Climate-sensitive Infectious Diseases Research Articles

Climate change and healthy ageing: An assessment of the impact of climate hazards on older people.

Climate change not only directly impacts older people's longevity but also healthy ageing, which is the process of maintaining physical and mental capacities while optimising functional abilities. The urgency to address both population ageing and climate change necessitates a rethink and assessment of the impact of climate change on older people. This includes identifying what can be done to anticipate, mitigate and adapt to climate change and engage older persons. A review of climate change and healthy ageing forms the basis of evidence in this report. We developed a comprehensive search to assess current literature, combining terms related to ageing and climate change across four major data sets and assessing articles published up to the end of 2021. We summarised the current and future impact of climate change on older people and developed a framework identifying climate change impacts on older persons, recognising social and environmental determinants of healthy ageing. Major hazards and some key exposure pathways include extreme temperatures, wildfire, drought, flooding, storm and sea level rise, air quality, climate-sensitive infectious diseases, food and water insecurities, health and social care system displacement, migration, and relocation. Strategies to address climate change require interventions to improve systems and infrastructure to reduce vulnerability and increase resilience. As a heterogeneous group, older people's perceptions of climate change should be integrated into climate activism. Increasing climate change literacy among older people and enabling them to promote intergenerational dialogue will drive the development and implementation of equitable solutions. Pathways may operate via direct or indirect exposures, requiring longitudinal studies that enable assessment of exposures and outcomes at multiple time points, and analyses of cumulative impacts of hazards across the life course. The lack of systematic reviews and primary research on the impact of most climate hazards, except for heat, on older people is apparent. Future research should include outcomes beyond mortality and morbidity and assess how older people interact with their environment by focusing on their capacities and optimising abilities for being and doing what they value.

Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes.

Climate change represents a fundamental threat to human health, with pregnant women and newborns being more susceptible than other populations. In this review, we aimed to describe the current landscape of available epidemiological evidence on key climate risks on maternal and newborn health (MNH). We sought to identify published systematic and scoping reviews investigating the impact of different climate hazards and air pollution on MNH outcomes. With this in mind, we developed a systematic search strategy based on the concepts of 'climate/air pollution hazards, 'maternal health,' and 'newborn health,' with restrictions to reviews published between 1 January 2010 and 6 February 2023, but without geographical or language restriction. Following full text screening and data extraction, we synthesised the results using narrative synthesis. We found 79 reviews investigating the effects of climate hazards on MNH, mainly focussing on outdoor air pollution (n = 47, 59%), heat (n = 24, 30%), and flood/storm disasters (n = 7, 9%). Most were published after 2015 (n = 60, 76%). These reviews had consistent findings regarding the positive association of exposure to heat and to air pollution with adverse birth outcomes, particularly preterm birth. We found limited evidence for impacts of climate-related food and water security on MNH and did not identify any reviews on climate-sensitive infectious diseases and MNH. Climate change could undermine recent improvements in maternal and newborn health. Our review provides an overview of key climate risks to MNH. It could therefore be useful to the MNH community to better understand the MNH needs for each climate hazard and to strengthen discussions on evidence and research gaps and potential actions. Despite the lack of comprehensive evidence for some climate hazards and for many maternal, perinatal, and newborn outcomes, we observed repeated findings of the impact of heat and air pollutants on birth outcomes, particularly preterm birth. It is time for policy dialogue to follow to specifically design climate policy and actions to protect the needs of MNH.

Climate change and its impact on infectious diseases in Asia.

Climate change, particularly increasing temperature, changes in rainfall, extreme weather events and changes in vector ecology, impacts the transmission of many climate-sensitive infectious diseases. Asia is the world's most populous, rapidly evolving and diverse continent, and it is already experiencing the effects of climate change. Climate change intersects with population, sociodemographic and geographical factors, amplifying the public health impact of infectious diseases and potentially widening existing disparities. In this narrative review, we outline the evidence of the impact of climate change on infectious diseases of importance in Asia, including vector-borne diseases, food- and water-borne diseases, antimicrobial resistance and other infectious diseases. We also highlight the imperative need for strategic intersectoral collaboration at the national and global levels and for the health sector to implement adaptation and mitigation measures, including responsibility for its own greenhouse gas emissions.

Development of Vaccines against Emerging Mosquito-Vectored Arbovirus Infections.

