Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought

Abstract

Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea; and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and/or sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.

Time series study of weather, water quality, and acute gastroenteritis at Water Safety Plan implementation sites in France and Spain

“…This study largely confirms the literature on drinking water-related gastrointestinal disease and contributors to health risks (Chhetri et al, 2017; Levy et al, 2016), while eliciting potential areas of site-specific management intervention. Precipitation, generally thought to be harmful, was inconsistently associated with acute gastroenteritis rates among sites, potentially due to differences in treatment processes and pollution sources.…”

Urban groundwater quality in sub-Saharan Africa: current status and implications for water security and public health

“…There are few studies that have been undertaken in Africa that provide direct evidence of the impact of climate change on deteriorating water quality and impacts on health; however, there is growing evidence globally of an association between water-borne diarrheal diseases and climatic factors that are likely to intensify under future climate change scenarios (Levy et al 2016). Levy et al (2016) suggest that these include risks associated with increased temperatures, more intense rainfall events and greater amounts of flooding.…”

“…There are few studies that have been undertaken in Africa that provide direct evidence of the impact of climate change on deteriorating water quality and impacts on health; however, there is growing evidence globally of an association between water-borne diarrheal diseases and climatic factors that are likely to intensify under future climate change scenarios (Levy et al 2016). Levy et al (2016) suggest that these include risks associated with increased temperatures, more intense rainfall events and greater amounts of flooding. Several studies suggest there are greater risks of microbiological contamination due to either flooding conditions in African cities or due to the onset of the rainy season (Howard et al 2003;de Magny et al 2012;Sorensen et al 2015a, b) and links between disease outbreaks and El Niño years have been proposed (de Magny et al 2012;Olago et al 2007).…”

El Niño Southern Oscillation (ENSO) and Health: An Overview for Climate and Health Researchers

“…Notwithstanding the complex pathways linking climate anomalies and diarrhoea [69] and the challenges this poses for quantifying the effects of weather and climate on water-associated diseases in general [70][71][72], diarrhoeal illness is generally sensitive to climate anomalies [73][74][75][76][77][78] with unusually warm conditions conducive to enhanced pathogen replication and survival rates, while rainfall surpluses may transport faecal matter into water courses with micro-organisms becoming concentrated in water bodies during periods of rainfall deficit. While Demisse and Mengisitie [79] noted that El Niño has an impact on diarrhoea incidence for a number of major geographic regions, many of the cited papers address temperature/rainfall-diarrhoea association as opposed to climate driven variations in diarrhoea moderated by ENSO.…”