The Impact of Heat Islands on Mortality in Paris during the August 2003 Heat Wave

Background: Heat waves have a drastic impact on urban populations, which could increase with climate change

A Systematic Review of the Time Series Studies Addressing the Endemic Risk of Acute Gastroenteritis According to Drinking Water Operation Conditions in Urban Areas of Developed Countries

Time series studies (TSS) can be viewed as an inexpensive way to tackle the non-epidemic health risk from fecal pathogens in tap water in urban areas. Following the PRISMA recommendations, I reviewed TSS addressing the endemic risk of acute gastroenteritis risk according to drinking water operation conditions in urban areas of developed countries. Eighteen studies were included, covering 17 urban sites (seven in North-America and 10 in Europe) with study populations ranging from 50,000 to 9 million people. Most studies used general practitioner consultations or visits to hospitals for acute gastroenteritis (AGE) as health outcomes. In 11 of the 17 sites, a significant and plausible association was found between turbidity (or particle count) in finished water and the AGE indicator. When provided and significant, the interquartile excess of relative risk estimates ranged from 3–13%. When examined, water temperature, river flow, and produced flow were strongly associated with the AGE indicator. The potential of TSS for the study of the health risk from fecal pathogens in tap water is limited by the lack of specificity of turbidity and its site-sensitive value as an exposure proxy. Nevertheless, at the DWS level, TSS could help water operators to identify operational conditions most at risk, almost if considering other water operation indicators, in addition to turbidity, as possible relevant proxies for exposure

Surveillance syndromique des gastroentérites aiguës : une opportunité pour la prévention du risque infectieux attribuable à l'ingestion d'eau du robinet

For more than a century, the provision of safe drinking water and the prevention of waterborne infectious risks essentially rely on water microbiology. However the water microbiological monitoring provides limited information in case of chlorinated water. As well, neither the water microbiological monitoring nor the reporting of disease case clusters by field actors enables a good coverage of waterborne outbreaks. Meanwhile, syndromic surveillance systems have been built up in connection with the development in the 2000s of databases devoted to health care management. This thesis dissertation shows the relevance of the surveillance of the acute gastroenteritis (AGE) incidence based on prescribed drug reimbursement data from the French social security, for the study and prevention of the waterborne infectious risk of fecal origin. It details the method used for the design of the indicator of AGE incidence, and its application to the retrospective detection of waterborne AGE outbreaks and to the study of the infectious risk due to large distribution units (time series studies). However the potential of a surveillance frame, including syndromic data and various data resources on exposure, exceeds the scope of these two applications. This frame should help identify, characterize and monitor tap water related risk factors in the context of global change. In the other hand, the erosion of the sensitivity of the AGE indicator, which could result from changes in the reimbursement rates of health cares, may challenges the follow-up of the waterborne AGE impact over time.La qualification sanitaire de l'eau distribuée et la prévention des risques infectieux s'appuie depuis plus d'un siècle sur la microbiologie de l'eau. Le contrôle microbiologique de l'eau distribuée fournit cependant des informations limitées dans le cas d'eaux traitées par le chlore, et pour la détection des épidémies. La surveillance syndromique s'est par ailleurs développée avec l'apparition, dans les années 2000, de bases de données médico-tarifaires. Cette thèse démontre, dans le cas de la France, la pertinence de la surveillance des gastroentérites aiguës (GEA) basée sur l'exploitation des données de remboursement des médicaments prescrits pour l'étude et la prévention du risque infectieux d'origine fécale porté par l'eau du robinet. Elle détaille la méthode de construction de l'indicateur d'incidence des GEA et son application à la détection rétrospective des épidémies d'origine hydrique et à l'étude des risques attribuables aux grandes unités de distribution (études de séries temporelles). Le potentiel d'une plate-forme de surveillance constituée par les données syndromiques et diverses sources de données sur l'exposition dépasse cependant le cadre de ces deux applications. Cette plateforme devrait aider de façon extensive à répondre au besoin d'identification, de caractérisation et de suivi des facteurs de risque dans le contexte du changement global. Le risque d'érosion de l'indicateur d'incidence des GEA, dû à l'évolution possible du niveau de prise en charge des soins de santé, limite par contre son usage pour un suivi précis à long terme de l'impact des GEA d'origine hydrique

Relevance of Green, Shaded Environments in the Prevention of Adverse Effects on Health from Heat and Air Pollution in Urban Areas

S’adapter à un monde plus chaud est devenu une priorité, particulièrement dans les villes qui combinent une population importante et des conditions d’exposition aggravées par l’îlot de chaleur urbain. Ces villes sont également soucieuses d’améliorer la qualité de l’air. Cet article synthétise et discute les principales connaissances sur l’intérêt de la végétalisation en ville comme outil de prévention des impacts sanitaires de la chaleur et sur les bénéfices potentiels associés, notamment sur la qualité de l’air. La littérature montre que la végétation peut créer des îlots de fraîcheur en ville et réduire localement la température et les concentrations de certains polluants de l’air. Peu d’études épidémiologiques s’intéressent aux répercussions sanitaires possibles, mais elles indiquent un effet protecteur probable de la végétation sur la mortalité et le recours aux soins pendant les vagues de chaleur. Les espaces verts peuvent également contribuer à restaurer et à construire les capacités de résilience des personnes, et à réduire les impacts sanitaires de la chaleur et de la pollution. Les connaissances actuelles permettent de développer des stratégies de végétalisation adaptées pour optimiser les bénéfices en termes de réduction des îlots de chaleur urbains, d’amélioration du confort thermique en hiver, et de qualité de l’air. Les bénéfices sanitaires associés sont potentiellement importants. Seule une partie peut en être quantifiée par les outils actuels d’évaluation des impacts sanitaires.Adaptation to a warmer world is a priority, especially in large urban centres where the population is concen-trated and heat-related risks are compounded by the urban heat island. These cities are also interested in improving their air quality. This paper summarizes and discusses current knowledge on how green spaces may be used to reduce heat-related health impacts and their potential co-benefits, especially for air quality. The literature shows that vegetation contributes to the creation of cool islands in cities, and to locally decreasing temperature and air pollutant concentrations. Few epidemiological studies have investigated the associated health impacts, but what is available indicates that vegetation is probably a protective factor that reduces mortality and morbidity during heat waves. Green spaces can also contribute to restoring and building resi-lience capabilities, thus reducing the health impacts of heat and pollution. Current knowledge provides the material to develop green space strategies adapted to optimize benefits in terms of urban heat island, ther-mal comfort and air quality, generating potentially large health benefits. Only a part of those benefits can be quantified with current health impact assessment tools

