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Repository of systematic reviews on interventions in environment, climate change and health

Plan de acción de salud y cambio climático de la provincia de Neuquén

Effect of climate change on infectious diseases in the UK – Health Effects of Climate Change in the UK

Predicting exposure to pathogens and AMR

A model to identify real-time pathogen risks

Real-time risk mapping to inform river users

Evaluating a bathing water quality app

Predicting Health Risks for Swimmers

How climate change affects bacterial communities

Sampling methods along the Arrone River

The spread of antimicrobial-resistant pathogens

Listening to Communities is Key to Preparing for the Public Health Implications of El Niño in Zambia

Integrating climate and environmental information from satellites into health surveillance systems for Myanmar

How Colombia’s Climate and Health Bulletin is improving the management of environmental health and climate services

Vulnerability to Resilience (V2R) project for climate-resilient WASH in Bangladesh

Detection of climate-sensitive pathogens via wastewater surveillance in refugee camps in Bangladesh

Climate change and public health indicators: scoping review

Earth Observation, Public Health and One Health: Activities, Challenges and Opportunities

Climate change and health resilience actions in São Tomé and Príncipe

The Fukuoka Method – A Clean Development Mechanism – at Haags Bosch Sanitary Landfill Facility in Guyana

Strong systems and sound investments: Evidence on and key insights into accelerating progress on sanitation, drinking-water and hygiene – UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2022 Report

Climate change as a threat to health and well-being in Europe: focus on heat and infectious diseases

Climate Change Impacts on the Health of Canadians

Climate Change Impact Map

The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels

Bulletin Climat-Santé – Madagascar

Review of the evidence for oceans and human health relationships in Europe: A systematic map

BACKGROUND: Globally, there is increasing scientific evidence of critical links between the oceans and human health, with research into issues such as pollution, harmful algal blooms and nutritional contributions. However, Oceans and Human Health (OHH) remains an emerging discipline. As such these links are poorly recognized in policy efforts such as the Sustainable Development Goals, with OHH not included in either marine (SDG14) or health (SDG3) goals. This is arguably short-sighted given recent development strategies such as the EU Blue Growth Agenda. OBJECTIVES: In this systematic map we aim to build on recent efforts to enhance OHH in Europe by setting a baseline of existing evidence, asking: What links have been researched between marine environments and the positive and negative impacts to human health and wellbeing? METHODS: We searched eight bibliographic databases and queried 57 organizations identified through stakeholder consultation. Results include primary research and systematic reviews which were screened double blind against pre-defined inclusion criteria as per a published protocol. Studies were limited to Europe, US, Australia, New Zealand and Canada. Data was extracted according to a stakeholder-defined code book. A narrative synthesis explores the current evidence for relationships between marine exposures and human health outcomes, trends in knowledge gaps and change over time in the OHH research landscape. The resulting database is available on the website of the Seas, Oceans and Public Health in Europe website (https://sophie2020.eu/). RESULTS: A total of 1,542 unique articles were included in the database, including those examined within 56 systematic reviews. Research was dominated by a US focus representing 50.1% of articles. A high number of articles were found to link: marine biotechnology and cardiovascular or immune conditions, consumption of seafood and cardiovascular health, chemical pollution and neurological conditions, microbial pollution and gastrointestinal or respiratory health, and oil industry occupations with mental health. A lack of evidence relates to direct impacts of plastic pollution and work within a number of industries identified as relevant by stakeholders. Research over time is dominated by marine biotechnology, though this is narrow in focus. Pollution, food and disease/injury research follow similar trajectories. Wellbeing and climate change have emerged more recently as key topics but lag behind other categories in volume of evidence. CONCLUSIONS: The evidence base for OHH of relevance to European policy is growing but remains patchy and poorly co-ordinated. Considerable scope for future evidence synthesis exists to better inform policy-makers, though reviews need to better incorporate complex exposures. Priorities for future research include: proactive assessments of chemical pollutants, measurable impacts arising from climate change, effects of emerging marine industries, and regional and global assessments for OHH interactions. Understanding of synergistic effects across multiple exposures and outcomes using systems approaches is recommended to guide policies within the Blue Growth Strategy. Co-ordination of research across Europe and dedicated centres of research would be effective first steps.

Temperature and risk of infectious diarrhea: A systematic review and meta-analysis

Infectious diarrhea (ID) is an intestinal infectious disease including cholera, typhoid and paratyphoid fever, bacterial and amebic dysentery, and other infectious diarrhea. There are many studies that have explored the relationship between ambient temperature and the spread of infectious diarrhea, but the results are inconsistent. It is necessary to systematically evaluate the impact of temperature on the incidence of ID. This study was based on the PRISMA statement to report this systematic review. We conducted literature searches from CNKI, VIP databases, CBM, PubMed, Web of Science, Cochrane Library, and other databases. The number registered in PROSPERO is CRD42021225472. After searching a total of 4915 articles in the database and references, 27 studies were included. The number of people involved exceeded 7.07 million. The overall result demonstrated when the temperature rises, the risk of infectious diarrhea increases significantly (RR(cumulative)=1.42, 95%CI: 1.07-1.88, RR(single-day)=1.08, 95%CI: 1.03-1.14). Subgroup analysis found the effect of temperature on the bacillary dysentery group (RR(cumulative)=1.85, 95%CI: 1.48-2.30) and unclassified diarrhea groups (RR(cumulative)=1.18, 95%CI: 0.59-2.34). The result of the single-day effect subgroup analysis was similar to the result of the cumulative effect. And the sensitivity analysis proved that the results were robust. This systematic review and meta-analysis support that temperature will increase the risk of ID, which is helpful for ID prediction and early warning in the future.

Impact of climate change on the vulnerability of drinking water intakes in a northern region

Climate change impacts the vulnerability of drinking water sources to contamination and water shortages. This review highlights key risk factors along the impact chain of climate change on water supply security, from precipitation and runoff to surface water quality and availability at drinking water intakes. How climate impacts water quantity (hydrology) and quality (fate, transport and loads of contaminants, via soils, forests, and urban water infrastructure) is examined across the scientific literature. An emphasis is placed on high-latitude regions, where the kinetics and intensity of projected changes are high. The province of Quebec, Canada, is used as a study area that covers diverse land and climate conditions, with extended relevance at a broader scale globally. This review aims at guiding researchers and water managers in considering the climate-related evolution of a range of threats when assessing the vulnerability of drinking water systems. It highlights how climate change increases the seasonal risks of water supply insecurity in a northern region, thereby increasing socioeconomic and public health risks. Accounting for multiple feedback effects is a major cause of uncertainty in assessing future risks in drinking water supplies. Under deep uncertainty, a paradigm change in assessing climate impacts on water supplies is needed.

Climate change and antibiotic resistance: A deadly combination

Climate change is driven primarily by humanity’s use of fossil fuels and the resultant greenhouse gases from their combustion. The effects of climate change on human health are myriad and becomingly increasingly severe as the pace of climate change accelerates. One relatively underreported intersection between health and climate change is that of infections, particularly antibiotic-resistant infections. In this perspective review, the aspects of climate change that have already, will, and could possibly impact the proliferation and dissemination of antibiotic resistance are discussed.

A review of the environmental trigger and transmission components for prediction of cholera

Climate variables influence the occurrence, growth, and distribution of Vibrio cholerae in the aquatic environment. Together with socio-economic factors, these variables affect the incidence and intensity of cholera outbreaks. The current pandemic of cholera began in the 1960s, and millions of cholera cases are reported each year globally. Hence, cholera remains a significant health challenge, notably where human vulnerability intersects with changes in hydrological and environmental processes. Cholera outbreaks may be epidemic or endemic, the mode of which is governed by trigger and transmission components that control the outbreak and spread of the disease, respectively. Traditional cholera risk assessment models, namely compartmental susceptible-exposed-infected-recovered (SEIR) type models, have been used to determine the predictive spread of cholera through the fecal-oral route in human populations. However, these models often fail to capture modes of infection via indirect routes, such as pathogen movement in the environment and heterogeneities relevant to disease transmission. Conversely, other models that rely solely on variability of selected environmental factors (i.e., examine only triggers) have accomplished real-time outbreak prediction but fail to capture the transmission of cholera within impacted populations. Since the mode of cholera outbreaks can transition from epidemic to endemic, a comprehensive transmission model is needed to achieve timely and reliable prediction with respect to quantitative environmental risk. Here, we discuss progression of the trigger module associated with both epidemic and endemic cholera, in the context of the autochthonous aquatic nature of the causative agent of cholera, V. cholerae, as well as disease prediction.

Advancing environmental public health in Latin America and the Caribbean

This paper highlights the important leadership role of the public health sector, working with other governmental sectors and nongovernmental entities, to advance environmental public health in Latin America and the Caribbean toward the achievement of 2030 Sustainable Development Goal 3: Health and Well-Being. The most pressing current and future environmental public health threats are discussed, followed by a brief review of major historical and current international and regional efforts to address these concerns. The paper concludes with a discussion of three major components of a regional environmental public health agenda that responsible parties can undertake to make significant progress toward ensuring the health and well-being of all people throughout Latin America and the Caribbean.

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.

Water, sanitation and hygiene risk factors for the transmission of cholera in a changing climate: Using a systematic review to develop a causal process diagram

Cholera is a severe diarrhoeal disease affecting vulnerable communities. A long-term solution to cholera transmission is improved access to and uptake of water, sanitation and hygiene (WASH). Climate change threatens WASH. A systematic review and meta-analysis determined five overarching WASH factors incorporating 17 specific WASH factors associated with cholera transmission, focussing upon community cases. Eight WASH factors showed lower odds and six showed higher odds for cholera transmission. These results were combined with findings in the climate change and WASH literature, to propose a health impact pathway illustrating potential routes through which climate change dynamics (e.g. drought, flooding) impact on WASH and cholera transmission. A causal process diagram visualising links between climate change dynamics, WASH factors, and cholera transmission was developed. Climate change dynamics can potentially affect multiple WASH factors (e.g. drought-induced reductions in handwashing and rainwater use). Multiple climate change dynamics can influence WASH factors (e.g. flooding and sea-level rise affect piped water usage). The influence of climate change dynamics on WASH factors can be negative or positive for cholera transmission (e.g. drought could increase pathogen desiccation but reduce rainwater harvesting). Identifying risk pathways helps policymakers focus on cholera risk mitigation, now and in the future.

Zika virus syndrome, lack of environmental policies and risks of worsening by cyanobacteria proliferation in a climate change scenario

Almost half of the Brazilian population has no access to sewage collection and treatment. Untreated effluents discharged in waters of reservoirs for human supply favor the flowering of cyanobacteria – and these microorganisms produce toxins, such as saxitoxin, which is a very potent neurotoxin present in reservoirs in the Northeast region. A recent study confirmed that chronic ingestion of neurotoxin-infected water associated with Zika virus infection could lead to a microcephaly-like outcome in pregnant mice. Cyanobacteria benefit from hot weather and organic matter in water, a condition that has been intensified by climate change, according to our previous studies. Considering the new findings, we emphasize that zika arbovirus is widespread and worsened when associated with climate change, especially in middle- or low-income countries with low levels of sanitation coverage.

The impact of climate change on Cholera: A review on the global status and future challenges

Water ecosystems can be rather sensitive to evolving or sudden changes in weather parameters. These changes can result in alterations in the natural habitat of pathogens, vectors, and human hosts, as well as in the transmission dynamics and geographic distribution of infectious agents. However, the interaction between climate change and infectious disease is rather complicated and not deeply understood. In this narrative review, we discuss climate-driven changes in the epidemiology of Vibrio species-associated diseases with an emphasis on cholera. Changes in environmental parameters do shape the epidemiology of Vibrio cholerae. Outbreaks of cholera cause significant disease burden, especially in developing countries. Improved sanitation systems, access to clean water, educational strategies, and vaccination campaigns can help control vibriosis. In addition, real-time assessment of climatic parameters with remote-sensing technologies in combination with robust surveillance systems could help detect environmental changes in high-risk areas and result in early public health interventions that can mitigate potential outbreaks.

