Evidence from Indonesia

Climate factors and the East Asian summer monsoon may drive large outbreaks of dengue in China

Climate change induced vulnerability and adaption for dengue incidence in Colombo and Kandy districts: The detailed investigation in Sri Lanka

Climate change and viral emergence: Evidence from Aedes-borne arboviruses

Climate change as an involuntary exposure: A comparative risk perception study from six countries across the global development gradient

Classification of daily weather types in Colombia: A tool to evaluate human health risks due to temperature variability

Biting rates and relative abundance of Simulium flies under different climatic conditions in an onchocerciasis endemic community in Ghana

Association of COVID-19 pandemic with meteorological parameters over Singapore

Assessment of thermal comfort parameters in various car models and mitigation strategies for extreme heat-health risks in the tropical climate

Ambient temperature, seasonal influenza and risk of cardiovascular disease in a subtropical area in Southern China

Ambulance services associated with extreme temperatures and fine particles in a subtropical island

The impact of extremely hot weather events on all-cause mortality in a highly urbanized and densely populated subtropical city: A 10-year time-series study (2006–2015)

Co-developing climate services for public health: Stakeholder needs and perceptions for the prevention and control of Aedes-transmitted diseases in the Caribbean

Assessing spatial variability of extreme hot weather conditions in Hong Kong: A land use regression approach

Weather-driven malaria transmission model with gonotrophic and sporogonic cycles

Vectors of arboviruses in the state of Sao Paulo: 30 years of Aedes aegypti and Aedes albopictus

Twenty-two years of dengue fever (1996-2017): An epidemiological study in a Brazilian city

Time series non-Gaussian Bayesian bivariate model applied to data on HMPV and RSV: A case of Dadaab in Kenya

The role of land use on the local climate and air quality during calm inter-monsoon in a tropical city

The seasonality of diarrheal pathogens: A retrospective study of seven sites over three years

The impact of perceived heat stress symptoms on work-related tasks and social factors: A cross-sectional survey of Australia’s Monsoonal North

The impact of climate change and urban growth on urban climate and heat stress in a subtropical city

The current and future global distribution and population at risk of dengue

The association between dengue incidences and provincial-level weather variables in Thailand from 2001 to 2014

Temporal variation of the presence of Rhodnius prolixus (Hemiptera: Reduviidae) into rural dwellings in the Department of Casanare, Eastern Colombia

Synoptic features responsible for heat waves in central Africa, a region with strong multidecadal trends

Spatiotemporal transmission patterns and determinants of dengue fever: A case study of Guangzhou, China

Spatio-temporal dynamics of dengue in Brazil: Seasonal travelling waves and determinants of regional synchrony

Simulating micro-scale thermal interactions in different building environments for mitigating urban heat islands

Short – term effects of temperature on hospital admissions for acute myocardial infarction: A comparison between two neighboring climate zones in Vietnam

Seasonality of influenza and its association with meteorological parameters in two cities of Pakistan: A time series analysis

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting

Prediction model of leptospirosis occurrence for Seremban (Malaysia) using meteorological data

Potential distribution of dominant malaria vector species in tropical region under climate change scenarios

Morbidity burden of respiratory diseases attributable to ambient temperature: A case study in a subtropical city in China

Mayaro virus distribution in South America

Long-term exposure to high temperature associated with the incidence of major depressive disorder

Leptospira detection in flood-prone environment of Jakarta, Indonesia

Influenza activity prediction using meteorological factors in a warm temperate to subtropical transitional zone, Eastern China

Impact of weather seasonality and sexual transmission on the spread of Zika fever

Identifying high risk areas of Zika virus infection by meteorological factors in Colombia

How are healthy, working populations affected by increasing temperatures in the tropics? Implications for climate change adaptation policies

Heat exposure assessment based on individual daily mobility patterns in Dhaka, Bangladesh

Epidemiology of dengue and the effect of seasonal climate variation on its dynamics: A spatio-temporal descriptive analysis in the Chao-Shan area on China’s southeastern coast

Entomological studies in Itauna, Brazil, an area with visceral leishmaniasis transmission: Fauna survey, natural leishmania infection, and molecular characterization of the species circulating in phlebotomine sand flies (Diptera: Psychodidae)

El Nino drought and tropical forest conversion synergistically determine mosquito development rate

Effects of extreme temperatures on mortality and hospitalization in Ho Chi Minh City, Vietnam

Ecological niche modeling for the prediction of cutaneous leishmaniasis epidemiology in current and projected future in Adana, Turkey

Dynamics of the occurrence of influenza in relation to seasonal variation in Chennai, Tamil Nadu: A 7 -year cumulative study

Developing a dengue prediction model based on climate in Tawau, Malaysia

Comparison of Mycobacterium ulcerans (Buruli ulcer) and Leptospira sp. (Leptospirosis) dynamics in urban and rural settings

Climate shocks constrain human fertility in Indonesia

Climate change impacts the epidemic of dysentery: Determining climate risk window, modeling and projection

Characterising the impact of heatwaves on work-related injuries and illnesses in three Australian cities using a standard heatwave definition- Excess Heat Factor (EHF)

Changes in the total ozone content over the period 2006 to 2100 and the effects on the erythemal and vitamin D effective UV doses for South America and Antarctica

Association between work in deforested, compared to forested, areas and human heat strain: An experimental study in a rural tropical environment

Association of meteorological factors with seasonal activity of influenza A subtypes and B lineages in subtropical western China

Assessing the role of climate factors on malaria transmission dynamics in South Sudan

Ambient temperature and mortality due to acute myocardial infarction in Brazil: An ecological study of time-series analyses

