“Sickenin’ in the rain” – increased risk of gastrointestinal and respiratory infections after urban pluvial flooding in a population-based cross-sectional study in the Netherlands

Abstract

Background Climate change is expected to increase the chance of extreme rainfall events in the Northern Hemisphere and herewith, there is an increased chance of urban pluvial flooding. Urban pluvial flooding often consists of street flooding and/or flooding of combined sewerage systems, leading to contamination of the floodwater with several gastrointestinal and/or respiratory pathogens. An increase in flooding events therefore pose a health risk to those exposed to urban floodwater. We studied the association between exposure to pluvial floodwater and acute gastroenteritis (AGE) and acute respiratory infection (ARI). Methods We performed a retrospective, cross-sectional survey during the summer of 2015 in 60 locations in the Netherlands with reported flooding. Two weeks after the flooding, questionnaires were sent to households in these locations, collecting data on self-reported AGE and ARI and information on floodwater exposure in the previous 2 weeks. Multivariable generalized estimating equations (GEE) regression models, accounting for the clustered data structure, were used to identify risk factors for AGE and ARI. Results In total, 699 households with 1,656 participants (response rate 21%) returned the questionnaire. Contact with floodwater was significantly associated with AGE (aOR 4.2, 95%CI 2.1–8.4) and ARI (aOR 3.3, 95%CI 2.0–5.4). Risk factors for AGE were skin contact with floodwater (aOR 4.0, 95%CI 1.8-9.0), performing post-flooding cleaning operations (aOR 8.6, 95%CI 3.5-20.9) and cycling through floodwater (aOR 2.3, 95%CI 1.0-5.0). Skin contact with floodwater (aOR 3.6, 95%CI 1.9-6.9) and performing post-flooding cleaning operations (aOR 5.5, 95%CI 3.0-10.3) were identified as risk factors for ARI. Conclusions Results suggest an association between direct exposure to pluvial floodwater and AGE and ARI. As it is predicted that the frequency of pluvial flooding events will increase in the future, there is a need for flood-proof solutions in urban development and increased awareness among stakeholders and the public about the potential health risks. Future prospective studies are recommended to confirm our results. Electronic supplementary material The online version of this article (10.1186/s12879-019-3984-5) contains supplementary material, which is available to authorized users.

Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians

“…Notwithstanding the strict methodology of this case-crossover study, including climatological and air pollutants, temperature, relative humidity and barometric pressure in the analysis as potential confounders, the authors recognise that further studies are required to clarify what could be the role of indoor crowding in this association [49]. More recently, a cross-sectional survey in 60 Dutch locations with reported flooding did not find a significant association between the exposure to pluvial floodwater and acute respiratory infections in children (OR = 1.6 (95% CI: 0.6, 4.0)) [50].…”

Increased risk of Legionella pneumonia as community-acquired pneumonia after heavy rainfall in 2018 in west Japan

“…The authors of that study suggested that the tsunami increased the risk of pneumonia death. Regarding ooding-related disasters, there are some reports of increases in the occurrence of acute respiratory infections [2][3][4]. These reports included patients who were outpatients and had symptoms but had not been diagnosed with pneumonia.…”

“…Regarding the aetiology of pneumonia, the rate of Haemophilus in uenzae infection was signi cantly higher after tsunami and earthquake disasters [7]. Both contact with oodwaters and post-ooding cleaning were reported to increase the risk of respiratory infections [4].…”

“…Previous reports demonstrated that acute respiratory infections are a major cause of disease after hydrologic events such as tropical cyclones, typhoons, and other heavy rainfall-related events [2][3][4][5][6], and numbers of both outpatients and inpatients with pneumonia increase after such disasters [7,8].…”

Increased Risk of Legionella Pneumonia as Community-acquired Pneumonia after Heavy Rainfall in 2018 in West Japan

“…Previous reports demonstrated that acute respiratory infections are a major cause of disease after hydrologic events such as tropical cyclones, typhoons, and other heavy rainfall-related events [2][3][4][5][6], and numbers of both outpatients and inpatients with pneumonia increase after such disasters [7,8].…”