Among emergent climate-sensitive infectious diseases, some mosquito-vectored arbovirus infections have epidemiological, social, and economic effects. Dengue virus (DENV), West Nile virus (WNV), and Chikungunya virus (CHIKV) disease, previously common only in the tropics, currently pose a major risk to global health and are expected to expand dramatically in the near future if adequate containment measures are not implemented. The lack of safe and effective vaccines is critical as it seems likely that emerging mosquito-vectored arbovirus infections will be con-trolled only when effective and safe vaccines against each of these infections become available. This paper discusses the clinical characteristics of DENV, WNV, and CHIKV infections and the state of development of vaccines against these viruses. An ideal vaccine should be able to evoke with a single administration a prompt activation of B and T cells, adequate concentrations of protecting/neutralizing antibodies, and the creation of a strong immune memory capable of triggering an effective secondary antibody response after new infection with a wild-type and/or mutated infectious agent. Moreover, the vaccine should be well tolerated, safe, easily administrated, cost-effective, and widely available throughout the world. However, the development of vaccines against emerging mosquito-vectored arbovirus diseases is far from being satisfactory, and it seems likely that it will take many years before effective and safe vaccines for all these infections are made available worldwide.

Ethics, equity, climate change, and infectious disease research: a scoping review

Objectives This scoping review aimed to summarise ethical issues related to climate-sensitive infectious diseases identified in the scientific literature. Methods We conducted a scoping review of PubMed to assess the level of engagement by scientists in the ethical and broader equity issues intersecting with climate-sensitive infectious diseases. Articles were included if they covered at least two out of three subjects – infectious disease, climate change, and ethics; and were published in English since 1995. Results The majority of scientific work in this field has focused on the relationship between climate change and vector-borne diseases (e.g., malaria and dengue fever) or water-borne diseases (e.g., cholera). Many studies identify the role of climate change in exacerbating inequities caused by the convergence of social and environmental determinants of health and show that the world’s most vulnerable populations are disproportionately impacted. However, few studies included explicitly normative ethical analysis of these trends, and there was limited discussion of the ethical responsibilities arising in infectious disease research including in relationships between researchers and communities. Conclusions This review provides a foundation for renewed and ethically-informed research on climate-sensitive diseases in low-and middle-income countries. It also highlights critical knowledge gaps and reveals where more work is needed to understand and respond to the ethical implications of these relationships and thereby inform more ethically conscious infectious disease research.

Climate change, environmental extremes, and human health in Australia: challenges, adaptation strategies, and policy gaps.

Climate change presents a major public health concern in Australia, marked by unprecedented wildfires, heatwaves, floods, droughts, and the spread of climate-sensitive infectious diseases. Despite these challenges, Australia's response to the climate crisis has been inadequate and subject to change by politics, public sentiment, and global developments. This study illustrates the spatiotemporal patterns of selected climate-related environmental extremes (heatwaves, wildfires, floods, and droughts) across Australia during the past two decades, and summarizes climate adaptation measures and actions that have been taken by the national, state/territory, and local governments. Our findings reveal significant impacts of climate-related environmental extremes on the health and well-being of Australians. While governments have implemented various adaptation strategies, these plans must be further developed to yield concrete actions. Moreover, Indigenous Australians should not be left out in these adaptation efforts. A collaborative, comprehensive approach involving all levels of government is urgently needed to prevent, mitigate, and adapt to the health impacts of climate change.

Challenges and implications of predicting the spatiotemporal distribution of dengue fever outbreak in Chinese Taiwan using remote sensing data and deep learning

ABSTRACT Ongoing climate change has accelerated the outbreak and expansion of climate-sensitive infectious diseases such as dengue fever. Dengue fever will remain a threat until safe and effective vaccines and antiviral drugs have been developed, distributed, and administered on a global scale. By predicting the spatiotemporal distribution of dengue fever outbreaks, we can effectively implement dengue fever prevention and control. Our study aims to predict the spatiotemporal distribution of dengue fever outbreaks in Chinese Taiwan using a U-Net based encoder – decoder model with daily datasets of sea-surface temperature, rainfall, and shortwave radiation from Remote Sensing (RS) instruments and dengue fever case notification data. Although the prediction accuracy of the proposed model was low and the overlapping areas between the ground truth and pixelwise prediction were few, some of the pixels were located nearby the ground truth, suggesting that the application of RS data and deep learning may help to predict the spatiotemporal distribution of dengue fever outbreaks. With further improvements, the deep learning model might effectively learn a small amount of training data for a specific task.

