title: Climate variability and nonstationary dynamics of Mycoplasma pneumoniae pneumonia in Japan.
abstract: BACKGROUND
  A stationary association between climate factors and epidemics of Mycoplasma pneumoniae (M. pneumoniae) pneumonia has been widely assumed. However, it is unclear whether elements of the local climate that are relevant to M. pneumoniae pneumonia transmission have stationary signatures of climate factors on their dynamics over different time scales.
  
  
  METHODS
  We performed a cross-wavelet coherency analysis to assess the patterns of association between monthly M. pneumoniae cases in Fukuoka, Japan, from 2000 to 2012 and indices for the Indian Ocean Dipole (IOD) and El Niño Southern Oscillation (ENSO).
  
  
  RESULTS
  Monthly M. pneumoniae cases were strongly associated with the dynamics of both the IOD and ENSO for the 1-2-year periodic mode in 2005-2007 and 2010-2011. This association was non-stationary and appeared to have a major influence on the synchrony of M. pneumoniae epidemics.
  
  
  CONCLUSIONS
  Our results call for the consideration of non-stationary, possibly non-linear, patterns of association between M. pneumoniae cases and climatic factors in early warning systems.
authors.affiliation: Department of Planning Information and Administration, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Onozuka
authors.affiliation: Programa de Investigación en Enfermedades Tropicales, Escuela de Medicina Veterinaria, Universidad Nacional, Heredia, Costa Rica; Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan.
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Chaves
mesh_terms: D004196:Disease Outbreaks; D059000:El Nino-Southern Oscillation; D006801:Humans; D019156:Indian Ocean; D007564:Japan / Q000453:epidemiology; D015233:Models, Statistical; D009177:Mycoplasma pneumoniae / Q000502:physiology*; D011019:Pneumonia, Mycoplasma / Q000453:epidemiology* / Q000635:transmission; D012621:Seasons; D013696:Temperature
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