Ulisses Confalonieri

Climate change and health: on the latest IPCC report

www.thelancet.com Vol 383 April 5, 2014 1185 The Intergovernmental Panel on Climate Change (IPCC) released its latest report on March 31, 2014. This report was the second instalment of the Fifth Assessment Report, prepared by Working Group 2, on impacts, vulnerability, and adaptation to climate change. In this Comment, we, as contributors to the chapter on human health, explain how the IPCC report was prepared and highlight important fi ndings. The IPCC reviews and assesses the scientifi c published work on climate change. As an intergovernmental body composed of members of the UN, the IPCC does not undertake research itself; instead it appoints Working Groups who assess the work. This assessment means more than simply to summarise the state of knowledge: Working Groups are asked to weigh what has been written (in both peer-reviewed publications and grey literature), to make judgments about likelihood and uncertainty, and to fl ag important emerging issues. The focus for Working Group 2 was mainly, but not exclusively, on what had been written since the previous assessment in 2007; papers were eligible for inclusion if they were published, or accepted for publication, before Aug 31, 2013. The Working Groups were required to highlight what might be relevant to policy, but did not recommend policies. The Fifth Assessment Report Working Group 1 reported on the physical science of climate change in September, 2013 (appendix). Working Group 3, concerned with mitigation (ie, reduction of greenhouse gas emissions), will release its report in April, 2014. The scale of the enterprise is remarkable—indeed, reports by the IPCC together probably represent the largest scientifi c assessment exercise in history. There are 310 authors and review editors in Working Group 2, and an even greater number of contributing authors who have added to the report from their areas of special expertise. In addition to health, Working Group 2 examined natural and managed resources (eg, fresh water, coastal systems, and food production), human settlements, and other aspects of wellbeing such as security and livelihoods. The report (30 chapters) will be published in two volumes, and includes integrated assessments of impacts and adaptation in nine geographic regions and an overarching summary for policy makers. Work on the Fifth Assessment Report began 5 years ago (appendix) and aspects of the IPCC process distinguish its assessments from other reviews and scientifi c publications. One diff erence is the substantial role of member states in determination of, in the initial stages, the scope of the reports and the membership of writing groups. At the beginning of each round of assessment, meetings organised by the IPCC decide on the structure of the reports, including the number of chapters and the topics to be covered, and then member states nominate potential authors. The fi nal decision about authors is made by a subgroup from the IPCC, the Bureau, on the basis of scientifi c merit and the necessary institutional and disciplinary perspectives for each chapter, seeking, at the same time, to achieve a balance of representation by gender and region. Once appointed, the IPCC authors work independently; government input occurs as part of the peer review process. However, the member states must approve and sign off on the fi nal report. Thus, the IPCC assessments are the outputs of many iterative interactions between scientists and policy makers. Another feature of the IPCC process is the intensity of peer review. There were four rounds of review for the Fifth Assessment Report, two of which involved hundreds of self-nominated experts and scientists appointed by member-state governments. Each round generated an enormous number of comments, questions, and requests for change. For instance, the IPCC received 1009 reviewer comments just on the second-order draft of chapter 11 (human health). Two dedicated review editors per chapter are charged with ensuring that the authors consider each comment seriously and, if they reject it, that they do so with good reasons. Both the comments and the chapter authors’ responses will be published on the IPCC website. The IPCC does not prescribe how chapter groups should gather and interpret the scientifi c work, partly because conventions and practice diff er among disciplines. Contributors to the health chapter used many strategies to identify relevant published work. Due to the breadth of the topic, including the range of health outcomes and exposure pathways, the chapter team decided that one systematic review would not be possible. Climate change and health: on the latest IPCC report

The finding of helminth eggs in a Brazilian mummy

Coprolites were collected with the aid of a rectosigmoidoscope from a naturally mummified body of a child. The body dates from 3.490 +/- 120 to 430 +/- 70 BP and was found in the State of Minas Gerais, Brazil. The coprolites were rehydrated with a trisodium phosphate solution and concentrated by the spontaneous sedimentation method. Microscopical examination showed eggs the same shape and size as those of Trichuris trichiura and of an ancylostomid.

Uso de agrotóxicos no Município de Cachoeiras de Macacu (RJ)

O artigo apresenta um levantamento efetuado no ano de 1997 em 40 propriedades rurais de Cachoeiras de Macacu (RJ) acerca da percepcao de risco e das praticas de uso dos agrotoxicos. A pesquisa de campo foi feita com agricultores (40 questionarios) e com autoridades (entrevistas abertas). A analise dos resultados demonstrou que 22,5% dos agricultores reportaram ja terem sido intoxicados por agrotoxico, sendo o inseticida Decis 25 CE e o herbicida Gramoxone (ambos extremamente toxicos) os mais utilizados na regiao. Verificou-se que 85% dos agricultores nao utilizavam Equipamentos de Protecao Individual (EPI), que 27,5% jogavam embalagens de agrotoxicos no rio ou no mato, que 60% de entrevistados nunca foram treinados para manusear agrotoxicos e que 85% disseram nao precisar de receituario agronomico para compra-los. Quanto a percepcao do risco do uso de agrotoxicos, foram identificadas tres categorias: 70% percebem, mas continuam usando; 27% nao percebem o risco; 3% percebem e nao utilizam mais. Discutem-se as razoes para estas praticas de risco, comparando-se com achados de outros autores.