Oncomelania hupensis quadrasi: Snail intermediate host of Schistosoma japonicum in the Philippines

Oncomelania hupensis quadrasi is the snail intermediate host of Schistosoma japonicum in the Philippines. It was discovered by Dr. Marcos Tubangui in 1932 more than two decades after the discovery of the disease in the country in 1906. This review, the first for O. h. quadrasi, presents past and present works on the taxonomy, biology, ecology, control, possible paleogeographic origin of the snail intermediate host and future in research, control and surveillance of the snail. Extensive references are made of other subspecies of O. hupensis such as the subspecies in China for which majority of the advances has been accomplished. Contrasting views on whether the snail is to be considered an independent species of Oncomelania or as one of several subspecies of Oncomelania hupensis are presented. Snail control methods such as chemical methods using synthetic and botanical molluscicides, environmental manipulation and biological control are reviewed. Use of technologies such as Remote Sensing, Geographical Information System and landscape genetics is stressed for snail surveillance. Control and prevention efforts in the Philippines have consistently focused on mass drug administration which has proved inadequate in elimination of the disease. An integrated approach that includes snail control, environmental sanitation and health education has been proposed. Population movement such as migration for employment and economic opportunities and ecotourism and global climate change resulting in heavy rains and flooding challenge the gains of control and elimination efforts. Concern for possible migration of snails to non-endemic areas is expressed given the various changes both natural and mostly man-made favoring habitat expansion.

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.

Marine harmful algal blooms and human health: A systematic scoping review

Exposure to harmful algal blooms (HABs) can lead to well recognised acute patterns of illness in humans. The objective of this scoping review was to use an established methodology and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting framework to map the evidence for associations between marine HABs and observed both acute and chronic human health effects. A systematic and reproducible search of publications from 1985 until May 2019 was conducted using diverse electronic databases. Following de-duplication, 5301 records were identified, of which 380 were included in the final qualitative synthesis. The majority of studies (220; 57.9%) related to Ciguatera Poisoning. Anecdotal and case reports made up the vast majority of study types (242; 63.7%), whereas there were fewer formal epidemiological studies (35; 9.2%). Only four studies related to chronic exposure to HABs. A low proportion of studies reported the use of human specimens for confirmation of the cause of illness (32; 8.4%). This study highlighted gaps in the evidence base including a lack of formal surveillance and epidemiological studies, limited use of toxin measurements in human samples, and a scarcity of studies of chronic exposure. Future research and policy should provide a baseline understanding of the burden of human disease to inform the evaluation of the current and future impacts of climate change and HABs on human health.

Human health and ocean pollution

BACKGROUND: Pollution – unwanted waste released to air, water, and land by human activity – is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood. GOALS: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health. METHODS: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention. ENVIRONMENTAL FINDINGS: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources – coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths. ECOSYSTEM FINDINGS: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks. HUMAN HEALTH FINDINGS: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children’s risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals – phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them

Impacts of flood on health of Iranian population: Infectious diseases with an emphasis on parasitic infections

BACKGROUND: Outbreaks of infectious diseases are the major concern after flooding. Flood makes people displacement which would be more complicated with inadequate sanitation. Settling in crowded shelters in absence of clean water and inaccessibility to health care services makes people more vulnerable to get infection. This review aimed to discuss about potential undesirable outcomes of flooding occurred in 2019 in Iran. METHODS: A comprehensive search was carried out in databases including PubMed, Google scholar, Scopus, Science Direct, Iran medex, Magiran and SID (Scientific information database) from 2000 to 2019. All original descriptive articles on flood were concerned. Related articles on flood disturbance were considered. Also, publication of red cross society was considered as only reliable reference in evaluation of consequences of flood occurred in 2019 in Iran. RESULTS: Flooding in Iran, was started in March 2019 and lasted to April 2019. Flood affected 31 provinces and 140 rivers burst their banks, and southwestern Iran being hit most severely. According the reports of international federation of red cross society, 3800 cities and villages were affected by the floods with 65,000 destroyed houses and 114,000 houses partially damaged. Also 70 hospitals or health care centers with 1200 schools were damaged along with many infrastructures including 159 main roads and 700 bridges. CONCLUSIONS: Considering 365,000 displaced persons and estimation of mentioned damages, it was one of the greatest natural disaster during the last 20 years. Various risk factors in favor of infectious diseases such as overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation and human contact among refugees provide suitable conditions for increased incidence of infectious diseases after flooding and also cause epidemics.More attention is needed to provide hygienic situation for people after natural disasters including flood.

In hot water: Effects of climate change on Vibrio-human interactions

Sea level rise and the anthropogenic warming of the world’s oceans is not only an environmental tragedy, but these changes also result in a significant threat to public health. Along with coastal flooding and the encroachment of saltwater farther inland comes an increased risk of human interaction with pathogenic Vibrio species, such as Vibrio cholerae, V. vulnificus and V. parahaemolyticus. This minireview examines the current literature for updates on the climatic changes and practices that impact the location and duration of the presence of Vibrio spp., as well as the infection routes, trends and virulence factors of these highly successful pathogens. Finally, an overview of current treatments and methods for the mitigation of both oral and cutaneous exposures are presented.

Indonesia: Country report on children’s environmental health

Children’s bodies are in dynamic stages of development that make them more susceptible to harm from exposure to environmental agents. Children’s physical, physiological and behavioral traits can lead to increased exposure to toxic chemicals or pathogens. In addition, the social determinants of health interact with this exposure and create an increasing risk for further disparities among children. In Indonesia, the fourth most populated country in the world, children are under threat of exposure to contaminated water, air, food and soil, which can cause gastrointestinal and respiratory diseases, birth defects and neurodevelopmental disorders. A safe and balanced nutrition is still an unmet need for too many children. At the same time, the prevalence of obesity and the risk of later development of metabolic diseases, including diabetes and cardiovascular diseases, are increasing as a consequence of both unhealthy diets and inadequate physical activity. The risks of potential long-term toxicity, including carcinogenic, neurotoxic, immunotoxic, genotoxic, endocrine-disrupting and allergenic effects of many chemicals, are also close to their lives. This paper provides an overview of common disease risks in Indonesian children, including: acute hepatitis A, diarrheal diseases, dengue and malaria due to lack of water supply and sanitation, vectors, and parasites; asthma, bronchopneumonia, chronic obstructive pulmonary disease (COPD) and acute respiratory infections (ARIs) due to air pollution and climate change; some chronic diseases caused by toxic and hazardous waste; and direct or indirect consequences due to the occurrence of disasters and health emergencies.

How climate change can affect cholera incidence and prevalence? A systematic review

Although the number of cholera infection decreased universally, climate change can potentially affect both incidence and prevalence rates of disease in endemic regions. There is considerable consistent evidence, explaining the associations between cholera and climatic variables. However, it is essentially required to compare and interpret these relationships globally. The aim of the present study was to carry out a systematic review in order to identify and appraise the literature concerning the relationship between nonanthropogenic climatic variabilities such as extreme weather- and ocean-related variables and cholera infection rates. The systematic literature review of studies was conducted by using determined search terms via four major electronic databases (PubMed, Web of Science, Embase, and Scopus) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. This search focused on published articles in English-language up to December 31, 2018. A total of 43 full-text studies that met our criteria have been identified and included in our analysis. The reviewed studies demonstrated that cholera incidence is highly attributed to climatic variables, especially rainfall, temperature, sea surface temperature (SST) and El Niño Southern Oscillation (ENSO). The association between cholera incidence and climatic variables has been investigated by a variety of data analysis methodologies, most commonly time series analysis, generalized linear model (GLM), regression analysis, and spatial/GIS. The results of this study assist the policy-makers who provide the efforts for planning and prevention actions in the face of changing global climatic variables.

Climate change, water quality and water-related challenges: A review with focus on Pakistan

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

Environmental abiotic and biotic factors affecting the distribution and abundance of Naegleria fowleri

Naegleria fowleri is a free-living protozoan that resides in soil and freshwater. Human intranasal amoebae exposure through water or potentially dust particles can culminate in primary amoebic meningoencephalitis, which generally causes death. While many questions remain regarding pathogenesis, the microbial ecology of N. fowleri is even less understood. This review outlines current knowledge of the environmental abiotic and biotic factors that affect the distribution and abundance of N. fowleri. Although the impacts of some abiotic factors remain poorly investigated or inconclusive, N. fowleri appears to have a wide pH range, low salinity tolerance and thermophilic preference. From what is known about biotic factors, the amoebae preferentially feed upon bacteria and are preyed upon by other free-living amoebae. Additional laboratory and environmental studies are needed to fill in knowledge gaps, which are crucial for surveillance and management of N. fowleri in freshwaters. As surface water temperatures increase with climate change, it is likely that this amoeba will pose a greater threat to human health, suggesting that identifying its abiotic and biotic preferences is critical to mitigating this risk.

The direct and interactive impacts of hydrological factors on bacillary dysentery across different geographical regions in central China

Previous studies found non-linear mutual interactions among hydrometeorological factors on diarrheal disease. However, the complex interactions of the hydrometeorological, topographical and human activity factors need to be further explored. This study aimed to reveal how hydrological and other factors jointly influence bacillary dysentery in different geographical regions. Using Anhui Province in China, consisted of Huaibei plain, Jianghuai hilly and Wannan mountainous regions, we integrated multi-source data (6 meteorological, 3 hydrological, 2 topographic, and 9 socioeconomic variables) to explore the direct and interactive relationship between hydrological factors (quick flow, baseflow and local recharge) and other factors by combining the ecosystem model InVEST with spatial statistical analysis. The results showed hydrological factors had significant impact powers (q = 0.444 (Huaibei plain) for local recharge, 0.412 (Jianghuai hilly region) and 0.891 (Wannan mountainous region) for quick flow, respectively) on bacillary dysentery in different regions, but lost powers at provincial level. Land use and soil properties have created significant interactions with hydrological factors across Anhui province. Particularly, percentage of farmland in Anhui province can influence quick flow across Jianghuai, Wannan regions and the whole province, and it also has significant interactions with the baseflow and local recharge across the plain as well as the whole province. Percentage of urban areas had interactions with baseflow and local recharge in Jianghuai and Wannan regions. Additionally, baseflow and local recharge could be interacted with meteorological factors (e.g. temperature and wind speed), while these interactions varied in different regions. In conclusion, it was evident that hydrological factors had significant impacts on bacillary dysentery, and also interacted significantly with meteorological and socioeconomic factors. This study applying ecosystem model and spatial analysis help reveal the complex and nonlinear transmission of bacillary dysentery in different geographical regions, supporting the development of precise public health interventions with consideration of hydrological factors.

Seasonal changes in dissolved trace elements and human health risk in the upper and middle reaches of the Bhavani River, southern India

The surface water is a significant feature in the hydrological system and is a vital compound for life growth. Assessment of trace elements in the water bodies is essential since it poses huge threats to aquatic organisms and humans if present in high concentrations. This study was carried out to assess the seasonal changes in the dissolved trace elements concentration in Bhavani river, which is one of the major rivers of Tamil Nadu, southern India and also to assess the human health risk due to its consumption. A total of 46 surface water samples were collected along the river during pre-monsoon and post-monsoon of 2018 and were analyzed for various trace elements such as Zn, Cu, Fe, Ni, and Pb. The variation in trace element concentration is observed spatially, where higher concentration is found in samples from agricultural and urban areas than the samples from the undisturbed natural-mountain terrains. The results highlighted that the concentrations of trace elements differ temporally where the concentration is greater during the monsoon due to increased discharge of sewage and agricultural run off to the river. Multivariate statistical analysis indicates stronger relationship between trace elements and other physio-chemical parameters hinting that natural and anthropogenic sources alters the riverine chemistry. Thus, the rainfall-runoff characteristics along with lithology, topography, and landuse of the basin plays a dominant role in the seasonal variation of dissolved trace elements. The water quality index value shows “good/excellent” during pre-monsoon and “marginal/fair” during monsoon season and the Heavy Metal Pollution Index values were also low during both the seasons. The river water samples which defy these indices were found to be either from urban or agricultural lands. The oral and dermal ingestion health risk to adults was assessed, which indicates that the risks posed to humans by consumption of water were minimal. The trace metal concentration of the river was then compared with the other rivers of world and India, where it shows that Zn, Cu, and Ni concentration was higher in Bhavani than in most of the rivers. Thus, the study highlighted that the urban settlements and agricultural lands have a considerable influence on river quality thereby triggering the increase in trace element concentrations. Therefore, the study necessitates on the continuous monitoring of river along with adoption of stringent discharge protocols.

Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa

Enteric infections and water-related illnesses are more frequent during times of relative water abundance, especially in regions that experience bimodal rainfall patterns. However, it is unclear how seasonal changes in water availability and drinking water source types affect enteric infections in young children. This study investigated seasonal shifts in primary drinking water source type and the effect of water source type on enteric pathogen prevalence in stool samples from 404 children below age 5 in rural communities in Limpopo Province, South Africa. From wet to dry season, 4.6% (n = 16) of households switched from a source with a higher risk of contamination to a source with lower risk, with the majority switching to municipal water during the dry season. In contrast, 2.6% (n = 9) of households switched from a source with a lower risk of contamination to a source with higher risk. 74.5% (n = 301) of the total households experienced interruptions in their water supply, regardless of source type. There were no significant differences in enteric pathogen prevalence between drinking water sources. Intermittent municipal water distribution and household water use and storage practices may have a larger impact on enteric infections than water source type. The limited differences in enteric pathogen prevalence in children by water source could also be due to other exposure pathways in addition to drinking water, for example through direct contact and food-borne transmission.

Quality assessment of harvested rainwater and seasonal variations in the southwest coastal area, Bangladesh

Secure potable water is indispensable to life. The presence of salinity in potable water has become a serious problem worldwide and it is essential to ensure secure potable water, particularly in the coastal areas of Bangladesh. In this work, 48 (forty-eight) harvested rainwater samples were assessed from Upazila (sub-district) of Mongla and Sarankhola, Bagerhat district, Bangladesh during the monsoon (May) and post-monsoon (October) periods. The objective was to examine the effect of seasonal variations on the quality of harvested rainwater. The harvested rainwater was analyzed for fecal coliform, total coliform, lead (Pb), zinc (Zn), pH, and turbidity. The mean pH in monsoon and post-monsoon periods was 6.93 and 7.24, respectively, which was within both the WHO guideline and Bangladesh Drinking Standard. In the monsoon season, turbidity levels in samples met the Bangladesh water quality standard but 10% of the harvested rainfall samples had Pb levels that exceeded the WHO drinking water limit. The turbidity of harvested rainwater in post-monsoon exceeded the WHO and Bangladesh Drinking Standard by 21% (10 out of 48) and 6% (3 out of 48), respectively. The fecal coliform of harvested rainwater exceeded both WHO and Bangladesh Drinking Standard by 56% (27 out of 48) and 67% (32 out of 48) in the monsoon and post-monsoon, correspondingly. Conversely, total coliform of harvested rainwater exceeded both the WHO and Bangladesh Drinking Standard by 67% (32 out of 48) and 79% (38 out of 48), accordingly in the monsoon and post-monsoon seasons. The Zn was below the WHO and Bangladesh Drinking Standard but Pb exceeded the WHO guideline in the monsoon and post-monsoon by 15% (7 out of 48) and 17% (8 out of 48), respectively. Pb is toxic to humans and children are especially vulnerable. The harvested rainwater should be treated effectively to reduce the toxicity and danger posed by Pb, fecal coliform, and total coliform before it is fit for drinking purposes.

Modelling the influence of short-term climate variability on drinking water quality in tropical developing countries: A case study in Tanzania

Climate change is expected to increase the prevalence of water-borne diseases especially in developing countries. Climate-resilient drinking water supplies are critical to protect communities from faecal contamination and thus against increasing disease risks. However, no quantitative assessment exists for the impacts of short-term climate variability on faecal contamination at different drinking water sources in developing countries, while existing understanding remains largely conceptual. This critical gap limits the ability to predict drinking water quality under climate change or to recommend climate-resilient water sources for vulnerable communities. This study aims to provide such quantitative understanding by investigating the relationships between faecal contamination and short-term climate variability across different types of water sources. We collected a novel dataset with over 20 months’ monitoring of weather, Escherichia coli (E. coli) and total coliforms, at 233 different water sources in three climatically different regions in Tanzania. We then took a rigorous statistical analysis with Bayesian hierarchical models, to relate both contamination occurrence and amount to climate variability. The model results explained the temporal variability in drinking water faecal contamination using climate predictors, and also revealed the climate sensitivity of faecal contamination for individual water sources. We found that: a) short-term climate variability and baseline contamination levels can explain about half the observed variability in faecal contamination (R(2) ? 0.44); b) increased contamination was most consistently related to recent heavy rainfall and high temperature across different water sources; c) unimproved water sources such as the unprotected dug wells have substantially higher climate sensitivity. Based on these results, we can expect substantial increases in drinking water contamination risks across tropical Sub-Saharan Africa and South-East Asian developing countries under a warmer climate, which highlight the urgent need of protecting vulnerable communities from the severe climate impacts.

Modelling the interplay of future changes and wastewater management measures on the microbiological river water quality considering safe drinking water production

Rivers are important for drinking water supply worldwide. However, they are often impacted by pathogen discharges via wastewater treatment plants (WWTP) and combined sewer overflows (CSO). To date, accurate predictions of the effects of future changes and pollution control measures on the microbiological water quality of rivers considering safe drinking water production are hindered due to the uncertainty of the pathogen source and transport variables. The aim of this study was to test an integrative approach for an improved understanding of these effects, i.e. climate change and population growth as well as enhanced treatment at WWTPs and/or prevention of CSOs. We applied a significantly extended version of QMRAcatch (v1.0 Python), a probabilistic-deterministic model that combines fate and transport modelling with quantitative microbial infection risk assessment. The impact of climatic changes until the period 2035-2049 was investigated by a conceptual semi-distributed hydrological model, based on regional climate model outputs. QMRAcatch was calibrated and validated using site- and source-specific data (human-associated genetic microbial source tracking marker and enterovirus). The study showed that the degree to which future changes affect drinking water safety strongly depends on the type and magnitude of faecal pollution sources and are thus highly site- and scenario-specific. For example, if the load of pathogens from WWTPs is reduced through enhanced treatment, climate-change driven increases in CSOs had a considerable impact. Preventing CSOs and installing enhanced treatment at the WWTPs together had the most significant positive effect. The simultaneous consideration of source apportionment and concentrations of reference pathogens, focusing on human-specific viruses (enterovirus, norovirus) and cross-comparison with bacterial and protozoan pathogens (Campylobacter, Cryptosporidium), was found crucial to quantify these effects. While demonstrated here for a large, wastewater-impacted river, the approach is applicable at other catchments and pollution sources. It allows assessing future changes and selecting suitable pollution control measures for long-term water safety planning.

Molecular detection of Cryptosporidium: An emerging parasite in different water sources of 2010 flood-affected district Nowshera, Pakistan

Cryptosporidium is a water-borne zoonotic parasite worldwide, usually found in lakes and rivers contaminated with sewage and animal wastes, causing outbreaks of cryptosporidiosis. In this study, 300 water samples were collected from four designated places of flood-affected district Nowshera consist of different water sources to find out the prevalence of Cryptosporidium via polymerase chain reaction (PCR). The overall prevalence of Cryptosporidium was 30.33% (91/300) with more prevalent 44% in drain water and low 5% in bore/tube well water. The prevalence in open well and tap water was recorded 33% and 20%, respectively. The highest prevalence was recorded in summer (June-September). The result of this study ensures enormous contamination of drinking water that requires appropriate treatment, cleaning and filtration to provide safe drinking water. Preventing water-borne disease and proper treatment of water supplies is essential to public health.

Natural disasters, population displacement and health emergencies: Multiple public health threats in Mozambique

In early 2019, following the 2015-2016 severe drought, the provinces of Sofala and Cabo Delgado, Mozambique, were hit by Cyclones Idai and Kenneth, respectively. These were the deadliest and most destructive cyclones in the country’s history. Currently, these two provinces host tens of thousands of vulnerable households due to the climatic catastrophes and the massive influx of displaced people associated with violent terrorist attacks plaguing Cabo Delgado. The emergence of the COVID-19 pandemic added a new challenge to this already critical scenario, serving as a real test for Mozambique’s public health preparedness. On the planetary level, Mozambique can be viewed as a ‘canary in the coal mine’, harbingering to the world the synergistic effects of co-occurring anthropogenic and natural disasters. Herein, we discuss how the COVID-19 pandemic has accentuated the need for an effective and comprehensive public health response in a country already deeply impacted by health problems associated with natural disasters and population displacement.

Meteorological factors and childhood diarrhea in Peru, 2005-2015: A time series analysis of historic associations, with implications for climate change

BACKGROUND: Global temperatures are projected to rise by ?2?°C by the end of the century, with expected impacts on infectious disease incidence. Establishing the historic relationship between temperature and childhood diarrhea is important to inform future vulnerability under projected climate change scenarios. METHODS: We compiled a national dataset from Peruvian government data sources, including weekly diarrhea surveillance records, annual administered doses of rotavirus vaccination, annual piped water access estimates, and daily temperature estimates. We used generalized estimating equations to quantify the association between ambient temperature and childhood (

Livelihood vulnerability and adaptability of coastal communities to extreme drought and salinity intrusion in the Vietnamese Mekong Delta

Many deltas worldwide have increasingly faced extreme drought and salinity intrusion, which have adversely affected millions of coastal inhabitants in terms of lives and property. The Vietnamese Mekong Delta (VMD) is considered one of the world?s most vulnerable regions to drought and saline water intrusion, especially in the context of climate change. This study aims to assess livelihood vulnerability and adaptation of the coastal people of the VMD under the impacts of drought and saltwater intrusion. A multi-disciplinary approach was applied, including desktop literature reviews, field surveys, interviews, and focus group discussions with 120 farmers and 30 local officials in two representative hamlets of Soc Trang, a coastal province of the VMD. A vulnerability assessment tool in combination with a sustainable livelihood framework was used to evaluate livelihood vulnerability using the five capital resources to indicate the largest effects of drought and salinity intrusion on the migration of local young people to large cities for adaptation. Livelihood Vulnerability Indexes revealed higher vulnerability in terms of the five capitals of coastal communities living in Nam Chanh hamlet compared to Soc Leo. Results of interviews with officials indicated an optimized mechanism between social organizations and local communities before, at the time, and after being impacted by the drought and salinity intrusion. Our findings contribute evidence-based knowledge to decision-makers to enable coastal communities in the VMD and other deltas worldwide to effectively adapt to the impacts of drought and salinity intrusion.

Incorporating stakeholders’ preferences into a multi-criteria framework for planning large-scale Nature-Based Solutions

Hydro-meteorological risks are a growing issue for societies, economies and environments around the world. An effective, sustainable response to such risks and their future uncertainty requires a paradigm shift in our research and practical efforts. In this respect, Nature-Based Solutions (NBSs) offer the potential to achieve a more effective and flexible response to hydro-meteorological risks while also enhancing human well-being and biodiversity. The present paper describes a new methodology that incorporates stakeholders’ preferences into a multi-criteria analysis framework, as part of a tool for selecting risk mitigation measures. The methodology has been applied to Tamnava river basin in Serbia and Nangang river basin in Taiwan within the EC-funded RECONECT project. The results highlight the importance of involving stakeholders in the early stages of projects in order to achieve successful implementation of NBSs. The methodology can assist decision-makers in formulating desirable benefits and co-benefits and can enable a systematic and transparent NBSs planning process.