Acute myocardial infarction hospitalizations between cold and hot Seasons in an island across tropical and subtropical climate zones-A population-based study

Nonlinear and delayed impacts of climate on dengue risk in Barbados: A modelling study

Urban-focused weather and climate services in Hong Kong

The utility of lasso-based models for real time forecasts of endemic infectious diseases: A cross country comparison

The relationship between extreme temperature and emergency incidences: A time series analysis in Shenzhen, China

The impact on food security and future adaptation under climate variation: A case study of Taiwan’s agriculture and fisheries

The effects of socioecological factors on variation of communicable diseases: A multiple-disease study at the national scale of Vietnam

The impact of Sharav weather conditions on airborne pollen in Jerusalem and Tel Aviv (Israel)

The effects of meteorological factors on influenza among children in Guangzhou, China

The burden of ambient temperature on years of life lost: A multi-community analysis in Hubei, China

The climatic factors affecting dengue fever outbreaks in southern Taiwan: An application of symbolic data analysis

Temperature dependent transmission potential model for chikungunya in India

Temperature explains broad patterns of Ross River virus transmission

Spatial modelling of malaria cases associated with environmental factors in South Sumatra, Indonesia

Spatial and temporal characteristics of temperature effects on cardiovascular disease in Southern China using the Empirical Mode Decomposition method

Spatial distribution and seasonality of Biomphalaria spp. in Sao Luis (Maranhao, Brazil)

Risk factors for the presence of dengue vector mosquitoes, and determinants of their prevalence and larval site selection in Dhaka, Bangladesh

Risk factors spatial-temporal detection for dengue fever in Guangzhou

Rainfall as a driver of epidemic cholera: Comparative model assessments of the effect of intra-seasonal precipitation events

Projections of rising heat stress over the western Maritime Continent from dynamically downscaled climate simulations

Projections for temperature-related years of life lost from cardiovascular diseases in the elderly in a Chinese city with typical subtropical climate

Potential influence of temperature and precipitation on preterm birth rate in Puerto Rico

Physiological and psychological reactions of sub-tropically acclimatized subjects exposed to different indoor temperatures at a relative humidity of 70

Outdoor thermal comfort in public space in warm-humid Guayaquil, Ecuador

Monitoring hand, foot and mouth disease by combining search engine query data and meteorological factors

Mortality and morbidity during extreme heat events and prevalence of outdoor work: An analysis of community-level data from Los Angeles County, California

Mortality burden attributable to heatwaves in Thailand: A systematic assessment incorporating evidence-based lag structure

Mortality effects of heat waves vary by age and area: A multi-area study in China

Modelling the distribution in Hawaii of Angiostrongylus cantonensis (rat lungworm) in its gastropod hosts

Modeling environmentally mediated rotavirus transmission: The role of temperature and hydrologic factors

Meteorological factors and respiratory syncytial virus seasonality in subtropical Australia

Mapping urban residents’ vulnerability to heat in Abidjan, Cote d’Ivoire

MaxEnt modeling of soil-transmitted helminth infection distributions in Thailand

Is climate associated with revision for prosthetic joint infection after primary TKA?

Influenza activity and province-level weather variations in Thailand, 2009 to 2014, using random forest time-series approach

Influence of latitude on the prevalence of Kawasaki disease: A retrospective cohort study from the Taiwan national health insurance database and review of the literature

Inferring distributional shifts of epidemiologically important North and Central American sandflies from Pleistocene to future scenarios

Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America

Impact of weather conditions on atopic dermatitis prevalence in Abuja, Nigeria

Impact of weather factors on influenza hospitalization across different age groups in subtropical Hong Kong

Impact of weekly climatic variables on weekly malaria incidence throughout Thailand: A country-based six-year retrospective study

Human susceptibility to outdoor hot environment

How socio-environmental factors are associated with Japanese Encephalitis in Shaanxi, China-A Bayesian spatial analysis

Heatstroke at home: Prediction by thermoregulation modeling

Global predictability of temperature extremes

Geographical information system (GIS) modeling territory receptivity to strengthen entomological surveillance: Anopheles (Nyssorhynchus) case study in Rio de Janeiro State, Brazil

Framework for mapping the drivers of coastal vulnerability and spatial decision making for climate-change adaptation: A case study from Maharashtra, India

Floods in southern Thailand in December 2016 and January 2017

Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change

Estimated work ability in warm outdoor environments depends on the chosen heat stress assessment metric

Epidemiology of HBoV1 infection and relationship with meteorological conditions in hospitalized pediatric patients with acute respiratory illness: A 7-year study in a subtropical region

Epidemiology of human leptospirosis in French Guiana (2007-2014): A retrospective study

Effects of ambient air pollution on daily hospital admissions for respiratory and cardiovascular diseases in Bangkok, Thailand

Effect of rainfall on the microbial water quality of a tropical urban catchment

Effect of the 2008 cold spell on preterm births in two subtropical cities of Guangdong Province, southern China

Dynamics of influenza in tropical Africa: Temperature, humidity, and co-circulating (sub)types

Ecological niche modeling of Aedes mosquito vectors of chikungunya virus in southeastern Senegal

Dynamic response of airborne infections to climate change: Predictions for varicella

Different response of human mortality to extreme temperatures (MoET) between rural and urban areas: A multi-scale study across China

Development of an empirical model to predict malaria outbreaks based on monthly case reports and climate variables in Hefei, China, 1990-2011

Diagnosing physical mechanisms leading to pure heat waves versus pure tropical nights over the Korean Peninsula

Dengue control in the context of climate change: Views from health professionals in different geographic regions of China

