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ABSTRACT: BACKGROUND: An 8-year era of interrupted indigenous measles transmission in Bulgaria came to an end in April 2009 when a large epidemic occurred that would eventually claim 24 253 cases and 24 deaths; infants, children and young adults of the Roma community were disproportionally affected. Compared with Western Europe, case-fatality rate and proportion of medical complications were uncharacteristically high. METHODS: To disentangle underlying drivers of the outbreak and reasons for these medical complications, we assembled a number of national ecologic variables as well as regional individual-level data for 206 measles cases, randomly selected from national medical records. We conducted a logit regression analysis of data from individuals with medical complications. RESULTS: Ecologic socio-economic predictors were not associated with measles cases by region, although the proportion of medical complications differed considerably. Individual-level data from a region with high medical complications revealed that mother's education [odds ratio (OR) 0.79; 95% confidence interval (CI) 0.68-0.92], immunization status of the child (OR 0.28; 95% CI 0.08-0.94) and households declaring an income (OR 0.31; 95% CI 0.10-0.93) decreased the risk for developing severe medical complications such as pneumonia or encephalitis from a measles infection. Discussion: The extent of this outbreak with a high case-fatality rate and high proportion of medical complications calls for resolute public health action. We found vaccination and maternal education to be crucial conduits of curbing medical complications from measles infections. Ultimately, the goal is measles elimination in Europe by 2015, and these data hint at intervention entry points.
The European Journal of Public Health 01/2013; · 2.73 Impact Factor
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ABSTRACT: Daily microbiological water quality and precipitation data spanning 6 years were collected from monitoring stations at southern California beaches. Daily precipitation projected for the twenty-first century was derived from downscaled CNRM CM3 global climate model. A time series model of Enterococcus concentrations that was driven by precipitation, matched the general trend of empirical water quality data; there was a positive association between precipitation and microbiological water contamination (P < 0.001). Future projections of precipitation result in a decrease in predicted Enterococcus levels through the majority of the twenty-first century. Nevertheless, variability of storminess due to climate change calls for innovative adaptation and surveillance strategies.
EcoHealth 07/2012; 9(3):293-7. · 1.70 Impact Factor
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Science 04/2012; 336(6080):418-9. · 31.20 Impact Factor
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The European Journal of Public Health 02/2012; 22(1):5-6. · 2.73 Impact Factor
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ABSTRACT: To examine the consequences of changing precipitation levels on southern California's recreational coastal water quality, and compare the responses of watersheds with differing levels of urban development.
The geo-temporal relationship for six years (2000-2005) of precipitation levels, discharge rates for the ten primary waterways, and coastal water bacteria concentrations at seventy-eight southern California beaches were examined.
Precipitation levels, river-creek discharge rates, and coastal water bacteria concentrations were significantly correlated (p < 0.01) for all ten watersheds investigated. Water bacteria concentrations significantly increased with higher levels of precipitation across 95% of the seventy-eight beaches investigated. A heavily developed watershed had significantly higher median bacteria concentrations (186 cfu) in the adjoining coastal waters compared to an undeveloped watershed (10 cfu) of similar size.
Precipitation and ensuing runoff strongly control the rate of polluted water delivered to most beaches in southern California. Variable precipitation generates a greater response in coastal water bacteria concentrations in developed watersheds compared to undeveloped areas. Projected declines in regional precipitation as a consequence of climate change may result in less contaminated water delivered to coastal waters, thus decreasing risk of water associated illnesses during winter months.
Water Environment Research 12/2011; 83(12):2121-30. · 0.88 Impact Factor
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ABSTRACT: The incidence, outbreak frequency, and distribution of many infectious diseases are generally expected to change as a consequence of climate change, yet there is limited regional information available to guide decision making.
We surveyed government officials designated as Competent Bodies for Scientific Advice concerning infectious diseases to examine the degree to which they are concerned about potential effects of climate change on infectious diseases, as well as their perceptions of institutional capacities in their respective countries.
In 2007 and 2009/2010, national infectious disease experts from 30 European Economic Area countries were surveyed about recent and projected infectious disease patterns in relation to climate change in their countries and the national capacity to cope with them.
