Abstract
BackgroundClimate change is expected to increase the chance of extreme rainfall events in the Northern Hemisphere and herewith, there is an increased chance of urban pluvial flooding. Urban pluvial flooding often consists of street flooding and/or flooding of combined sewerage systems, leading to contamination of the floodwater with several gastrointestinal and/or respiratory pathogens. An increase in flooding events therefore pose a health risk to those exposed to urban floodwater. We studied the association between exposure to pluvial floodwater and acute gastroenteritis (AGE) and acute respiratory infection (ARI).MethodsWe performed a retrospective, cross-sectional survey during the summer of 2015 in 60 locations in the Netherlands with reported flooding. Two weeks after the flooding, questionnaires were sent to households in these locations, collecting data on self-reported AGE and ARI and information on floodwater exposure in the previous 2 weeks. Multivariable generalized estimating equations (GEE) regression models, accounting for the clustered data structure, were used to identify risk factors for AGE and ARI.ResultsIn total, 699 households with 1,656 participants (response rate 21%) returned the questionnaire. Contact with floodwater was significantly associated with AGE (aOR 4.2, 95%CI 2.1–8.4) and ARI (aOR 3.3, 95%CI 2.0–5.4). Risk factors for AGE were skin contact with floodwater (aOR 4.0, 95%CI 1.8-9.0), performing post-flooding cleaning operations (aOR 8.6, 95%CI 3.5-20.9) and cycling through floodwater (aOR 2.3, 95%CI 1.0-5.0). Skin contact with floodwater (aOR 3.6, 95%CI 1.9-6.9) and performing post-flooding cleaning operations (aOR 5.5, 95%CI 3.0-10.3) were identified as risk factors for ARI.ConclusionsResults suggest an association between direct exposure to pluvial floodwater and AGE and ARI. As it is predicted that the frequency of pluvial flooding events will increase in the future, there is a need for flood-proof solutions in urban development and increased awareness among stakeholders and the public about the potential health risks. Future prospective studies are recommended to confirm our results.
Highlights
Climate change is expected to increase the chance of extreme rainfall events in the Northern Hemisphere and there is an increased chance of urban pluvial flooding
Urban pluvial flooding often entails street flooding and/or flooding of combined sewerage system, where rainwater mixes with sewage water, thereby heavily contaminating floodwater with fecal material
With a focus on a high-income country like the Netherlands, the aim of this study was to quantify the acute gastroenteritis (AGE) and acute respiratory infection (ARI) risks associated with exposure to pluvial floodwater, as well as to identify specific risk factors for AGE and ARI, in pluvial flood-ravaged urban areas
Summary
Climate change is expected to increase the chance of extreme rainfall events in the Northern Hemisphere and there is an increased chance of urban pluvial flooding. Urban pluvial flooding often consists of street flooding and/or flooding of combined sewerage systems, leading to contamination of the floodwater with several gastrointestinal and/or respiratory pathogens. Urban pluvial flooding often entails street flooding and/or flooding of combined sewerage system, where rainwater mixes with sewage water, thereby heavily contaminating floodwater with fecal material. In this way, floodwater becomes a possible vehicle of several pathogens such as noroviruses, enteroviruses, or Campylobacter [6], many of which are recognized causative agents of gastrointestinal and respiratory infections
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