Evidence of Gastroenteritis Outbreaks and Climate Change

This systematic review literature explores the evidence linking gastroenteritis outbreaks to climate change and weather patterns. It reviews current literature to establish the association between climate change and its impact on gastroenteritis. The research examines the effects of extreme weather events and meteorological changes on the spread of viral gastroenteritis.

Running head: WHAT EVIDENCE ARE THEE THAT GASTROENTIRITIS OUTBREAK IS
ASSOCIATED WITH CLIMATE CHANGE/ WEATHER PATTERNS
WHAT EVIDENCES ARE THERE THAT GASTROENTERITIS OUTBREAK IS
ASSOCIATED WITH CLIMATE CHANGE/ WEATHER PATTERNS
Systematic Review Literature
Student Name: MAKINDE OLUWAMAYOWA
Public Health Practice (7707 MED)
Course Supervisor: Dr. Megan Young

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WHAT ARE THE EVIDENCES THAT GASTROENTERITIS OUTBREAK ARE
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Abstract
The systematic review literature has been focused on obtaining evidence to whether
Gastroenteritis outbreaks are associated with weather patterns/climate change. The objective of
this research is to establish the association between climate change and its effect on
gastroenteritis by reviewing the current literature available and finding evidence from them. The
methodology used for this project in systemic literature review using the databases such as
CINAHL, COCHRANE, PubMed and MEDLINE using the keywords Gastroenteritis and
Climate Change, weather changes. The studies chosen for the project are published from January
2004 to December 2018. On the basis of relevance to the research question the articles were
reviewed and duplicates and unrelated articles were omitted from the project. The research
project objective was to find the evidence to impact of weather variability on the incidence of
gastroenteritis. What will be the effect of Extreme weather events such as Quasi-Biennial
Oscillation, El Nino, La Nina, and local level meteorological changes such as droughts, floods on
the spread of viral gastroenteritis.

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Table of Contents
Abstract............................................................................................................................................1
Background......................................................................................................................................3
Prevalence of gastroenteritis........................................................................................................3
Causes of climate change.............................................................................................................4
Relation between climate change and gastroenteritis..................................................................5
Relation in between climate change and distribution of pathogens............................................6
Rationale..........................................................................................................................................8
Aim..................................................................................................................................................8
Objectives........................................................................................................................................8
Methods...........................................................................................................................................9
The required resources.....................................................................................................................9
Results..............................................................................................................................................9
Discussion........................................................................................................................................9
Research significance....................................................................................................................15
Conclusion.....................................................................................................................................16
References......................................................................................................................................17

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WHAT ARE THE EVIDENCES THAT GASTROENTERITIS OUTBREAK ARE
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Background
The infectious gastroenteritis is one of the present health issues worldwide and the
primary symptom of this disease, diarrhoea lead to the death of almost 3 million people and
cause diseases to almost 1 million people throughout the world. In the different industrialised
countries the death rates are very high in comparison to the birth rates mainly because of the
occurrences of intestinal problems. Recently due to changes in the global climate, scientists have
become very interested in doing researches on the relation between the changes in the climate
and different climatic factors and the occurrence of the gastrointestinal problems. It has been
found that the gastrointestinal diseases are very much related with the changes in the sudden
climatic conditions and weather patterns. Gastroenteritis is the inflammation of the stomach and
the large and small intestines which means gastroenteritis means the inflammation of the whole
gastrointestinal tract (Cronk, Slaymaker & Bartram, 2015). It also known as infectious diarrhea
and usually called Stomach Flu, but it has no relation to Influenza. Diarrhea, abdominal pain,
lack of energy, fever, and vomiting are the main symptoms associated with gastroenteritis.
(Cronk, Slaymaker & Bartram, 2015). The occurrence of gastroenteritis due to the changes in
the weather patterns can be decreased if the human activities against the environment decreases.
Prevalence of gastroenteritis
Infectious gastroenteritis is a common illness in developed and developing as well as
underdeveloped countries. In United States, gastroenteritis is responsible for 3.7 million hospital
visits and 135,000 to 220,000 paediatric visits, and gastroenteritis also contributes to the deaths
of 150 to 300 children of below 5 years within a few period of time (Singh, A., Fleurat, M.,

