Title
Pathogen-specific impacts of the 2011–2012 la Niña-associated floods on enteric infections in the MAL-ED Peru Cohort: A comparative interrupted time series analysis
Date Issued
02 January 2020
Access level
open access
Resource Type
journal article
Author(s)
Colston J.
Zaitchik B.
Yori P.P.
Kang G.
Ahmed T.
Bessong P.
Mduma E.
Bhutta Z.
Shrestha P.S.
Lima A.
Publisher(s)
MDPI AG
Abstract
Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites—Loreto, Peru—were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens—including vaccines as they become available—in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.
Volume
17
Issue
2
Language
English
OCDE Knowledge area
Epidemiología
Subjects
Scopus EID
2-s2.0-85077941734
PubMed ID
Source
International Journal of Environmental Research and Public Health
ISSN of the container
16617827
Sponsor(s)
Funding: The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (47075). The project obtained additional support from the BMGF under OPP1066146 and OPP1152146 (to MNK) and the Foundation for the National Institutes of Health, and the National Institutes of Health, Fogarty International Center. Additional support for MAL-ED was obtained from the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases of the Johns Hopkins School of Medicine (10KOS2015). The research presented in this Article was supported financially by NASA’s Group on Earth Observations Work Program (16-GEO16-0047). The funders played no role in the design and implementation of the study or the analysis and interpretation of the results.
The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (47075). The project obtained additional support from the BMGF under OPP1066146 and OPP1152146 (to MNK) and the Foundation for the National Institutes of Health, and the National Institutes of Health, Fogarty International Center. Additional support for MAL-ED was obtained from the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases of the Johns Hopkins School of Medicine (10KOS2015). The research presented in this Article was supported financially by NASA?s Group on Earth Observations Work Program (16-GEO16-0047). The funders played no role in the design and implementation of the study or the analysis and interpretation of the results. Acknowledgments: We thank the participants, their families, and the study communities for their dedicated time and effort to better the understanding the transmission and more enduring impact of enteric infections in early childhood on the health of individuals and populations. We also thank Elizabeth Stuart (Johns Hopkins Bloomberg School of Public Health) for consultation regarding the statistical analysis.
Sources of information:
Directorio de Producción Científica
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