Decision tool for climate disasters and infectious disease at sub-national level in India: Ensuring a paradigm shift in health planning from prevalence to vulnerability

Correlation of dengue incidence and rainfall occurrence using wavelet transform for Joao Pessoa city

Climate variability and dengue hemorrhagic fever in Hanoi, Viet Nam, during 2008 to 2015

Climate variability and dengue hemorrhagic fever in Southeast Sulawesi Province, Indonesia

Climate variability and salmonellosis in Singapore – A time series analysis

Characterizing the atmospheric conditions during the 2010 heatwave in Rio de Janeiro marked by excessive mortality rates

Beyond threshold approaches to extreme heat: Repositioning adaptation as everyday practice

Associations of Salmonella hospitalizations with ambient temperature, humidity and rainfall in Hong Kong

Associations of ambient temperature with mortality rates of cardiovascular and respiratory diseases in Taiwan: A subtropical country

Association between malaria incidence and meteorological factors: A multi-location study in China, 2005-2012

Association between precipitation and diarrheal disease in Mozambique

Association between ambient temperatures and mental disorder hospitalizations in a subtropical city: A time-series study of Hong Kong special administrative region

Assessment of risk, vulnerability and adaptation to climate change by the health sector in Madagascar

Approaching resilience for climate change adaptation in complex milieus: The case of vulnerable neighborhoods in Cartagena de Indias

An assessment of the relationships between extreme weather events, vulnerability, and the impacts on human wellbeing in Latin America

Ambient air pollution of particles and gas pollutants, and the predicted health risks from long-term exposure to PM2.5 in Zhejiang province, China

Airborne particles in the city center of Kuala Lumpur: Origin, potential driving factors, and deposition flux in human respiratory airways

What drives cold-related excess mortality in a south Asian tropical monsoon climate-season vs. temperatures and diurnal temperature changes

Weather information acquisition and health significance during extreme cold weather in a subtropical city: A cross-sectional survey in Hong Kong

Unravelling diurnal asymmetry of surface temperature in different climate zones

Urban Heat Island (UHI) influence on secondary pollutant formation in a tropical humid environment

The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou

The location of Australian Buruli ulcer lesions-Implications for unravelling disease transmission

The impact of global environmental changes on infectious disease emergence with a focus on risks for Brazil

The climate impact on female acute pyelonephritis in Taiwan: A population-based study

Temperature and cardiovascular mortality associations in four southern Chinese cities: A time-series study using a distributed lag non-linear model

Spatial-temporal distribution of dengue and climate characteristics for two clusters in Sri Lanka from 2012 to 2016

Socio-environmental exposures and health outcomes among persons with sickle cell disease

Seasonal variation of the dominant allergenic fungal aerosols – One year study from southern Indian region

Seasonal patterns of dengue fever and associated climate factors in 4 provinces in Vietnam from 1994 to 2013

Role of meteorological conditions in reported chickenpox cases in Wuhan and Hong Kong, China

Relationship between emergency care utilization, ambient temperature, and the pollution standard index in Taiwan

Relationship between air mass type and emergency department visits for migraine headache across the Triangle region of North Carolina

Prevalence of spheroidal degeneration of cornea and its association with other eye diseases in tribes of Western Rajasthan

Predictive determinants of scorpion stings in a tropical zone of South Iran: Use of mixed seasonal autoregressive moving average model

Nonlinear relationship between extreme temperature and mortality in different temperature zones: A systematic study of 122 communities across the mainland of China

Monitoring spatiotemporal variations in nutrients in a large drinking water reservoir and their relationships with hydrological and meteorological conditions based on Landsat 8 imagery

Mercury critical concentrations to Enchytraeus crypticus (Annelida: Oligochaeta) under normal and extreme conditions of moisture in tropical soils – reproduction and survival

Low impact development planning and adaptation decision-making under climate change for a community against pluvial flooding

Influenza transmission during extreme indoor conditions in a low-resource tropical setting

Influence of meteorological variables on diversity and abundance of mosquito vectors in two livestock farms in Ibadan, Nigeria: Public health implications

Influence of weather on incidence of bronchiolitis in Australia and New Zealand

Human and animal leptospirosis in southern Brazil: A five-year retrospective study

How does ambient air temperature affect diabetes mortality in tropical cities?

Heterogeneous climate effects on human migration in Indonesia

Global and local environmental changes as drivers of Buruli ulcer emergence

Forecasting the number of zoonotic cutaneous leishmaniasis cases in south of Fars province, Iran using seasonal ARIMA time series method

Extreme temperatures in Southeast Asia caused by El Nino and worsened by global warming

Estimating effects of temperature on dengue transmission in Colombian cities

Effects of local and regional climatic fluctuations on dengue outbreaks in southern Taiwan

Effects of climate change on coral grouper (Plectropomus spp.) and possible adaptation options

Detecting the impact of temperature on transmission of Zika, dengue, and chikungunya using mechanistic models

Defining and predicting heat waves in Bangladesh

Cognitive performance during passive heat exposure in Japanese males and tropical Asian males from Southeast Asian living in Japan

Case studies in co-benefits approaches to climate change mitigation and adaptation

Calibration of the physiological equivalent temperature index for three different climatic regions

Associations between meteorological parameters and influenza activity in a subtropical country: Case of five sentinel sites in Yaounde-Cameroon

Bayesian dynamic modeling of time series of dengue disease case counts

Association between fine particulate air pollution and hospital admissions for chest pain in a subtropical city: Taipei, Taiwan

