title: Global distribution of outbreaks of water-associated infectious diseases.
abstract: BACKGROUND
  Water plays an important role in the transmission of many infectious diseases, which pose a great burden on global public health. However, the global distribution of these water-associated infectious diseases and underlying factors remain largely unexplored.
  
  
  RESULTS
  Based on the Global Infectious Disease and Epidemiology Network (GIDEON), a global database including water-associated pathogens and diseases was developed. In this study, reported outbreak events associated with corresponding water-associated infectious diseases from 1991 to 2008 were extracted from the database. The location of each reported outbreak event was identified and geocoded into a GIS database. Also collected in the GIS database included geo-referenced socio-environmental information including population density (2000), annual accumulated temperature, surface water area, and average annual precipitation. Poisson models with Bayesian inference were developed to explore the association between these socio-environmental factors and distribution of the reported outbreak events. Based on model predictions a global relative risk map was generated. A total of 1,428 reported outbreak events were retrieved from the database. The analysis suggested that outbreaks of water-associated diseases are significantly correlated with socio-environmental factors. Population density is a significant risk factor for all categories of reported outbreaks of water-associated diseases; water-related diseases (e.g., vector-borne diseases) are associated with accumulated temperature; water-washed diseases (e.g., conjunctivitis) are inversely related to surface water area; both water-borne and water-related diseases are inversely related to average annual rainfall. Based on the model predictions, "hotspots" of risks for all categories of water-associated diseases were explored.
  
  
  CONCLUSIONS
  At the global scale, water-associated infectious diseases are significantly correlated with socio-environmental factors, impacting all regions which are affected disproportionately by different categories of water-associated infectious diseases.
authors.affiliation: College of Public Health, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.forename: Jeffrey
authors.initials: J
authors.lastname: LeJeune
authors.forename: Doug
authors.initials: D
authors.lastname: Alsdorf
authors.forename: Bo
authors.initials: B
authors.lastname: Lu
authors.forename: C K
authors.initials: CK
authors.lastname: Shum
authors.forename: Song
authors.initials: S
authors.lastname: Liang
mesh_terms: D003141:Communicable Diseases / Q000453:epidemiology*; D016208:Databases, Factual; D003710:Demography; D004196:Disease Outbreaks; D005843:Geography; D014943:Global Health; D006801:Humans; D015233:Models, Statistical; D012959:Socioeconomic Factors; D014867:Water
chemical_list: D014867:Water