Grantee Research Project Results
2000 Progress Report: Integrated Assessment of the Public Health Effects of Climate Change for the United States
EPA Grant Number: R824995Title: Integrated Assessment of the Public Health Effects of Climate Change for the United States
Investigators: Patz, J. F.
Institution: The Johns Hopkins University
EPA Project Officer: Chung, Serena
Project Period: October 1, 1996 through September 30, 1999
Project Period Covered by this Report: October 1, 1999 through September 30, 2000
Project Amount: $2,700,728
RFA: Global Climate (1996) RFA Text | Recipients Lists
Research Category: Climate Change , Ecological Indicators/Assessment/Restoration
Objective:
The objectives of the research project were to: (1) assess the potential impact of climate change on important regional public health endpoints, including water-borne diseases (Cryptosporidiosis and Cholera) and vector-borne diseases (Hantavirus, Dengue and Lyme disease); and (2) appropriately characterize and communicate this information to support policy development and analysis.
Progress Summary:
The amount of research conducted and published in peer review journals across many fields of health and environmental sciences is evident (see Publications/Presentations below). In each of the projects, key new findings have been made in better understanding the link between climate and human health. These are specific to each disease listed below. Our findings will serve as an excellent foundation for further integration across these public health threats and across climate change assessments from other sectors.
Cryptosporidiosis. We completed the first historical analysis of reported waterborne disease outbreaks (all agents, not just cryptosporidium) across the entire United States since 1948, as potentially related to preceding rainfall. Of the 548 reported outbreaks, 51 percent were preceded by a precipitation event about the 90 percentile and 68 percent above the 80 percentile (p <0.001). Outbreaks due to surface water contamination were associated with extreme precipitation during the month of the outbreak, while outbreaks due to groundwater contamination had the strongest association with extreme precipitation for 2 months prior to the outbreak (Curriero, et al., 2001; Rose, et al., 2000). More policy relevant analysis included other important risk factors; in our Lancaster study area, 64 percent of livestock operations located within the 100-year flood plain tested positive for Cryptosporidium parvum oocysts in manure samples (Graczyk, et al., 2000). Work is still ongoing to establish a statistical relationship between C. parvum oocyst density and weather and watershed characteristics in the Susquehanna River basin.
Intermediate steps in this integrated assessment have led to major advances in hydrological runoff modeling achieved by this research. Papers by Brutsaert and Parlange, Cahill, et al., Gibson and Najjar, Najjar, and Szilagyi, et al. (listed and annotated in the Publications section below) add much to improving hydrologic modeling relevant to microbial contamination of drinking water sources. Also, economic analysis for baseline costs of cryptosporidiosis cases was completed (Kocagil, et al., 1998) and strategies provided for improving risk communication to stakeholders (Fisher, 1998).
Cholera. In the Chesapeake Bay, the presence of V. cholerae bacteria was significantly correlated with temperature and total bacterial counts, with the maximum detected in samples collected from the Baltimore Harbor. These results suggest that temperature is a leading factor in determining the population of V. cholerae in the Chesapeake Bay (Jiang, et al., 2000a). Fresh water sites had fewer isolates compared to the brackish water sites, suggesting that salinity also alters the dynamics of the V. cholerae population. Because no virulence factors were found in the isolated bacteria, this population presents low public health risk under current conditions in the bay. In our Mexico study site, sea surface temperature and precipitation data obtained from satellite sensors were used along with epidemiological data from the Ministry of Health. Temperature was always an important parameter associated with increased cholera cases.
Several key findings emerged from our Peruvian study site. Warm temperatures from El Ni?o during 1997/98 led to a doubling of childhood hospital admissions for diarrheal disease (Checkley, et al., 2000). Also, from sewage sampling, a threshold ambient temperature of 19.3?C was predictive of occurrence of V cholera O1 in sewage and subsequent cases of cholera in Lima (Speelmon, et al., 2000). Our epidemiological study of the 1991 massive cholera epidemic (Seas, et al., 2000) revealed 11 initial cases of cholera occurring at nearly the same time, but spread geographically (>1,000 Km) in location. With no cases identified in the previous year, these results suggest regional environmental or climatic conditions as among key determining factors in the 1991 epidemic.
Environmental analysis comprised of seawater and plankton samples from 500 meters offshore at four different marine stations along the coast of Trujillo, Lima and Arequipa, Peru. During August 1997 to September 1999, V. cholerae O1 was cultured from 5 percent of the samples and detected in a "viable but non-culturable" (VBNC) state in 16 percent. V. cholerae O139 was detected in a VBNC state in 27 percent of the samples, but on further analysis, these strains were found to belong to the O22 serogroup. However, the presumptive presence of the V. cholerae O22, ancestor of the dangerous O139 serogroup, suggests the possibility that a new pathogenic serogroup may be emerging.
