title: Impacts of tropical cyclones and accompanying precipitation on infectious diarrhea in cyclone landing areas of Zhejiang Province, China.
abstract: BACKGROUND
  Zhejiang Province, located in southeastern China, is frequently hit by tropical cyclones. This study quantified the associations between infectious diarrhea and the seven tropical cyclones that landed in Zhejiang from 2005-2011 to assess the impacts of the accompanying precipitation on the studied diseases.
  
  
  METHODS
  A unidirectional case-crossover study design was used to evaluate the impacts of tropical storms and typhoons on infectious diarrhea. Principal component analysis (PCA) was applied to eliminate multicollinearity. A multivariate logistic regression model was used to estimate the odds ratios (ORs) and the 95% confidence intervals (CIs).
  
  
  RESULTS
  For all typhoons studied, the greatest impacts on bacillary dysentery and other infectious diarrhea were identified on lag 6 days (OR = 2.30, 95% CI: 1.81-2.93) and lag 5 days (OR = 3.56, 95% CI: 2.98-4.25), respectively. For all tropical storms, impacts on these diseases were highest on lag 2 days (OR = 2.47, 95% CI: 1.41-4.33) and lag 6 days (OR = 2.46, 95% CI: 1.69-3.56), respectively. The tropical cyclone precipitation was a risk factor for both bacillary dysentery and other infectious diarrhea when daily precipitation reached 25 mm and 50 mm with the largest OR = 3.25 (95% CI: 1.45-7.27) and OR = 3.05 (95% CI: 2.20-4.23), respectively.
  
  
  CONCLUSIONS
  Both typhoons and tropical storms could contribute to an increase in risk of bacillary dysentery and other infectious diarrhea in Zhejiang. Tropical cyclone precipitation may also be a risk factor for these diseases when it reaches or is above 25 mm and 50 mm, respectively. Public health preventive and intervention measures should consider the adverse health impacts from tropical cyclones.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. deng.zhengyi@hotmail.com.
authors.forename: Zhengyi
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. xun1huan2miao3@yeah.net.
authors.forename: Huanmiao
authors.initials: H
authors.lastname: Xun
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China. maigengzhou@126.com.
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. bjiang@sdu.edu.cn.
authors.forename: Baofa
authors.initials: B
authors.lastname: Jiang
authors.affiliation: National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China. wsw002@126.com.
authors.forename: Songwang
authors.initials: S
authors.lastname: Wang
authors.affiliation: National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China. guoqing@chinacdc.cn.
authors.forename: Qing
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. shandawangwei@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. kangrh@yahoo.com.
authors.forename: Ruihua
authors.initials: R
authors.lastname: Kang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. wangxin0730@yeah.net.
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. giftatluck@yahoo.com.
authors.forename: Gifty
authors.initials: G
authors.lastname: Marley
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan 250012, China. weima@sdu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
mesh_terms: D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D055867:Cyclonic Storms; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004403:Dysentery / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008954:Models, Biological; D008962:Models, Theoretical; D016017:Odds Ratio; D011634:Public Health; D011891:Rain; D012307:Risk Factors