Uncovering social and environmental factors that increase the burden of climate-sensitive diarrheal infections on children.

Climate-sensitive infectious diseases are an issue of growing concern due to global warming and the related increase in the incidence of extreme weather and climate events. Diarrhea, which is strongly associated with climatic factors, remains among the leading causes of child death globally, disproportionately affecting populations in low- and middle-income countries (LMICs). We use survey data for 51 LMICs between 2000 and 2019 in combination with gridded climate data to estimate the association between precipitation shocks and reported symptoms of diarrheal illness in young children. Weaccount for differences in exposure risk by climate type and explore the modifying role of various social factors. We find that droughts are positively associated with diarrhea in the tropical savanna regions, particularly during the dry season and dry-to-wet and wet-to-dry transition seasons. In the humid subtropical regions, we find that heavy precipitation events are associated with increased risk of diarrhea during the dry season and the transition from dry-to-wet season. Our analysis of effect modifiers highlights certain social vulnerabilities that exacerbate these associations in the two climate zones and present opportunities for public health intervention. For example, we show that stool disposal practices, child feeding practices, and immunizing against the rotavirus modify the association between drought and diarrhea in the tropical savanna regions. Inthe humid subtropical regions, household's source of water and water disinfection practices modify the association between heavy precipitation and diarrhea. The evidence of effect modification varies depending on the type and duration of the precipitation shock.

Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019

Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear. To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association. This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022. City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019. The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development. Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60). Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.

Climate-driven scrub typhus incidence dynamics in South China: A time-series study

Background: Scrub typhus (ST) is a climate-sensitive infectious disease. However, the nonlinear relationship between important meteorological factors and ST incidence is not clear. The present study identified the quantitative relationship between ST incidence and meteorological factors in southern China.Methods: The weekly number of ST cases and simultaneous meteorological variables in central Guangdong Province from 2006 to 2018 were obtained from the National Notifiable Infectious Disease Reporting Information System and the Meteorological Data Sharing Service System, respectively. A quasi-Poisson generalized additive model combined with a distributed lag nonlinear model (DLNM) was constructed to analyze the lag-exposure-response relationship between meteorological factors and the incidence of ST.Results: A total of 18,415 ST cases were reported in the study area. The estimated effects of meteorological factors on ST incidence were nonlinear and exhibited obvious lag characteristics. A J-shaped nonlinear association was identified between weekly mean temperature and ST incidence. A reversed U-shaped nonlinear association was noted between weekly mean relative humidity and ST incidence. The risk of ST incidence increased when the temperature ranged from 24°C to 28°C, the relative humidity was between 78% and 82%, or the precipitation was between 50 mm and 150 mm, using the medians as references. For high temperatures (75th percentile of temperature), the highest relative risk (RR) was 1.18 (95% CI: 1.10–1.27), with a lag effect that lasted 5 weeks. High relative humidity (75th percentile of relative humidity) and high precipitation (75th percentile of precipitation) could also increase the risk of ST.Conclusion: This study demonstrated the nonlinear relationship and the significant positive lag effects of temperature, relative humidity, and precipitation on the incidence of ST. Between particular thresholds, temperature, humidity, and levels of precipitation increased the risk of ST. These findings suggest that relevant government departments should address climate change and develop a meteorological conditions-depend strategy for ST prevention and control.

Climate Change and Cascading Risks from Infectious Disease.

