Niven Caitlin G, Islam Mahfuza, Nguyen Anna, Grembi Jessica A, Mertens Andrew, Pickering Amy J, Kwong Laura H, Alam Mahfuja, Sen Debashis, Islam Sharmin, Rahman Mahbubur, Unicomb Leanne, Hubbard Alan E, Luby Stephen P, Colford John M, Arnold Benjamin F, Benjamin-Chung Jade, Ercumen Ayse
Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA.
Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
Lancet Planet Health. 2025 Jan;9(1):e5-e13. doi: 10.1016/S2542-5196(24)00306-1.
Weather extremes are predicted to influence pathogen exposure but their effects on specific faecal-oral transmission pathways are not well investigated. We evaluated associations between extreme rain and temperature during different antecedent periods (0-14 days) and Escherichia coli along eight faecal-oral pathways in rural Bangladeshi households.
We used data from the WASH Benefits Bangladesh cluster-randomised controlled trial (NCT01590095). E coli was enumerated in hand rinses from children younger than 5 years and their mothers, food, stored drinking water, tubewells, captured flies, ponds, and courtyard soil using IDEXX Quanti-Tray/2000 in nine rounds over 3·5 years and spatiotemporally matched to daily weather data. We used generalised linear models with robust standard errors to estimate E coli count ratios (ECRs) associated with extreme rain and temperature, defined as greater than the 90th percentile of daily values during the study period.
A total of 26 659 samples were collected during the study period. Controlling for temperature, extreme rain on the sampling day was associated with increased E coli in food (ECR=3·13 [95% CI 1·63-5·99], p=0·0010), stored drinking water (ECR=1·98 [1·36-2·88], p=0·0004), and ponds (ECR=3·46 [2·34-5·11], p<0·0001), and reduced E coli in soil (ECR=0·36 [0·24-0·53], p<0·0001). Extreme rain the day before sampling was associated with reduced E coli in tubewells (ECR=0·10 [0·02-0·62], p=0·014). Associations were similar for rainfall 1-7 days before sampling and slightly attenuated for rainfall 14 days before sampling. Controlling for rainfall, extreme temperature on the sampling day was associated with increased E coli in stored drinking water (ECR=1·49 [1·05-2·12], p=0·025) and food (ECR=3·01 [1·51-6·01], p=0·0020). Associations with temperature were similar for all antecedent periods and particularly pronounced for food. Neither rainfall nor temperature were consistently associated with E coli on hands and flies.
In rural Bangladesh, measures to control enteric infections following weather extremes should focus on water treatment and safe storage to reduce contamination of drinking water and food stored at home and on reducing exposure to surface waters.
Bill & Melinda Gates Foundation, National Institutes of Health, World Bank.
预计极端天气会影响病原体暴露，但它们对特定粪口传播途径的影响尚未得到充分研究。我们评估了孟加拉国农村家庭在不同前期时段（0 - 14天）的极端降雨和温度与沿八条粪口传播途径的大肠杆菌之间的关联。
我们使用了来自孟加拉国水、卫生与健康促进项目（WASH Benefits Bangladesh）整群随机对照试验（NCT01590095）的数据。在3.5年的时间里分九轮，使用IDEXX Quanti - Tray/2000对5岁以下儿童及其母亲的洗手水、食物、储存的饮用水、管井、捕获的苍蝇、池塘和庭院土壤中的大肠杆菌进行计数，并在时空上与每日天气数据相匹配。我们使用具有稳健标准误的广义线性模型来估计与极端降雨和温度相关的大肠杆菌计数比（ECR），极端降雨和温度定义为高于研究期间每日值的第90百分位数。
研究期间共收集了26659个样本。在控制温度的情况下，采样当天的极端降雨与食物中大肠杆菌增加相关（ECR = 3.13 [95% CI 1.63 - 5.99]，p = 0.0010）、储存的饮用水中大肠杆菌增加相关（ECR = 1.98 [1.36 - 2.88]，p = 0.0004）以及池塘中大肠杆菌增加相关（ECR = 3.46 [2.34 - 5.11]，p < 0.0001），而土壤中大肠杆菌减少（ECR = 0.36 [0.24 - 0.53]，p < 0.0001）。采样前一天的极端降雨与管井中大肠杆菌减少相关（ECR = 0.10 [0.02 - 0.62]，p = 0.014）。采样前1 - 7天的降雨情况与之关联相似，采样前14天的降雨关联则略有减弱。在控制降雨的情况下，采样当天的极端温度与储存的饮用水中大肠杆菌增加相关（ECR = 1.49 [1.05 - 2.12]，p = 0.025）以及食物中大肠杆菌增加相关（ECR = 3.01 [1.51 - 6.01]，p = 0.0020）。在所有前期时段，与温度的关联都相似，且对食物的影响尤为明显。降雨和温度与手部和苍蝇上的大肠杆菌均无持续关联。
在孟加拉国农村，极端天气后控制肠道感染的措施应侧重于水处理和安全储存，以减少家庭储存的饮用水和食物的污染，并减少接触地表水。
比尔及梅琳达·盖茨基金会、美国国立卫生研究院、世界银行。
