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January 17, 1996, Vol 275, No. 3 >
ARTICLE | January 17, 1996

Global Climate Change and Emerging Infectious Diseases FREE

Jonathan A. Patz, MD, MPH; Paul R. Epstein, MD, MPH; Thomas A. Burke, PhD, MPH; John M. Balbus, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Molecular Microbiology and Immunology, Johns Hopkins School of Hygiene and Public Health, 615 N Wolfe St, Baltimore, MD 21205-2179 (Dr Patz).


JAMA. 1996;275(3):217-223. doi:10.1001/jama.1996.03530270057032
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References

Climatic factors influence the emergence and reemergence of infectious diseases, in addition to multiple human, biological, and ecological determinants. Climatologists have identified upward trends in global temperatures and now estimate an unprecedented rise of 2.0°C by the year 2100. Of major concern is that these changes can affect the introduction and dissemination of many serious infectious diseases.

The incidence of mosquito-borne diseases, including malaria, dengue, and viral encephalitides, are among those diseases most sensitive to climate. Climate change would directly affect disease transmission by shifting the vector's geographic range and increasing reproductive and biting rates and by shortening the pathogen incubation period. Climate-related increases in sea surface temperature and sea level can lead to higher incidence of water-borne infectious and toxin-related illnesses, such as cholera and shellfish poisoning. Human migration and damage to health infrastructures from the projected increase in climate variability could indirectly contribute to disease transmission. Human susceptibility to infections might be further compounded by malnutrition due to climate stress on agriculture and potential alterations in the human immune system caused by increased flux of ultraviolet radiation.

Analyzing the role of climate in the emergence of human infectious diseases will require interdisciplinary cooperation among physicians, climatologists, biologists, and social scientists. Increased disease surveillance, integrated modeling, and use of geographically based data systems will afford more anticipatory measures by the medical community. Understanding the linkages between climatological and ecological change as determinants of disease emergence and redistribution will ultimately help optimize preventive strategies.

(JAMA. 1995;275:217-223)

REFERENCES

1 +
Centers for Disease Control and Prevention. Addressing emerging infectious disease threats: a prevention strategy for the United States . Atlanta, Ga: US Dept Health and Human Services, Public Health Service; 1994;.
2 +
Lederberg J, Shope RE, Oaks SC Jr, eds. Emerging Infections: Microbial Threats to Health in the United States . Washington, DC: Institute of Medicine, National Academy Press; 1992;.
3 +
Morse S.  Factors in the emergence of infectious diseases. Emerging Infect Dis . 1995;;1:7-15.
4 +
Houghton JT, Jenkins GJ, Ephraums JJ, eds. Climate Change: The IPCC Scientific Assessment . Cambridge, England: Cambridge University Press; 1990;.
5 +
Houghton JT, Callander BA, Varney SK, eds. Climate Change 1992: The Supplementary Report to the IPCC Scientific Assessment . Cambridge, England: Cambridge University Press; 1992;.
6 +
Intergovernmental Panel on Climate Change. Climate Change: The Second IPCC Scientific Assessment . In press.
7 +
Karl TR, Knight RW, Easterling DR, Quayle RG.  Trends in U.S. climate during the 20th century. Consequences . 1995;;1:3-12.
8 +
Karl TR, Knight RW, Plummer N.  Trends in high-frequency climate variability in the twentieth century. Nature . 1995;;377:217-220.
9 +
Mitchell JFB, Johns TC, Gregory JM, Tett SFB.  Climate response to increasing levels of greenhouse gases and sulphate aerosols. Nature . 1995;;376:501-504.
10 +
Wigley TML, Raper SCB.  Implications for climate and sea level of revised IPCC emissions scenarios. Nature . 1992;;357:293-300.
11 +
Wenzel RP.  A new Hantavirus infection in North America. N Engl J Med . 1994;;330:1004-1005.
12 +
Levins R, Awerbuch T, Brinkmann U, et al.  The emergence of new diseases. Am Sci . 1994;;82:52-60.
13 +
Stone R.  The mouse-pinon nut connection. Science . 1993;;262:833.
14 +
Moore PS.  Meningococcal meningitis in sub-Saharan Africa: a model for the epidemic process. Clin Infect Dis . 1992;;14:515-525.
15 +
Greenwood BM, Blakebrough IS, Bradley AK, Wali S, Whittle HC.  Meningococcal disease and season in sub-Saharan Africa. Lancet . 1984;;1:1339-1342.
16 +
Dobson A, Carper R. Global Warming and Biological Diversity . New Haven, Conn: Yale University Press; 1992;.
17 +
Dobson A, Carper R.  Biodiversity. Lancet . 1993;; 342:1096-1099.
18 +
Longstreth J, Wiseman J.  The potential impact of climate change on patterns of infectious disease in the United States.  In: Smith JB, Tirpak DA, eds. The Potential Effects of Global Climate Change in the United States . Washington, DC: US Environmental Protection Agency; 1989;: Appendix G. Document 230-05-89-057.
19 +
Shope RE.  Infectious diseases and atmospheric change.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
20 +
Noden BH, Kent MD, Beier JC.  The influence of temperature on early Plasmodium falciparum development in Anopheles stephensi. Parisitology . In press.
21 +
Chandler AC.  Factors influencing the uneven distribution of Aedes aegypti in Texas cities. Am J Trop Med Hyg . 1945;;25:145-149.
22 +
Shope RE.  Global climate change and infectious diseases. Environ Health Perspect . 1991;;96:171-174.
23 +
Karl TR, Jones PD, Knight RW, et al.  A new perspective on global warming: asymmetric trends of daily maximum and mininum temperatures. Bull Am Meteorol Soc . 1993;;74:1007-1023.
24 +
Barnola JM, Raynaud D, Lorius C, Korotkevich YS.  Introduction.  In: Boden TA, Kaiser DP, Sepanski RJ, Stoss FW, eds. Trends '93: A Compendium of Data on Global Change . Oak Ridge, Tenn: Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory; 1994;. Vol ORNL/CDIAC-65.