A large majority of respondents agreed that climate change would affect vector-borne (86% of country representatives), food-borne (70%), water-borne (68%), and rodent-borne (68%) diseases in their countries. In addition, most indicated that institutional improvements are needed for ongoing surveillance programs (83%), collaboration with the veterinary sector (69%), management of animal disease outbreaks (66%), national monitoring and control of climate-sensitive infectious diseases (64%), health services during an infectious disease outbreak (61%), and diagnostic support during an epidemic (54%).
Expert responses were generally consistent with the peer-reviewed literature regarding the relationship between climate change and vector- and water-borne diseases, but were less so for food-borne diseases. Shortcomings in institutional capacity to manage climate change vulnerability, identified in this assessment, should be addressed in impact, vulnerability, and adaptation assessments.
Environmental Health Perspectives 11/2011; 120(3):385-92. · 7.04 Impact Factor
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ABSTRACT: Biotechnological research poses a special security problem because of the duality between beneficial use and misuse. In order to find a balance between regulating potentially dangerous research and assuring scientific advancement, a number of assessments have tried to define which types of research are especially open to misuse and should therefore be considered dual-use research of special concern requiring rigorous oversight. So far, there has been no common understanding of what such activities are. Here we present a review of 27 assessments focusing on biological dual-use issues published between 1997 and 2008. Dual-use research activities identified by these assessments as being of special concern were compiled and compared. Moreover, from these 27 assessments, the primary research publications explicitly identified as examples of concerning research activities were extracted and analyzed. We extracted a core list of 11 activities of special concern and show that this list does not match with the reasons why primary research publications were identified as being of special concern. Additionally, we note that the 11 activities identified are not easily conducted or replicated, and therefore the likelihood of their being used in a high-tech mass casualty bioterrorism event should be reevaluated.
Biosecurity and bioterrorism: biodefense strategy, practice, and science 11/2011; 9(4):372-8. · 1.64 Impact Factor
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ABSTRACT: We examined how different drivers of infectious disease could interact to threaten control efforts in Europe. We considered projected trends through 2020 for 3 broad groups of drivers: globalization and environmental change, social and demographic change, and health system capacity. Eight plausible infectious disease threats with the potential to be significantly more problematic than they are today were identified through an expert consultation: extensively drug-resistant bacteria, vector-borne diseases, sexually transmitted infections, food-borne infections, a resurgence of vaccine-preventable diseases, health care-associated infections, multidrug-resistant tuberculosis, and pandemic influenza. Preemptive measures to be taken by the public health community to counteract these threats were identified.
American Journal of Public Health 09/2011; 101(11):2068-79. · 3.93 Impact Factor
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Boika Rechel,
Marc Suhrcke,
Svetla Tsolova,
Jonathan E Suk,
Monica Desai,
Martin McKee,
David Stuckler,
Ibrahim Abubakar,
Paul Hunter,
Michaela Senek, Jan C Semenza
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ABSTRACT: The effects of the current global economic crisis on the spread and control of communicable diseases remain uncertain. This study aimed to explore experts' views about the impact of the current crisis and measures that have been undertaken by governments to mitigate an alleged adverse effect of the crisis on communicable diseases.
An online survey was conducted during November 2009-February 2010 among experts from national agencies for communicable disease control from European Union (EU) and European Free Trade Association (EFTA) countries.
There were few specific national policies and programmes aimed at mitigating the impact of the economic crisis. Prevention services were deemed particularly susceptible to budget cuts (68%) as a result of the economic crisis compared to primary care (28%), according to survey respondents. Services targeted at vulnerable and hard-to-reach population groups were perceived to be at particular risk of deterioration (67%) in contrast to travel medicine (11%), according to respondents.
There is a need for sustainability of financial resources, public health workforce and infrastructures to ensure that the services and programmes for the surveillance and control of the spread of communicable disease are maintained and developed. There is also a need to explore and foster better linkage in data on socioeconomic circumstances and communicable disease outcomes.
