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Protecting our Health from Climate Change: a Training Course for Public Health Professionals. Water Stress: Chapter 11: Water and Foodborne Diseases. Overview: Water Stress and Water and Foodborne Disease. Water quantity and quality Burden of diarrheal disease

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Protecting our health from climate change a training course for public health professionals

Protecting our Health from Climate Change: a Training Course for Public Health Professionals

Water Stress:Chapter 11: Water and Foodborne Diseases


Overview water stress and water and foodborne disease
Overview: Water Stress and Water and Foodborne Disease

Water quantity and quality

Burden of diarrheal disease

How climate and weather affects diarrheal diseases and food and waterborne pathogens

Season

Temperature

Precipitation (flooding and drought)

Sea level rise

Summary




Burden of waterborne disease
Burden of Waterborne Disease

1.8 million deaths (4 million cases) in 2004 due to gastroenteritis (WHO)

88% due to unsafe water and poor sanitation

Prüss-Üstün et al., 2008


Burden of waterborne disease cont
Burden of Waterborne Disease (cont.)

Prüss-Üstün et al., 2008


Distribution of fatal drownings
Distribution of Fatal Drownings

World Health Organization, 2008c


Burden of diarrheal diseases
Burden of Diarrheal Diseases

Diarrheal diseases are vastly underestimated

211 million cases estimated in the US annually (Mead et al., 1999)

Reported cases

Actual cases

> 38 x reported cases


Climate change and waterborne disease
Climate Change and Waterborne Disease

Climate change scenarios include

Rising temperature

Changes in hydrologic cycle

Increased drought

Increased storm intensity

Change in frequency of “extreme events”

Hurricanes

Ocean-atmosphere oscillations

ENSO

NAO

Others

Sea level rise

Can affect a wide range of enteric pathogens, especially those with an environmental reservoir


Direction and magnitude of climate change health impacts
Direction and Magnitude of Climate Change Health Impacts

IPCC AR4, 2007



How do climate and weather affect enteric pathogens
How Do Climate and Weather Affect Enteric Pathogens?


Diarrheal disease pathways
Diarrheal Disease Pathways

Prüss-Üstün et al., 2008


How climate can influence water and foodborne disease trends
How Climate Can Influence Water and Foodborne Disease Trends

Local temperature

Replication in the environment or associated with food products

Persistence

Local rainfall

Loading into the environment (contamination)

Increased concentration of contaminants (drought)


How climate can influence water and foodborne disease trends cont
How Climate Can Influence Water and Foodborne Disease Trends (cont.)

Sea level rise

Influx of marine pathogens

Flooding (storm surge), contamination, loss of infrastructure

Range expansion among zoonotic agents and their hosts


Seasonal trends in rotavirus infections
Seasonal Trends in Rotavirus Infections (cont.)

Cook et al., 1990





Salmonellosis
Salmonellosis (cont.)

Kovats et al., 2004


Salmonella trends
Salmonella (cont.) Trends

Hall et al., 2002


Campylobacteriosis
Campylobacteriosis (cont.)

Kovats et al., 2005


Vibrio spp
Vibrio (cont.)spp.

Vibrio are commonly estuarine and marine bacteria and include at least 12 known pathogens to humans

V. vulnificus

V. parahaemolyticus

V. cholerae

In general, this group replicates easily in natural waters and biota, especially under high temperatures

Directly related to increasing water temperatures



Vibrio parahaemolyticus outbreak alaska 2004
Vibrio parahaemolyticus (cont.) OutbreakAlaska – 2004

McLaughlin et al., 2005


Local rainfall

Local Rainfall (cont.)

Run-off

Flooding

Drought





Flooding
Flooding over Time

Risk factors

Direct contact with contaminated water

Skin

Respiratory

Ear and eye infections

Ingestion of contaminated water (wells, etc.)

Gastroenteritis

Insufficient water treatment (i.e., problem at the tap)

Additional secondary spread



Walkerton rainfall
Walkerton Rainfall over Time

Auld et al., 2004


Example walkerton outbreak
Example: Walkerton Outbreak over Time

Worthington et al., 2002


Cryptosporidiosis and precipitation
Cryptosporidiosis over Timeand Precipitation

C. hominis

Other Crypto spp.

Das et al., 2006


Rainfall run off and pathogen contamination
Rainfall, Run-off, and Pathogen Contamination over Time

Building evidence for the association between diarrheal disease and increased precipitation, especially with heavy rainfall events

In addition, several studies note increased pathogen loads related to floods, run-off, and heavy precipitation including:

Enteric viruses (e.g., enteroviruses, noroviruses, adenoviruses)

Protozoan parasites (e.g., Cryptosporidium, Giardia, others)

Enteric bacteria (e.g., Salmonella, Campylobacter, E. coli, fecal indicator bacteria)


Drought effects on water quality
Drought Effects on Water Quality over Time

CRCWQT, 2005


Sea level rise

Sea Level Rise over Time


Cities vulnerable to sea level rise
Cities Vulnerable to Sea Level Rise over Time

Heavily populated Delta regions that are vulnerable to sea level rise

World Health Organization, 1996, Figure 7.3


Cholera south asia
Cholera: South Asia over Time

Yearly epidemics correspond to natural environmental cycles and contamination

Influx of estuarine water

Plankton blooms

Monsoons

Warm temperatures

Cycles can be modeled for year to year changes in outbreaks


Bay of Bengal: Sea Surface Height over Time

Lobitz et al., 2000


Bay of Bengal: Sea Surface Temperature over Time

Lobitz et al., 2000


Bay of Bengal: Cholera and Sea Surface Height over Time

Lobitz et al., 2000


Waterborne disease
Waterborne Disease over Time

Climate projections for increased warming and increased extreme events suggest waterborne diseases may increase

Mitigation and adaptation will be enhanced by understanding the ecology of pathogens

What underlying factors provide the link to climate?

How do changing landscapes affect disease incidence under changing climate conditions?


Public measures to address potential issues associated with climate change
Public Measures to Address Potential Issues Associated with Climate Change

The effects of climate change on water and foodborne diseases can be mitigated

Focus on public health response

Focus on basic infrastructure

Increased attention to treatment options

We have tools to address problems and prevent disease, understanding how climate may increase risk can be used to prioritize adaptation or rapid response measures


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