Effects of drought on environmental health risk posed by groundwater contamination

This publication presents a comparison of the content of pollutants in groundwater samples taken at 117 measurement points in four regions of Poland during a drought period and in the reference period without drought. Based on the chemical analyses of water, an assessment of the health risk resulting from the use of underground water for consumption was carried out. The study aimed to determine whether drought affects the increase in health risk exposure of the population. It was found that despite the occurrence of drought, the expected increase in the concentration of pollutants in water does not take place in all locations. This study found that in some cases the occurrence of drought did not cause an increase in the non-cancerogenic threat expressed by the hazard index. There were also no clear changes in excess lifetime cancer risk values except for selected measurement points. On the other hand, the statistical analysis of all data collected in the regions where the research was conducted showed a general trend of increasing environmental health risk caused by changes in groundwater pollution during drought.

Effects of meteorological factors on human leptospirosis in Colombia

Leptospirosis is a disease usually acquired by humans through water contaminated with the urine of rodents that comes into direct contact with the cutaneous lesions, eyes, or mucous membranes. The disease has an important environmental component associated with climatic conditions and natural disasters, such as floods. We analyzed the relationship between rainfall and temperature and the incidence of leptospirosis in the top 30 municipalities with the highest numbers of cases of the disease in the period of 2007 to 2016. It was an ecological study of the time series of cases of leptospirosis, rainfall, and temperature with lags of 0, 1, 2, 3, and 4 weeks. A multilevel negative binomial regression model was implemented to evaluate the relationship between leptospirosis and both meteorological factors. In the 30 evaluated municipalities during the study period, a total of 5136 cases of leptospirosis were reported. According to the implemented statistical model, there was a positive association between the incidence of leptospirosis and rainfall with a lag of 1 week and a negative association with temperature with a lag of 4 weeks. Our results show the importance of short-term lags in rainfall and temperature for the occurrence of new cases of leptospirosis in Colombia.

Elucidation of health risks using metataxonomic and antibiotic resistance profiles of microbes in flood affected waterbodies, Kerala 2018

The floods of 2018 caused havoc in the State of Kerala, situated in the extreme south-west of India, in terms of infrastructure and health. This research provides the first-ever assessment of the bacterial diversity and its antibiotic susceptibility of the inundated areas of Pampa, Periyar and Vembanad waterbodies by comparing the data collected in two different time intervals succeeding the calamitous floods that is, immediately after flood and 5 months post-flood. An elevated total coliform count was detected in the waterbodies after the flood thereby rendering it unsafe for drinking. Variation in bacterial diversity was observed in the river and lake water samples with a distinct increase in that of the river samples immediately after flood indicated by shannon diversity index (>5.5). Resistance to ampicillin and cefotaxime was observed in a major proportion of isolates from the three biotopes thus indicating the influence of antibiotic wastes accumulated from different sources of human interventions. Furthermore, operational taxonomic units clustering to Acinetobacter, Legionella, Pseudomonas and Burkholderia genera were detected by metataxonomic analysis which portray as a potential health risk in the future. The article emphasises the importance of adopting sanitation programmes for effective management of epidemic outbreaks post floods.

Detection and correlation analysis of shellfish pathogens in Dadeng Island, Xiamen

Food poisoning is caused by pathogenic bacteria in water and aquatic products, especially bivalves (e.g., oysters, clams), which can bioaccumulate pathogenic bacteria. Polluted water and aquatic products thus pose a serious threat to human health and safety. In this study, the types of pathogenic bacteria in water samples and shellfish collected from the Dadeng offshore area in Xiamen were examined. We also analyzed the relationships between dominant pathogens and major climate and water quality parameters. Our objective was to provide reference data that may be used to help prevent bacterial infections and to improve aquatic food hygiene in Xiamen and its surrounding areas to safe levels, thus ensuring the health of Xiamen residents. We found that the main pathogenic bacteria were Vibrio and Bacillus, with the dominant pathogen being Vibrio parahaemolyticus. Physical and chemical indexes (water temperature, salinity, pH, dissolved oxygen, and turbidity) of water bodies and the 3-day accumulated rainfall were found to be important factors affecting the occurrence and abundance of V. parahaemolyticus.

Coliform bacteria in San Pedro Lake, western Mexico

Urbanization, livestock activities, and rainfall are factors that contribute to the contamination of inland water. This study aimed to determine the spatial and temporal variability of total coliforms (TCs) and fecal coliforms (FCs) in the surface water of San Pedro Lake as well as the gills and skin of Nile tilapia (Oreochromis niloticus) cultivated in the lake. The study consisted of seasonal sampling during an annual cycle. Using the multiple-tube fermentation technique, we quantified the microbial load of TCs in the lake and fish. The median of the TC and FC groups in surface water showed differences during the seasonal cycle, in which a significant correlation was observed between rainfall and bacterial load in the lake surface water. There was a significant seasonal difference between FCs and TCs in the gills as well as in skin FCs. Anthropogenic activities in the watershed combined with rainfall influence the bacterial load of San Pedro Lake. However, the water quality is still classified as excellent and uncontaminated according to Mexican regulations with lower FC values acceptable for higher FC values. In addition, the bacterial load in tilapia from San Pedro Lake does not pose a risk to human health. PRACTITIONER POINTS: Watershed livestock activities combined with rainfall increase fecal matter pollution in specific areas of the lake. San Pedro Lake displays satisfactory quality for aquatic life. The median fecal coliform population in lake fish (gills and skin) differs by season.

Climate change and Vibrio cholerae in Herring eggs: The role of indigenous communities in public health outbreak responses

Chamoli disaster: Pronounced changes in water quality and flood plains using Sentinel data

The Himalayan rivers are vulnerable to devastating flooding caused by landslides and outbreak of glacial lakes. On 7 February 2021, a deadly disaster occurred near the Rishi Ganga Hydropower Plant in the Rishi Ganga River, killing more than 100 people. During the event, a large volume of debris and broken glacial fragments flooded the Rishi Ganga River and washed away the Rishi Ganga Hydropower plant ongoing project. This study presents the impact of the Chamoli disaster on the water quality of Rishi Ganga River in upstream near Tapovan and Ganga River in downstream near Haridwar through remote sensing data. Five points have been used at different locations across the two study areas and three different indices were used such as Normalized difference water index (NDWI), Normalized difference turbidity Index (NDTI), and Normalized difference chlorophyll index (NDCI), to analyze changes in water quality. Spectral signatures and backscattering coefficients derived from Sentinel-2 Optical and Sentinel-1 Synthetic-aperture radar (SAR) data were also compared to study the changes in water quality. It was evident from the water quality indices and spectral signatures that the flood plains changed significantly. Using spectral signatures and different indices, the water level in the Chilla dam canal near Haridwar was found to decreased after the Chamoli disaster event as the flood gates were closed to stop the deposit of sediments in the canal. Results suggest changes in water quality parameters (turbidity, chlorophyll concentration, NDWI) at the five locations near the deadly site and far away at Haridwar along the Ganga River. This study is a preliminary qualitative analysis showing changes in river flood plain and water quality after the Chamoli disaster.

A large epidemic of a necrotic skin infection in the Democratic Republic of São Tomé and Principe: An epidemiological study

INTRODUCTION: In 2016-18, the Democratic Republic of São Tomé and Príncipe suffered a necrotic skin infection epidemic. METHODS: A surveillance system was established after increased hospitalisations for this infection. Microbiology results were available for samples analysed in December 2016 and March 2017 using whole genome sequencing and metagenomics. Negative binomial regression was used to study the association of weather conditions with monthly case counts in a time-series analysis. RESULTS: From October 2016 to October 2018, the epidemic cumulative attack rate was 1.5%. The first peak lasted 5 months, accounting for one-third of total cases. We could not conclusively identify the aetiological agent(s) due to the country’s lack of microbiology capacity. Increased relative humidity was associated with increased monthly cases (incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.09), and higher precipitation in the previous month with a higher number of cases in the following month (months with 0-49 mm rainfall compared with months with 50-149 mm and ?150 mm: IRR 1.44, 95 % CI 1.13-1.78 and 1.50, 95% CI 1.12-1.99, respectively). DISCUSSION: This epidemic was favoured by increased relative humidity and precipitation, potentially contributing to community-based transmission of ubiquitous bacterial strains superinfecting skin wounds. FUNDING: World Health Organization Regional Office for Africa, Ministry of Health.

Water quality and human health: A simple monitoring model of toxic cyanobacteria growth in highly variable Mediterranean hot dry environments

Due to population growth, urbanization and economic development, demand for freshwater in urban areas is increasing throughout Europe. At the same time, climate change, eutrophication and pollution are affecting the availability of water supplies. Sicily, a big island in southern Italy, suffers from an increasing drought and consequently water shortage. In the last decades, in Sicilian freshwater reservoirs several Microcystis aeruginosa and more recently Planktothrix rubescens blooms were reported. The aims of the study were: (1) identify and quantify the occurring species of cyanobacteria (CB), (2) identify which parameters, among those investigated in the waters, could favor their growth, (3) set up a model to identify reservoirs that need continuous monitoring due to the presences, current or prospected, of cyanobacterial blooms and of microcystins, relevant for environmental and, consequentially, for human health. Fifteen artificial reservoirs among the large set of Sicilian artificial water bodies were selected and examined for physicochemical and microbiological characterization. Additional parameters were assessed, including the presence, identification and count of the cyanobacterial occurring species, the measurement of microcystins (MCs) levels and the search for the genes responsible for the toxins production. Principal Component Analysis (PCA) was used to relate environmental condition to cyanobacterial growth. Water quality was poor for very few parameters, suggesting common anthropic pressures, and PCA highlighted clusters of reservoirs vulnerable to hydrological conditions, related to semi-arid Mediterranean climate and to the use of the reservoir. In summer, bloom was detected in only one reservoir and different species was highlighted among the Cyanobacteria community. The only toxins detected were microcystins, although always well below the WHO reference value for drinking waters (1.0 ?g/L). However, molecular analysis could not show the presence of potential cyanotoxins producers since a few numbers of cells among total could be sufficient to produce these low MCs levels but not enough high to be proved by the traditional molecular method applied. A simple environmental risk-based model, which accounts for the high variability of both cyanobacteria growth and cyanotoxins producing, is proposed as a cost-effective tool to evaluate the need for monitoring activities in reservoirs aimed to guarantee supplying waters safety.

Water scarcity and challenges for access to safe water: A case of Bangladesh’s coastal area vulnerable to climate change

Existing efforts to ensure safe water access in coastal Bangladesh are challenged by increasing freshwater salinity. This research explored/explores safe water consumption choices in coastal Bangladesh, which data are scarce to date, using a mixed-methods approach. In 2014, a cross-sectional survey was conducted in southwestern coastal Bangladesh (n=261) and data was generated on water supply and consumption. Data collection also involved 29 in-depth interviews of household care givers and focus group discussions were performed with three community groups. Descriptive statistics were applied to analyse quantitative data and thematic analysis was used for qualitative data. The survey showed that 60% of the study population used tube well water while 40% used pond water for drinking. It was observed that for cooking purposes, the use of pond water was slightly higher than the tube well water. Only 13% of the respondents mentioned that their drinking water tasted salty whereas 6% of the respondents reported health problem (diarrhoea, dysentery, gastric issues and skin problems) after using these water sources. The qualitative data reveals that water available for drinking and cooking is causing a serious threat to this coastal community, particularly during the dry season. In-depth assessments indicated that drinking water choices were less driven by concerns for health than practical issues such as travel distance and time taken and taste. The palatability of water was an important determinant of choice for drinking and other domestic uses. Furthermore, the utility of alternative options for safe drinking water is driven by beliefs and traditions and source maintenance. Given the increasing salinisation of freshwaters in many low-lying countries and likely exacerbation related to climate change-induced sea level rise, therefore, promotion of low saline drinking water along with salt reducing interventions consider that community beliefs and practices must be a made priority.

Waterborne outbreaks: A public health concern for rural municipalities with unchlorinated drinking water distribution systems

OBJECTIVES: The objective of this study is to describe an important waterborne outbreak of gastrointestinal illness observed in a rural municipality of Quebec. METHODS: A population-based retrospective cohort study was conducted to identify risk factors associated with acute gastroenteritis. Indirect surveillance data were used to estimate the extent and the resolution of the epidemic. RESULTS: The cohort consisted of 140 randomly selected individuals of whom 22 met the illness case definition (15.7% attack rate). The epidemic curve was similar to the evolution of antidiarrheal products sold by the only pharmacy in town and calls made to the Health Info Line. Bivariate analysis led to identifying five risk factors of gastrointestinal illness: consumption of municipal water, contact with someone with acute gastroenteritis (within and outside of the household), contact with a child in daycare, and being less than 35 years of age. Drinking municipal water had the highest risk ratio (RR?=?24.31; 95% CI?=?1.50-393.4). Drinking water from a private artesian well was a protective factor (RR?=?0.28; 95% CI?=?0.09-0.90). CONCLUSION: This study highlighted that managing the risks associated with the consumption of untreated drinking water remains an important public health challenge, particularly in small rural municipalities vulnerable to climate variability.

Toxicity travels in a changing climate

Climate change is imposing substantial consequences across physical and social infrastructures. The extent of social disruption and risk to human health are, however, potentially much broader than these general consequences, taken individually, would suggest. To address this gap, we assess the distribution of contaminated sites in the United States (US) and then estimate the impact that flood hazards in urban areas will have on these contaminated sites. Using these measures, we draw inferences about the risk of contamination from climate impacted extreme weather events, climate adaptation at the local level, social risk and how it is distributed, and a broader understanding of the potential global consequences of climate change. In this paper we address three critical points: 1) the role classification of contaminated sites on our understanding of risk due to climate change; 2) the relationship between contaminated sites and flood risk; and 3) the potential for climate adaption strategies to mediate this risk. We estimate that of the roughly one-third of the US population living in urban areas, up to 3,338,518 people, are living in high-risk flood zones near contaminated sites. Our results suggest severe potential implications for estimates of the negative consequences from climate change and contamination and provide critical insights into the relationship between climate change and the built environment for urban planners and environmental policy makers and managers alike.

The magnitude and drivers of harmful algal blooms in China’s lakes and reservoirs: A national-scale characterization

Harmful algal blooms (HABs) can have dire repercussions on aquatic wildlife and human health, and may negatively affect recreational uses, aesthetics, taste, and odor in drinking water. The factors that influence the occurrence and magnitude of harmful algal blooms and toxin production remain poorly understood and can vary in space and time. It is within this context that we use machine learning (ML) and two 14-year (2005-2018) data sets on water quality and meteorological conditions of China’s lakes and reservoirs to shed light on the magnitude and associated drivers of HAB events. General regression neural network (GRNN) models are developed to predict chlorophyll a concentrations for each lake and reservoir during two study periods (2005-2010 and 2011-2018). The developed models with an acceptable model fit are then analyzed by two indices to determine the areal HAB magnitudes and associated drivers. Our national assessment suggests that HAB magnitudes for China’s lakes and reservoirs displayed a decreasing trend from 2006 (1363.3 km(2)) to 2013 (665.2 km(2)), and a slightly increasing trend from 2013 to 2018 (775.4 km(2)). Among the 142 studied lakes and reservoirs, most severe HABs were found in Lakes Taihu, Dianchi and Chaohu with their contribution to the total HAB magnitude varying from 89.2% (2013) to 62.6% (2018). HABs in Lakes Taihu and Chaohu were strongly associated with both total phosphorus and nitrogen concentrations, while our results were inconclusive with respect to the predominant environmental factors shaping the eutrophication phenomena in Lake Dianchi. The present study provides evidence that effective HAB mitigation may require both nitrogen and phosphorus reductions and longer recovery times; especially in view of the current climate-change projections. ML represents a robust strategy to elucidate water quality patterns in lakes, where the available information is sufficient to train the constructed algorithms. Our mapping of HAB magnitudes and associated environmental/meteorological drivers can help managers to delineate hot-spots at a national scale, and comprehensively design the best management practices for mitigating the eutrophication severity in China’s lakes and reservoirs.

The prediction of hepatitis E through ensemble learning

According to the World Health Organization, about 20 million people are infected with Hepatitis E every year. In 2015, there were 44,000 deaths due to HEV infection worldwide. Food, water and climate are key factors that affect the outbreak of Hepatitis E. This paper presents an ensemble learning model for Hepatitis E prediction by studying the correlation between historical epidemic cases of hepatitis E and environmental factors (water quality and meteorological data). Environmental factors include many features, and ones that are most relevant to HEV are selected and input into the ensemble learning model composed by Gradient Boosting Decision Tree (GBDT) and Random Forest for training and prediction. Three indicators, root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE), are used to evaluate the effectiveness of the ensemble learning model against the classical time series prediction model. It is concluded that the ensemble learning model has a better prediction effect than the classical model, and the prediction effectiveness can be improved by exploiting water quality and meteorological factors (radiation, air pressure, precipitation).

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 environmental health impact of Hurricane Katrina on New Orleans

Hurricane Katrina caused unprecedented flood damage to New Orleans, Louisiana, and has been the costliest hurricane in US history. We analyzed the environmental and public health outcomes of Hurricane Katrina by using Internet searches to identify epidemiological, sociodemographic, and toxicological measurements provided by regulatory agencies.Atmospheric scientists have now warned that global warming will increase the proportion of stronger hurricanes (categories 4-5) by 25% to 30% compared with weaker hurricanes (categories 1-2).With the new $14.6 billion Hurricane Storm Damage Risk Reduction System providing a 100-year storm surge-defensive wall across the Southeast Louisiana coast, New Orleans will be ready for stronger storms in the future.

The cyanobacterial saxitoxin exacerbates neural cell death and brain malformations induced by Zika virus

The northeast (NE) region of Brazil commonly goes through drought periods, which favor cyanobacterial blooms, capable of producing neurotoxins with implications for human and animal health. The most severe dry spell in the history of Brazil occurred between 2012 and 2016. Coincidently, the highest incidence of microcephaly associated with the Zika virus (ZIKV) outbreak took place in the NE region of Brazil during the same years. In this work, we tested the hypothesis that saxitoxin (STX), a neurotoxin produced in South America by the freshwater cyanobacteria Raphidiopsis raciborskii, could have contributed to the most severe Congenital Zika Syndrome (CZS) profile described worldwide. Quality surveillance showed higher cyanobacteria amounts and STX occurrence in human drinking water supplies of NE compared to other regions of Brazil. Experimentally, we described that STX doubled the quantity of ZIKV-induced neural cell death in progenitor areas of human brain organoids, while the chronic ingestion of water contaminated with STX before and during gestation caused brain abnormalities in offspring of ZIKV-infected immunocompetent C57BL/6J mice. Our data indicate that saxitoxin-producing cyanobacteria is overspread in water reservoirs of the NE and might have acted as a co-insult to ZIKV infection in Brazil. These results raise a public health concern regarding the consequences of arbovirus outbreaks happening in areas with droughts and/or frequent freshwater cyanobacterial blooms.

The association between child and parent mental health disorders in families exposed to flood and/or dioxin

Temperature and light effects on Trichobilharzia szidati cercariae with implications for a risk analysis

BACKGROUND: Cercarial dermatitis (swimmer’s itch) caused by bird schistosome cercariae, released from intermediate host snails, is a common disorder also at higher latitudes. Several cases were observed in the artificial Danish freshwater Ringen Lake frequently used by the public for recreational purposes. The lake may serve as a model system when establishing a risk analysis for this zoonotic disease. In order to explain high risk periods we determined infection levels of intermediate host snails from early spring to late summer (March, June and August) and elucidated the effect of temperature and light on parasite shedding, behavior and life span. RESULTS: Field studies revealed no shedding snails in March and June but in late summer the prevalence of Trichobilharzia szidati infection (in a sample of 226 pulmonate Lymnaea stagnalis snails) reached 10%. When investigated under laboratory conditions the cercarial shedding rate (number of cercariae shed per snail per day) was positively correlated to temperature raising from a mean of 3000 (SD 4000) at 7 °C to a mean of 44,000 (SD 30,000) at 27 °C). The cercarial life span was inversely correlated to temperature but the parasites remained active for up to 60 h at 20 °C indicating accumulation of cercariae in the lake during summer periods. Cercariae exhibited positive phototaxy suggesting a higher pathogen concentration in surface water of the lake during daytime when the public visits the lake. CONCLUSION: The only causative agent of cercarial dermatitis in Ringen Lake detected was T. szidati. The infection risk associated with aquatic activities is low during spring and early summer (March-June). In late summer the risk of infection is high since the release, behavior and life span of the infective parasite larvae have optimal conditions.

Successive epidemic waves of cholera in South Sudan between 2014 and 2017: A descriptive epidemiological study

BACKGROUND: Between 2014 and 2017, successive cholera epidemics occurred in South Sudan within the context of civil war, population displacement, flooding, and drought. We aim to describe the spatiotemporal and molecular features of the three distinct epidemic waves and explore the role of vaccination campaigns, precipitation, and population movement in shaping cholera spread in this complex setting. METHODS: In this descriptive epidemiological study, we analysed cholera linelist data to describe the spatiotemporal progression of the epidemics. We placed whole-genome sequence data from pandemic Vibrio cholerae collected throughout these epidemics into the global phylogenetic context. Using whole-genome sequence data in combination with other molecular attributes, we characterise the relatedness of strains circulating in each wave and the region. We investigated the association of rainfall and the instantaneous basic reproduction number using distributed lag non-linear models, compared county-level attack rates between those with early and late reactive vaccination campaigns, and explored the consistency of the spatial patterns of displacement and suspected cholera case reports. FINDINGS: The 2014 (6389 cases) and 2015 (1818 cases) cholera epidemics in South Sudan remained spatially limited whereas the 2016-17 epidemic (20?438 cases) spread among settlements along the Nile river. Initial cases of each epidemic were reported in or around Juba soon after the start of the rainy season, but we found no evidence that rainfall modulated transmission during each epidemic. All isolates analysed had similar genotypic and phenotypic characteristics, closely related to sequences from Uganda and Democratic Republic of the Congo. Large-scale population movements between counties of South Sudan with cholera outbreaks were consistent with the spatial distribution of cases. 21 of 26 vaccination campaigns occurred during or after the county-level epidemic peak. Counties vaccinated on or after the peak incidence week had 2·2 times (95% CI 2·1-2·3) higher attack rates than those where vaccination occurred before the peak. INTERPRETATION: Pandemic V cholerae of the same clonal origin was isolated throughout the study period despite interepidemic periods of no reported cases. Although the complex emergency in South Sudan probably shaped some of the observed spatial and temporal patterns of cases, the full scope of transmission determinants remains unclear. Timely and well targeted use of vaccines can reduce the burden of cholera; however, rapid vaccine deployment in complex emergencies remains challenging. FUNDING: The Bill & Melinda Gates Foundation.

