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

International Journal of Environmental Research and Public Health

Pascal Bessong¹  Maribel Paredes Olortegui²  Gagandeep Kang³  Aldo Lima⁴  Benjamin Zaitchik⁵  Prakash Sunder Shrestha⁶  Josh Colston⁷  Pablo Peñataro Yori⁸  Margaret Kosek⁹  Zulfiqar Bhutta^1,10  Tahmeed Ahmed^1,11  Esto Mduma^1,12 

[1]Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1213, Bangladesh

[2]Asociación Benéfica Prisma, Iquitos 16006, Peru

[3]Christian Medical College, Vellore 632004, India

[4]Department of Child Health, Institute of Medicine of Tribhuvan University, Kirtipur 44618, Nepal

[5]Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MD 21218, USA

[6]Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan

[7]Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22903, USA

[8]Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA

[9]Federal University of Ceará, Fortaleza 60020-181, Brazil

[10]Haydom Global Health Institute, Haydom P.O. Box 9000, Tanzania

[11]

[12]Nutrition &University of Venda, Thohoyandou 0950, South Africa

关键词: climate change;    diarrheal disease;    infectious disease;    enso;    la niña;    flooding;    natural disasters;    enteric viruses;    enteric bacteria;    rotavirus;   

DOI  :  10.3390/ijerph17020487

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown