Shlomit Paz

Environmental Drivers of West Nile Fever Epidemiology in Europe and Western Asia—A Review

Abiotic and biotic conditions are both important determinants of West Nile Fever (WNF) epidemiology. Ambient temperature plays an important role in the growth rates of vector populations, the interval between blood meals, viral replication rates and transmission of West Nile Virus (WNV). The contribution of precipitation is more complex and less well understood. In this paper we discuss impacts of climatic parameters (temperature, relative humidity, precipitation) and other environmental drivers (such as bird migration, land use) on WNV transmission in Europe. WNV recently became established in southeastern Europe, with a large outbreak in the summer of 2010 and recurrent outbreaks in 2011 and 2012. Abundant competent mosquito vectors, bridge vectors, infected (viremic) migrating and local (amplifying) birds are all important characteristics of WNV transmission. In addition, certain key climatic factors, such as increased ambient temperatures, and by extension climate change, may also favor WNF transmission, and they should be taken into account when evaluating the risk of disease spread in the coming years. Monitoring epidemic precursors of WNF, such as significant temperature deviations in high risk areas, could be used to trigger vector control programs and public education campaigns.

Permissive Summer Temperatures of the 2010 European West Nile Fever Upsurge

Background In the summer of 2010, Europe experienced outbreaks of West Nile Fever (WNF) in humans, which was preceded by hot spells. The objective of this study was to identify potential drivers of these outbreaks, such as spring and summer temperatures, relative humidity (RH), and precipitation. Methods Pearson and lag correlations, binary and multinomial logistic regressions were used to assess the relationship between the climatic parameters and these outbreaks. Results For human morbidity, significant (<0.05) positive correlations were observed between a number of WNF cases and temperature, with a geographic latitude gradient: northern (“colder”) countries displayed strong correlations with a lag of up to four weeks, in contrast to southern (“warmer”) countries, where the response was immediate. The correlations with RH were weaker, while the association with precipitation was not consistent. Horse morbidity started three weeks later than in humans where integrated surveillance was conducted, and no significant associations with temperature or RH were found for lags of 0 to 4 weeks. Conclusions Significant temperature deviations during summer months might be considered environmental precursors of WNF outbreaks in humans, particularly at more northern latitudes. These insights can guide vector abatement strategies by health practitioners in areas at risk for persistent transmission cycles.

El Niño and climate change—contributing factors in the dispersal of Zika virus in the Americas?

In their letter, Isaac I Bogoch and colleagues ( Jan 23, p 335) anticipated the international spread of Zika virus from Brazil through air traffi c. Permissive climatic conditions for Aedes mosquitoes might have contributed to the explosive spread of Zika virus in Brazil. In fact, the 2015 El Niño caused exceptional climatic conditions in northeastern South America during winter and spring in the southern hemisphere. According to the US National Oceanic and Atmospheric Administration, the temperatures over north and eastern South America were “record warmest”, accompanied by a severe drought, throughout the second half of 2015. These extreme conditions might also be a manifestation of climate change that have contributed to the rapid dispersal of the Zika virus. A striking overlap emerges when regions with extreme climatic conditions in one month are juxtaposed to the geographic distribution of Zika virus in the subsequent month (appendix). Temperature is known to have a role in adult vector survival, viral replication, and infective periods. Elevated temperatures (within a temperature envelope) can expand the geographic vector range, decrease the extrinsic incubation period of the pathogen, and increase the female mosquito biting rate. Although precipitation provides essential habitat for larvae during the aquatic stages of the Aedes lifecycle, drought can indirectly expand the vector’s range. In several locations (including northeastern Brazil), the risk of range expansion of Aedes aegypti is correlated with an increase in water storage in household containers during a persistent regional drought. Thus, the unique climatic conditions created during this severe El Niño event should be considered contributing factors in the dispersal of Zika virus in the Americas and should also be considered as the virus continues to spread.

Influence of warming tendency on Culex pipiens population abundance and on the probability of West Nile fever outbreaks (Israeli Case Study: 2001-2005).