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Kwon, K. T., & Whiteman, P., 2010). In Australia gastroenteritis infection is prevalent and
affects an estimated 17 million people per annum (Harley et al.,2011).
The main causes of gastroenteritis are the infections cause by some viruses and bacteria
and rather than by the infection caused by the parasitic infections. The main viruses which cause
this disease are Novovirus and Rotavirus (Helms, A Richard, 2006). Among the bacteria the
main causative agents are Escherichia coli, Campylobacter and Salmonella are the primary
causes of gastroenteritis (Webber, Roger., 2009). Alone in the United States it is estimated that
one million Campylobacter gastroenteritis cases were recorded every year (Scallan et al.,2011).
Salmonella is also one of the leading cause of acute gastroenteritis throughout the world. In the
United States, salmonellosis is responsible for 1.4 million cases of gastroenteritis including
15,000 hospitalizations and 400 deaths each year. (Callaway et al., 2008).
Causes of climate change
Climate change or Weather Change is the long-term shifts in climate patterns. Due to
increase in population, human activities against the nature and for the natural products are
increasing. Increasing human population is consuming the natural products in such a way that it
is leading to the changes in the climate. The massive rate of deforestation is increasing the
atmospheric temperature of the Earth and thus climate change is occurring ultimately. Due to the
changes in the climate humans and animals are suffering a lot as the changes in climate is
affecting the health conditions of animals. The death rate has increased much more than it was
few years before. Variations in the climatic conditions play a major part in deciding the
behaviour patterns and activities of human beings and other organisms (Viboud et al., 2004) and
hence climate change patterns may influence patterns of disease transmission (Kuhn et al., 2005).

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It can be understood from the figure that the changes in the climate and the occurrence of
the infectious diseases are very much interrelated. In one side it can be seen that that the changes
in human activities impact the climate negatively as the increase in human population increases
the demands of the people. To meet the increasing demand of the people, deforestation are done
and people are contaminating the rivers and using water from rivers. This automatically changes
the climate (McIver et al., 2016) Lack of trees will lead to increase in the temperature of the
Earth, scanty rainfall and many other things. Due to this increased temperature, pathogens which
require higher temperature to grow will start growing and will infect humans. People will suffer
from disease and also the disease will spread from one person to another Sometimes even, the
organisms get adapted to the normal temperature also. Some bacteria get involved the food items
and also get mixed with underground water and cause gastroenteritis (Maal-Bared et al., 2012).
Supporting this theory is the seasonality of infection with pathogens such as rotavirus,
salmonella and campylobacter. Rotavirus has a peak rate of infection in winter, salmonella in
summer and Campylobacter in spring (Kovats RS, et al..2005).
Relation between climate change and gastroenteritis.
The direct relation between the changes in climate and the increasing number of
gastroenteritis diseases are already proved by many researches done till now. (Kovats, RS, et al.,
2005), (Kovats RS, et al..2004). The transmission of the gastroenteritis causing pathogens is a
very important factor as the whole medication system is dependent mainly on the route of the
occurrances of the disease. (Haley et al., 2009).
The way of transmission of the bacteria can be in different ways. It can transmit through
foor, water, air and insects (Celik et al., 2015). The other most important way of transmission of

