title: Association of climatic factors with infectious diseases in the Arctic and subarctic region--a systematic review.
abstract: BACKGROUND
  The Arctic and subarctic area are likely to be highly affected by climate change, with possible impacts on human health due to effects on food security and infectious diseases.
  
  
  OBJECTIVE
  To investigate the evidence for an association between climatic factors and infectious diseases, and to identify the most climate-sensitive diseases and vulnerable populations in the Arctic and subarctic region.
  
  
  METHODS
  A systematic review was conducted. A search was made in PubMed, with the last update in May 2013. Inclusion criteria included human cases of infectious disease as outcome, climate or weather factor as exposure, and Arctic or subarctic areas as study origin. Narrative reviews, case reports, and projection studies were excluded. Abstracts and selected full texts were read and evaluated by two independent readers. A data collection sheet and an adjusted version of the SIGN methodology checklist were used to assess the quality grade of each article.
  
  
  RESULTS
  In total, 1953 abstracts were initially found, of which finally 29 articles were included. Almost half of the studies were carried out in Canada (n=14), the rest from Sweden (n=6), Finland (n=4), Norway (n=2), Russia (n=2), and Alaska, US (n=1). Articles were analyzed by disease group: food- and waterborne diseases, vector-borne diseases, airborne viral- and airborne bacterial diseases. Strong evidence was found in our review for an association between climatic factors and food- and waterborne diseases. The scientific evidence for a link between climate and specific vector- and rodent-borne diseases was weak due to that only a few diseases being addressed in more than one publication, although several articles were of very high quality. Air temperature and humidity seem to be important climatic factors to investigate further for viral- and bacterial airborne diseases, but from our results no conclusion about a causal relationship could be drawn.
  
  
  CONCLUSIONS
  More studies of high quality are needed to investigate the adverse health impacts of weather and climatic factors in the Arctic and subarctic region. No studies from Greenland or Iceland were found, and only a few from Siberia and Alaska. Disease and syndromic surveillance should be part of climate change adaptation measures in the Arctic and subarctic regions, with monitoring of extreme weather events known to pose a risk for certain infectious diseases implemented at the community level.
authors.affiliation: Department of Public Health and Clinical Medicine, Centre for Global Health Research, Umeå University, Umeå, Sweden; christina.hedlund@climi.umu.se.
authors.forename: Christina
authors.initials: C
authors.lastname: Hedlund
authors.affiliation: Department of Public Health and Clinical Medicine, Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Blomstedt
authors.affiliation: Department of Public Health and Clinical Medicine, Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schumann
mesh_terms: D001110:Arctic Regions / Q000453:epidemiology*; D002980:Climate; D057231:Climate Change; D003141:Communicable Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D014887:Weather
keywords: Arctic; climatic factors; infectious diseases; subarctic region; systematic reviews