Hantavirus. We have found that high risk areas for Hantavirus Pulmonary Syndrome can be predicted based on satellite generated risk maps of climate-dependent land cover over 6 months in advance (Glass, et al., 2000). Predicted risk paralleled vegetative growth, supporting the hypothesis that heavy rainfall from El Ni?o in 1992 was associated with higher rodent populations that triggered the Hantavirus outbreak in 1993. Landsat satellite remote sensing images from 1995, a non El Ni?o "control" year, showed low risk in the region, whereas the images from the 1998 strong El Ni?o again showed high risk areas. Trapping mice in the field (collectors blinded to risk category), validated these satellite generated risk maps with mouse populations directly related to risk level, with a correlation factor over 0.90 (Glass, et al., unpublished data). Risk classification also was consistent with the numbers of HPS cases in 1994, 1996, 1998, and 1999. Our methods, developed in partnership with CDC and the Indian Health Service are already being implemented for disease prevention in the southwest by the U.S. Department of Health and Human Services (DHHS).
Dengue Fever. The dengue fever transmission model (DENSiM) was improved to better account for water container temperature and water height, important to larval mosquito development rates (Chen, et al., 1998). Dengue simulation model runs have been completed for Brownsville, Texas using the Hadley Center HADCM2 and VEMAP interpolated climate projections for the years 2030, 2060 and 2100. Dengue transmission simulation shows very high sensitivity to relative humidity and temperature (e.g., excessive dryness limits mosquito survival). Also, while warm temperatures generally increase transmission dynamics, the extreme high temperatures predicted by HADCM2 for Texas diminish the risk of dengue in this location. Dengue is currently more relevant to our other study site, the U.S. territory of Puerto Rico, where we have completed all field data collection, and are currently completing model simulation runs. It is expected that these results will differ from those of Texas due to humidity differences. These findings that better characterize the relationship between climate and risk of dengue transmission have international public health application, and can be used to optimize environmental intervention strategies to bring disease risk below threshold levels that are determined by climatic conditions.
Lyme Disease. In the mid-Atlantic region, tick survey data was analyzed for 15 locales. Multi-Resolution Land Characteristics (MRLC) data provided landcover characteristics based on satellite imagery and, along with 10-year retrospective climate values (1984-93) were entered into the USDA Lyme simulation model (LYMSiM) to determine baseline Lyme disease risk via the vertebrate hosts involved in maintaining its life cycle: white-tailed deer and white-footed mice. With the exception of a few sparsely forested sites, deer carriage of the Ixodes tick approached 100 percent and mouse infection by the Lyme spirochete varied between 60-80 percent for the baseline model runs. Under climate change scenarios from GCMs generated from GFDL and Max Plank transient 2 (2020) and transient 3 (2050), the risk of infection increases for mice in most locales, and tick carriage remains high for deer. Transient 2 models yielded slightly higher infection rates than transient 3 models. Plans are already underway to apply this simulation modeling to another EPA project in the upper Midwest, where Lyme disease also is endemic.
Future Activities:
Now that the grant period has ended, the first priority is completion of any unfinished analysis and manuscripts. Analysis is still underway in the integrated assessment of waterborne cryptosporidiosis. We are now linking the completed components of historical outbreak analysis, hydrological run-off modeling, and landuse practices in Pennsylvania to arrive at a more predictive model that water managers can use. We also are completing dengue fever simulation analysis for Puerto Rico, where field data have already been collected and computer simulation runs are still planned to complete analysis. Finally, in addition to peer reviewed papers from these activities, several other papers are in progress including: Lyme disease simulation analysis, Vibrio cholera in the Chesapeake Bay, and human case data analysis for hantavirus. Further integration across sectors is desirable (e.g., implications of salinity change in the Chesapeake Bay and subsequent risk of cholera; however, this cannot be assumed as a "wrapping up" activity, but would be an important follow-up study).