25 +
Intergovernmental Panel on Climate Change. Radiative Forcing of Climate Change, the 1994 Report of the Scientific Assessment Working Group of IPCC: Summary for Policy Makers . Oxford, England: Oxford University Press; 1994;.
26 +
Flavin C.  Storm warnings: climate change hits the insurance industry. World Watch . 1994;;7:10-20.
27 +
Raper SCB, Wigley TML, Warrick RA.  Global sea level rise: past and future.  In: Milliman J, ed. Rising Sea Level and Subsiding Coastal Areas . Dordrecht, The Netherlands: Kluwer Academic Publisher; 1995;.
28 +
Parrilla G, Lavin A, Boyden H, Garcia M, Millard R.  Rising temperatures in the subtropical North Atlantic Ocean over the past 35 years. Nature . 1994;; 369:204-207.
29 +
Titus JG, Naraynan VK, eds. The Probability of Sea Level Rise . Washington, DC: US Environmental Protection Agency; October 1995;. EPA Report 230-R-95-008.
30 +
Ciais P, Tans PP, Trolier M, White JWC, Francey RJ.  A large Northern Hemisphere terrestrial CO2 sink indicated by the 13C/12C ratio of atmospheric CO2. Science . 1995;;269:1098-1102.
31 +
World Health Organization. Potential Health Effects of Climatic Change . Geneva, Switzerland: World Health Organization; 1990;.
32 +
World Health Organization. Climate Change and Human Health . Geneva, Switzerland: World Health Organization. In press.
33 +
Oaks SC Jr, Mitchell VS, Pearson GW, Carpenter CC, eds. Malaria: Obstacles and Opportunities . Washington, DC: Institute of Medicine, National Academy Press; 1991;.
34 +
Gilles HM.  Epidemiology of malaria.  In: Gilles HM, Warrell DA, eds. Bruce-Chwatt's Essential Malariology . London, England: Edward Arnold; 1993;.
35 +
Brown AWA.  Insecticide resistance as a factor in the integrated control of Culicidae.  In: Laird M, Miles JW, eds. Integrated Mosquito Control Methodologies . New York, NY: Academic Press; 1983;:161-235.
36 +
Alonso PL, Smith T, Armstrong Schellenberg JRM, et al.  Randomised trial of efficacy of SPf66 vaccine against Plasmodium falciparum malaria in children in southern Tanzania. Lancet . 1994;;344:1175-1181.
37 +
Valero MV, Amador LR, Galindo C, et al.  Vaccination with SPf66, a chemically synthesized vaccine, against Plasmodium falciparum malaria in Columbia. Lancet . 1993;;341:705-710.
38 +
Maskell K, Mintzer IM, Callander B.  Basic science of climate change. Lancet . 1993;;342:1027-1031.
39 +
Loevinsohn M.  Climatic warming and increased malaria incidence in Rwanda. Lancet . 1994;;343:714-718.
40 +
Taylor P, Mutambu SL.  A review of the malaria situation in Zimbabwe with special reference to the period 1972-1981. Trans R Soc Trop Med Hyg . 1986;; 80:12-19.
41 +
Martens WJM, Niessen LW, Rotmans J, Jetten TH, McMichael TJ.  Potential impact of global climate change on malaria risk. Environ Health Perspect . 1995;;103:458-464.
42 +
Matsuoka Y, Kai K.  An estimation of climatic change effects on malaria. J Global Environ Eng . 1995;;1:43-57.
43 +
Martens WJM, Rotmans J, Niessen LW. Climate change and malaria risk: an integrated modelling approach . Bilthoven, the Netherlands: RIVM; 1994;. Global Dynamics & Sustainable Development Programme, report series 3, report 461-502-0031994.
44 +
Benenson AS, ed. Control of Communicable Diseases in Man . Washington, DC: American Public Health Association; 1990;.
45 +
Gubler DJ, Clark GC.  Dengue/dengue hemorrhagic fever: the emergence of a global health problem. Emerging Infect Dis . 1995;;1:55-57.
46 +
Pan American Health Organization. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control . Washington, DC: Pan American Health Organization; 1994;:98.
47 +
MacDonald WW.  Aedes aegypti in Malaysia, II: larval and adult biology. Ann Trop Med Parasitol . 1956;;50:399-414.
48 +
Reiter P.  Weather, vector biology, and arboviral recrudescence.  In: Monath TP, ed. The Arboviruses: Epidemiology and Ecology, I . Boca Raton, Fla: CRC Press; 1988;:245-255.
49 +
Centers for Disease Control and Prevention.  Update: Aedes albopictus infestation—United States, Mexico. MMWR Morb Mortal Wkly Rep . 1989;;38: 440-446.
50 +
Gubler DJ, Trent DW.  Emergence of epidemic dengue/dengue hemorrhagic fever as a public health problem in the Americas. Infect Agents Dis . 1994;;2: 383-393.
51 +
Halstead SB.  Dengue hemorrhagic fever.  In: Gear JHS, ed. Handbook of Viral and Rickettsial Hemorrhagic Fevers . Boca Raton, Fla: CRC Press; 1988;: 85-94.
52 +
Halstead SB.  Global epidemiology of dengue: health systems in disarray. Trop Med . 1993;;35:137-146.
53 +
Trent DW, Grant JA, Rosen L, Monath TP.  Genetic variation among dengue 2 viruses of different geographic origin. Virology . 1983;;128:271-284.
54 +
Chandler AC.  Factors influencing the uneven distribution of Aedes aegypti in Texas cities. Am J Trop Med Hyg . 1945;;25:145-149.
55 +
Herrera-Basto E, Prevots DR, Luisa Zarate MA, Luis Silva J, Sepulveda-Armor J.  First reported outbreak of classical dengue fever at 1700 meters above sea level in Guerrero State, Mexico, June 1988. Am J Trop Med Hyg . 1992;;46:649-653.
56 +
Figueroa M, Pereira R, Gutierrez H, Demejia C, Padilla N.  Dengue epidemic in Honduras, 1978-1980. Bull Pan Am Health Organ . 1982;;16:130-137.
57 +
Koopman JS, Prevots DR, Marin MAV, et al.  Determinants and predictors of dengue infection in Mexico. Am J Epidemiol . 1991;;133:1168-1178.