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gastroenteritis is the changes in the climate weather pattern and climate change. Variability of
climate or weather change can influence the human health (Costello et al., 2009, & Willox et al.,
2015) not only by the causing gastroenteritis but also by causing many other health issues
involving like the diseases of the respiratory organs lings, heart and even the airways. Many
problems of liver and the disease like cholera occurs because of the consumption of
contaminated food and water. (Altizer et al., 2013, Bouzid et al., 2014, Epstein, 2001a). For the
transmission of the infectious disease, most essential components are a host (vector) an agent (or
pathogen) and a transmission medium (environment). (Epstein, 2001a). The occurrence of the
diseases through vectors is the most fatal causative agent as it becomes very difficult to control
the causative agents. The vectors can small insects like flies or it can be pests from the fields and
also from homes.
Relation in between climate change and distribution of pathogens.
Climate is a very important factor in the survival and distribution of the disease
pathogens. Normally in the unhealthy environment many insects can be found which are very
hard to find at the normal conditions this is because most of these vectors become active in the
unhealthy environmental conditions, so it can be said that the changes in climate are very much
responsible for the occurrances of diseases. (Epstein, 2001a, Wu et al., 2014). An example of this
is in the monsoon most of the people suffer from different infectious diseases. These diseases
occur because of contaminations in food and water and at the same time are caused because of
the increase in different disease causing insects. Many people suffer from viral fevers and it is
very contagious and spreads from one disease person to anther healthy person. The increase in
the number of rats and other such animals contaminate the food items stored in the store houses
and thus when people consume those foods are infected with the diseases (Hellberg & Chu,

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2016). According to Ostfeld and Brunner, 2015, Rodó et al., 2013, long-term changes in climate
or warming up of climate, tends in favor of the expansion of infectious diseases geographically.
More outbreaks of the disease in new places were results of the extreme weather events.
According to (Kuhn et al., 2005, Wu et al., 2014) the transmission and distribution of infectious
diseases seasonally are constrained by the weather conditions, climatic conditions influence the
intensity and timing of the epidemic. For example, in the winter season sometimes rainfall
happens in specific some geographical areas and in those places the people suffer from same
diseases. Due to this sudden change in weather bacteria which needs such climate to grow will
start to grow and people will get infected and if the disease is infectious then it spreads from one
person to another and people from a specific area will get infected. In this way epidemic diseases
and pandemic diseases occur (Alexander et al., 2013) Alteration in infectious disease contact
patterns of vector-human, host- human or human pathogen is due to changes in climatic patterns
which in turn affect the transmission of disease.
The pathogens responsible for the gastroenteritis have different characteristics and
reproductive cycles and even different methods of transmission, so the seasonal patterns for each
pathogen vary from each other. The propensity of human behavior towards food habits and
lifestyle changes like picnics or social gatherings may also be affected by the temperature
changes according to seasons, which brings changes in rainfall rate and humidity. According to
Akil, L., Ahmad, H. A., & Reddy, R. S. 2014 the prevalence of salmonellosis and the rise in the
temperature holds a strong positive relationship. As the global temperatures are in rise due to
global warming and an increase in extreme weather events such as cyclones, flood, In turn affect
the proliferation of the disease pathogens. Variabilities in temperature and impact on
gastroenteritis and their association draws more attention. The disease increases with the increase

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in the temperature, as in such high temperatures the body metabolism sometimes do not able to
work properly. So the body systems get hampered and cannot work properly (Manser et al.,
2013). So it is very important to address the topic of association of gastroenteritis with climate
change as has great importance in public health and finding evidence in support of the main
research question will help in improving the public health.
This literature review examines and summarises the evidence on how climate changes are
associated with gastroenteritis. Many evidences are there which shows that the disease
gastroenteritis is very much dependent on the changes in climate and in the patterns of weather.
Rationale
The rationale behind doing this study is the increasing health effects due to the increase
in the changes in climate. The disease gastroenteritis is one of the major health issues due to the
changes in climate. This disease is increasing globally involving both the developed and the
under developed countries not only in Australia (Onozuka, 2014). The proper understanding of
the evidences on associating the disease gastroenteritis and the changes in climate must help in
the designing proper systems and pursue different interventions to reduce the occurrence of
gastroenteritis globally. Because of this disease, the death rate has increased than it was in the
past. So it has become very necessary to reduce the incidences of this disease and the occurrence
of death because of this disease otherwise in future this disease will take severe form and many
people will die (Wade et al., 2014). So to reduce the disease people must take much care about
the climate change and the weather patterns.