Journal Articles on this Report : 18 Displayed | Download in RIS Format
Other project views: | All 129 publications | 47 publications in selected types | All 45 journal articles |
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Benson K, Kocagil P, Shortle J. Climate change and health in the Mid-Atlantic Region. Climate Research 2000;14(3):245-253. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit |
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Checkley W, Epstein LD, Gilman RH, Figueroa D, Cama RI, Patz JA, Black RE. Effects of El Niño and ambient temperature on hospital admissions for diarrhoeal diseases in Peruvian children. Lancet 2000;355(9202):442-450. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit Exit |
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Curriero FC, Lele S. A composite likelihood approach to semivariogram estimation. Journal of Agricultural, Biological, and Environmental Statistics 1999;4(1):9-28. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit |
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Curriero FC, Patz JA, Rose JB, Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. American Journal of Public Health 2001;91(8):1194-1199. |
R824995 (2000) R824995 (Final) |
Exit Exit Exit |
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Curriero FC, Patz JA, Rose JB, Lele S. The association between extreme precipitation and waterborne disease outbreaks in the United States, 1948-1994. American Journal of Public Health 2001;91(8):1194-1199. |
R824995 (1999) R824995 (2000) |
Exit Exit |
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Easterling DR. Development of regional climate scenarios using a downscaling approach. Climatic Change 1999;41(3-4):615-634. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit |
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Gibson JR, Najjar RG. The response of Chesapeake Bay salinity to climate-induced changes in streamflow. Limnology and Oceanography 2000;45(8):1764-1772. |
R824995 (1999) R824995 (2000) |
Exit Exit |
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Jiang SC, Louis V, Choopun N, Sharma A, Huq A, Colwell RR. Genetic diversity of Vibrio cholerae in Chesapeake Bay determined by amplified fragment length polymorphism fingerprinting. Applied and Environmental Microbiology 2000;66(1):140-147. |
R824995 (1999) R824995 (2000) R824995 (Final) |
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Jiang SC, Matte M, Matte G, Huq A, Colwell RR. Genetic diversity of clinical and environmental isolates of Vibrio cholerae determined by amplified fragment length polymorphism fingerprinting. Applied and Environmental Microbiology 2000;66(1):148-153. |
R824995 (1999) R824995 (2000) R824995 (Final) |
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Kocagil P, Demarteau N, Fisher A, Shortle JS. The value of preventing Crytosporidium contamination. Risk–Health, Safety & Environment 1998;9(2):175-196. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit |
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Lobitz B, Beck L, Huq A, Wood B, Fuchs G, Faruque ASG, Colwell R. Climate and infectious disease: use of remote sensing for detection of Vibrio cholerae by indirect measurement. Proceedings of the National Academy of Sciences of the United States of America 2000;97(4):1438-1443. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit Exit |
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Najjar RG. The water balance of the Susquehanna River Basin and its response to climate change. Journal of Hydrology 1999;219(1-2):7-19. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit Exit |
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Patz JA, Martens WJM, Focks DA, Jetten TH. Dengue fever epidemic potential as projected by general circulation models of global climate change. Environmental Health Perspectives 1998;106(3):147-153. |
R824995 (1999) R824995 (2000) |
Exit |
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Rose JB, Daeschner S, Easterling DR, Curriero FC, Lele S, Patz JA. Climate and waterborne disease outbreaks. Journal of the American Water Works Association 2000;92(9):77-87. |
R824995 (2000) R824995 (Final) |
Exit Exit |
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Seas C, Miranda J, Gil AI, Leon-Barua R, Patz J, Huq A, Colwell RR, Sack RB. New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience. American Journal of Tropical Medicine and Hygiene 2000;62(4):513-517. |
R824995 (1999) R824995 (2000) R824995 (Final) |
Exit Exit |
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Speelmon EC, Checkley W, Gilman RH, Patz J, Calderon M, Manga S. Cholera incidence and El Niño-related higher ambient temperature. JAMA: Journal of the American Medical Association 2000;283(23):3072-3074. |
R824995 (2000) R824995 (Final) |
Exit |
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Szilagyi J, Parlange MB. Baseflow separation based on analytical solutions of the Boussinesq equation. Journal of Hydrology 1998;204(1-4):251-260. |
R824995 (2000) R824995 (Final) |
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Szilagyi J, Parlange MB. A geomorphology-based semi-distributed watershed model. Advances in Water Resources 1999;23(2):177-187. |
R824995 (1999) R824995 (2000) |
Exit Exit Exit |
Supplemental Keywords:
global climate, human health, health effect, regionalization, habitat, integrated assessment, hydrology, public health, climate model, remote sensing, estuary, public policy, decision making, cost benefit, willingness-to-pay., RFA, Scientific Discipline, Air, Water, Hydrology, Health Risk Assessment, climate change, Atmospheric Sciences, Ecological Risk Assessment, Drinking Water, remote sensing, integrated assessments, Cholera, public health endpoints, microbial risk assessment, environmental monitoring, policy making, water-borne disease, hydrologic models, habitat diversity, climate variability, climatic models, public health effectsRelevant Websites:
http://www.jhu.edu/~climate
http://www.jhsph.edu/globalchange
The dedicated project site (http://www.jhu.edu/~climate ) aims to appropriately characterize and communicate current research in an accessible format. The site has received several design awards and has been featured by search engines and similar sites. The Web site was submitted to multiple search engines and linked to key programs and institutions in the sciences and academia.
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Progress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.