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Effects of Large-Scale Oceanic Phenomena on Non-Cholera Vibriosis Incidence in the United States: Implications for Climate Change
31 Pages Posted: 24 Sep 2018
More...Abstract
Purpose: Epidemics of diarrhea caused by toxigenic strains of Vibrio cholerae are of global public health concern, but non-cholera Vibrio (NCV) species are also important causes of disease. These pathogens are thermophilic, and climate change could increase the risk of NCV infection. The El Nino Southern Oscillation (ENSO) is a "natural experiment" that may presage the effects of ocean warming on disease incidence.
Method: We obtained United States vibriosis case counts by digitizing annual reports from the U.S. Cholera and Other Vibrio Illness Surveillance surveillance system. Trends and environmental impacts (of ENSO and the North Atlantic Oscillation) were evaluated using negative binomial and distributed nonlinear lag models. Associations between latitude and changing risk were evaluated with meta-regression.
Results: Trend models demonstrated significant seasonality (P < 0.001) and a 7% annual increase in disease risk from 1999 to 2014 (annual IRR 1.071, 95% CI 1.061 to 1.081). Distributed lag models demonstrated increased vibriosis risk following ENSO conditions over the subsequent 12 months (integrated RR 1.940, 95% CI 1.298 to 2.901). The rate of increase in vibriosis risk increased with state latitude (RR per 10° increase 1.066, 95% CI 1.027 to 1.107 ).
Conclusion: We find that vibriosis risk in the United States is impacted by irregular large-scale ocean warming, and exhibits a north-south gradient in rate of change as would be expected if changing disease incidence is attributable to ocean warming, suggesting increasing, climate-change-related risk of this disease in vulnerable populations, even in high income countries with well-developed public health systems.
Funding: Unfunded
Declaration of Interest: No author had a competing interest to declare.
Ethical Approval: The study was performed using aggregate, publicly available case data from public documents, and so research ethics approval was waived.
Keywords: Vibrio; Vibrio vulnificus; Vibrio parahaemolyticus; Vibrio fluvialis; vibriosis; foodborne illness; sepsis; climate change; El Niño Southern Oscillation; statistical modeling; epidemiology
Suggested Citation: Suggested Citation