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Aim
The aim of this study is to understand if there is any evidence to support the link between
the changes in climate and the gastroenteritis.
Objectives
The objective of doing this research is do a thorough literature review and to do the
summary the evidences that are already existing which link the changes in climate or changes in
weather and the gastroenteritis outbreaks or cases.
Methods
This research is completely a systematic study and a thorough research has been done for
doing this research work from the databases CINAHL, COCHRANE, EMBASE and MEDLINE.
While doing this research the keywords that were used for doing the searching are climate
change, greenhouse effect, gastroenteritis, diarrhoea, vomiting, food borne diseases, water borne
diseases and extreme weather conditions. So many papers were found involving these key words
but not all of them were relevant for this research work. The papers which were having proper
and relevant information for this paper work were used. If improper papers were used then the
results would not match according to the requirements of this research work.
The required resources
The resources that were used for doing this research work are mostly from the databases
and some knowledge were obtained from the library also.

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Results
From the CINAHL database, 6290 articles were found relevant to this research work.
From the database MEDLINE 3561 articles were found to meeting the requirements of this
research work. From the database EMBASE, the relevant number of articles were only 349 and 8
articles from COCHRANE were found to be relevant for the study. All of these papers involved
research works from different countries and thus the result obtained from these papers made our
work more easy in knowing about how the disease gastroenteritis is occurring worldwide.
Discussion
This study has identified the significant gastrointestinal disorders which are occurred
because of the changes in the climate. Most of the data that are involved in this study are
collected from the research works that are done by collecting primary data, so the data that are
used for this experiment are all correct and quite valuable. Many papers are there which included
the wet seasons and obviously the reasons why gastrointestinal diseases occur during the wet
seasons. Much evidences are also there which showed that not only in the wet seasons, but in the
dry seasons also the gastrointestinal disease occurs. Studies are also related about the different
bacteria which mainly cause the disease including Salmonella many other Enterobacters.
It is already proved evidently that the disease gastroenteritis is very much associated with
the consumption of water. The water safety plans provided by the World Health Organisation has
guided with some rules which can help the supplies of the water to effectively find the potential
risks associated with the drinking of the water and can also implement the preventive barriers
which can improve the safety of people drinking water (Guentchev et al., 2016). Long term
studies have shown that the drinking of contaminated water has very less risk of occurring of

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gastroenteritis but in some countries like France and Spain, evidences are there which how that if
proper measures are taken in maintaining the quality of the drinking water then, the occurrence
of the disease can be reduced and in some cases it has reduced also. The relationships between
the controls and exposures to different variables can be used to know how the occurrence of this
disease can be reduced because of the consumption of water. The exposures can be precipitation,
temperatures, the water quality which is raw and also the quality of water after the treatment is
over. The controls can be taken as the temporal trends in the reporting diseases, mainly the
suspected ones should be used. In countries like France the tracking of the gastroenteritis cases
are done by properly keeping the reimbursements of the prescriptions. In Spain the tracking is
done by visiting the hospitals from time to time. Several relationships can be found in between
the different indicators of all the exposures and the gastroenteritis, only the acute ones. It has
been found that the sources of pollution which were non-point are responsible for the 10%
increase in the cases of acute gastroenteritis in a certain location where the surface water was
provided. The cases of this acute disease has also found to be increased to a certain amount
where both the surface water and ground water was provided (Horn et al., 2018). Where as in
some places the different risks that were associated with the occurrence of gastroenteritis with
the consumption of water was mitigated by following the rules made by the World Health
Organization. This paper suggested that the drinking of water is associated with high risks of
gastrointestinal diseases in certain risk prone areas (Setty et al., 2018). Another reason in the
increase of the disease gastroenteritis is the increase in the serotypes of the Salmonella. The main
reason for the increase in the serotypes of this organism is the gradual increase in the generation
of heat waves. In Australia experiments were done to determine how the increase in the heat
waves lead to the increase in the serotypes of Salmonella sp. The time taken and the duration of

