title: Analytical studies assessing the association between extreme precipitation or temperature and drinking water-related waterborne infections: a review.
abstract: Determining the role of weather in waterborne infections is a priority public health research issue as climate change is predicted to increase the frequency of extreme precipitation and temperature events. To document the current knowledge on this topic, we performed a literature review of analytical research studies that have combined epidemiological and meteorological data in order to analyze associations between extreme precipitation or temperature and waterborne disease.A search of the databases Ovid MEDLINE, EMBASE, SCOPUS and Web of Science was conducted, using search terms related to waterborne infections and precipitation or temperature. Results were limited to studies published in English between January 2001 and December 2013.Twenty-four articles were included in this review, predominantly from Asia and North-America. Four articles used waterborne outbreaks as study units, while the remaining articles used number of cases of waterborne infections. Results presented in the different articles were heterogeneous. Although most of the studies identified a positive association between increased precipitation or temperature and infection, there were several in which this association was not evidenced. A number of articles also identified an association between decreased precipitation and infections. This highlights the complex relationship between precipitation or temperature driven transmission and waterborne disease. We encourage researchers to conduct studies examining potential effect modifiers, such as the specific type of microorganism, geographical region, season, type of water supply, water source or water treatment, in order to assess how they modulate the relationship between heavy rain events or temperature and waterborne disease. Addressing these gaps is of primary importance in order to identify the areas where action is needed to minimize negative impact of climate change on health in the future.
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. BernardoRafael.Guzman.Herrador@fhi.no.
authors.forename: Bernardo R
authors.initials: BR
authors.lastname: Guzman Herrador
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. Birgitte.Freiesleben.DeBlasio@fhi.no.|Oslo Centre for Statistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway. Birgitte.Freiesleben.DeBlasio@fhi.no.
authors.forename: Birgitte Freiesleben
authors.initials: BF
authors.lastname: de Blasio
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. Emily.MacDonald@fhi.no.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Emily.MacDonald@fhi.no.
authors.forename: Emily
authors.initials: E
authors.lastname: MacDonald
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden. Gordon.Nichols@phe.gov.uk.|Gastrointestinal, Emerging and Zoonotic Diseases Department, Public Health England, London, UK. Gordon.Nichols@phe.gov.uk.|Norwich Medical School, University of East Anglia, Norwich, UK. Gordon.Nichols@phe.gov.uk.|Department of Hygiene & Epidemiology, University of Thessaly, Thessaly, Greece. Gordon.Nichols@phe.gov.uk.
authors.forename: Gordon
authors.initials: G
authors.lastname: Nichols
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden. Bertrand.sudre@ecdc.europa.eu.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sudre
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. Line.Vold@fhi.no.
authors.forename: Line
authors.initials: L
authors.lastname: Vold
authors.affiliation: European Centre for Disease Prevention and Control, Stockholm, Sweden. Jan.Semenza@ecdc.europa.eu.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Semenza
authors.affiliation: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. Karin.Nygard@fhi.no.
authors.forename: Karin
authors.initials: K
authors.lastname: Nygård
mesh_terms: D057231:Climate Change; D060766:Drinking Water / Q000382:microbiology* / Q000469:parasitology* / Q000821:virology; D055874:Extreme Heat; D006801:Humans; D011891:Rain; D000069578:Waterborne Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology
chemical_list: D060766:Drinking Water