Health Policy 08/2011; 103(2-3):168-75. · 1.51 Impact Factor
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ABSTRACT: This meta-analysis of reports examining ticks throughout the Western Palearctic region indicates a distinct geographic pattern for Borrelia burgdorferi sensu lato prevalence in questing nymphal Ixodes ricinus ticks. The greatest prevalence was reported between the 5°E and 25°E longitudes based on an analysis of 123 collection points with 37,940 nymphal tick specimens (87.43% of total nymphs; 56.35% of total ticks in the set of reports over the target area). Climatic traits, such as temperature and vegetation stress, and their seasonality correlated with Borrelia prevalence in questing ticks. The greatest prevalence was associated with mild winter, high summer, and low seasonal amplitude of temperatures within the range of the tick vector, higher vegetation indices in the May-June period, and well-connected vegetation patches below a threshold at which rates suddenly drop. Classification of the target territory using a qualitative risk index derived from the abiotic variables produced an indicator of the probability of finding infected ticks in the Western Palearctic region. No specific temporal trends were detected in the reported prevalence. The ranges of the different B. burgdorferi sensu lato genospecies showed a pattern of high biodiversity between 4°W and 20°E, partially overlapping the area of highest prevalence in ticks. Borrelia afzelii and Borrelia garinii are the dominant species in central Europe (east of ∼25°E), but B. garinii may appear alone at southern latitudes and Borrelia lusitaniae is the main indicator species for meridional territories.
Applied and environmental microbiology 06/2011; 77(11):3838-45. · 3.69 Impact Factor
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ABSTRACT: Global climate change impacts on human and natural systems are predicted to be severe, far reaching, and to affect the most physically and economically vulnerable disproportionately. Society can respond to these threats through two strategies: mitigation and adaptation. Industry, commerce, and government play indispensable roles in these actions but so do individuals, if they are receptive to behavior change. We explored whether the health frame can be used as a context to motivate behavioral reductions of greenhouse gas emissions and adaptation measures.
In 2008, we conducted a cross-sectional survey in the United States using random digit dialing. Personal relevance of climate change from health threats was explored with the Health Belief Model (HBM) as a conceptual frame and analyzed through logistic regressions and path analysis.
Of 771 individuals surveyed, 81% (n = 622) acknowledged that climate change was occurring, and were aware of the associated ecologic and human health risks. Respondents reported reduced energy consumption if they believed climate change could affect their way of life (perceived susceptibility), Odds Ratio (OR) = 2.4 (95% Confidence Interval (CI): 1.4-4.0), endanger their life (perceived severity), OR = 1.9 (95% CI: 1.1-3.1), or saw serious barriers to protecting themselves from climate change, OR = 2.1 (95% CI: 1.2-3.5). Perceived susceptibility had the strongest effect on reduced energy consumption, either directly or indirectly via perceived severity. Those that reported having the necessary information to prepare for climate change impacts were more likely to have an emergency kit OR = 2.1 (95% CI: 1.4-3.1) or plan, OR = 2.2 (95% CI: 1.5-3.2) for their household, but also saw serious barriers to protecting themselves from climate change or climate variability, either by having an emergency kit OR = 1.6 (95% CI: 1.1-2.4) or an emergency plan OR = 1.5 (95%CI: 1.0-2.2).
Motivation for voluntary mitigation is mostly dependent on perceived susceptibility to threats and severity of climate change or climate variability impacts, whereas adaptation is largely dependent on the availability of information relevant to climate change. Thus, the climate change discourse could be framed from a health perspective to motivate behaviour change.
Environmental Health 05/2011; 10:46. · 2.65 Impact Factor
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PLoS Pathogens 01/2011; 7(1):e1001253. · 9.13 Impact Factor
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Marc Suhrcke,
David Stuckler,
Jonathan E Suk,
Monica Desai,
Michaela Senek,
Martin McKee,
Svetla Tsolova,
Sanjay Basu,
Ibrahim Abubakar,
Paul Hunter,
Boika Rechel, Jan C Semenza
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ABSTRACT: There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control.
PLoS ONE 01/2011; 6(6):e20724. · 4.09 Impact Factor
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ABSTRACT: In Europe, wealth inequality is directly related to tuberculosis (TB) notification (R2 = 0.69), while in countries with lower TB rates, higher proportions of TB cases occur in foreign-born persons. Particularly during times of financial upheaval, efforts to eliminate TB must address social inequality.