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the salmonellosis was noted from 1992 to 2012. The result was that one of the strains of
Salmmnella typhimurium has increased its number to two folds. He study also identifies the
impacts that the increased heat waves have on the different serotypes of Salmonella. The cases of
this experiment was obtained from the daily records from the laboratories. For determining the
effects of the heat waves, the variables, heat waves and the nom heat waves were included (Setty
et al., 2018). The effect of this organism were tested daily within the heat waves. Another
experiment was also included to determine the effect of short as well as the long durations. The
result of this experiment showed that out of 7845 cases, 4412 of the patients showed that the
onset of the disease was in the warm season in between the months October to march (Milazzo et
al., 2016). Apart from the heat waves there are other factors which lead to the increase in
Salmonellosis. In United States of America many other environmental causes are found which
increase in the occurring of the disease. The organism has increased with the increasing in the
temperature and increase in precipitation. In an experiment exposure matrices in relation to the
extreme temperature and extreme precipitation within 30 years baseline was done and the data
obtained was linked with the data that was obtained in the country level. The result that was
obtained showed that a single degree increase in the temperature can lead to many cases of
Salmonellosis. Only one degree increase in the temperature has increased 4.1% increase in the
risks associated with the disease salmonellosis (Jiang et al., 2015). This study has showed that
increase in the temperature and the increase in the precipitation suddenly can cause a massive
increase in the occurrence of this disease. Mostly the increase in the disease occurs in the coastal
areas where the chances of precipitation is very high. Even at the time of monsoons, flood
happens and specifically at that time more people suffer from this disease as the chances of
infection is also increased (Jiang et al., 2015). When one person is suffering from

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gastrointestinal problems, then the persons living with that person also has chances of getting
infected. When the temperature of the coastal regions get increased, the ecological niches
changes to much higher conditions and thus the number of bacteria are amplified to a large
extent and thus the disease gets spread. Another reason for the increase in the disease is that due
to the increase in the temperature people tend to consume more foods as compared to the foods
that they consume in normal days. People tend to consume foods that are not cooked properly
and thus people get infected with the disease (Jiang et al., 2015).
The changes in the climatic conditions effects on the persistence of the foodborne
pathogens and also in the dispersal of the pathogens in the outdoor environment. According to
Hellberg & Chu (2016) in some areas the increase in the trends of heat waves and hot extremes
as well as the increase in the storms in some places have direct relationships with the increase in
the gastrointestinal diseases (Khan et al., 2015). The different hosts of the food borne pathogens
are also affected by the changes in the climatic patterns as the physiological stress get increased.
The zoonotic pathogens are also the sufferers of the change in climate. These bacteria include
Bacillus, Campylobacter, Clostridium , Escherichia coli, Salmonella, Staphylococcus, Yersinia
and vibrio. These are the causative agent of most of the cases of the gastrointestinal diseases
(Hall et al., 2011). Bacillus is mostly found in the outdoor environment and this bacteria is spore
producing. So the spores of this bacteria is resistant to the adverse conditions of the environment.
So when these spores are mixed with foods, then intestinal problems can occur. These spores can
even tolerate the high level of salts. Another bacteria of importance is Brucella (Ghazani et al.,
2018). This bacteria is transmitted to humans from some animals like cow. Though this disease
has been eradicated from some countries but still some countries are there where this bacteria is
prevalent (Hellberg & Chu, 2016).

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Not only the under developed countries, the countries who are developed and whose
income are very high also suffers a lot from the food borne pathogen and the changes in the
climate. According to some studies, due to changes in climate production of food will get altered
in the changed climatic condition (Milazzo et al., 2017).The interaction between the changes in
climate and the system of food are very complex. An example of the spread of disease because of
the interaction between the animal the human is the increased use of animal husbandry in doors.
This activity will no doubt spread the zoonotic diseases from the animal to humans. The climatic
changes like the changes in the rainfall, temperature and other extreme environmental events
changes the environmental conditions including the geography and the weather at the baseline.
The pathogen ecology changes, the practices of the agriculture, the food preparation and
transport and also the sources of food are also changed (Lake & Barker, 2018).
Another most important factor of the gastrointestinal diseases is the variations in the
rainfall. Due to the variations in rainfall, the children are mostly effected and mostly those whose
age in under the age of 5 years. In Rwanda, an experiment was done regarding the occurrence of
the gastrointestinal disease among children under 5 years of age. According to the previous
studies, direct relation have been found with the variations in rainfall and the gastrointestinal
diseases among the children (Ahdoot, & Pacheco, 2015).. The variables of rain were collected by
daily measuring the rainfall in the city. For doing the survey, 8601 children were involved who
were under the age of 5 years. Among them 13.2% have reported diarrhoea in between the 2
weeks prior of the survey was to be done. Children who were living at home having improper
facilities of toilet but children who were living at home having proper toilet facilities showed
reduced gastrointestinal diseases. This experiment was done in India. The chances of occurring
of diarrhoea and other gastrointestinal disease are related with the amount of rainfall that the area