Spatiotemporal variability and key influencing factors of river fecal coliform within a typical complex watershed

Fecal coliform bacteria are a key indicator of human health risks; however, the spatiotemporal variability and key influencing factors of river fecal coliform have yet to be explored in a rural-suburban-urban watershed with multiple land uses. In this study, the fecal coliform concentrations in 21 river sections were monitored for 20 months, and 441 samples were analyzed. Multivariable regressions were used to evaluate the spatiotemporal dynamics of fecal coliform. The results showed that spatial differences were mainly dominated by urbanization level, and environmental factors could explain the temporal dynamics of fecal coliform in different urban patterns except in areas with high urbanization levels. Reducing suspended solids is a direct way to manage fecal coliform in the Beiyun River when the natural factors are difficulty to change, such as temperature and solar radiation. The export of fecal coliform from urban areas showed a quick and sensitive response to rainfall events and increased dozens of times in the short term. Landscape patterns, such as the fragmentation of impervious surfaces and the overall landscape, were identified as key factors influencing urban non-point source bacteria. The results obtained from this study will provide insight into the management of river fecal pollution.

Seasonal contamination of well-water in flood-prone colonias and other unincorporated U.S. communities

Many of the six million residents of unincorporated communities in the United States depend on well-water to meet their needs. One group of unincorporated communities is the colonias, located primarily in several southwestern U.S. states. Texas is home to the largest number of these self-built communities, of mostly low-income families, lacking basic infrastructure. While some states have regulations that mandate minimum infrastructure for these communities, water and sewage systems are still lacking for many of their residents. Unprotected wells and self-built septic/cesspool systems serve as the primary infrastructure for many such colonias. This research was designed to probe how wells and septic/cesspool systems are influenced by heavy rainfall events. Such events are hypothesized to impact water quality with regard to human health. Inorganic and microbiological water quality of the wells in nine colonias located in Nueces County, Texas, were evaluated during dry and wet periods. Nueces County was selected as an example based on its flooding history and the fact that many colonias there depend entirely on well-water and septic/cesspool systems. The results demonstrate that well-water quality in these communities varies seasonally with respect to arsenic (up to 35 ?g/L) and bacterial contamination (Escherichia coli), dependent on the amount of rainfall, which leaves this population vulnerable to health risks during both wet and dry periods. Microbial community analyses were also conducted on selected samples. To explore similar seasonal contamination of well-water, an analysis of unincorporated communities, flooding frequency, and arsenic contamination in wells was conducted by county throughout the United States. This nationwide analysis indicates that unincorporated communities elsewhere in the United States are likely experiencing comparable challenges for potable water access because of a confluence of socioeconomic, infrastructural, and policy realities.

Residential urban stormwater runoff: A comprehensive profile of microbiome and antibiotic resistance

Non-point stormwater runoff is a major contamination source of receiving waterbodies. Heightened incidence of waterborne disease outbreaks related to recreational use and source water contamination is associated with extreme rainfall events. Such extreme events are predicted to increase in some regions due to climate change. Consequently, municipal separate storm sewer systems (MS4s) conveying pathogens to receiving waters are a growing public health concern. In addition, the spread of antibiotic resistance genes (ARGs) and antibiotic resistant bacteria in various environmental matrices, including urban runoff, is an emerging threat. The resistome and microbiota profile of MS4 discharges has yet to be fully characterized. To address this knowledge gap, we first analyzed the relationship between rainfall depth and intensity and E. coli densities (fecal indicator) in stormwater from four MS4 outflows in Columbus, Ohio, USA during the spring and summer of 2017. Microbial source tracking (MST) was conducted to examine major fecal contamination sources in the study sewersheds. A subset of samples was analyzed for microbial and resistome profiles using a metagenomic approach. The results showed a significant positive relationship between outflow E. coli density and rainfall intensity. MST results indicate prevalent fecal contamination from ruminant populations in the study sites (91% positive among the samples tested). Protobacteria and Actinobacteria were two dominant bacteria at a phylum level. A diverse array of ARGs and potentially pathogenic bacteria (e.g. Salmonella enterica Typhimurium), fungi (e.g. Scedosporium apiospermum), and protists (e.g. Acanthamoeba palestinensis) were found in urban stormwater outflows that discharge into adjacent streams. The most prevalent ARGs among samples were ?-lactam resistance genes and the most predominant virulence genes within bacterial community were related with Staphylococcus aureus. A comprehensive contamination profile indicates a need for sustainable strategies to manage urban stormwater runoff amid increasingly intense rainfall events to protect public and environmental health.

Random forest classification to determine environmental drivers and forecast paralytic shellfish toxins in Southeast Alaska with high temporal resolution

Paralytic shellfish poison toxins (PSTs) produced by the dinoflagellate in the genus Alexandrium are a threat to human health and subsistence lifestyles in Southeast Alaska. It is important to understand the drivers of Alexandrium blooms to inform shellfish management and aquaculture, as well as to predict trends of PST in a changing climate. In this study, we aggregate environmental data sets from multiple agencies and tribal partners to model and predict concentrations of PSTs in Southeast Alaska from 2016 to 2019. We used daily PST concentrations interpolated from regularly sampled blue mussels (Mytilus trossulus) analyzed for total PSTs using a receptor binding assay. We then created random forest models to classify shellfish above and below a threshold of toxicity (80 µg 100 g(-1)) and used two methods to determine variable importance. We obtained a multivariate model with key variables being sea surface temperature, salinity, freshwater discharge, and air temperature. We then used a similar model trained using lagged environmental variables to hindcast out-of-sample (OOS) shellfish toxicities during April-October in 2017, 2018, and 2019. Hindcast OOS accuracies were low (37-50%); however, we found forecasting using environmental variables may be useful in predicting the timing of early summer blooms. This study reinforces the efficacy of machine learning to determine important drivers of harmful algal blooms, although more complex models incorporating other parameters such as toxicokinetics are likely needed for accurate regional forecasts.

Particle-attached riverine bacteriome shifts in a pollutant-resistant and pathogenic community during a Mediterranean extreme storm event

Rivers are representative of the overall contamination found in their catchment area. Contaminant concentrations in watercourses depend on numerous factors including land use and rainfall events. Globally, in Mediterranean regions, rainstorms are at the origin of fluvial multipollution phenomena as a result of Combined Sewer Overflows (CSOs) and floods. Large loads of urban-associated microorganisms, including faecal bacteria, are released from CSOs which place public health – as well as ecosystems – at risk. The impacts of freshwater contamination on river ecosystems have not yet been adequately addressed, as is the case for the release of pollutant mixtures linked to extreme weather events. In this context, microbial communities provide critical ecosystem services as they are the only biological compartment capable of degrading or transforming pollutants. Through the use of 16S rRNA gene metabarcoding of environmental DNA at different seasons and during a flood event in a typical Mediterranean coastal river, we show that the impacts of multipollution phenomena on structural shifts in the particle-attached riverine bacteriome were greater than those of seasonality. Key players were identified via multivariate statistical modelling combined with network module eigengene analysis. These included species highly resistant to pollutants as well as pathogens. Their rapid response to contaminant mixtures makes them ideal candidates as potential early biosignatures of multipollution stress. Multiple resistance gene transfer is likely enhanced with drastic consequences for the environment and human-health, particularly in a scenario of intensification of extreme hydrological events.

Pathogen infection risk to recreational water users, associated with surface waters impacted by de facto and indirect potable reuse activities

Water deficit, exacerbated by global population increases and climate change, necessitates the investigation of alternative non-traditional water sources to augment existing supplies. Indirect potable reuse (IPR) represents a promising alternative water source in water-stressed regions. Of high concern is the presence of pathogenic microorganisms in wastewater, such as enteric viruses, protozoa and bacteria. Therefore, a greater understanding of the potential impact to human health is required. The aim of this research was to use a quantitative microbial risk assessment (QMRA) approach to calculate the probability of potential pathogen infection risk to the public in surface waters used for a range of recreational activities under scenarios: 1) existing de facto wastewater reuse conditions; 2) after augmentation with conventionally treated wastewater; and 3) after augmentation with reclaimed wastewater from proposed IPR schemes. Forty-four 31 l samples were collected from river sites and a coastal wastewater treatment works from July 2016-May 2017. Concentrations of faecal indicator organisms (enterococci, faecal coliforms, somatic coliphages and Bacteroides phages) determined using culture-based approaches and selected pathogens (adenovirus, Salmonella and Cryptosporidium) determined using molecular approaches (qPCR) were used to inform QMRA. The mean probability of infection from adenovirus under de facto conditions was high (>0.90) for all recreational activities, per single event. The risk of adenovirus and Cryptosporidium infection increased under augmentation scenario (2) (mean probability 0.95-1.00 and 0.01-0.06 per single event, respectively). Adenovirus and Cryptosporidium infection risk decreased under reclaimed water augmentation scenario (3) (mean probability <0.79, excluding swimming, which remained 1.00 and <0.01 per single event, respectively). Pathogen reduction after reclaimed water augmentation in surface waters impacted by de facto reuse, provides important evidence for alternative water supply option selection. As such, this evidence may inform water managers and the public of the potential benefits of IPR and improve acceptance of such practices in the future.

Pathogen-specific impacts of the 2011-2012 La Niña-associated floods on enteric infections in the MAL-ED Peru Cohort: A comparative interrupted time series analysis

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

Perceptions of local vulnerability and the relative importance of climate change in rural Ecuador

Rural, natural resource dependent communities are especially vulnerable to climate change, and their input is critical in developing solutions, but the study of risk perception within and among vulnerable communities remains underdeveloped. Our multi-disciplinary research team used a mixed-methods approach to document, analyze, and conceptualize the interacting factors that shape vulnerability and to explore community members’ perceptions of the role and relative importance of climate change compared to other factors in three rural communities in Ecuador. Economic instability, lack of access to basic services, and environmental degradation are perceived as greater threats to community well being than increasing seasonal variability and flooding. Programs and policies directed at climate change adaptation should integrate climate and non-climate related stressors. Our findings also point to a greater need for collaboration across public health, poverty alleviation, and environmental management fields through practical research targeting assistance to vulnerable populations.

Occurrence of domoic acid and cyclic imines in marine biota from Lebanon-Eastern Mediterranean Sea

Marine biotoxins are naturally existing chemicals produced by toxic algae and can accumulate in marine biota. When consumed with seafood, these phycotoxins can cause human intoxication with symptoms varying from barely-noticed illness to death depending on the type of toxin and its concentration. Recently, the occurrence of marine biotoxins has been given special attention in the Mediterranean as it increased in frequency and severity due to anthropogenic pressures and climate change. Up to our knowledge, no previous study reported the presence of lipophilic toxins (LTs) and cyclic imines (CIs) in marine biota in Lebanon. Hence, this study reports LTs and CIs in marine organisms: one gastropod (Phorcus turbinatus), two bivalves (Spondylus spinosus and Patella rustica complex) and one fish species (Siganus rivulatus), collected from various Lebanese coastal areas. The results show values below the limit of detection (LOD) for okadaic acid, dinophysistoxin-1 and 2, pectenotoxin-1 and 2, yessotoxins, azaspiracids and saxitoxins. The spiny oyster (S. spinosus) showed the highest levels of domoic acid (DA; 3.88 mg kg(-1)), gymnodimine (GYM-B) and spirolide (SPX) (102.9 and 15.07 ?g kg(-1), respectively) in congruence with the occurrence of high abundance of Pseudo-nitzchia spp., Gymnodinium spp., and Alexandrium spp. DA levels were below the European Union (EU) regulatory limit, but higher than the Lowest Observed Adverse Effect Level (0.9 ?g g(-1)) for neurotoxicity in humans and lower than the Acute Reference Dose (30 ?g kg(-1) bw) both set by the European Food Safety Authority (EFSA, 2009). Based on these findings, it is unlikely that a health risk exists due to the exposure to these toxins through seafood consumption in Lebanon. Despite this fact, the chronic toxicity of DA, GYMs and SPXs remains unclear and the effect of the repetitive consumption of contaminated seafood needs to be more investigated.