58 +
Rueda LM, Patel KJ, Axtell RC, Stinner RE.  Temperature-dependent development and survival rates of Culex quinquefasciatus and Aedes aegypti (Diptera: Culicidae). J Med Entomol . 1990;;27:892-898.
59 +
Scott TW, Chow E, Strickman D, et al.  Blood-feeding patterns of Aedes aegypti (Diptera: Culicidae) collected in a rural Thai village. J Med Entomol . 1993;;30:922-927.
60 +
Pant CP, Yasuno M.  Field studies on the gonotrophic cycle of Aedes aegypti in Bangkok, Thailand. J Med Entomol . 1973;;10:219-223.
61 +
Watts DM, Burke DS, Harrison BA, et al.  Effect of temperature on the vector efficiency of Aedes aegypti for dengue 2 virus. Am J Trop Med Hyg . 1987;; 36:143-152.
62 +
Focks DA, Daniels E, Haile DG, Keesling JE.  A simulation model of the epidemiology of urban dengue fever: literature analysis, model development, preliminary validation, and samples of simulation results. Am J Trop Med Hyg . 1995;;53:489-506.
63 +
Shope RE.  Arbovirus-related encephalitis. Yale J Biol Med . 1980;;53:93-99.
64 +
Monath TP, Tsai TF.  St Louis encephalitis: lessons from the last decade. Am J Trop Med Hyg . 1987;;37( (suppl) ):40S-59S.
65 +
Monath TP.  Flaviridae: Flavivirus (yellow fever, dengue, and St Louis encephalitis).  In: Mandell GL, Douglas RG, Bennet JE, eds. Principles and Practice of Infectious Diseases . 3rd ed. New York, NY: Churchill Livingston; 1990;.
66 +
Bowen SG, Francy DB.  Surveillance.  In: Monath TP, ed. St Louis Encephalitis . Washington, DC: American Public Health Association; 1980;.
67 +
Schneider SH. Global Warming: Are We Entering the Greenhouse Century? New York, NY: Vintage Books; 1990;.
68 +
Reeves WC, Hardy JL, Reisen WK, Milby MM.  The potential effect of global warming on mosquitoborne arboviruses. J Med Entomol . 1994;;31:323-332.
69 +
Hardy JL.  Susceptibility and resistance of vector mosquitoes.  In: Monath TP, ed. The Arboviruses: Epidemiology and Ecology, I . Boca Raton, Fla: CRC Press; 1988;.
70 +
Reisin WK, Meyer RP, Presser SB, Hardy JL.  Effects of temperature on the transmission of Western Equine encephalomyelitis and St Louis encephalitis viruses by Culex tarsalis (Diptera: Culicidae). J Med Entomol . 1993;;30:151-160.
71 +
Shiff CJ, Evans A, Yiannakis C, Eardley M.  Seasonal influence on the production of Schistosoma haematobium and S mansoni cercariae in Rhodesia. Int J Parisitol . 1975;;5:119-123.
72 +
Shiff CJ, Coutts WCC, Yiannakis C, Holmes RW.  Seasonal patterns in the transmission of Schistosoma haematobium in Rhodesia, and its control by winter application of molluscicide. Trans R Soc Trop Med Hyg . 1979;;73:375-380.
73 +
Gillet JD.  Direct and indirect influences of temperature on the transmission of parasites from insects to man.  In: Taylor AER, Muller R, ed. The Effects of Meteorological Factors Upon Parasites . Oxford, England: Blackwell Scientific Publications; 1974;:79-95.
74 +
Martens WJM. Modelling the effect of global warming on the prevalence of schistosomiasis . Bilthoven, the Netherlands: RIVM; 1995;. GLOBO report series 10, report 461502010.
75 +
World Health Organization. Ten Years of Onchocerciasis Control in West Africa: Review of Work of the OCP in the Volta River Basin Area From 1974 to 1984 . Geneva, Switzerland: World Health Organization; 1985;.
76 +
Mills DM.  A climatic water budget approach to black fly population dynamics. Publications in Climatology . 1995;;48:1-84.
77 +
Rogers DJ, Randolph SE.  Mortality rates and population density of tsetse flies correlated with satellite imagery. Nature . 1991;;351:739-741.
78 +
Rogers DL, Packer MJ.  Vector-borne diseases, models, and global change. Lancet . 1993;;342:1282-1284.
79 +
Rogers DJ, Randolph SE.  Distribution of tsetse and ticks in Africa: past, present and future. Parasitol Today . 1993;;9:266-271.
80 +
Haile DG.  Computer simulation of the effects of changes in weather patterns on vector-borne disease transmission.  In: Smith JB, Tirpak DA, eds. The Potential Effects of Global Climate Change in the United States . Washington, DC: US Environmental Protection Agency; 1989;. Appendix G. Document 230-05-89-057.
81 +
Anderson DM.  WESTPAC symposium and harmful blooms workshop, International Oceanographic Commission, UNESCO. Harmful Algae News . 1992;;2:4.
82 +
Tester P.  Red tide: effects on health and economics. Health Environ Digest . 1991;;5:4-5.
83 +
Valiela I. Marine Ecological Processes . New York, NY: Springer-Verlag;1984;.
84 +
Epstein PR.  Emerging diseases and ecosystem instability: new threats to public health. Am J Public Health . 1995;;85:168-172.
85 +
Huq A, Colwell RR, Rahman R, et al.  Detection of Vibrio cholerae 01 in the aquatic environment by fluorescent-monoclonal antibody and culture methods. Appl Environ Microbiol . 1990;;56:2370-2373.
86 +
Lembeye G.  Major PSP outbreak in Chile, 1991-1992. Harmful Algae News . 1992;;2:1-2.
87 +
Bruce JP.  Natural disaster reduction and global change. Bull Am Meteorol Soc . 1994;;75:1831-1835.
88 +
Whetton PH, Fowler AM, Haylock MR, Pittock AB.  Implications of climate change due to the enhanced greenhouse effect on floods and droughts in Australia. Climatic Change . 1993;;25:289-317.
89 +
Patz JA, Balbus JM.  Methods for assessing public health vulnerability to global climate change. Climate Research . In press.
