Pathogen-Specific Impacts of the 2011–2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

Josh Colston, Maribel Paredes Olortegui, Benjamin Zaitchik, Pablo Peñataro Yori, Gagandeep Kang, Tahmeed Ahmed, Pascal Bessong, Esto Mduma, Zulfiqar Bhutta, Prakash Sunder Shrestha, Aldo Lima and Margaret Kosek
Additional contact information
Josh Colston: Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
Maribel Paredes Olortegui: Asociación Benéfica Prisma, Iquitos 16006, Peru
Benjamin Zaitchik: Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MD 21218, USA
Pablo Peñataro Yori: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA
Gagandeep Kang: Christian Medical College, Vellore 632004, India
Tahmeed Ahmed: Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1213, Bangladesh
Pascal Bessong: University of Venda, Thohoyandou 0950, South Africa
Esto Mduma: Haydom Global Health Institute, Haydom P.O. Box 9000, Tanzania
Zulfiqar Bhutta: Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
Prakash Sunder Shrestha: Department of Child Health, Institute of Medicine of Tribhuvan University, Kirtipur 44618, Nepal
Aldo Lima: Federal University of Ceará, Fortaleza 60020-181, Brazil
Margaret Kosek: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA

IJERPH, 2020, vol. 17, issue 2, 1-17

Abstract: Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites—Loreto, Peru—were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens—including vaccines as they become available—in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.

Keywords: climate change; diarrheal disease; infectious disease; ENSO; La Niña; flooding; natural disasters; enteric viruses; enteric bacteria; rotavirus (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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