Occurrence of enteric viruses in surface water and the relationship with changes in season and physical water quality dynamics

Environmental water quality issues have dominated global discourse and studies over the past five decades. Significant parameters of environmental water quality include changes in biological and physical parameters. Some of the biological parameters of significance include occurrence of enteric viruses. Enteric viruses can affect both human and animal’s health by causing diseases such as gastrointestinal and respiratory infections. In this study, the relationship between the occurrence of enteric viruses with reference to adenoviruses and enteroviruses and the physical water quality characteristics was assessed from water samples collected from Lake Victoria (LV) in Kenya. In order to understand the dynamics of season driven enteric viruses’ contamination of the lake waters, we additionally analysed seasonal behavior of the lake’s catchment area in terms of rainfall effects. Physical quality parameters were measured on-site while viral analysis was carried out by molecular methods using the nested polymerase chain reaction (nPCR). From 216 samples that were analysed for viral contamination, enteric viral genomes were discovered in 18 (8.3%) of the samples. Out of half of the samples (108) collected during the rainy season, enteric viral genomes were detected in 9.26% (10) while 8 (7.41%) samples tested positive from the other half of the samples (108) collected during the dry season. There was, however, no significant correlation noted between the physical water quality characteristics and the enteric viruses’ occurrence. Neither wet season nor dry season was significantly associated with the prevalence of the viruses. In Lake Victoria waters, most of the samples had an average of physical water quality parameters that were within the range accepted by the World Health Organization (WHO) for surface waters with exemption of turbidity which was above the recommended 5 NTU as recorded from some sampling sites. Continuous and long-term surveillance of the lake water to accurately monitor the contaminants and possible correlation between chemical, physical, and biological characteristics is recommended. This would be important in continuous understanding of the hydrological characteristics changes of the lake for proper management of its quality with reference to the WHO standards. A multiple varied-sampling approach in different geographical regions during different seasons is recommended to establish the geographical distribution and relatedness to seasonal distribution patterns of the viruses. The data generated from this study will be useful in providing a basis for assessment of seasonally driven fecal pollution load of the lake and enteric virus contamination for proper management of the sanitary situation around the lake.

Microbiological assessment of tap water following the 2016 Louisiana flooding

Floods are a prominent risk factor in the world of public health, as there is a risk of dispersal of harmful biological and chemical contaminants in floodwater. As climate change increases, the occurrence of natural disasters and risk of adverse health outcomes due to flash flooding also increases. Fecal indicator bacteria, such as Escherichia coli and Enterococci, are often encountered in contaminated floodwater and can cause gastrointestinal illnesses as well as a variety of infections. In August 2016, East Baton Rouge and surrounding parishes in Louisiana suffered heavy floods due to intense rainfall. No study of water quality during flooding has been conducted previously in Baton Rouge, Louisiana. Twenty-three pre-flush and post-flush water samples were collected immediately from accessible homes that had been affected by the floods in order to quantify concentrations of fecal indicator bacteria. These samples were analyzed for the presence of E. coli and Enterococci through both quantitative polymerase chain reaction (qPCR) and the IDEXX enzyme substrate method. The qPCR results indicated that 30% of the samples contained Enterococci and 61% of the samples contained E. coli, with the highest concentrations found in the pre-flush outdoor hose and the pre-flush kitchen tap. The IDEXX method yielded total coliforms in 65% of the samples, E. coli in 4%, and Enterococci in 35%, with the highest concentrations in the pre-flush outdoor faucet and the pre-flush post-filtration kitchen tap. Physical parameters including temperature, barometer pressure, dissolved oxygen, oxidation reduction potential, pH, conductivity, and salinity of these samples were also recorded. Of these parameters, conductivity and salinity were significant, suggesting they may positively influence E. coli and Enterococci growth.

Large waterborne Campylobacter outbreak: Use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019

On 6 June 2019, the Norwegian Institute of Public Health was notified of?more than?50 cases of gastroenteritis in Askøy. A reservoir in a water supply system was suspected as the source of the outbreak because of the acute onset and geographical distribution of cases. We investigated the outbreak to confirm the source, extent of the outbreak and effect of control measures. A case was defined as a person in a household served by Water Supply System A (WSS-A) who had gastroenteritis for more than?24 h between 1 and 19 June 2019. We conducted pilot interviews, a telephone survey and an SMS-based cohort study of residents served by WSS-A. System information of WSS-A was collected. Whole genome sequencing on human and environmental isolates was performed. Among 6,108 individuals, 1,573 fulfilled the case definition. Residents served by the reservoir had a 4.6× higher risk of illness than others. Campylobacter jejuni isolated from cases (n?=?24) and water samples (n?=?4) had identical core genome MLST profiles. Contamination through cracks in the reservoir most probably occurred during heavy rainfall. Water supply systems are susceptible to contamination, particularly to certain weather conditions. This highlights the importance of water safety planning and risk-based surveillance to mitigate risks.

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.

Inland cholera in freshwater environs of north India

In the freshwater environment of north India, cholera appears seasonally in form of clusters as well as sporadically, accounting for a significant piece of the puzzle of cholera epidemiology. We describe a number of cholera outbreaks with an average attack rate of 96.5/1000 but an overall low case fatality (0.17). Clinical cholera cases coincided with high rainfall and elevated temperatures, whereas isolation of V. cholerae non-O1 non-O139 from water was dependent on temperature (p??0.05). However, isolation from plankton samples correlated with increased temperature and pH (p?

Impact of average temperature, energy demand, sectoral value added, and population growth on water resource quality and mortality rate: It is time to stop waiting around

It is an overwhelming concern that increases in global average temperature lead to serious consequences on the natural environment in the form of deteriorating water resource quality and damaging healthcare sustainability agenda. The sustainable innovation forum (COP21) shows a high concern on climate changes and suggested to reduce global average temperature less than 2 °C. The study brings an idea from the stated theme and analyzed the relationship between climate change and water resource quality in order to redesign economic and environmental policies to improve water quality and healthcare sustainability in the context of Pakistan. The country has serious issues regarding the provision of safe drinking water, improved water resource quality, and healthcare sustainability, which can be achieved by sustainable policies to handle the extreme temperature in Pakistan. The study employed simultaneous generalized method of moments (GMM) technique in order to estimate parameters of the study during the period of 1980-2016. The results show that energy demand and industry value added substantially decrease water resource quality (WRQ), while agriculture value added and per capita income significantly increase WRQ in a country. The other regression apparatus, where health expenditures serve as the response variable, shows that average temperature, industry value added, population growth, and foreign direct investment (FDI) inflows significantly increase healthcare expenditures while WRQ has a negative impact on healthcare expenditures in a country. The final regression model shows that average temperature and per capita income decrease, while WRQ and industrial value added increase mortality rate in a country. The overall results confirm that WRQ affected by climate change, energy demand, and population growth that need sustainable water resource policies in order to achieve long-term sustained growth. The climate actions required more policy instruments to combat environmental challenges that should support healthcare sustainability agenda across the globe.

Impact of flooding on urban soils: Changes in antibiotic resistance and bacterial community after Hurricane Harvey

Major perturbations in soil and water quality are factors that can negatively impact human health. In soil environments of urban areas, changes in antibiotic-resistance profiles may represent an increased risk of exposure to antibiotic-resistant bacteria via oral, dermal, or inhalation routes. We studied the perturbation of antibiotic-resistance profiles and microbial communities in soils following a major flooding event in Houston, Texas, caused by Hurricane Harvey. The main objective of this study was to examine the presence of targeted antibiotic-resistance genes and changes in the diversity of microbial communities in soils a short time (3-5?months) and a long time (18?months) after the catastrophic flooding event. Using polymerase chain reaction, we surveyed fourteen antibiotic-resistance elements: intI1, intI2, sul1, sul2, tet(A) to (E), tet(M), tet(O), tet(W), tet(X), and bla(CMY-2). The number of antibiotic-resistance genes detected were higher in short-time samples compared to samples taken a long time after flooding. From all the genes surveyed, only tet(E), bla(CMY-2), and intI1 were prevalent in short-time samples but not observed in long-time samples; thus, we propose these genes as indicators of exogenous antibiotic resistance in the soils. Sequencing of the V3-V4 region of the bacterial 16S rRNA gene was used to find that flooding may have affected bacterial community diversity, enhanced differences among bacterial lineages profiles, and affected the relative abundance of Actinobacteria, Verrucomicrobia, and Gemmatimonadetes. A major conclusion of this study is that antibiotic resistance profiles of soil bacteria are impacted by urban flooding events such that they may pose an enhanced risk of exposure for up to three to five months following the hurricane. The occurrence of targeted antibiotic-resistance elements decreased eighteen months after the hurricane indicating a reduction of the risk of exposure long time after Harvey.

Heavy precipitation, drinking water source, and acute gastrointestinal illness in Philadelphia, 2015-2017

Runoff from heavy precipitation events can lead to microbiological contamination of source waters for public drinking water supplies. Philadelphia is a city of interest for a study of waterborne acute gastrointestinal illness (AGI) because of frequent heavy precipitation, extensive impervious landcover, and combined sewer systems that lead to overflows. We conducted a time-series analysis of the association between heavy precipitation and AGI incidence in Philadelphia, served by drinking water from Delaware River and Schuylkill River source waters. AGI cases on each day during the study period (2015-2017) were captured through syndromic surveillance of patients’ chief complaint upon presentation at local emergency departments. Daily precipitation was represented by measurements at the Philadelphia International Airport and by modeled precipitation within the watershed boundaries, and we also evaluated stream flowrate as a proxy of precipitation. We estimated the association using distributed lag nonlinear models, assuming a quasi-Poisson distribution of the outcome variable and with adjustment for potential confounding by seasonal and long-term time trends, ambient temperature, day-of-week, and major holidays. We observed an association between heavy precipitation and AGI incidence in Philadelphia that was primarily limited to the spring season, with significant increases in AGI that peaked from 8 to 16 days following a heavy precipitation event. For example, the increase in AGI incidence related to airport precipitation above the 95th percentile (vs no precipitation) during spring reached statistical significance on lag day 7, peaked on day 16 (102% increase, 95% confidence interval: 16%, 252%), and declined while remaining significantly elevated through day 28. Similar associations were observed in analyses of watershed-specific precipitation in relation to AGI cases within the populations served by drinking water from each river. Our results suggest that heavy precipitation events in Philadelphia result in detectable local increases in waterborne AGI.

Groundwater quality and associated health risks in flood affected public schools: A case study of district Sanghar, Pakistan

Drinking water quality is of vital importance for the healthy life of a community especially if consumer is a teenager. In order to compare groundwater profile of flooded area (FA) and non-flooded area (NFA) of district Sanghar, 120 water samples from public schools were collected and investigated for physico-chemical parameters, essential metals, trace elements and microbiological indicators. Analysis data revealed that 47% samples in FA were contaminated with faecal coliform bacteria as compared to only 8.3% in NFA. On the other hand, chemical indicators like TDS, Ca, Na, K, SO4, Mg and hardness were higher in FA. Comparison of trace elements content with WHO guidelines revealed that concentration of Fe, As and Zn was higher in 66.7%, 31.7% and 13.3% water samples, respectively in FA whereas content of these elements was also on higher side in 3.3%, 23.3% and 1.7% samples in NFA, respectively. Health risk assessment due to high concentration of Fe, As and Zn showed that As HRI>1, for children in 35 and 23% water samples in FA and NFA, respectively.