90 +
Haines A, Fuchs C.  Potential impacts on health of atmospheric change. J Pub Health Med . 1991;; 13:69-80.
91 +
Leaf A.  Potential health effects of global climatic and environmental changes. N Engl J Med . 1989;; 321:1577-1583.
92 +
Nicholls N.  El Niño-southern oscillation and vector-borne disease. Lancet . 1993;;342:1284-1285.
93 +
Kiladis GN, Dias HF.  Global climatic anomalies associated with extremes in the Southern Oscillation. J Climate . 1989;;2:1069.
94 +
Glantz MH, Katz RW, Nicholls N. Teleconnections Linking Worldwide Climate Anomalies . Cambridge, England: Cambridge University Press; 1991;.
95 +
MacDonald G.  The analysis of malaria epidemics. Trop Dis Bull . 1954;;50:871-892.
96 +
Zulueta J.  Malaria control and long-term periodicity of the disease in Pakistan. Trans R Soc Trop Med Hyg . 1980;;74:624-632.
97 +
Bouma MJ, Sondorp HE, van der Kaay HJ.  Climate change and periodic epidemic malaria. Lancet . 1994;;343:1440.
98 +
Nicholls N.  Teleconnections and health.  In: Glantz MH, Katz RW, eds. Teleconnections Linking Worldwide Climate Anomalies . Cambridge, England: Cambridge University Press; 1991;:493-510.
99 +
Scripps Institute of Oceanography. Simulated Global Warming and Model ENSO Cycles . La Jolla, Calif: Scripps Institute of Oceanography; 1992;. Reference report 9404.
100 +
United Nations Environment Program and the National Center for Atmospheric Research. ENSO and Climate Change: UNEP Conference Proceedings: Bangkok, 1991 . Boulder, Colo: National Center for Atmospheric Research; 1991;.
101 +
Mearns LO.  Implications of global warming for climate variability and the occurrence of extreme climate events.  In: Wilhite DA, ed. Drought Assessment, Management and Planning: Theory and Case Studies . Boston, Mass: Kluwer; 1993;:109-130.
102 +
Tegart WJM, Sheldon GW, Griffiths DC, eds. Climate Change: The IPCC Impacts Assessment . Canberra: Australian Government Publishing Service; 1990;.
103 +
Parry ML, Rosenzweig C.  Food supply and the risk of hunger. Lancet . 1993;;342:1345-1347.
104 +
Kerr JB, McElroy CT.  Evidence for large upward trends of ultraviolet-B radiation linked to ozone depletion. Science . 1993;;262:1032-1034.
105 +
Molina MJ, Rowland FS.  Stratospheric sink for chloro-fluoro-methanes: chlorine atom-catalyzed destruction of ozone. Nature . 1974;;249:810-814.
106 +
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Solar and Ultraviolet Radiation, 55. Lyon, France: International Agency for Research on Cancer; 1992;.
107 +
Taylor HR, West SK, Rosenthal FS, et al.  Effects of ultraviolet radiation on cataract formation. N Engl J Med . 1988;;319:1429-1433.
108 +
Baadsgaard O.  In vivo ultraviolet irradiation of human skin results in profound perturbation of the immune system. Arch Dermatol . 1991;;127:99-109.
109 +
Cestari TF, Kripke ML, Baptista PL, Bakos L, Bucana CD.  Ultraviolet radiation decreases the granulomatous response to lepromin in humans. J Invest Dermatol . 1995;;105:8-13.
110 +
Cooper KD, Oberhelman L, Hamilton TA, et al.  UV exposure reduces immunization rates and promotes tolerance to epicutaneous antigens in humans. Proc Natl Acad Sci US A . 1992;;89:8497-8501.
111 +
Jeevan A, Kripke ML.  Alteration of the immune response to Mycobacterium bovis BCG in mice exposed chronically to low doses of UV radiation. Cell Immunol . 1990;;130:32-41.
112 +
Kripke ML. Effects on Human Health: UV-B Monitoring Workshop . Washington, DC: Science and Policy Associates; 1992;.
113 +
Larcom LL, Morris TE, Smith ME.  Suppression of immunocompetence and DNA repair capacity by exposure in commercial tanning salons. J Natl Cancer Inst . 1990;;82:1361.
114 +
van der Leun JC, Tevini M, Worrest RC, eds. Environmental Effects of Ozone Depletion: 1991 Update . Nairobi, Kenya: United Nations Environment Programme; 1991;.
115 +
Cruz PD, Bergstresser PR.  The low-dose model of UVB-induced immunosuppression. Photodermatology . 1988;;5:151-161.
116 +
Morison W.  Effects of ultraviolet radiation on the immune system in humans. Photochem Photobiol . 1989;;50:515-524.
117 +
Wolff K, Stingl G.  The Langerhan cell. J Invest Dermatol . 1983;;80( (suppl) ):17S-21S.
118 +
Daynes RA.  Immune system and ultraviolet light.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
119 +
DeFabo EC, Noonan FP.  Mechanism of immune suppression by ultraviolet irradiation in vivo. J Exp Med . 1983;;158:84-98.
120 +
Hersey P, Haren G, Hasic E, Edwards A.  Alteration of T cell subsets and induction of suppressor T cell activity in normal subjects after exposure to sunlight. J Immunol . 1983;;31:171-174.
121 +
Kripke ML, Morison WL.  Studies on the mechanism of systemic suppression of contact hypersensitivity by UVB radiation, II: differences in the suppression of delayed and contact hypersensitivity in mice. J Invest Dermatol . 1986;;86:543-549.
122 +
Noonan FP, DeFabo EC, Kripke ML.  Suppression of contact hypersensitivity by UV radiation and its relationship to UV-induced suppression of tumor immunity. Photochem Photobiol . 1981;;34:683-689.
123 +
Giannini MS.  Effects of UVB on infectious disease.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
124 +
Epstein PR.  Framework for an integrated assessment of climatic change and ecosystem vulnerability.  In: Wilson MB, Levins R, Spielman A, ed. Diseases in Evolution: Global Change and Emergence of Infectious Diseases . New York, NY: New York Academy of Science; 1994;:423-435.
