title: Seasonality of cryptosporidiosis: A meta-analysis approach.
abstract: OBJECTIVE
  We developed methodology for and conducted a meta-analysis to examine how seasonal patterns of cryptosporidiosis, a primarily waterborne diarrheal illness, relate to precipitation and temperature fluctuations worldwide.
  
  
  METHODS
  Monthly cryptosporidiosis data were abstracted from 61 published epidemiological studies that cover various climate regions based on the Köppen Climate Classification. Outcome data were supplemented with monthly aggregated ambient temperature and precipitation for each study location. We applied a linear mixed-effect model to relate the monthly normalized cryptosporidiosis incidence with normalized location-specific temperature and precipitation data. We also conducted a sub-analysis of associations between the Normalized Difference Vegetation Index (NDVI), a remote sensing measure for the combined effect of temperature and precipitation on vegetation, and cryptosporidiosis in Sub-Saharan Africa.
  
  
  RESULTS
  Overall, and after adjusting for distance from the equator, increases in temperature and precipitation predict an increase in cryptosporidiosis; the strengths of relationship vary by climate subcategory. In moist tropical locations, precipitation is a strong seasonal driver for cryptosporidiosis whereas temperature is in mid-latitude and temperate climates. When assessing lagged relationships, temperature and precipitation remain strong predictors. In Sub-Saharan Africa, after adjusting for distance from the equator, low NDVI values are predictive of an increase in cryptosporidiosis in the following month.
  
  
  CONCLUSIONS
  In this study we propose novel methodology to assess relationships between disease outcomes and meteorological data on a global scale. Our findings demonstrate that while climatic conditions typically define a pathogen habitat area, meteorological factors affect timing and intensity of seasonal outbreaks. Therefore, meteorological forecasts can be utilized to develop focused prevention programs for waterborne cryptosporidiosis.
authors.affiliation: Department of Public Health and Family Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA. jyotsna.jagai@tufts.edu
authors.forename: Jyotsna S
authors.initials: JS
authors.lastname: Jagai
authors.forename: Denise A
authors.initials: DA
authors.lastname: Castronovo
authors.forename: Jim
authors.initials: J
authors.lastname: Monchak
authors.forename: Elena N
authors.initials: EN
authors.lastname: Naumova