Assessing seasonal variations in urban thermal comfort and potential health risks using physiologically equivalent temperature: A case of Ibadan, Nigeria

An integrated approach for the assessment of the Aedes aegypti and Aedes albopictus global spatial distribution, and determination of the zones susceptible to the development of Zika virus

Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at Kinshasa University clinics, Democratic Republic of Congo (DRC)

A weather-based prediction model of malaria prevalence in Amenfi West District, Ghana

The development of the Hong Kong Heat Index for enhancing the heat stress information service of the Hong Kong Observatory

Unveiling hidden migration and mobility patterns in climate stressed regions: A longitudinal study of six million anonymous mobile phone users in Bangladesh

Time trend of malaria in relation to climate variability in Papua New Guinea

Time-lagging interplay effect and excess risk of meteorological/mosquito parameters and petrochemical gas explosion on dengue incidence

The impact of temperature on mortality in a subtropical city: Effects of cold, heat, and heat waves in So Paulo, Brazil

The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam

Subsistence-patterns, gender roles, effective temperature, and the evolutionary timing of a post reproductive life span

Spatial distribution estimation of malaria in northern China and its scenarios in 2020, 2030, 2040 and 2050

Spatial patterns of heat-related cardiovascular mortality in the Czech Republic

Space-time epidemiology and effect of meteorological parameters on influenza-like illness in Phitsanulok, a northern province in Thailand

Short-term effects of floods on Japanese encephalitis in Nanchong, China, 2007-2012: a time-stratified case-crossover study

Seasonality of influenza and respiratory syncytial viruses and the effect of climate factors in subtropical-tropical Asia using influenza-like illness surveillance data, 2010 -2012

Rainwater harvesting as an alternative water resource in Malaysia: Potential, policies and development

Public health risks of prolonged fine particle events associated with stagnation and air quality index based on fine particle matter with a diameter <2.5 mum in the Kaoping region of Taiwan

Potentially extreme population displacement and concentration in the tropics under non-extreme warming

Predicting dengue incidences using cluster based regression on climate data

Predicting the spatial distribution of Biomphalaria straminea, a potential intermediate host for schistoma mansoni, in China

Post-flooding surveillance of leptospirosis after the onslaught of typhoons Nesat,Nalgae and Washi in the Philippines

Meteorological factors for dengue fever control and prevention in south China

Interactive effects of temperature and drought on cassava growth and toxicity: Implications for food security?

Influence of meteorological factors on acute aortic events in a subtropical territory

Impact of weather factors on hand, foot and mouth disease, and its role in short-term incidence trend forecast in Huainan City, Anhui Province

Impact of meteorological changes on the incidence of scarlet fever in Hefei City, China

Impact of climate conditions on occupational health and related economic losses: A new feature of global and urban health in the context of climate change

High temperature and risk of hospitalizations, and effect modifying potential of socio-economic conditions: A multi-province study in the tropical Mekong Delta Region

Heat stress and inadequate sanitary facilities at workplaces – an occupational health concern for women?

Global vegetation productivity response to climatic oscillations during the satellite era

Hand, foot and mouth disease in Hong Kong: A time-series analysis on its relationship with weather

Farmers’ perception and adaptation practice to climate variability and change: A case study of the Vea catchment in Ghana

Evaluating water supply risk in the middle and lower reaches of Hanjiang River Basin based on an integrated optimal water resources allocation model

Epidemic activity of respiratory syncytial virus is related to temperature and rainfall in equatorial tropical countries

El Nino-based malaria epidemic warning for Oromia, Ethiopia, from August 2016 to July 2017

Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d’Ivoire

Comparative epidemiology of influenza A and B viral infection in a subtropical region: A 7-year surveillance in Okinawa, Japan

Comparison of two detailed models of Aedes aegypti population dynamics

Climate change, heat, and mortality in the tropical urban area of San Juan, Puerto Rico

Climate factors as important determinants of dengue incidence in Curacao

Climate resilient low-income tropical housing

Climate change modeling based public health resource planning for Narmada basin, India

Climate change trends in Malta and related beliefs, concerns and attitudes toward adaptation among Gozitan farmers

Characterizing the relationship between temperature and mortality in tropical and subtropical cities: A distributed lag non-linear model analysis in Hue, Viet Nam, 2009-2013

Cholera in Cameroon, 2000-2012: Spatial and temporal analysis at the operational (health district) and sub climate levels

Association of cold temperature and mortality and effect modification in the subtropical plateau monsoon climate of Yuxi, China

An assessment of urban vulnerability in the Amazon Delta and Estuary: a multi-criterion index of flood exposure, socio-economic conditions and infrastructure

Ambient temperature and the risk of preterm birth in Guangzhou, China (2001-2011)

A spatial hierarchical analysis of the temporal influences of the El Nino-Southern Oscillation and weather on dengue in Kalutara District, Sri Lanka

A spatial model of socioeconomic and environmental determinants of dengue fever in Cali, Colombia

A climate-based prediction model in the high-risk clusters of the Mekong Delta region, Vietnam: Towards improving dengue prevention and control

The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong

Weather parameters and nosocomial bloodstream infection: A case-referent study

Weather variability associated with Aedes (Stegomyia) aegypti (Dengue Vector) oviposition dynamics in northwestern Argentina

Tropical agriculturalisation: Scenarios, their environmental impacts and the role of climate change in determining water-for-food, locally and along supply chains

The trends in excess mortality in winter vs. summer in a sub-tropical city and its association with extreme climate conditions

The link between knowledge, attitudes and practices in relation to atmospheric haze pollution in peninsular Malaysia