Climate change is adversely affecting the burden of infectious disease throughout the world, which is a health security threat. Climate-sensitive infectious disease includes vector-borne diseases such as malaria, whose transmission potential is expected to increase because of enhanced climatic suitability for the mosquito vector in Asia, sub-Saharan Africa, and South America. Climatic suitability for the mosquitoes that can carry dengue, Zika, and chikungunya is also likely to increase, facilitating further increases in the geographic range and longer transmission seasons, and raising concern for expansion of these diseases into temperate zones, particularly under higher greenhouse gas emission scenarios. Early spring temperatures in 2018 seem to have contributed to the early onset and extensive West Nile virus outbreak in Europe, a pathogen expected to expand further beyond its current distribution, due to a warming climate. As for tick-borne diseases, climate change is projected to continue to contribute to the spread of Lyme disease and tick-borne encephalitis, particularly in North America and Europe. Schistosomiasis is a water-borne disease and public health concern in Africa, Latin America, the Middle East, and Southeast Asia; climate change is anticipated to change its distribution, with both expansions and contractions expected. Other water-borne diseases that cause diarrheal diseases have declined significantly over the last decades owing to socioeconomic development and public health measures but changes in climate can reverse some of these positive developments. Weather and climate events, population movement, land use changes, urbanization, global trade, and other drivers can catalyze a succession of secondary events that can lead to a range of health impacts, including infectious disease outbreaks. These cascading risk pathways of causally connected events can result in large-scale outbreaks and affect society at large. We review climatic and other cascading drivers of infectious disease with projections under different climate change scenarios. Supplementary file1 (MP4 328467 KB)Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-022-00647-3.

Earth System's Gatekeeping of "One Health" Approach to Manage Climate-Sensitive Infectious Diseases.

Global response to climate‐sensitive infectious diseases has been uncertain and slow. The understanding of the underlying vulnerabilities which forms part of changes created by forces within the Earth system has never before been critical until the coronavirus disease 2019, “COVID‐19” pandemic with the initial developmental phase linked to weather elements and climate change. Hence, the heightened interest in climate‐sensitive infectious diseases and GeoHealth, evident in the renewed calls for “One Health” approach to disease management. “One Health” explains the commonality of human and animal medicine, and links to the bio‐geophysical environment, yet are at crossroads with how forces within the Earth system shape etiologies, incidences, and transmission dynamics of infectious diseases. Hence, the paper explores how these forces, which are multistage and driven by climate change impacts on ecosystems affect emerging infectious diseases, leading to the question “what drive the drivers of diseases?” Three questions that challenge broad theories of Earth system science on boundaries and connectivity emerged to guide study designs to further interrogating disease surveillance and health early warning systems. This is because, climate change (a) drives prevailing biological health hazards as part of forces within the Earth system, (b) shifts disease control services of ecosystems and functioning to effectively regulate disease incidence, and (c) modifies pathogen—species hosts relationships. Hence, the need to rethink pluralistic concepts of climate‐sensitive diseases in their infection and management from a GeoHealth perspective, which “One Health” potentially conveys, and to also maintain ecosystem health.

El Niño Southern Oscillation, monsoon anomaly, and childhood diarrheal disease morbidity in Nepal.

Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002-2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16-1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19-1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using Demographic and Health Survey data

Precipitation variability is a potentially important driver of infectious diseases that are leading causes of child morbidity and mortality worldwide. Disentangling the links between precipitation variability and disease risk is crucial in a changing climate. We aimed to investigate the links between precipitation variability and reported symptoms of infectious disease (cough, fever, and diarrhoea) in children younger than 5 years. We used nationally representative survey data collected between 2014 and 2019 from Demographic and Health Survey (DHS) surveys for 32 low-income to middle-income countries in combination with high-resolution precipitation data (via the Climate Hazards Group InfraRed Precipitation with Station dataset). We only included DHS data for which interview dates and GPS coordinates (latitude and longitude) of household clusters were available. We used a regression modelling approach to assess the relationship between different precipitation variability measures and infectious disease symptoms (cough, fever, and diarrhoea), and explored the effect modification of different climate zones and disease susceptibility factors. Our global analysis showed that anomalously wet conditions increase the risk of cough, fever, and diarrhoea symptoms in humid, subtropical regions. These health risks also increased in tropical savanna regions as a result of anomalously dry conditions. Our analysis of susceptibility factors suggests that unimproved sanitation and unsafe drinking water sources are exacerbating these effects, particularly for rural populations and in drought-prone areas in tropical savanna. Weather shifts can affect the survival and transmission of pathogens that are particularly harmful to young children. As our findings show, the health burden of climate-sensitive infectious diseases can be substantial and is likely to fall on populations that are already among the most disadvantaged, including households living in remote rural areas and those lacking access to safe water and sanitation infrastructure. University of California, San Diego FY19 Center Launch programme.