Climate change and West Nile fever (WNV) are both subjects of global importance. Many mosquitoes and the diseases they carry, including West Nile virus (WNV), are sensitive to temperature increase. The current study analyzes the lag correlations between weather conditions (especially air temperature) and 1) Culex pipiens mosquito population abundance, and 2) WNF frequency in humans, between 2001 and 2005 in Israel. These 5 years follow a long period with a documented tendency for temperature increase in the hot season in the country. Monthly anomalies of minimum and maximum temperatures, relative seasonal rainfall contribution, mosquito samplings (hazard level), and WNF cases (hospital admission dates and patients’ addresses) were analyzed. Logistic regression was calculated between the climatic data and the mosquito samples, as Spearman correlations and Pearson cross-correlations were calculated between daily temperature values (or daily precipitation amounts) and the hospital admission dates. It was found that the disease appearance reflects the population distribution, while the risk tends to escalate around the metropolis characterized by an urban heat island. Positive anomalies of the temperature during the study period appear to have facilitated the mosquito abundance and, consequently, the disease emergence in humans. An important finding is the potential influence of extreme heat in the early spring on the vector population increase and on the disease’s appearance weeks later. Awareness of such situations at the beginning of the spring may help authorities to reduce the disease risk before it becomes a real danger.

Climate change impacts on West Nile virus transmission in a global context

West Nile virus (WNV), the most widely distributed virus of the encephalitic flaviviruses, is a vector-borne pathogen of global importance. The transmission cycle exists in rural and urban areas where the virus infects birds, humans, horses and other mammals. Multiple factors impact the transmission and distribution of WNV, related to the dynamics and interactions between pathogen, vector, vertebrate hosts and environment. Hence, among other drivers, weather conditions have direct and indirect influences on vector competence (the ability to acquire, maintain and transmit the virus), on the vector population dynamic and on the virus replication rate within the mosquito, which are mostly weather dependent. The importance of climatic factors (temperature, precipitation, relative humidity and winds) as drivers in WNV epidemiology is increasing under conditions of climate change. Indeed, recent changes in climatic conditions, particularly increased ambient temperature and fluctuations in rainfall amounts, contributed to the maintenance (endemization process) of WNV in various locations in southern Europe, western Asia, the eastern Mediterranean, the Canadian Prairies, parts of the USA and Australia. As predictions show that the current trends are expected to continue, for better preparedness, any assessment of future transmission of WNV should take into consideration the impacts of climate change.

Environmental predictors of West Nile fever risk in Europe.

BackgroundWest Nile virus (WNV) is a mosquito-borne pathogen of global public health importance. Transmission of WNV is determined by abiotic and biotic factors. The objective of this study was to examine environmental variables as predictors of WNV risk in Europe and neighboring countries, considering the anomalies of remotely sensed water and vegetation indices and of temperature at the locations of West Nile fever (WNF) outbreaks reported in humans between 2002 and 2013.MethodsThe status of infection by WNV in relationship to environmental and climatic risk factors was analyzed at the district level using logistic regression models. Temperature, remotely sensed Normalized Difference Vegetation Index (NDVI) and Modified Normalized Difference Water Index (MNDWI) anomalies, as well as population, birds’ migratory routes, and presence of wetlands were considered as explanatory variables.ResultsThe anomalies of temperature in July, of MNDWI in early June, the presence of wetlands, the location under migratory routes, and the occurrence of a WNF outbreak the previous year were identified as risk factors. The best statistical model according to the Akaike Information Criterion was used to map WNF risk areas in 2012 and 2013. Model validations showed a good level of prediction: area under Receiver Operator Characteristic curve = 0.854 (95% Confidence Interval 0.850-0.856) for internal validation and 0.819 (95% Confidence Interval 0.814-0.823) (2012) and 0.853 (95% Confidence Interval 0.850-0.855) (2013) for external validations, respectively.ConclusionsWNF incidence is increasing in Europe and WNV is expanding into new areas where it had never been observed before. Our model can be used to direct surveillance activities and public health interventions for the upcoming WNF season.

Impact of Temperature Variability on Cholera Incidence in Southeastern Africa, 1971–2006

Africa has a number of climate-sensitive diseases. One that remains a threat to public health is cholera. The aquatic environment temperature is the most important ecological parameter governing the survival and growth of Vibrio cholerae. Indeed, recent studies indicate that global warming might create a favorable environment for V. cholerae and increase its incidence in vulnerable areas. In light of this, a Poisson Regression Model has been used to analyze the possible association between the cholera rates in southeastern Africa and the annual variability of air temperature and sea surface temperature (SST) at regional and hemispheric scales, for the period 1971–2006. The results showed a significant exponential increase of cholera rates in humans during the study period. In addition, it was found that the annual mean air temperature and SST at the local scale, as well as anomalies at hemispheric scales, had significant impact on the cholera incidence during the study period. Despite future uncertainty, the climate variability has to be considered in predicting further cholera outbreaks in Africa. This may help to promote better, more efficient preparedness.