125 +
McMichael AJ.  Global environmental change and human population health: conceptual and scientific challenge for epidemiology. Int J Epidemiol . 1993;; 22:1-8.
126 +
McMichael AJ, Martens WJM.  The health impacts of global climate change: grappling with scenarios, predictive models, and multiple uncertainties. Ecosystem Health . 1995;;1:23-33.
127 +
Jetten TH, Takken W.  Impact of climate change on malaria vectors. Change . 1994;;18:10-12.
128 +
Patz JA.  Assessing the public health effects of global warming: new and ongoing international efforts. World Resource Rev . 1995;;7:104-112.
129 +
Glass GE, Aron JL, Ellis JH, Yoon SS. Applications of GIS Technology to Disease Control . Baltimore, Md: The Johns Hopkins University; 1993;.
130 +
Washino RK, Wood BL.  Application of remote sensing to arthropod vector surveillance and control. Am J Trop Med Hyg . 1994;;50( (suppl) ):134-144.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Centers for Disease Control and Prevention. Addressing emerging infectious disease threats: a prevention strategy for the United States . Atlanta, Ga: US Dept Health and Human Services, Public Health Service; 1994;.
2 +
Lederberg J, Shope RE, Oaks SC Jr, eds. Emerging Infections: Microbial Threats to Health in the United States . Washington, DC: Institute of Medicine, National Academy Press; 1992;.
3 +
Morse S.  Factors in the emergence of infectious diseases. Emerging Infect Dis . 1995;;1:7-15.
4 +
Houghton JT, Jenkins GJ, Ephraums JJ, eds. Climate Change: The IPCC Scientific Assessment . Cambridge, England: Cambridge University Press; 1990;.
5 +
Houghton JT, Callander BA, Varney SK, eds. Climate Change 1992: The Supplementary Report to the IPCC Scientific Assessment . Cambridge, England: Cambridge University Press; 1992;.
6 +
Intergovernmental Panel on Climate Change. Climate Change: The Second IPCC Scientific Assessment . In press.
7 +
Karl TR, Knight RW, Easterling DR, Quayle RG.  Trends in U.S. climate during the 20th century. Consequences . 1995;;1:3-12.
8 +
Karl TR, Knight RW, Plummer N.  Trends in high-frequency climate variability in the twentieth century. Nature . 1995;;377:217-220.
9 +
Mitchell JFB, Johns TC, Gregory JM, Tett SFB.  Climate response to increasing levels of greenhouse gases and sulphate aerosols. Nature . 1995;;376:501-504.
10 +
Wigley TML, Raper SCB.  Implications for climate and sea level of revised IPCC emissions scenarios. Nature . 1992;;357:293-300.
11 +
Wenzel RP.  A new Hantavirus infection in North America. N Engl J Med . 1994;;330:1004-1005.
12 +
Levins R, Awerbuch T, Brinkmann U, et al.  The emergence of new diseases. Am Sci . 1994;;82:52-60.
13 +
Stone R.  The mouse-pinon nut connection. Science . 1993;;262:833.
14 +
Moore PS.  Meningococcal meningitis in sub-Saharan Africa: a model for the epidemic process. Clin Infect Dis . 1992;;14:515-525.
15 +
Greenwood BM, Blakebrough IS, Bradley AK, Wali S, Whittle HC.  Meningococcal disease and season in sub-Saharan Africa. Lancet . 1984;;1:1339-1342.
16 +
Dobson A, Carper R. Global Warming and Biological Diversity . New Haven, Conn: Yale University Press; 1992;.
17 +
Dobson A, Carper R.  Biodiversity. Lancet . 1993;; 342:1096-1099.
18 +
Longstreth J, Wiseman J.  The potential impact of climate change on patterns of infectious disease in the United States.  In: Smith JB, Tirpak DA, eds. The Potential Effects of Global Climate Change in the United States . Washington, DC: US Environmental Protection Agency; 1989;: Appendix G. Document 230-05-89-057.
19 +
Shope RE.  Infectious diseases and atmospheric change.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
20 +
Noden BH, Kent MD, Beier JC.  The influence of temperature on early Plasmodium falciparum development in Anopheles stephensi. Parisitology . In press.
21 +
Chandler AC.  Factors influencing the uneven distribution of Aedes aegypti in Texas cities. Am J Trop Med Hyg . 1945;;25:145-149.
22 +
Shope RE.  Global climate change and infectious diseases. Environ Health Perspect . 1991;;96:171-174.
23 +
Karl TR, Jones PD, Knight RW, et al.  A new perspective on global warming: asymmetric trends of daily maximum and mininum temperatures. Bull Am Meteorol Soc . 1993;;74:1007-1023.
24 +
Barnola JM, Raynaud D, Lorius C, Korotkevich YS.  Introduction.  In: Boden TA, Kaiser DP, Sepanski RJ, Stoss FW, eds. Trends '93: A Compendium of Data on Global Change . Oak Ridge, Tenn: Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory; 1994;. Vol ORNL/CDIAC-65.
25 +
Intergovernmental Panel on Climate Change. Radiative Forcing of Climate Change, the 1994 Report of the Scientific Assessment Working Group of IPCC: Summary for Policy Makers . Oxford, England: Oxford University Press; 1994;.
26 +
Flavin C.  Storm warnings: climate change hits the insurance industry. World Watch . 1994;;7:10-20.
27 +
Raper SCB, Wigley TML, Warrick RA.  Global sea level rise: past and future.  In: Milliman J, ed. Rising Sea Level and Subsiding Coastal Areas . Dordrecht, The Netherlands: Kluwer Academic Publisher; 1995;.
28 +
Parrilla G, Lavin A, Boyden H, Garcia M, Millard R.  Rising temperatures in the subtropical North Atlantic Ocean over the past 35 years. Nature . 1994;; 369:204-207.
29 +
Titus JG, Naraynan VK, eds. The Probability of Sea Level Rise . Washington, DC: US Environmental Protection Agency; October 1995;. EPA Report 230-R-95-008.
30 +
Ciais P, Tans PP, Trolier M, White JWC, Francey RJ.  A large Northern Hemisphere terrestrial CO2 sink indicated by the 13C/12C ratio of atmospheric CO2. Science . 1995;;269:1098-1102.