Detection and distribution of putative pathogenicity-associated genes among serologically important Leptospira strains and post-flood environmental isolates in Malaysia

Aims: Leptospirosis is an infectious disease that is endemic to many tropical regions. Large epidemics usually happen after heavy rainfall and flooding. This potentially fatal zoonosis is caused by pathogenic bacteria belonging to the genus Leptospira. Leptospirosis can be diagnosed using specific biomarkers such as target genes and virulence indicators that are well preserved across various Leptospira spp., including those that are prevalent in clinical samples and in the environment. To date, several pathogenicity-determinant genes, including lipL32 and lipL41, have been described and used for diagnosing leptospirosis. However, prevalence of these genes in leptospiral strains is unclear. Methodology and results: In the present study, we assessed the distribution of eight pathogenicity-determinant genes in reference Leptospira strains and environmental isolates in Malaysia, by polymerase chain reaction (PCR). We found that only lipL32 and ligB were consistently expressed in all pathogenic Leptospira strains compared with the other tested genes. Moreover, our results suggested that the use of lipL41, lipL21, ompL1, lfb1, ligA, and ligC as biomarkers could incorrectly misdetect pathogenic Leptospira strains present in the environment. Conclusion: Thus, our results suggest that the pathogenicity-determinant genes lipL32 and ligB can be used as biomarkers for detection pathogenic Leptospira.

Cholera risk: A machine learning approach applied to essential climate variables

Oceanic and coastal ecosystems have undergone complex environmental changes in recent years, amid a context of climate change. These changes are also reflected in the dynamics of water-borne diseases as some of the causative agents of these illnesses are ubiquitous in the aquatic environment and their survival rates are impacted by changes in climatic conditions. Previous studies have established strong relationships between essential climate variables and the coastal distribution and seasonal dynamics of the bacteria Vibrio cholerae, pathogenic types of which are responsible for human cholera disease. In this study we provide a novel exploration of the potential of a machine learning approach to forecast environmental cholera risk in coastal India, home to more than 200 million inhabitants, utilising atmospheric, terrestrial and oceanic satellite-derived essential climate variables. A Random Forest classifier model is developed, trained and tested on a cholera outbreak dataset over the period 2010-2018 for districts along coastal India. The random forest classifier model has an Accuracy of 0.99, an F1 Score of 0.942 and a Sensitivity score of 0.895, meaning that 89.5% of outbreaks are correctly identified. Spatio-temporal patterns emerged in terms of the model’s performance based on seasons and coastal locations. Further analysis of the specific contribution of each Essential Climate Variable to the model outputs shows that chlorophyll-a concentration, sea surface salinity and land surface temperature are the strongest predictors of the cholera outbreaks in the dataset used. The study reveals promising potential of the use of random forest classifiers and remotely-sensed essential climate variables for the development of environmental cholera-risk applications. Further exploration of the present random forest model and associated essential climate variables is encouraged on cholera surveillance datasets in other coastal areas affected by the disease to determine the model’s transferability potential and applicative value for cholera forecasting systems.

Advancing the toxics mobility inventory: Development and application of a toxics mobility vulnerability index to Harris County, Texas

Harris County, Texas, is home to thousands of documented sources of environmental pollution. It is also highly vulnerable to impacts from natural hazards, including floods. Building on the Toxics Mobility Inventory (TMI), this article discusses how the authors developed a Toxics Mobility Vulnerability Index (TMVI) and applied it to Harris County to assess potential exposure risks to residents from the transfer of toxic materials during flood events. The TMI concept was operationalized and standardized by combining multiple spatial data sets to simultaneously evaluate various factors in the weather hazards-extant toxics-social vulnerability nexus (e.g., floodplain area, industrial land use, social vulnerability measures). Findings indicated hot spots of vulnerability to hazard-induced toxics transfer concentrated in Northeast Houston US Census tracts in Harris County. The main drivers of increased risk in these areas include the proportion of the area that is impervious surface, consistently high social vulnerabilities, and poor health. However, the most vulnerable areas also have overlapping exposure to both industrial land use and floodplains. Assessing the contribution of a set of industrial land use, social vulnerability, natural hazard, emergency response, and topography variables in a single index on the same spatial scale (e.g., US Census tract) provides detailed information for policy makers tasked with mitigating risk. Applying tools such as the TMVI to highly vulnerable urban and coastal locations may help identify changes needed for preparedness and mitigation planning and highlight areas where limited resources for investment- and policy-related remediation should be focused, both before and after disasters.

Protocolo para evaluar la situación del agua, el saneamiento y la higiene en establecimientos de salud con atención a la resiliencia al clima

Climate Change Adaptation through Implementation of Climate-resilient Water Safety Planning in Tanzania

UNDRR Hazard Information Profile: Waterborne Diseases

UNDRR Hazard Information Profile: Cholera

Third Inter-ministerial Conference On Health And Environment In Africa: Conference Proceedings and Outcomes

Climate-sensitive infectious disease modelling software tools

Landscape mapping of software tools for climate-sensitive infectious disease modelling

Comprehensive climate risk modelling framework to help protect future food and water safety in Canada

Healthy Futures Atlas: A publicly available resource for evaluating climate change risks on water-related and vector-borne disease in eastern Africa

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

Innovative community-based data collection to understand and find solutions to rainfall-related diarrhoeal diseases in Ecuador

Working with communities in East Africa to manage diarrhoeal disease and dengue risk in a changing climate

Developing a forecasting model for cholera incidence in Dhaka megacity through time series climate data

Climate change and the spread of disease: An illustrative case of the first Australian invasive non-toxigenic Vibrio cholerae infection in a newborn

The effect of climate change on cholera disease: The road ahead using artificial neural network

Survey and genetic characterization of Vibrio cholerae in Apalachicola Bay, Florida (2012-2014)

Rapid forecasting of cholera risk in Mozambique: Translational challenges and opportunities

Post-monsoon waterlogging-associated upsurge of cholera cases in and around Kolkata metropolis, 2015

Outbreak of cholera due to Cyclone Kenneth in Northern Mozambique, 2019

Food-borne and water-borne diseases under climate change in low- and middle-income countries: Further efforts needed for reducing environmental health exposure risks

Effects of large-scale oceanic phenomena on non-cholera vibriosis incidence in the United States: Implications for climate change

Analysis of factors contributing to the spread of cholera in developing countries

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

Near real-time forecasting for cholera decision making in Haiti after Hurricane Matthew

Mathematical modelling and numerical simulations of the influence of hygiene and seasons on the spread of cholera

Influences of heatwave, rainfall, and tree cover on cholera in Bangladesh

Increase in reported cholera cases in Haiti following Hurricane Matthew: An interrupted time series model

Fresh water, marine and terrestrial cyanobacteria display distinct allergen characteristics

A new methodology for modelling of health risk from urban flooding exemplified by cholera – case Dhaka, Bangladesh

The complex interplay between everyday risks and disaster risks: The case of the 2014 cholera pandemic and 2015 flood disaster in Accra, Ghana

Seasonality in cholera dynamics: A rainfall-driven model explains the wide range of patterns in endemic areas

Natural disasters and cholera outbreaks: Current understanding and future outlook

Molecular epidemiology of cholera outbreaks during the rainy season in Mandalay, Myanmar

Healthcare waste management during disasters and its effects on climate change: Lessons from 2010 earthquake and cholera tragedies in Haiti

Evaluating the complex interactions between malaria and cholera prevalence, neglected tropical disease comorbidities, and community perception of health risks of climate change

El Nino and the shifting geography of cholera in Africa

Climate-driven endemic cholera is modulated by human mobility in a megacity

Climate variability and avian cholera transmission in Guangxi, China

Cholera – Management and prevention

Cholera forecast for Dhaka, Bangladesh, with the 2015-2016 El Nino: Lessons learned

Assessment of risk of cholera in Haiti following Hurricane Matthew

Aquatic food security: Insights into challenges and solutions from an analysis of interactions between fisheries, aquaculture, food safety, human health, fish and human welfare, economy and environment

Vibrio cholerae non-O1, non-O139 bacteraemia associated with pneumonia, Italy 2016

The impact of meteorology on the occurrence of waterborne outbreaks of vero cytotoxin-producing Escherichia coli (VTEC): A logistic regression approach

Necrotizing fasciitis due to Vibrio cholerae non-O1/non-O139 after exposure to Austrian bathing sites

Molecular epidemiology of Vibrio cholerae associated with flood in Brahamputra River valley, Assam, India

El Nino, climate, and cholera associations in Piura, Peru, 1991-2001: A wavelet analysis

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

Survey on antimicrobial resistance patterns in Vibrio vulnificus and Vibrio cholerae non-O1/non-O139 in Germany reveals carbapenemase-producing Vibrio cholerae in coastal waters

Satellite based assessment of hydroclimatic conditions related to cholera in Zimbabwe

Predictive time series analysis linking Bengal cholera with terrestrial water storage measured from gravity recovery and climate experiment sensors

Downscaling river discharge to assess the effects of climate change on cholera outbreaks in the Bengal Delta

Climate and socioeconomic influences on interannual variability of cholera in Nigeria

A global map of suitability for coastal Vibrio cholerae under current and future climate conditions

Genetic and phenotypic analysis of Vibrio cholerae non-O1, non-O139 isolated from German and Austrian patients

Cholera in the Lake Kivu region (DRC): Integrating remote sensing and spatially explicit epidemiological modeling

Cholera and shigellosis: Different epidemiology but similar responses to climate variability

A differential effect of Indian ocean dipole and El Nino on cholera dynamics in Bangladesh

Knowledge Mapping for Climate Change and Food- and Waterborne Diseases

Highly localized sensitivity to climate forcing drives endemic cholera in a megacity

Oral vaccines against cholera

Warming oceans, phytoplankton, and river discharge: Implications for cholera outbreaks

The costs of climate change: A study of cholera in Tanzania

Influence of relative humidity in Vibrio cholerae infection: A time series model

Climate variability and the outbreaks of cholera in Zanzibar, East Africa: A time series analysis

Cholera in Bangladesh: Climatic components of seasonal variation

Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003-2006: Analysis of a time series

Impact of drainage networks on cholera outbreaks in Lusaka, Zambia

Impact of temperature variability on cholera incidence in southeastern Africa, 1971-2006

Effects of local climate variability on transmission dynamics of cholera in Matlab, Bangladesh

Climatic components of seasonal variation in cholera incidence

The effect of rainfall on the incidence of cholera in Bangladesh

Seasonality of cholera from 1974 to 2005: A review of global patterns

Prediction of epidemic cholera due to Vibrio cholerae O1 in children younger than 10 years using climate data in Bangladesh

Environmental signatures associated with cholera epidemics

Regional-scale climate-variability synchrony of cholera epidemics in West Africa

Climatic, socio-economic, and health factors affecting human vulnerability to cholera in the Lake Victoria basin, East Africa

Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: Effects and vulnerable groups

Hazard Information Profiles: Supplement to UNDRR-ISC Hazard Definition & Classification Review – Technical Report

Quality criteria for the evaluation of climate-informed early warning systems for infectious diseases

Predicting Climate Sensitive Infectious Diseases to Protect Public Health and Strengthen National Security

Taking a Multisectoral one-health Approach: A Tripartite Guide to Addressing Zoonotic diseases in Countries

Management of A Cholera Epidemic

One Health: Operational framework for strengthening human, animal, and environmental public health systems at their interface

Ending Cholera – A global roadmap to 2030

Guidance on Integrating Biodiversity Considerations into one-health Approaches

Climate-resilient water safety plans: Managing health risks associated with climate variability and change

Connecting global Priorities: Biodiversity and Human Health, a State of Knowledge Review

Atlas of Health and Climate

Early detection, assessment and response to acute public health events: Implementation of Early Warning and Response with a focus on Event-Based Surveillance

Contributing to One World, one-health: A Strategic Framework for Reducing Risks of Infectious diseases at the Animal-Human-Ecosystems Interface

Flooding and Communicable Diseases Factsheet

Communicable disease surveillance and response systems. Guide to monitoring and evaluating

Combating waterborne disease at the household level

The Biology of Water and Health – Fundamentals

The Biology of Water and Health – Sustainable Interventions

WHO Cholera Outbreak Toolbox

UNICEF Cholera Toolkit

Surveillance and disease data for cholera

World Animal Health Information System (WAHIS)

LAWA Environmental Data Explorer (New Zealand)

New Zealand Shellfish biotoxin alerts

WHO Global Health Observatory

US Vibrio Predictive Models