The burden of ambient temperature on years of life lost in Guangzhou, China

Temperature and humidity effects on hospital morbidity in Darwin, Australia

Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam

Temperature variation and heat wave and cold spell impacts on years of life lost among the urban poor population of Nairobi, Kenya

Spatio-temporal transmission and environmental determinants of Schistosomiasis Japonica in Anhui Province, China

Suitable days for plant growth disappear under projected climate change: potential human and biotic vulnerability

Socio-economic, epidemiological and geographic features based on GIS-integrated mapping to identify malarial hotspots

Space-time clustering characteristics of dengue based on ecological, socio-economic and demographic factors in northern Sri Lanka

Seasonality of absolute humidity explains seasonality of influenza-like illness in Vietnam

Seasonality of dizziness and vertigo in a tropical region

Sao Paulo urban heat islands have a higher incidence of dengue than other urban areas

Respiratory syncytial virus seasonality in tropical Australia

Rising temperatures may increase growth rates and microcystin production in tropical Microcystis species

Role of asymptomatic carriers and weather variables in persistent transmission of malaria in an endemic district of Assam, India

Regional response of dengue fever epidemics to interannual variation and related climate variability

Relationship between meteorological conditions and respiratory syncytial virus in a tropical country

Predicting unprecedented dengue outbreak using imported cases and climatic factors in Guangzhou, 2014

Potential effects of climate change on ecological interaction outcomes between two disease-vector mosquitoes: A mesocosm experimental study

Potential impact of climatic variability on the epidemiology of dengue in Risaralda, Colombia, 2010-2011

Non-stationary dynamics of climate variability in synchronous influenza epidemics in Japan

Meteorologically driven simulations of dengue epidemics in San Juan, PR

Influenza seasonality in Madagascar: The mysterious African free-runner

Increasing dengue incidence in Singapore over the past 40 years: Population growth, climate and mobility

Impact of subtropical climate on frequency of ambulance use for trauma patients in a coastal area of China

Identifying meteorological drivers for the seasonal variations of influenza infections in a subtropical city – Hong Kong

I-C-SEA Change: A participatory tool for rapid assessment of vulnerability of tropical coastal communities to climate change impacts

Identification of the prediction model for dengue incidence in Can Tho city, a Mekong Delta area in Vietnam

Heat-related symptoms in sugarcane harvesters

Hospitalization incidence, mortality, and seasonality of common respiratory viruses over a period of 15 Years in a developed subtropical city

Heat and hydration status: Predictors of repeated measures of urine specific gravity among Tsimane’ adults in the Bolivian Amazon

Evaluation of climate change impacts and adaptation measures for maize cultivation in the western Uganda agro-ecological zone

Effects of ocean warming on growth and distribution of dinoflagellates associated with ciguatera fish poisoning in the Caribbean

El Nino-Southern Oscillation, local weather and occurrences of dengue virus serotypes

Ecological niche modelling predicts southward expansion of Lutzomyia (Nyssomyia) flaviscutellata (Diptera: Psychodidae: Phlebotominae), vector of Leishmania (Leishmania) amazonensis in South America, under climate change

Determinants of the lethality of climate-related disasters in the Caribbean Community (CARICOM): A cross-country analysis

Dengue is still an imported disease in China: A case study in Guangzhou

Contribution of homestead forests to rural economy and climate change mitigation: A study from the ecologically critical area of Cox’s Bazar-Teknaf Peninsula, Bangladesh

Cool roofs in Guangzhou, China: Outdoor air temperature reductions during heat waves and typical summer conditions

Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study

Climate change, agriculture and economic effects on different regions of Brazil

Climate change and adverse health events: Community perceptions from the Tanahu district of Nepal

Changing social contact patterns under tropical weather conditions relevant for the spread of infectious diseases

Can glacial retreat lead to migration? A critical discussion of the impact of glacier shrinkage upon population mobility in the Bolivian Andes

Assessment of the impacts of climate change on the water quality of a small deep reservoir in a humid-subtropical climatic region

Association between fine particulate air pollution and daily clinic visits for migraine in a subtropical city: Taipei, Taiwan

Assessing the impact of global changes on the surface water resources of southwestern Nigeria

Analysis of meteorological drought pattern during different climatic and cropping seasons in Bangladesh

Analysis and simulation of heat index for developing a heat alert system over Thailand

Vectorial capacity of Aedes aegypti: Effects of temperature and implications for global dengue epidemic potential

Using mathematical transmission modelling to investigate drivers of respiratory syncytial virus seasonality in children in the Philippines

Tropical healthcare epidemiology: Weather determinants of the etiology of bloodstream infections in a Brazilian hospital

Tropical influenza and weather variability among children in an urban low-income population in Bangladesh

The lag effects and vulnerabilities of temperature effects on cardiovascular disease mortality in a subtropical climate zone in China

The impact of ambient particle pollution during extreme-temperature days in Guangzhou City, China

The effects of weather conditions on measles incidence in Guangzhou, Southern China

The association between temperature and mortality in tropical middle income Thailand from 1999 to 2008

The 2012 Madeira dengue outbreak: Epidemiological determinants and future epidemic potential

Temperature and nutrients are significant drivers of seasonal shift in phytoplankton community from a drinking water reservoir, subtropical China

Stakeholder perceptions of ecosystem service declines in Milne Bay, Papua New Guinea: Is human population a more critical driver than climate change?