31 +
World Health Organization. Potential Health Effects of Climatic Change . Geneva, Switzerland: World Health Organization; 1990;.
32 +
World Health Organization. Climate Change and Human Health . Geneva, Switzerland: World Health Organization. In press.
33 +
Oaks SC Jr, Mitchell VS, Pearson GW, Carpenter CC, eds. Malaria: Obstacles and Opportunities . Washington, DC: Institute of Medicine, National Academy Press; 1991;.
34 +
Gilles HM.  Epidemiology of malaria.  In: Gilles HM, Warrell DA, eds. Bruce-Chwatt's Essential Malariology . London, England: Edward Arnold; 1993;.
35 +
Brown AWA.  Insecticide resistance as a factor in the integrated control of Culicidae.  In: Laird M, Miles JW, eds. Integrated Mosquito Control Methodologies . New York, NY: Academic Press; 1983;:161-235.
36 +
Alonso PL, Smith T, Armstrong Schellenberg JRM, et al.  Randomised trial of efficacy of SPf66 vaccine against Plasmodium falciparum malaria in children in southern Tanzania. Lancet . 1994;;344:1175-1181.
37 +
Valero MV, Amador LR, Galindo C, et al.  Vaccination with SPf66, a chemically synthesized vaccine, against Plasmodium falciparum malaria in Columbia. Lancet . 1993;;341:705-710.
38 +
Maskell K, Mintzer IM, Callander B.  Basic science of climate change. Lancet . 1993;;342:1027-1031.
39 +
Loevinsohn M.  Climatic warming and increased malaria incidence in Rwanda. Lancet . 1994;;343:714-718.
40 +
Taylor P, Mutambu SL.  A review of the malaria situation in Zimbabwe with special reference to the period 1972-1981. Trans R Soc Trop Med Hyg . 1986;; 80:12-19.
41 +
Martens WJM, Niessen LW, Rotmans J, Jetten TH, McMichael TJ.  Potential impact of global climate change on malaria risk. Environ Health Perspect . 1995;;103:458-464.
42 +
Matsuoka Y, Kai K.  An estimation of climatic change effects on malaria. J Global Environ Eng . 1995;;1:43-57.
43 +
Martens WJM, Rotmans J, Niessen LW. Climate change and malaria risk: an integrated modelling approach . Bilthoven, the Netherlands: RIVM; 1994;. Global Dynamics & Sustainable Development Programme, report series 3, report 461-502-0031994.
44 +
Benenson AS, ed. Control of Communicable Diseases in Man . Washington, DC: American Public Health Association; 1990;.
45 +
Gubler DJ, Clark GC.  Dengue/dengue hemorrhagic fever: the emergence of a global health problem. Emerging Infect Dis . 1995;;1:55-57.
46 +
Pan American Health Organization. Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control . Washington, DC: Pan American Health Organization; 1994;:98.
47 +
MacDonald WW.  Aedes aegypti in Malaysia, II: larval and adult biology. Ann Trop Med Parasitol . 1956;;50:399-414.
48 +
Reiter P.  Weather, vector biology, and arboviral recrudescence.  In: Monath TP, ed. The Arboviruses: Epidemiology and Ecology, I . Boca Raton, Fla: CRC Press; 1988;:245-255.
49 +
Centers for Disease Control and Prevention.  Update: Aedes albopictus infestation—United States, Mexico. MMWR Morb Mortal Wkly Rep . 1989;;38: 440-446.
50 +
Gubler DJ, Trent DW.  Emergence of epidemic dengue/dengue hemorrhagic fever as a public health problem in the Americas. Infect Agents Dis . 1994;;2: 383-393.
51 +
Halstead SB.  Dengue hemorrhagic fever.  In: Gear JHS, ed. Handbook of Viral and Rickettsial Hemorrhagic Fevers . Boca Raton, Fla: CRC Press; 1988;: 85-94.
52 +
Halstead SB.  Global epidemiology of dengue: health systems in disarray. Trop Med . 1993;;35:137-146.
53 +
Trent DW, Grant JA, Rosen L, Monath TP.  Genetic variation among dengue 2 viruses of different geographic origin. Virology . 1983;;128:271-284.
54 +
Chandler AC.  Factors influencing the uneven distribution of Aedes aegypti in Texas cities. Am J Trop Med Hyg . 1945;;25:145-149.
55 +
Herrera-Basto E, Prevots DR, Luisa Zarate MA, Luis Silva J, Sepulveda-Armor J.  First reported outbreak of classical dengue fever at 1700 meters above sea level in Guerrero State, Mexico, June 1988. Am J Trop Med Hyg . 1992;;46:649-653.
56 +
Figueroa M, Pereira R, Gutierrez H, Demejia C, Padilla N.  Dengue epidemic in Honduras, 1978-1980. Bull Pan Am Health Organ . 1982;;16:130-137.
57 +
Koopman JS, Prevots DR, Marin MAV, et al.  Determinants and predictors of dengue infection in Mexico. Am J Epidemiol . 1991;;133:1168-1178.
58 +
Rueda LM, Patel KJ, Axtell RC, Stinner RE.  Temperature-dependent development and survival rates of Culex quinquefasciatus and Aedes aegypti (Diptera: Culicidae). J Med Entomol . 1990;;27:892-898.
59 +
Scott TW, Chow E, Strickman D, et al.  Blood-feeding patterns of Aedes aegypti (Diptera: Culicidae) collected in a rural Thai village. J Med Entomol . 1993;;30:922-927.
60 +
Pant CP, Yasuno M.  Field studies on the gonotrophic cycle of Aedes aegypti in Bangkok, Thailand. J Med Entomol . 1973;;10:219-223.
61 +
Watts DM, Burke DS, Harrison BA, et al.  Effect of temperature on the vector efficiency of Aedes aegypti for dengue 2 virus. Am J Trop Med Hyg . 1987;; 36:143-152.
62 +
Focks DA, Daniels E, Haile DG, Keesling JE.  A simulation model of the epidemiology of urban dengue fever: literature analysis, model development, preliminary validation, and samples of simulation results. Am J Trop Med Hyg . 1995;;53:489-506.
