An approach for assessing human health vulnerability and public health interventions to adapt to climate change.

Assessments of the potential human health impacts of climate change are needed to inform the development of adaptation strategies, policies, and measures to lessen projected adverse impacts. We developed methods for country-level assessments to help policy makers make evidence-based decisions to increase resilience to current and future climates, and to provide information for national communications to the United Nations Framework Convention on Climate Change. The steps in an assessment should include the following: a) determine the scope of the assessment; b) describe the current distribution and burden of climate-sensitive health determinants and outcomes; c) identify and describe current strategies, policies, and measures designed to reduce the burden of climate-sensitive health determinants and outcomes; d) review the health implications of the potential impacts of climate variability and change in other sectors; e) estimate the future potential health impacts using scenarios of future changes in climate, socioeconomic, and other factors; f) synthesize the results; and g) identify additional adaptation policies and measures to reduce potential negative health impacts. Key issues for ensuring that an assessment is informative, timely, and useful include stakeholder involvement, an adequate management structure, and a communication strategy

Climate Change, Crop Yields, and Undernutrition: Development of a Model to Quantify the Impact of Climate Scenarios on Child Undernutrition

Background: Global climate change is anticipated to reduce future cereal yields and threaten food security, thus potentially increasing the risk of undernutrition. The causation of undernutrition is complex, and there is a need to develop models that better quantify the potential impacts of climate change on population health

UK Climate Change Risk Assessment 2017: Evidence Report. Chapter 5: People & the built environment

Increasing temperatures, rising sea-levels and modified rainfall patterns will change the climate-related risks to people and the built environment. Climate change is expected to increase the frequency, severity and extent of flooding. According to research conducted to support the CCRA, at present an estimated 1.8 million people are living in areas of the UK at significant risk of river, surface water or coastal flooding. The population living in such areas is projected to rise to 2.6 million by the 2050s under a 2°C scenario and 3.3 million under a 4°C scenario, assuming low population growth and a continuation of current levels of adaptation. Analysis conducted for the CCRA suggests that 0.5 to 1 metre of sea level rise could make some 200km of coastal flood defences in England highly vulnerable to failure in storm conditions. Sea level rise and increased wave action will make it increasingly difficult and costly to maintain current sea defence lines in some areas. The number of heat-related deaths in the UK are projected to increase by around 250% by the 2050s (median estimate), due to climate change, population growth and ageing, from a current annual baseline of around 2,000 heat-related deaths per year. There are also potential opportunities associated with higher temperatures. For example, outdoor activities may become more attractive, with perhaps an increase in active travel such as cycling and walking. Very little quantitative evidence exists that considers these benefits. Cold is currently a significant public health problem, with between 35,800 and 49,700 cold-related deaths per year on average in the UK. Climate change is projected to reduce the health risks from cold, but the number of cold-related deaths is projected to decline only slightly due to the effects of a growing, ageing population increasing the number of vulnerable people at risk. Health services will be vulnerable to an increase in the frequency and intensity of extreme weather events. The capacity of the system to cope with shocks is unknown but could decrease given pressures on the health service and local authorities. Higher temperatures in the future may lead to the expansion of insect vectors for certain diseases. For example, Culex modestus has recently been found in south-east England and is a vector for West Nile virus. Higher temperatures in the future will also increase the suitability of the UK’s climate for invasive mosquito species. The risk of dengue and the Chikungunya virus remains low in the near term but may increase under a 4C scenario. The risk of malaria in the UK remains low

The Immune Response to Herpes Simplex Virus Type 1 Infection in Susceptible Mice is a Major Cause of CNS Pathology Resulting in Fatal Encephalitis

This study was undertaken to investigate possible immune mechanisms in fatal HSV-1 encephalitis (HSE) after HSV-1 corneal inoculation. Susceptible 129S6 (129) but not resistant C57BL/6 (B6) mice developed intense focal inflammatory brainstem lesions of primarily F4/80+ macrophages and Gr-1+ neutrophils detectable by MRI as early as day 6 post infection (PI). Depletion of macrophages and neutrophils significantly enhanced survival of infected 129 mice. Immunodeficient B6 (IL-7R-/-Kitw41/w41) mice lacking adaptive cells (B6-E mice) transplanted with 129 bone marrow showed significantly accelerated fatal HSE compared to B6-E mice transplanted with B6 marrow or control non-transplanted B6-E mice. In contrast, there was no difference in ocular viral shedding in B6-E mice transplanted with 129 bone marrow or B6 bone marrow. Acyclovir treatment of 129 mice beginning day 4 PI (24 h after HSV-1 first reaches the brain stem) reduced nervous system viral titers to undetectable levels but did not alter brainstem inflammation or mortality. We conclude that fatal HSE in 129 mice results from widespread damage in the brainstem caused by destructive inflammatory responses initiated early in infection by massive infiltration of innate cells

Decrease in water clarity of the southern and central North Sea during the 20th century