Statistical modeling reveals the effect of absolute humidity on dengue in Singapore

Spatial and temporal patterns of locally-acquired dengue transmission in northern Queensland, Australia, 1993-2012

Short-term effect of temperature on daily emergency visits for acute myocardial infarction with threshold temperatures

Simulating population genetics of pathogen vectors in changing landscapes: Guidelines and application with Triatoma brasiliensis

Small scale farmers’ vulnerability to climatic changes in southern Benin: The importance of farmers’ perceptions of existing institutions

Role of climate variability in the heatstroke death rates of Kanto region in Japan

Recent weather extremes and impacts on agricultural production and vector-borne disease outbreak patterns

Regional impact of climate on Japanese encephalitis in areas located near the Three Gorges Dam

Projecting the impact of climate change on dengue transmission in Dhaka, Bangladesh

Predicting the spread of Aedes albopictus in Australia under current and future climates: Multiple approaches and datasets to incorporate potential evolutionary divergence

Predictiveness of disease risk in a global outreach tourist setting in Thailand using meteorological data and vector-borne disease incidences

Phlebotomine fauna in the urban area of Tim—teo, State of Minas Gerais, Brazil

Possible effects of vaccination and environmental changes on the presence of disease in northern Spanish fish farms

Occurrence and persistence of future atmospheric stagnation events

Multivariate analysis of effects of diurnal temperature and seasonal humidity variations by tropical savanna climate on the emissions of anthropogenic volatile organic compounds

Migration from atolls as climate change adaptation: Current practices, barriers and options in Solomon Islands

Meteorological factors and risk of scrub typhus in Guangzhou, southern China, 2006-2012

Local communities vulnerability to climate change and adaptation strategies in Bukavu in DR Congo

Long-term and seasonal dynamics of dengue in Iquitos, Peru

Ischemic heart disease hospitalization among older people in a subtropical city–Hong Kong: Does winter have a greater impact than summer?

Increased risk of emergency hospital admissions for children with renal diseases during heatwaves in Brisbane, Australia

Hydroclimatic assessment of water resources of low Pacific islands: Evaluating sensitivity to climatic change and variability

Health impact of the 2008 cold spell on mortality in subtropical China: The climate and health impact national assessment study (CHINAs)

Health impacts of climate change in the Solomon Islands: An assessment and adaptation action plan

Geographical distribution of the association between El Nino South Oscillation and dengue fever in the Americas: A continental analysis using geographical information system-based techniques

Global decline in suitable habitat for Angiostrongylus (= Parastrongylus) cantonensis: The role of climate change

GIS development to monitor climate change and its geohydrological consequences on non-monsoon crop pattern in Himalaya

Flaviviruses, an expanding threat in public health: Focus on dengue, West Nile, and Japanese encephalitis virus

Forecasting temporal dynamics of cutaneous leishmaniasis in northeast Brazil

Extremely cold and hot temperatures increase the risk of diabetes mortality in metropolitan areas of two Chinese cities

Exposure to ambient heat and urolithiasis among outdoor workers in Guangzhou, China

El Nino Southern Oscillation and leptospirosis outbreaks in New Caledonia

Dynamic spatiotemporal trends of dengue transmission in the Asia-Pacific Region, 1955-2004

Cyclones in a changing climate: The case of Bangladesh

Correlating remote sensing data with the abundance of pupae of the dengue virus mosquito vector, Aedes aegypti, in central Mexico

Climatic factors and community – associated methicillin-resistant Staphylococcus aureus skin and soft-tissue infections – a time-series analysis study

Climatic-driven seasonality of emerging dengue fever in Hanoi, Vietnam

Climate change and waterborne diarrhoea in northern India: Impacts and adaptation strategies

Chromobacterium violaceum nosocomial pneumonia in two Japanese patients at an intensive care unit

Association of meteorological factors with childhood viral acute respiratory infections in subtropical China: An analysis over 11 years

Association of meteorological factors with pediatric intussusception in subtropical China: A 5-year analysis

Assessment of the health impacts of climate change in Kiribati

Assessing climate variability effects on dengue incidence in San Juan, Puerto Rico

Anopheles arabiensis seasonal densities and infection rates in relation to landscape classes and climatic parameters in a Sahelian area of Senegal

An agent-based model driven by tropical rainfall to understand the spatio-temporal heterogeneity of a chikungunya outbreak

A study of the dengue epidemic and meteorological factors in Guangzhou, China, by using a zero-inflated Poisson regression model

Climate change and mosquito-borne diseases in China: A review

The effects of climate variables on the outbreak of dengue in Queensland 2008-2009

Short-term effects of the 2008 cold spell on mortality in three subtropical cities in Guangdong province, China

Pathogen-host associations and predicted range shifts of human monkeypox in response to climate change in Central Africa

Modeling the impacts of global warming on predation and biotic resistance: Mosquitoes, damselflies and avian malaria in Hawaii

Hydrologic response to climate change and human activities in a subtropical coastal watershed of southeast China

Global climate change: Impact of diurnal temperature range on mortality in Guangzhou, China

Climate change or urbanization? Impacts on a traditional coffee production system in East Africa over the last 80 years

Current and future niche of North and Central American sand flies (Diptera: Psychodidae) in climate change scenarios

Climate change is likely to worsen the public health threat of diarrheal disease in Botswana

Time-series analysis of weather and mortality patterns in Nairobi’s informal settlements

The impact of point source pollution on shallow groundwater used for human consumption in a threshold country

The impact of regional climate change due to greenhouse forcing and land-use changes on malaria risk in tropical Africa

The impact of regional climate change on malaria risk due to greenhouse forcing and land-use changes in tropical Africa

Temporal, seasonal and weather effects on cycle volume: An ecological study

Status of blood pressure among individuals consuming saline water

Successful outcome of an integrated strategy for the reduction of schistosomiasis transmission in an endemically complex area