A hot topic at the environment–health nexus: investigating the impact of climate change on infectious diseases

Climate change — the ultimate challenge of our timeCOVID-19 pandemic aside, climate change is the ultimate challenge of our time. However, to date, there has been insufficient political thrust to make that much-needed climate action a reality. Climate change and infectious diseasesInfectious diseases represent only one facet of the threats arising from climate change. Direct impacts from climate change include the more frequent occurrence and increased magnitude of extreme weather events, as well as changing temperatures and precipitation patterns. For climate-sensitive infectious diseases, these changes implicate a shift in geographical and temporal distribution, seasonality, and transmission intensity. Sizing up the problemSusceptibility to the deleterious effects of climate change is a net result of the interplay of not only environmental factors, but also human, societal, and economic factors, with social inequalities being a major determinant of vulnerability. The global South is already disproportionately affected by the climate crisis. The financial capacity to pursue adaptation options is also limited and unevenly distributed. ConclusionsClimate change-induced mortality and morbidity from both infectious and non-infectious diseases, among other adverse scenarios, are expected to rise globally in the future. The coming decade will be crucial for using all remaining opportunities to develop and implement adequate mitigation and adaptation strategies.

Health-related vulnerability to climate extremes in homoclimatic zones of Amazonia and Northeast region of Brazil.

Amazonia and the Northeast region of Brazil exhibit the highest levels of climate vulnerability in the country. While Amazonia is characterized by an extremely hot and humid climate and hosts the world largest rainforest, the Northeast is home to sharp climatic contrasts, ranging from rainy areas along the coast to semiarid regions that are often affected by droughts. Both regions are subject to extremely high temperatures and are susceptible to many tropical diseases. This study develops a multidimensional Extreme Climate Vulnerability Index (ECVI) for Brazilian Amazonia and the Northeast region based on the Alkire-Foster method. Vulnerability is defined by three components, encompassing exposure (proxied by seven climate extreme indicators), susceptibility (proxied by sociodemographic indicators), and adaptive capacity (proxied by sanitation conditions, urbanization rate, and healthcare provision). In addition to the estimated vulnerability levels and intensity, we break down the ECVI by indicators, dimensions, and regions, in order to explore how the incidence levels of climate-sensitive infectious and parasitic diseases correlate with regional vulnerability. We use the Grade of Membership method to reclassify the mesoregions into homoclimatic zones based on extreme climatic events, so climate and population/health data can be analyzed at comparable resolutions. We find two homoclimatic zones: Extreme Rain (ER) and Extreme Drought and High Temperature (ED-HT). Vulnerability is higher in the ED-HT areas than in the ER. The contribution of each dimension to overall vulnerability levels varies by homoclimatic zone. In the ER zone, adaptive capacity (39%) prevails as the main driver of vulnerability among the three dimensions, in contrast with the approximately even dimensional contribution in the ED-HT. When we compare areas by disease incidence levels, exposure emerges as the most influential dimension. Our results suggest that climate can exacerbate existing infrastructure deficiencies and socioeconomic conditions that are correlated with tropical disease incidence in impoverished areas.

Linking climate and infectious disease trends in the Northern/Arctic Region

Recognition of climate-sensitive infectious diseases is crucial for mitigating health threats from climate change. Recent studies have reasoned about potential climate sensitivity of diseases in the Northern/Arctic Region, where climate change is particularly pronounced. By linking disease and climate data for this region, we here comprehensively quantify empirical climate-disease relationships. Results show significant relationships of borreliosis, leptospirosis, tick-borne encephalitis (TBE), Puumala virus infection, cryptosporidiosis, and Q fever with climate variables related to temperature and freshwater conditions. These data-driven results are consistent with previous reasoning-based propositions of climate-sensitive infections as increasing threats for humans, with notable exceptions for TBE and leptospirosis. For the latter, the data imply decrease with increasing temperature and precipitation experienced in, and projected for, the Northern/Arctic Region. This study provides significant data-based underpinning for simplified empirical assessments of the risks of several infectious diseases under future climate change.