Light in the marine environment is a key environmental variable coupling physics to marine biogeochemistry and ecology. Weak light penetration reduces light available for photosynthesis, changing energy fluxes through the marine food web. Based on published and unpublished data, this study shows that the central and southern North Sea has become significantly less clear over the second half of the 20th century. In particular, in the different regions and seasons investigated, the average Secchi depth pre-1950 decreased between 25% and 75% compared to the average Secchi depth post-1950. Consequently, in summer pre-1950, most (74%) of the sea floor in the permanently mixed area off East Anglia was within the photic zone. For the last 25+ years, changes in water clarity were more likely driven by an increase in the concentration of suspended sediments, rather than phytoplankton. We suggest that a combination of causes have contributed to this increase in suspended sediments such as changes in sea-bed communities and in weather patterns, decreased sink of sediments in estuaries, and increased coastal erosion. A predicted future increase in storminess (Beniston et al., 2007; Kovats et al., 2014) could enhance the concentration of suspended sediments in the water column and consequently lead to a further decrease in clarity, with potential impacts on phytoplankton production, CO2 fluxes, and fishery production

Using infectious intestinal disease surveillance data to explore illness aetiology; a cryptosporidiosis case study.

Infectious intestinal disease (IID) surveillance data are an under-utilised information source on illness geography. This paper uses a case study of cryptosporidiosis in England and Wales to demonstrate how these data can be converted into area-based rates and the factors underlying illness geography investigated. Ascertainment bias is common in surveillance datasets, and we develop techniques to investigate and control this. Rural areas, locations with many livestock and localities with poor water treatment had elevated levels of cryptosporidiosis. These findings accord with previous research validating the techniques developed. Their use in future studies investigating IID geography is therefore recommended

Modelling the influences of climate change-associated sea-level rise and socioeconomic development on future storm surge mortality

Climate change is expected to affect health through changes in exposure to weather disasters. Vulnerability to coastal flooding has decreased in recent decades but remains disproportionately high in low-income countries. We developed a new statistical model for estimating future storm surge-attributable mortality. The model accounts for sea-level rise and socioeconomic change, and allows for an initial increase in risk as low-income countries develop. We used observed disaster mortality data to fit the model, splitting the dataset to allow the use of a longer time-series of high intensity, high mortality but infrequent events. The model could not be validated due to a lack of data. However, model fit suggests it may make reasonable estimates of log mortality risk but that mortality estimates are unreliable. We made future projections with and without climate change (A1B) and sea-based adaptation, but given the lack of model validation we interpret the results qualitatively. In low-income countries, risk initially increases with development up to mid-century before decreasing. If implemented, sea-based adaptation reduces climate-associated mortality in some regions, but in others mortality remains high. These patterns reinforce the importance of implementing disaster risk reduction strategies now. Further, while average mortality changes discontinuously over time, vulnerability and risk are evolving conditions of everyday life shaped by socioeconomic processes. Given this, and the apparent importance of socioeconomic factors that condition risk in our projections, we suggest future models should focus on estimating risk rather than mortality. This would strengthen the knowledge base for averting future storm surge-attributable health impacts

Effect of night-time temperatures on cause and age-specific mortality in London.

BACKGROUND: High ambient temperatures are associated with an acute increase in mortality risk. Although heat exposure during the night is anecdotally cited as being important, this has not been rigorously demonstrated in the epidemiological literature. METHODS: We quantified the contribution of nighttime temperatures using time-series quasi-Poisson regression on cause and age-specific daily mortality in London between 1993 and 2015. Daytime and nighttime exposures were characterized by average temperatures between 9 am and 9 pm and between 4 am and 8 am, respectively, lagged by 7 days. We also examined the differential impacts of hot and cool nights preceded by very hot days. All models were adjusted for air quality, season, and day of the week. Nighttime models were additionally adjusted for daytime exposure. RESULTS: Effects from nighttime exposure persisted after adjusting for daytime exposure. This was highest for stroke, RR (relative risk) = 1.65 (95% confidence interval (CI) = 1.27 to 2.14) estimated by comparing mortality risk at the 80th and 99th temperature percentiles. Compared to daytime exposure, nighttime exposure had a higher mortality risk on chronic ischemic and stroke and in the younger age groups. Respiratory mortality was most sensitive to daytime temperatures. Hot days followed by hot nights had a greater mortality risk than hot days followed by cool nights. CONCLUSIONS: Nighttime exposures make an additional important contribution to heat-related mortality. This impact was highest on warm nights that were preceded by a hot day, which justifies the alert criteria in heat-health warning system that is based on hot days followed by hot nights. The highest mortality risk was from stroke; targeted interventions would benefit patients most susceptible to stroke

El Niño and health

El Niño Southern Oscillation (ENSO) is a climate event that originates in the Pacific Ocean but has wide-ranging consequences for weather around the world, and is especially associated with droughts and floods. The irregular occurrence of El Niño and La Niña events has implications for public health. On a global scale, the human effect of natural disasters increases during El Niño. The effect of ENSO on cholera risk in Bangladesh, and malaria epidemics in parts of South Asia and South America has been well established. The strongest evidence for an association between ENSO and disease is provided by time-series analysis with data series that include more than one event. Evidence for ENSO's effect on other mosquito-borne and rodent-borne diseases is weaker than that for malaria and cholera. Health planners are used to dealing with spatial risk concepts but have little experience with temporal risk management. ENSO and seasonal climate forecasts might offer the opportunity to target scarce resources for epidemic control and disaster preparedness