Quelques clarifications sur l’évaluation monétaire des effets sanitaires relatifs à la pollution atmosphérique

ADInternational audienceL'évaluation des impacts sanitaires et économiques de la pollution atmosphérique constitue un enjeu majeur pour la population et pour les décideurs. Impliqués de longue date dans ce domaine, nous ne pouvons que nous féliciter de la parution de l'article de Rafenberg et al. (2015). II contribue en effet à la prise en compte de la morbidité chronique dans l'évaluation économique des effets de la pollution atmosphérique, une voie que le projet Aphekom avait également exploré par d'autres approches. Il nous a pourtant semblé nécessaire de clarifier un certain nombre de points relatifs à cette publication. Nous commencerons par évoquer les questions de méthodes. Nous aborderons ensuite la présentation et l'interprétation de certaines études discutées dans Rafenberg et al. (2015), car la présence d'erreurs relativise la portée de certains points de la discussion de cet article

Health risks associated with drinking water in a context of climate change in France: a review of surveillance requirements

International audienceIt is widely recognized that climate change will impact upon human health in a variety of ways. Assessing these impacts and identifying adaptation opportunities requires appropriate monitoring. To identify the need for reinforced surveillance in metropolitan France, we defined a conceptual framework of how climate change could impact upon health risks in relation to drinking water. Three types of climate change-related impacts were identified: changes in raw water quality, changes in water treatment processes and changes in human determinants of exposure in relation to consumers' behaviour. This framework was applied to existing risks and exposure situations in France. An increase in the health burden attributable to drinking water intake is expected due to increased exposure to faecal pathogens, disinfection by-products and cyanobacteria as a result of a combination of natural, technical and human factors. Current sources of health and water data should satisfy surveillance requirements. However, we believe that the creation of a sustainable database comprising behavioural and water management data would be valuable in following and understanding emerging trends

An Assessment of Current and Past Concentrations of Trihalomethanes in Drinking Water throughout France

In France, 95% of people are supplied with chlorinated tap water. Due to the presence of natural organic matter that reacts with chlorine, the concentrations of chlorination by-products (CBPs) are much higher in chlorinated water produced from surface water than from groundwater. Surface water supplies 33% of the French population. Until the 1980s, almost all surface water utilities pre-chlorinated water at the intake. Pre-chlorination was then gradually banned from 1980 to 2000. Trihalomethanes (THMs) are the only regulated CBP in France. Since 2003, THMs have been monitored at the outlet of all utilities. This study assessed current (2005–2011) and past (1960–2000) exposure of the French population to THMs. We developed an original method to model THM concentrations between 1960 and 2000 according to current concentrations of THMs, concentration of total organic carbon in raw and finished water, and the evolution of water treatments from 1960 onward. Current and past mean exposure of the French population to THMs was estimated at 11.7 µg·L−1 and 17.3 µg·L−1, respectively. In the past, approximately 10% of the French population was exposed to concentrations >50 µg·L−1 vs. 1% currently. Large variations in exposure were observed among France’s 100 administrative districts, mainly depending on the water origin (i.e., surface vs. ground), ranging between 0.2 and 122.1 µg·L−1 versus between 1.8 and 38.6 µg·L−1 currently

Using animal performance data to evidence the under-reporting of case herds during an epizootic: application to an outbreak of bluetongue in cattle

Following the emergence of the Bluetongue virus serotype 8 (BTV-8) in France in 2006, a surveillance system (both passive and active) was implemented to detect and follow precociously the progression of the epizootic wave. This system did not allow a precise estimation of the extent of the epizootic. Infection by BTV-8 is associated with a decrease of fertility. The objective of this study was to evaluate whether a decrease in fertility can be used to evidence the under-reporting of cases during an epizootic and to quantify to what extent non-reported cases contribute to the total burden of the epizootic. The cow fertility in herds in the outbreak area (reported or not) was monitored around the date of clinical signs. A geostatistical interpolation method was used to estimate a date of clinical signs for non-reported herds. This interpolation was based on the spatiotemporal dynamic of confirmed case herds reported in 2007. Decreases in fertility were evidenced for both types of herds around the date of clinical signs. In non-reported herds, the decrease fertility was large (60% of the effect in reported herds), suggesting that some of these herds have been infected by the virus during 2007. Production losses in non-reported infected herds could thus contribute to an important part of the total burden of the epizootic. Overall, results indicate that performance data can be used to evidence the under-reporting during an epizootic. This approach could be generalized to pathogens that affect cattle's performance, including zoonotic agents such as Coxiella burnetii or Rift Valley fever virus

Using the reproductive performance data to evaluate the under-reporting of Bluetongue virus serotype 8 (BTV-8) case herds during the 2007 epizootic in France

International audienc