Projected burden of disease for Salmonella infection due to increased temperature in Australian temperate and subtropical regions

Potential impacts of climate variability on dengue hemorrhagic fever in Honduras, 2010

Patterns and perceptions of climate change in a biodiversity conservation hotspot

Meteorological factors and El Nino Southern Oscillation are independently associated with dengue infections

Modeling the influence of local environmental factors on malaria transmission in Benin and its implications for cohort study

Modelling the effect of temperature change on the extrinsic incubation period and reproductive number of Plasmodium falciparum in Malaysia

Impact of urban atmospheric environment on hospital admissions in the elderly

Future climate change driven sea-level rise: Secondary consequences from human displacement for island biodiversity

Estimated effect of climatic variables on the transmission of Plasmodium vivax malaria in the Republic of Korea

Climatic factors influencing dengue cases in Dhaka city: A model for dengue prediction

Projecting future heat-related mortality under climate change scenarios: A systematic review

Uncertainties associated with quantifying climate change impacts on human health: A case study for diarrhea

Time series analysis of dengue incidence in Guadeloupe, French West Indies: Forecasting models using climate variables as predictors

Theoretical investigation of malaria prevalence in two Indian cities using the response surface method

The influence of climate variables on dengue in Singapore

Seasonality of retinal detachment incidence and its associations with climate: An 11-year nationwide population-based study

Projected years lost due to disabilities (YLDs) for bacillary dysentery related to increased temperature in temperate and subtropical cities of China

Influence of climate and river level on the incidence of malaria in Cacao, French Guiana

Integrating knowledge and management regarding the climate-malaria linkages in Colombia

Inventing Caribbean climates: How science, medicine, and tourism changed tropical weather from deadly to healthy

High temperature effects on out-patient visits and hospital admissions in Chiang Mai, Thailand

Does mosquito control have an effect on mosquito-borne disease? The case of Ross River virus disease and mosquito management in Queensland, Australia

Decomposing the association of completed suicide with air pollution, weather, and unemployment data at different time scales

Climate variability and dengue fever in warm and humid Mexico

Assessing the relationship between global warming and mortality: Lag effects of temperature fluctuations by age and mortality categories

Arabian Sea tropical cyclones intensified by emissions of black carbon and other aerosols

Migration in the context of vulnerability and adaptation to climate change: Insights from analogues

Update on methodologies available for ciguatoxin determination: Perspectives to confront the onset of ciguatera fish poisoning in Europe

A climate model for predicting the abundance of Aedes mosquitoes in Hong Kong

Ciguatera fish poisoning and sea surface temperatures in the Caribbean Sea and the West Indies

Health and climate-opportunities

Vulnerability to epidemic malaria in the highlands of Lake Victoria basin: The role of climate change/variability, hydrology and socio-economic factors

The role of imported cases and favorable meteorological conditions in the onset of dengue epidemics

The use of ZIP and CART to model cryptosporidiosis in relation to climatic variables

The extinction of dengue through natural vulnerability of its vectors

The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers

Spatiotemporal distribution of malaria and the association between its epidemic and climate factors in Hainan, China

Robust negative impacts of climate change on African agriculture

Potential influence of climate variability on dengue incidence registered in a western pediatric hospital of Venezuela

Predicting the vulnerability of reservoirs to poor water quality and cyanobacterial blooms

Modeling the impact of climate variability on diarrhea-associated diseases in Taiwan (1996-2007)

Monthly district level risk of dengue occurrences in Sakon Nakhon Province, Thailand

Is the association between temperature and mortality modified by age, gender and socio-economic status?

Livelihood diversification in tropical coastal communities: A network-based approach to analyzing ‘livelihood landscapes’

Locally acquired dengue – Key West, Florida, 2009-2010

Identifying potential synergies and trade-offs for meeting food security and climate change objectives in sub-Saharan Africa

Heat exposure in sugarcane workers in Costa Rica during the non-harvest season

Dengue dynamics in Binh Thuan province, southern Vietnam: Periodicity, synchronicity and climate variability

Comparisons of urban and rural heat stress conditions in a hot-humid tropical city

Climate variations and Salmonella infection in Australian subtropical and tropical regions

Climate change and altitudinal structuring of malaria vectors in south-western Cameroon: Their relation to malaria transmission

Case studies on heat stress related perceptions in different industrial sectors in southern India

Changes in dengue risk potential in Hawaii, USA, due to climate variability and change

Beyond Copenhagen: Mitigating climate change and achieving food security through soil carbon sequestration

Analysis of variation and relation of climate, hydrology and water quality in the lower Mekong River

Apoptosis induced by Oropouche virus infection in HeLa cells is dependent on virus protein expression

Air pollution and hospital admissions for myocardial infarction in a subtropical city: Taipei, Taiwan

Adapting to climate change: Agricultural system and household impacts in East Africa

Seasonal influenza activity in Hong Kong and its association with meteorological variations

The impact of cold and hot weather on senior citizens in Hong Kong

Seasonality of cryptosporidiosis: A meta-analysis approach

Work-related heat stress concerns in automotive industries: A case study from Chennai, India

Vulnerability of national economies to the impacts of climate change on fisheries

Turning points, reproduction number, and impact of climatological events for multi-wave dengue outbreaks

The public health implications of melioidosis

Time series analysis of dengue fever and weather in Guangzhou, China

Temperature-dependent association between mortality rate and carbon monoxide level in a subtropical city: Kaohsiung, Taiwan

Spatial variation of crop yield response to climate change in East Africa

Socio-environmental conditions and geographical variability of asthma prevalence in Northeast Brazil