The ENBEL project: From research findings to policy

BACKGROUND AND AIM: The Horizon 2020 ENBEL project (Enhancing Belmont Research Action to support EU policy making on climate change and health) brings together climate change and health research projects from Belmont Forum, EU’s Horizon2020 and other international and national funding schemes. The aim is to achieve convergence between climate change and health research and policy making, to optimise research outputs across the projects, standardise epidemiological measures and research approaches, where possible, and contribute to policy advice. ENBEL focuses on three major climate change related health hazards: environmental and occupational heat, air pollution (particularly from wildfires) and climate-sensitive infectious diseases, with specific attention to high-risk groups. METHODS: The overall concept of ENBEL is a bottom-up approach to networking and cooperation across often separate worlds of climate and health research communities. We aim to mainstream climate change into health conferences and vice versa to increase understanding, knowledge exchange and collaboration and enable integrated and evidence-based policy advice for mitigating impacts of climate change on human health. The network is synthesizing research evidence on climate change and health links and engaging with policymakers to translate science into policies. We will undertake evidence gap analysis of adaptation policies, strategies and measures to identify evidence gaps in Europe and Africa and produce tailor-made knowledge products. RESULTS:The network is bringing together researchers and experts on climate change and health and contribute to bridge gaps in approaches and methods that can make collaboration difficult, and thereby laying the ground for establishing actionable knowledge on climate change-related health risks. CONCLUSIONS:ENBEL will formalise a strong network of projects and researchers at the forefront of the climate change and health nexus. The synthesis of knowledge from a broad range of scientific institutions will enable decision-makers to make evidence-based decision to alleviate climate change impacts on health. KEYWORDS: Climate, Wildfires, Infectious diseases, International collaboration, Research translation to affect policy and practice

Belmont Forum Climate, Environment and Health Collaborative Research Action: current projects and future perspectives

BACKGROUND AND AIM: The Belmont Forum, a partnership of over 30 funding organizations, international science councils and regional consortia across five continents, is committed to advancing international transdisciplinary research and providing knowledge for understanding, mitigating and adapting to global environmental change. Since its establishment in 2009, the Forum has supported 134 research projects and represented scientists from over 90 countries. METHODS: In 2019, the Belmont Forum launched a Collaborative Research Action (CRA) to strengthen and expand the current scientific understanding of links between climate variability and change, the environment and health impacts. The geographical scope was global and welcomed proposals that considered challenges in low- and middle-income countries. RESULTS:The ‘Climate, Environment and Health’ CRA supports nine transdisciplinary projects that address one of more of the following topics: 1) heat and health, 2) climate-sensitive infectious disease and 3) food systems and nutrition, with the aim to improve the understanding of the complex pathways between climate variability, the environment and health, and to protect and promote human health and well-being in the face of climate challenges. An important research output is to foster the use of scientific information and climate-related decision support tools to better inform planning and enhance resilience. CONCLUSIONS:This talk will introduce the research projects and outline future research perspectives, considering the current gaps in knowledge and research priorities. KEYWORDS: Climate, Environmental epidemiology, Exposures, Policy and practice, Natural disasters, Socio-economic factors

Strategies for reducing the burden of climate-sensitive diarrheal infections on young children

BACKGROUND AND AIM: Climate-sensitive infectious diseases are an issue of growing concern due to global warming and the related increase in extreme climate and weather events. Diarrhea, which is strongly associated with climatic factors, remains among the leading causes of child death globally, disproportionately affecting populations in low- and middle-income countries. METHODS: We use Demographic and Health Survey data for 28 low- to middle-income countries in combination with high resolution climate data to estimate the association between precipitation shocks and symptoms of diarrhea in children under 3. We account for difference in exposure risk by climate zone and explore cost-effective intervention strategies, including immunization and caregiving practices. RESULTS:We find that anomalously dry weather increases the risk of diarrhea symptoms in the tropical savannah regions. In the humid subtropical regions, the same health risk is increased due to anomalously wet weather. Our analysis of effect modifiers reveals that different interventions may be effective in both climate zones. Improved feeding practices are found to significantly reduce children’s susceptibility to diarrheal infections associated with droughts. Basic immunization seems to provide some protection against diarrheal infections following heavy precipitation events. Moreover, we find evidence that the rotavirus vaccine can significantly reduce or even eliminate the risk of diarrhea symptoms associated with both droughts and heavy precipitation events. CONCLUSIONS:We identified areas of intervention that can reduce the burden of climate-sensitive infectious diseases on children, focusing on diarrheal infections. The presented findings call for urgent action to improve child feeding practices and expand access to the rotavirus vaccine in low- and middle-income countries where climate change poses considerable risk to population health. Future research needs to explore other cost-effective interventions that can address the mounting risks to child health posed by climate change. KEYWORDS: precipitation, childhood diarrhea, immunization, child feeding practices