SEASONALITY OF CHILDHOOD CRYPTOSPORIDIOSIS LINKED TO TEMPERATURE AND PRECIPITATION: A META-ANALYSIS APPROACH

Abstract

ISEE-448 Introduction: The incidence of cryptosporidiosis infection (CPI) typically exhibits a seasonal pattern with periods of low incidence alternated by periods of outbreak clusters. Outbreaks of cryptosporidiosis are often associated with water contamination. Several studies conducted in tropical climates have found an increase in CPI during the rainy season. In temperate climates, spring and fall waves in cryptosporidiosis have been typically observed. We conducted a meta-analysis study to examine how a seasonal pattern in childhood CPI relates to ambient temperature and precipitation on a global worldwide scale using a mixed effects modeling approach. Methods: We abstracted CPI monthly incidence data from 13 published studies which satisfied three criteria: 1) a study includes at least one year of data; 2) monthly incidence data are reported; and 3) study subjects are primarily children. In order to normalize the incidence data, monthly counts of cases or percent prevalence were converted into z-scores, a measure of relative incidence. Based on the study’s longitude and latitude, we supplemented monthly relative incidence data with aggregated norms for ambient temperature and precipitation, obtained from the National Climatic Data Center databases. We applied a linear mixed effect model to link the incidence z-score with temperature and precipitation values adjusting for the latitude of the study’s location. Results: In areas with high annual precipitation (above 10 inches per year & |latitude| <15), the month with the highest incidence coincided with either the month of highest precipitation level (2 studies); or the month with moderate precipitation of 1.5-2 inches after a dry period of 2-3 months (5 studies). In localities with temperate climate (mean precipitation 1.95±1.43 inches per month), two seasonal patterns were observed, with the dominant spring (3 studies) or fall waves (3 studies). The results of the modeling indicate, that precipitation alone explained 9 to 12 percent of variation in the relative CPI incidence. On average, with a one inch increase in monthly precipitation, the relative incidence increased by 0.05 [95% CI: 0.02-0.08]. There was also a strong synergetic effect of high temperature and high precipitation levels on the incidence of CPI. Discussion: The observed associations between CPI incidence and precipitation support the following: while climatic conditions typically define or restrict a habitat area of a pathogen, meteorological factors can affect timing and intensity of infectious outbreaks, thereby leading to different seasonal patterns in various climates of the world. Further research is needed to quantify this phenomenon.