Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, United States of America.
Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America.
PLoS Negl Trop Dis. 2024 May 13;18(5):e0012157. doi: 10.1371/journal.pntd.0012157. eCollection 2024 May.
A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change.
Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change.
We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters.
Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null.
Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.
多项研究已经发现了天气与腹泻之间的关系。但很少有研究调查特定肠道病原体与天气之间的关联。了解特定病原体与天气之间的关系对于告知资源匮乏地区的公共卫生部门至关重要，因为这些地区在气候变化下尤其容易受到天气变化的影响。
我们的目的是确定孟加拉国农村地区与儿童腹泻和肠道病原体流行相关的天气和环境风险因素，该地区儿童腹泻疾病负担高，并且容易受到气候变化下天气变化的影响。
我们将温度、降水、地表水和湿度数据与 2012-2016 年期间一项针对 6 个月至 5.5 岁儿童进行的腹泻和肠道病原体流行的群组随机试验的观测性纵向数据相匹配。我们使用广义加性混合模型，采用三次回归样条和最大似然估计进行平滑参数拟合。
与平均温度为 30°C 的周相比，平均温度为 15°C 的周腹泻的流行率高 3.5%，产志贺毒素大肠杆菌（STEC）高 7.3%，肠毒性大肠杆菌（ETEC）高 17.3%，隐孢子虫高 8.0%。每周降水量高于中位数（中位数：13mm；范围：0-396mm）与腹泻增加 29%相关（调整后流行率比 1.29，95%CI 1.07，1.55）；隐孢子虫、ETEC、STEC、志贺菌、空肠弯曲菌、气单胞菌和腺病毒 40/41 的流行率增加；而贾第虫、诺如病毒和轮状病毒的流行率降低。其他关联较弱或为零。
较高的温度和降水与腹泻和多种肠道病原体的高流行率有关；较高的降水与一些肠道病毒的低流行率有关。我们的研究结果强调了水气象变量与特定肠道病原体之间关系的异质性，而当观察综合指标（如所有原因腹泻）时，这些关系可能会被掩盖。我们的结果表明，在孟加拉国农村地区以及在具有类似气象特征、基础设施和肠道病原体传播的情况下，有针对性地在雨季前后减少肠道病原体的预防干预措施，可能更有效地减少儿童腹泻和肠道病原体携带。
