title: Climatic Drivers of Diarrheagenic Escherichia coli Incidence: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Positive associations have been noted between temperature and diarrhea incidence, but considerable uncertainty surrounds quantitative estimates of this relationship because of pathogen-specific factors and a scarcity of data on the influence of meteorological factors on the risk of disease. Quantifying these relationships is important for disease prevention and climate change adaptation.
  
  
  METHODS
  To address these issues, we performed a systematic literature review of studies in which at least 1 full year of data on the monthly incidence of diarrheagenic Escherichia coli were reported. We characterized seasonal patterns of disease incidence from 28 studies. In addition, using monthly time- and location-specific weather data for 18 studies, we performed univariate Poisson models on individual studies and a meta-analysis, using a generalized estimating equation, on the entire data set.
  
  
  RESULTS
  We found an 8% increase in the incidence of diarrheagenic E. coli (95% confidence interval, 5%-11%; P < .0001) for each 1°C increase in mean monthly temperature. We found a modest positive association between 1-month-lagged mean rainfall and incidence of diarrheagenic E. coli, which was not statistically significant when we controlled for temperature.
  
  
  CONCLUSIONS
  These results suggest that increases in ambient temperature correspond to an elevated incidence of diarrheagenic E. coli and underscore the need to redouble efforts to prevent the transmission of these pathogens in the face of increasing global temperatures.
authors.affiliation: School of Medicine.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Philipsborn
authors.affiliation: Department of Environmental Health, Rollins School of Public Health.
authors.forename: Sharia M
authors.initials: SM
authors.lastname: Ahmed
authors.affiliation: Department of Environmental Sciences, Emory University, Atlanta, Georgia.
authors.forename: Berry J
authors.initials: BJ
authors.lastname: Brosi
authors.affiliation: Department of Environmental Health, Rollins School of Public Health.
authors.forename: Karen
authors.initials: K
authors.lastname: Levy
mesh_terms: D057231:Climate Change; D003967:Diarrhea / Q000453:epidemiology*; D004927:Escherichia coli Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D012621:Seasons; D013696:Temperature
keywords: Escherichia coli; climate change; diarrhea; seasonality