Environmental change and the dynamics of parasitic diseases in the Amazon

The Amazonian environment is changing rapidly, due to deforestation, in the short term, and, climatic change is projected to alter its forest cover, in the next few decades. These modifications to the, environment have been altering the dynamics of infectious diseases which have natural foci in the, Amazonian biome, especially in its forest. Current land use practices which are changing the, epidemiological profile of the parasitic diseases in the region are road building; logging; mining; expansion of agriculture and cattle ranching and the building of large dams. Malaria and the cutaneous, leishmaniasis are the diseases best known for their rapid changes in response to environmental, modifications. Others such as soil-transmitted helminthiases, filarial infections and toxoplasmosis, which have part of their developmental cycles in the biophysical environment, are also expected to, change rapidly. An interdisciplinary approach and an integrated, international surveillance are needed, to manage the environmentally-driven changes in the Amazonian parasitic diseases in the near future.

Hookworms and the peopling of America

The occurrence of certain parasites in human groups from different regions has been used to study the geographical origin of both hosts and parasites. The presence of hookworm infection in an isolated tribe in remote regions of Paraguay led to speculations about its origin, since the prehistoric migrations through the Behring Land Bridge could not have brought the parasite, which needs for its mantenance a temperature of about 22oC in the soil. It was then proposed that only transpacific migrations of Asiatic populations could have brought the parasite to America. This discussion dates back to the beginning of this Century and it was only with recent paleoparasitological findings that it arose again. This paper is a review of hookworm findings in archaeological material and suggests possible routes followed by their hosts to reach the New World.

The finding of Enterobius vermicularis eggs in pré-Columbian human coprolites

Enterobius vermicularis eggs were found in human coprolites collected in the archaeological site of Caserones, Tarapaca Valley, Chile, dating from 400 BC to 800 AD. The human pinworm had already been found in other pre-historic archaeological sites in America, and its introduction in this continent is discussed.

Ecology of Haemagogus sp. and Sabethes sp. (Diptera: Culicidae) in relation to the microclimates of the Caxiuanã National Forest, Pará, Brazil

This study was conducted in a meteorological tower located in the Caxiuanã Forest (municipality of Melgaço, Pará, Brazil) with the aim of assessing the vertical stratification of species of Haemagogus and Sabethes, potential vectors of the yellow fever virus. To investigate the role of microclimates in mosquito stratification, bimonthly collections were conducted at ground level (0 m), 8 m, 16 m and 30 m (canopy level), with the aid of entomological nets and suction tubes, from July 2005-April 2006. A total of 25,498 mosquitoes were collected; specimens of Sabethes sp. and Haemagogus janthinomyswere found mostly at heights of 16 m and 30 m while Hg. leucocelaenus was most frequently observed at ground level. The largest number of vector species was collected during the rainiest months, but this difference between seasons was not statistically significant. However, the number of Hg. janthinomys was positively correlated with variations in temperature and relative humidity.

Parity and age composition for Anopheles darlingi Root (Diptera: Culicidae) and Anopheles albitarsis Lynch-Arribálzaga (Diptera: Culicidae) of the northern Amazon Basin, Brazil

ABSTRACT Parity and age composition for Anopheles darlingi and Anopheles albitarsis in the northern Amazon Basin, Brazil, were investigated. Anopheline ovaries and ovarioles were examined in order to determine whether hourly and seasonal parity status for the vectors An. albitarsis and An. darlingi would vary in two different landscapes (forest and savanna/forest) where malaria is endemic in the northern Amazon Basin. A total of 1,199 anophelines (535 An. darlingi and 664 An. albitarsis) was dissected for parity status, ovariole dilatations, and follicular stages. The total number of nulliparous and parous females for both species varied by time of collection, locality, and season. During the rainy season for the first two h of collection, more nulliparous An. albitarsis and An. darlingi females were collected in the first hour (18:00–19:00), but during the second hour (19:00–20:00) more parous females of both species were captured. During the dry season in Copaíbas, more parous females of An. albitarsis were observed in the first hour while more nulliparous females were observed in the second hour. Nulliparous and parous females of both species for both hours were not significantly different at Road 19 in the dry season. This location was characterized by a forest malaria pattern of transmission with higher numbers of parous females and population stability in the dry season. In Copaíbas, the density and parity of An. darlingi increased during the rainy season, and it could be classified as an alluvial malaria pattern of transmission. For Copaíbas, control measures would be more successful if adopted at the transition from dry to rainy season. Further investigation on longitudinal spatiotemporal change in longevity and survival rates would help us to clarify differences in vector competence for An. darlingi and An. albitarsis and add to the understanding of differences regarding prevailing landscapes in malaria epidemiology in the northern Amazon Basin.

Eimeria oocysts in deer coprolites dated from 9,000 years BP

Excavations performed by the archaeological team of the Fundacao Museu do Homem Americano at the site of Perna I, Sao Raimundo Nonato, Piaui State, northeast Brazil, yielded small rounded coprolites from a layer dated by radiocarbon from 9.000 years BP (Before Present).

Infecção por Enterobius vermicularis em populações agro-pastoris pré-colombianas de San Pedro de Atacama, Chile

Enterobius vermicularis eggs were found in human coprolites collected from the archaeological site of San Pedro de Atacama, North of Chile, in occupational layers dated from 1,000 BC. Agricultures and herding were begining at this period of time in this region of South America. The paleoparasitological data amplifies the knowledge about the distribution of human oxyuriasis in Pre-Columbian America.