Emerging Infectious Diseases 11/2009; 15(11):1812-4. · 6.79 Impact Factor
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ABSTRACT: Concerted action is needed to address public health issues raised by climate change. In this Review we discuss infections acquired through various routes (arthropod vector, rodent, water, food, and air) in view of a changing climate in Europe. Based on an extensive review of published work and expert workshops, we present an assessment of the infectious disease challenges: incidence, prevalence, and distribution are projected to shift in a changing environment. Due to the high level of uncertainty on the rate of climate change and its impact on infectious diseases, we propose to mount a proactive public health response by building an integrated network for environmental and epidemiological data. This network would have the capacity to connect epidemic intelligence and infectious disease surveillance with meteorological, entomological, water quality, remote sensing, and other data, for multivariate analyses and predictions. Insights from these analyses could then guide adaptation strategies and protect population health from impending threats related to climate change.
The Lancet Infectious Diseases 07/2009; 9(6):365-75. · 17.39 Impact Factor
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Archives of Environmental and Occupational Health 01/2009; 64(3):145-7. · 0.85 Impact Factor
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ABSTRACT: The effects of and responses to the health impacts of climate change will affect individuals, communities, and societies. Effectively preparing for and responding to current and projected climate change requires ongoing assessment and action, not a one-time assessment of risks and interventions. To promote resilience to climate change and other community stressors, a stepwise course of action is proposed for community-based adaptation that engages stakeholders in a proactive problem solving process to enhance social capital across local and national levels. In addition to grassroots actions undertaken at the community level, reducing vulnerability to current and projected climate change will require top-down interventions implemented by public health organizations and agencies.
American journal of preventive medicine 12/2008; 35(5):501-7. · 4.24 Impact Factor
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ABSTRACT: Mitigating global climate change requires not only government action but also cooperation from consumers. Population-based, cross-sectional surveys were conducted among 1202 respondents in Portland OR and Houston TX between June and September 2007 regarding awareness, concern, and behavior change related to climate change. The data were subjected to both quantitative and qualitative analyses. Awareness about climate change is virtually universal (98% in Portland and 92% in Houston) with the vast majority reporting some level of concern (90% in Portland and 82% in Houston). A multivariate analysis revealed significant predictors of behavior change: individuals with heightened concern about climate change (p<0.001); respondents with higher level of education (p= 0.03); younger compared with older individuals (p<0.001); and Portlanders more likely to change behavior compared with Houstonians (p<0.001). Of those who changed behavior, 43% reported having reduced their energy usage at home, 39% had reduced gasoline consumption, and 26% engaged in other behaviors, largely recycling. Qualitative data indicate a number of cognitive, behavioral, and structural obstacles to voluntary mitigation. Although consumers are interested in global climate change-mitigation strategies and willing to act accordingly, considerable impediments remain. Government policy must eliminate economic, structural, and social barriers to change and advance accessible and economical alternatives. Individual-level mitigation can be a policy option under favorable contextual conditions, as these results indicate, but must be accompanied by mitigation efforts from industry, commerce, and government.
American journal of preventive medicine 11/2008; 35(5):479-87. · 4.24 Impact Factor
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American Journal of Public Health 09/2008; 98(8):1351-2; author reply 1352. · 3.93 Impact Factor
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ABSTRACT: Changes in climate systems are increasing heat wave frequency and air stagnation, both conditions associated with exacerbating poor air quality and of considerable public health concern.
Heat and air pollution advisory systems are in place in many cities for early detection and response to reduce health consequences, or severity of adverse conditions. Whereas the ability to forecast heat waves and/or air pollution episodes has become increasingly sophisticated and accurate, little is known about the effectiveness of advisories in altering public behavior.
Air quality and meteorological conditions were measured during advisory and control days in Portland, OR and Houston, TX in 2005 and 2006 and 1962 subjects were interviewed by telephone about their perception and response to these conditions.
Elevated ambient temperatures were accurately recognized regardless of air conditioning use; in Portland, respondents resorted to active cooling behavior (AC, fan, etc.), while in Houston no such change was observed. More heat-related symptoms were reported in Portland compared to Houston, probably due to low air conditioning use in the northwest. One-third of study participants were aware of air quality advisories but only approximately 10-15% claimed to have changed activities during such an episode. Not the advisory, however, drove their behavior change, but rather the perception of poor air quality, which was not related to PM(2.5) or ozone measurements.
Messages are not reaching the public during potentially hazardous weather and air quality conditions. Climatic forecasts are increasingly predictive but public agencies fail to mount an appropriate outreach response.
Environmental Research 08/2008; 107(3):401-11. · 3.40 Impact Factor