Seasonality of pneumonia admissions and its association with climate: An eight-year nationwide population-based study

Multiyear climate variability and dengue–El Nino southern oscillation, weather, and dengue incidence in Puerto Rico, Mexico, and Thailand: A longitudinal data analysis

New data on epidemiology of visceral leishmaniasis in Georgia

Links between climate, malaria, and wetlands in the Amazon Basin

Local and global effects of climate on dengue transmission in Puerto Rico

Historical warnings of future food insecurity with unprecedented seasonal heat

Hot weather warning might help to reduce elderly mortality in Hong Kong

Higher temperature and urbanization affect the spatial patterns of dengue fever transmission in subtropical Taiwan

El Ni–o Southern Oscillation and vegetation dynamics as predictors of dengue fever cases in Costa Rica

El Ni–o and variations in the prevalence of Plasmodium vivax and P. falciparum in Vanuatu

Estimating the economic impacts of climate change on infectious diseases: A case study on dengue fever in Taiwan

Effects of the El Nino-Southern Oscillation on dengue epidemics in Thailand, 1996-2005

Climate change projections for the tropical Andes using a regional climate model: Temperature and precipitation simulations for the end of the 21st century

Climate variability and increase in intensity and magnitude of dengue incidence in Singapore

Climate variability, global change, immunity, and the dynamics of infectious diseases

Air pollution and emergency room visits for cardiac arrhythmia in a subtropical city: Taipei, Taiwan Air pollution and cardiac arrhythmia admissions

Air quality and early-life mortality: Evidence from Indonesia’s wildfires

A mechanistic approach for accurate simulation of village scale malaria transmission

The effect of rainfall during gestation and early childhood on adult height in a foraging and horticultural society of the Bolivian Amazon

Rain, temperature, and child-adolescent height among Native Amazonians in Bolivia

Seasonal contamination of public squares and lawns by parasites with zoonotic potential in southern Brazil

Seasonal variations in urinary calculi attacks and their association with climate: A population based study

Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR

Predictive indicators for Ross River virus infection in the Darwin area of tropical northern Australia, using long-term mosquito trapping data

Malaria and pond-based rainwater harvesting linkages in the fringes of central highland Ethiopia

Malaria transmission pattern resilience to climatic variability is mediated by insecticide-treated nets

One-year delayed effect of fog on malaria transmission: A time-series analysis in the rain forest area of Mengla County, south-west China

Interactions between rainfall, deforestation and fires during recent years in the Brazilian Amazonia

High-resolution spatiotemporal weather models for climate studies

Effects of climate events driven hydrodynamics on dissolved oxygen in a subtropical deep reservoir in Taiwan

Correlation of climatic factors and dengue incidence in Metro Manila, Philippines

Climate influence on dengue epidemics in Puerto Rico

Climatic influence on the prevalence of noncutaneous disease flare in systemic lupus erythematosus in Hong Kong

Climate change and food security in tropical West Africa – A dynamic-statistical modelling approach

An urban epidemic of human myiasis caused by Dermatobia hominis in French Guiana

Assessment of human health vulnerability to climate variability and change in Cuba

A predictive model for dengue hemorrhagic fever epidemics

A stochastic model for ecological systems with strong nonlinear response to environmental drivers: Application to two water-borne diseases

Impact of climate change on health: What is required of climate modellers?

Weather as an effective predictor for occurrence of dengue fever in Taiwan

Weather variability and the incidence of cryptosporidiosis: Comparison of time series Poisson regression and SARIMA models

A report accepted by Working Group II of the Intergovernmental Panel on Climate Change but not approved in detail: Technical Summary

The quest for safe drinking water: An example from Guinea-Bissau (West Africa)

Thermal comfort investigation of naturally ventilated classrooms in a subtropical region

Seasonal variation in the incidence of preeclampsia and eclampsia in tropical climatic conditions

Simulating malaria model for different treatment intensities in a variable environment

Social and economic impacts of carbon sequestration and land use change on peasant households in rural China: A case study of Liping, Guizhou Province

Spatial distribution and temporal variability of arsenic in irrigated rice fields in Bangladesh. 2. Paddy soil

Regional variability in relationships between climate and dengue/DHF in Indonesia

Pesticide fate in tropical wetlands of Brazil: An aquatic microcosm study under semi-field conditions

Habitat suitability mapping of Anopheles darlingi in the surroundings of the Manso hydropower plant reservoir, Mato Grosso, Central Brazil

Climate variations and bacillary dysentery in northern and southern cities of China

Air pollution and hospital admissions for asthma in a subtropical city: Taipei, Taiwan

Air pollution and hospital admissions for congestive heart failure in a tropical city: Kaohsiung, Taiwan

Air pollution and hospital admissions for pneumonia in a tropical city: Kaohsiung, Taiwan

A knowledge, attitude and practices study of the issues of climate change/variability impacts and public health in Trinidad and Tobago, and St Kitts and Nevis

COPE Natural Disasters Book Series

The Caribbean Agrometeorological Initiative (CAMI): An Evaluation of Climate Services

Measurement and Forecasting of Ultraviolet Index in Hong Kong

A proposed Approach to Monitoring and Assessing drought in the Caribbean

Hong Kong Heat Index

Cold and Very Hot Weather Warnings

Location-specific Lightning Alerts

Hong Kong Regional Information on Heavy Rain and Thunderstorm

Hong Kong Ultraviolet (UV) radiation information

Weather information for Senior Citizens

Hong Kong Air Quality Health Index

Caribbean Health-Climatic Bulletin

Eastern Caribbean Dust and Air Quality Forecasting System