Climate change projections of West Nile virus infections in Europe: implications for blood safety practices

BackgroundWest Nile virus (WNV) is transmitted by mosquitoes in both urban as well as in rural environments and can be pathogenic in birds, horses and humans. Extrinsic factors such as temperature and land use are determinants of WNV outbreaks in Europe, along with intrinsic factors of the vector and virus.MethodsWith a multivariate model for WNV transmission we computed the probability of WNV infection in 2014, with July 2014 temperature anomalies. We applied the July temperature anomalies under the balanced A1B climate change scenario (mix of all energy sources, fossil and non-fossil) for 2025 and 2050 to model and project the risk of WNV infection in the future. Since asymptomatic infections are common in humans (which can result in the contamination of the donated blood) we estimated the predictive prevalence of WNV infections in the blood donor population.ResultsExternal validation of the probability model with 2014 cases indicated good prediction, based on an Area Under Curve (AUC) of 0.871 (SD = 0.032), on the Receiver Operating Characteristic Curve (ROC). The climate change projections for 2025 reveal a higher probability of WNV infection particularly at the edges of the current transmission areas (for example in Eastern Croatia, Northeastern and Northwestern Turkey) and an even further expansion in 2050. The prevalence of infection in (blood donor) populations in the outbreak-affected districts is expected to expand in the future.ConclusionsPredictive modelling of environmental and climatic drivers of WNV can be a valuable tool for public health practice. It can help delineate districts at risk for future transmission. These areas can be subjected to integrated disease and vector surveillance, outreach to the public and health care providers, implementation of personal protective measures, screening of blood donors, and vector abatement activities.

Impacts of Climate Change on Vector Borne Diseases in the Mediterranean Basin — Implications for Preparedness and Adaptation Policy

The Mediterranean region is vulnerable to climatic changes. A warming trend exists in the basin with changes in rainfall patterns. It is expected that vector-borne diseases (VBD) in the region will be influenced by climate change since weather conditions influence their emergence. For some diseases (i.e., West Nile virus) the linkage between emergence andclimate change was recently proved; for others (such as dengue) the risk for local transmission is real. Consequently, adaptation and preparation for changing patterns of VBD distribution is crucial in the Mediterranean basin. We analyzed six representative Mediterranean countries and found that they have started to prepare for this threat, but the preparation levels among them differ, and policy mechanisms are limited and basic. Furthermore, cross-border cooperation is not stable and depends on international frameworks. The Mediterranean countries should improve their adaptation plans, and develop more cross-sectoral, multidisciplinary and participatory approaches. In addition, based on experience from existing local networks in advancing national legislation and trans-border cooperation, we outline recommendations for a regional cooperation framework. We suggest that a stable and neutral framework is required, and that it should address the characteristics and needs of African, Asian and European countries around the Mediterranean in order to ensure participation. Such a regional framework is essential to reduce the risk of VBD transmission, since the vectors of infectious diseases know no political borders.

Health Aspects of Climate Change in Cities with Mediterranean Climate, and Local Adaptation Plans

Cities with a Mediterranean-type climate (Med-cities) are particularly susceptible to health risks from climate change since they are located in biogeographical hot-spots that experience some of the strongest effects of the changing climate. The study aims to highlight health impacts of climate change in Med-cities, analyze local climate adaptation plans and make adaptation policy recommendations for the Med-city level. We identified five Med-cities with a climate change adaptation plan: Adelaide, Barcelona, Cape Town, Los Angeles and Santiago. Beyond their similar Med-climate features (although Santiago’s are slightly different), the cities have different socio-economic characteristics in various aspects. We analyzed each plan according to how it addresses climate change-related drivers of health impacts among city dwellers. For each driver, we identified the types of policy adaptation tools that address it in the urban climate adaptation plans. The surveyed cities address most of the fundamental climate change-related drivers of risks to human health, including rising temperatures, flooding and drought, but the policy measures to reduce negative impacts vary across cities. We suggest recommendations for Med-cities in various aspects, depending on their local needs and vulnerability challenges: assessment of health risks, extreme events management and long-term adaptation, among others.