63 +
Shope RE.  Arbovirus-related encephalitis. Yale J Biol Med . 1980;;53:93-99.
64 +
Monath TP, Tsai TF.  St Louis encephalitis: lessons from the last decade. Am J Trop Med Hyg . 1987;;37( (suppl) ):40S-59S.
65 +
Monath TP.  Flaviridae: Flavivirus (yellow fever, dengue, and St Louis encephalitis).  In: Mandell GL, Douglas RG, Bennet JE, eds. Principles and Practice of Infectious Diseases . 3rd ed. New York, NY: Churchill Livingston; 1990;.
66 +
Bowen SG, Francy DB.  Surveillance.  In: Monath TP, ed. St Louis Encephalitis . Washington, DC: American Public Health Association; 1980;.
67 +
Schneider SH. Global Warming: Are We Entering the Greenhouse Century? New York, NY: Vintage Books; 1990;.
68 +
Reeves WC, Hardy JL, Reisen WK, Milby MM.  The potential effect of global warming on mosquitoborne arboviruses. J Med Entomol . 1994;;31:323-332.
69 +
Hardy JL.  Susceptibility and resistance of vector mosquitoes.  In: Monath TP, ed. The Arboviruses: Epidemiology and Ecology, I . Boca Raton, Fla: CRC Press; 1988;.
70 +
Reisin WK, Meyer RP, Presser SB, Hardy JL.  Effects of temperature on the transmission of Western Equine encephalomyelitis and St Louis encephalitis viruses by Culex tarsalis (Diptera: Culicidae). J Med Entomol . 1993;;30:151-160.
71 +
Shiff CJ, Evans A, Yiannakis C, Eardley M.  Seasonal influence on the production of Schistosoma haematobium and S mansoni cercariae in Rhodesia. Int J Parisitol . 1975;;5:119-123.
72 +
Shiff CJ, Coutts WCC, Yiannakis C, Holmes RW.  Seasonal patterns in the transmission of Schistosoma haematobium in Rhodesia, and its control by winter application of molluscicide. Trans R Soc Trop Med Hyg . 1979;;73:375-380.
73 +
Gillet JD.  Direct and indirect influences of temperature on the transmission of parasites from insects to man.  In: Taylor AER, Muller R, ed. The Effects of Meteorological Factors Upon Parasites . Oxford, England: Blackwell Scientific Publications; 1974;:79-95.
74 +
Martens WJM. Modelling the effect of global warming on the prevalence of schistosomiasis . Bilthoven, the Netherlands: RIVM; 1995;. GLOBO report series 10, report 461502010.
75 +
World Health Organization. Ten Years of Onchocerciasis Control in West Africa: Review of Work of the OCP in the Volta River Basin Area From 1974 to 1984 . Geneva, Switzerland: World Health Organization; 1985;.
76 +
Mills DM.  A climatic water budget approach to black fly population dynamics. Publications in Climatology . 1995;;48:1-84.
77 +
Rogers DJ, Randolph SE.  Mortality rates and population density of tsetse flies correlated with satellite imagery. Nature . 1991;;351:739-741.
78 +
Rogers DL, Packer MJ.  Vector-borne diseases, models, and global change. Lancet . 1993;;342:1282-1284.
79 +
Rogers DJ, Randolph SE.  Distribution of tsetse and ticks in Africa: past, present and future. Parasitol Today . 1993;;9:266-271.
80 +
Haile DG.  Computer simulation of the effects of changes in weather patterns on vector-borne disease transmission.  In: Smith JB, Tirpak DA, eds. The Potential Effects of Global Climate Change in the United States . Washington, DC: US Environmental Protection Agency; 1989;. Appendix G. Document 230-05-89-057.
81 +
Anderson DM.  WESTPAC symposium and harmful blooms workshop, International Oceanographic Commission, UNESCO. Harmful Algae News . 1992;;2:4.
82 +
Tester P.  Red tide: effects on health and economics. Health Environ Digest . 1991;;5:4-5.
83 +
Valiela I. Marine Ecological Processes . New York, NY: Springer-Verlag;1984;.
84 +
Epstein PR.  Emerging diseases and ecosystem instability: new threats to public health. Am J Public Health . 1995;;85:168-172.
85 +
Huq A, Colwell RR, Rahman R, et al.  Detection of Vibrio cholerae 01 in the aquatic environment by fluorescent-monoclonal antibody and culture methods. Appl Environ Microbiol . 1990;;56:2370-2373.
86 +
Lembeye G.  Major PSP outbreak in Chile, 1991-1992. Harmful Algae News . 1992;;2:1-2.
87 +
Bruce JP.  Natural disaster reduction and global change. Bull Am Meteorol Soc . 1994;;75:1831-1835.
88 +
Whetton PH, Fowler AM, Haylock MR, Pittock AB.  Implications of climate change due to the enhanced greenhouse effect on floods and droughts in Australia. Climatic Change . 1993;;25:289-317.
89 +
Patz JA, Balbus JM.  Methods for assessing public health vulnerability to global climate change. Climate Research . In press.
90 +
Haines A, Fuchs C.  Potential impacts on health of atmospheric change. J Pub Health Med . 1991;; 13:69-80.
91 +
Leaf A.  Potential health effects of global climatic and environmental changes. N Engl J Med . 1989;; 321:1577-1583.
92 +
Nicholls N.  El Niño-southern oscillation and vector-borne disease. Lancet . 1993;;342:1284-1285.
93 +
Kiladis GN, Dias HF.  Global climatic anomalies associated with extremes in the Southern Oscillation. J Climate . 1989;;2:1069.
94 +
Glantz MH, Katz RW, Nicholls N. Teleconnections Linking Worldwide Climate Anomalies . Cambridge, England: Cambridge University Press; 1991;.
95 +
MacDonald G.  The analysis of malaria epidemics. Trop Dis Bull . 1954;;50:871-892.
96 +
Zulueta J.  Malaria control and long-term periodicity of the disease in Pakistan. Trans R Soc Trop Med Hyg . 1980;;74:624-632.