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is experiencing. The small children are mostly effected because their immunity is not as strong as
the immunity of the elders. So they get infect easily than other people and the infection also
spreads among other children (Phung et al., 2015). Due to high rainfall, the quality of water gets
changed, the heavy rainfall contaminate the surface water and carries the waste materials into the
rivers and oceans and the low amount of rainfall may force the people to use the water that is
already contaminated. With the changes in the amount of rainfall the quality of the toilets also
differ. When there is sufficient rainfall people will get involved in proper cleaning of the toilets
while the low amount of rainfall lead to compromises in proper cleaning of the toilets. Even the
shared toilets and the public toilets are effected as with high rainfall, the toilet can be cleaned as
sufficient amount of water is there but during low amount of rainfall as shortage of water is
there, the toilets cannot be cleaned. The runoff water and the flood water also causes
contamination of the surface water, the sediments that are found in the surface water may clog
the filters and thus hampers the filtering operation of water (McIver et al., 2016). The high runoff
water help in clearing of the contaminated faeces however, low runoff water foster the growth of
the microorganisms which are unwanted. High monthly rainfall lead to more access of surface
wate (Onozuka & Hagihara, 2015).. During the rainy season, the people who use the pump water
or the surface water for consumption can use the water of the rainfall. The water that remains in
the pipe get contaminated because the silts and other materials get contaminated in the pipe and
increases the contamination of water. During the dry season, the area which are dependent on the
rainfall water do not get sufficient amount of water and also suffer from disease. The household
works are also hampered because of the shortages of sufficient amount of water. In the result
13.2% of the children were effected in between the two weeks of prior to the survey. 51% of the
boys and 40% of the girls were equally involved in the study (Mukabutera et al., 2016).

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In another research work in India it is mentioned that by the application of the conceptual
framework of the new regional projections of climate of the northern India, the increase in the
present cases of gastrointestinal diseases and the future cases of the gastrointestinal diseases has
been detected. It is shown in the study that the diarrhoeal cases has increased from no case to
21% and 13.1% increase in cases in the gangetic basin (Moors et al., 2013). This appear has
discussed about the different actions that should be taken to prevent the occurrence of this
disease and the actions are reactive actions, different preventive actions and the options of the
national policy. The preventive actions if taken properly can combat the occurrence of
gastrointestinal disease (Moors et al., 2013).
Research significance
This research study has completely dealt with the relation between the changes in
weather conditions and climatic change with the occurrence of the gastrointestinal disease. This
research work can also be followed in different schools, colleges and working areas as it is
dealing with the reasons of the occurring of the gastrointestinal disease and also how the disease
occurs. The greatest achievement of this study is this paper has the capability to make people
aware about the causes and different issues of the gastrointestinal diseases.
Conclusion
From this work it can be concluded and it is proved that the changes in climate and
weather changes really influence a lot on the well-being of people. All the research papers that
are used for doing this research work have valid evidences about the direct relation between the
climate change and occurrence of intestinal diseases. So to reduce the gastrointestinal cases and
death of persons because of this disease people must be aware about the changes in the

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environmental conditions. Evidences are already discussed about the relation between the
changes in the climate and the distribution of the pathogens. It has already been discussed that
because of the sudden rise of temperature the micro-organisms which are can tolerate high
temperatures starts growing while when the temperature falls down, then the micro-organisms
which can develop at very low temperature starts growing. The pathogens which are water borne
can be managed by following special hygienic conditions.

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