97 +
Bouma MJ, Sondorp HE, van der Kaay HJ.  Climate change and periodic epidemic malaria. Lancet . 1994;;343:1440.
98 +
Nicholls N.  Teleconnections and health.  In: Glantz MH, Katz RW, eds. Teleconnections Linking Worldwide Climate Anomalies . Cambridge, England: Cambridge University Press; 1991;:493-510.
99 +
Scripps Institute of Oceanography. Simulated Global Warming and Model ENSO Cycles . La Jolla, Calif: Scripps Institute of Oceanography; 1992;. Reference report 9404.
100 +
United Nations Environment Program and the National Center for Atmospheric Research. ENSO and Climate Change: UNEP Conference Proceedings: Bangkok, 1991 . Boulder, Colo: National Center for Atmospheric Research; 1991;.
101 +
Mearns LO.  Implications of global warming for climate variability and the occurrence of extreme climate events.  In: Wilhite DA, ed. Drought Assessment, Management and Planning: Theory and Case Studies . Boston, Mass: Kluwer; 1993;:109-130.
102 +
Tegart WJM, Sheldon GW, Griffiths DC, eds. Climate Change: The IPCC Impacts Assessment . Canberra: Australian Government Publishing Service; 1990;.
103 +
Parry ML, Rosenzweig C.  Food supply and the risk of hunger. Lancet . 1993;;342:1345-1347.
104 +
Kerr JB, McElroy CT.  Evidence for large upward trends of ultraviolet-B radiation linked to ozone depletion. Science . 1993;;262:1032-1034.
105 +
Molina MJ, Rowland FS.  Stratospheric sink for chloro-fluoro-methanes: chlorine atom-catalyzed destruction of ozone. Nature . 1974;;249:810-814.
106 +
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Solar and Ultraviolet Radiation, 55. Lyon, France: International Agency for Research on Cancer; 1992;.
107 +
Taylor HR, West SK, Rosenthal FS, et al.  Effects of ultraviolet radiation on cataract formation. N Engl J Med . 1988;;319:1429-1433.
108 +
Baadsgaard O.  In vivo ultraviolet irradiation of human skin results in profound perturbation of the immune system. Arch Dermatol . 1991;;127:99-109.
109 +
Cestari TF, Kripke ML, Baptista PL, Bakos L, Bucana CD.  Ultraviolet radiation decreases the granulomatous response to lepromin in humans. J Invest Dermatol . 1995;;105:8-13.
110 +
Cooper KD, Oberhelman L, Hamilton TA, et al.  UV exposure reduces immunization rates and promotes tolerance to epicutaneous antigens in humans. Proc Natl Acad Sci US A . 1992;;89:8497-8501.
111 +
Jeevan A, Kripke ML.  Alteration of the immune response to Mycobacterium bovis BCG in mice exposed chronically to low doses of UV radiation. Cell Immunol . 1990;;130:32-41.
112 +
Kripke ML. Effects on Human Health: UV-B Monitoring Workshop . Washington, DC: Science and Policy Associates; 1992;.
113 +
Larcom LL, Morris TE, Smith ME.  Suppression of immunocompetence and DNA repair capacity by exposure in commercial tanning salons. J Natl Cancer Inst . 1990;;82:1361.
114 +
van der Leun JC, Tevini M, Worrest RC, eds. Environmental Effects of Ozone Depletion: 1991 Update . Nairobi, Kenya: United Nations Environment Programme; 1991;.
115 +
Cruz PD, Bergstresser PR.  The low-dose model of UVB-induced immunosuppression. Photodermatology . 1988;;5:151-161.
116 +
Morison W.  Effects of ultraviolet radiation on the immune system in humans. Photochem Photobiol . 1989;;50:515-524.
117 +
Wolff K, Stingl G.  The Langerhan cell. J Invest Dermatol . 1983;;80( (suppl) ):17S-21S.
118 +
Daynes RA.  Immune system and ultraviolet light.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
119 +
DeFabo EC, Noonan FP.  Mechanism of immune suppression by ultraviolet irradiation in vivo. J Exp Med . 1983;;158:84-98.
120 +
Hersey P, Haren G, Hasic E, Edwards A.  Alteration of T cell subsets and induction of suppressor T cell activity in normal subjects after exposure to sunlight. J Immunol . 1983;;31:171-174.
121 +
Kripke ML, Morison WL.  Studies on the mechanism of systemic suppression of contact hypersensitivity by UVB radiation, II: differences in the suppression of delayed and contact hypersensitivity in mice. J Invest Dermatol . 1986;;86:543-549.
122 +
Noonan FP, DeFabo EC, Kripke ML.  Suppression of contact hypersensitivity by UV radiation and its relationship to UV-induced suppression of tumor immunity. Photochem Photobiol . 1981;;34:683-689.
123 +
Giannini MS.  Effects of UVB on infectious disease.  In: White JC, ed. Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information . New York, NY: Elsevier; 1990;.
124 +
Epstein PR.  Framework for an integrated assessment of climatic change and ecosystem vulnerability.  In: Wilson MB, Levins R, Spielman A, ed. Diseases in Evolution: Global Change and Emergence of Infectious Diseases . New York, NY: New York Academy of Science; 1994;:423-435.
125 +
McMichael AJ.  Global environmental change and human population health: conceptual and scientific challenge for epidemiology. Int J Epidemiol . 1993;; 22:1-8.
126 +
McMichael AJ, Martens WJM.  The health impacts of global climate change: grappling with scenarios, predictive models, and multiple uncertainties. Ecosystem Health . 1995;;1:23-33.
127 +
Jetten TH, Takken W.  Impact of climate change on malaria vectors. Change . 1994;;18:10-12.
128 +
Patz JA.  Assessing the public health effects of global warming: new and ongoing international efforts. World Resource Rev . 1995;;7:104-112.
129 +
Glass GE, Aron JL, Ellis JH, Yoon SS. Applications of GIS Technology to Disease Control . Baltimore, Md: The Johns Hopkins University; 1993;.
130 +
Washino RK, Wood BL.  Application of remote sensing to arthropod vector surveillance and control. Am J Trop Med Hyg . 1994;;50( (suppl) ):134-144.

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