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Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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UNDER THE WEATHER

Climate, Ecosystems, and Infectious Disease




Committee on Climate, Ecosystems, Infectious Disease, and Human Health

Board on Atmospheric Sciences and Climate

Division on Earth and Life Studies

National Research Council




NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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    NATIONAL ACADEMY PRESS 2101 Constitution Ave., N.W. Washington, DC 20418

    NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

    Support for this project was provided by U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, National Science Foundation, National Aeronautics and Space Administration, National Oceanic and Atmospheric Administration, U.S. Geological Survey, U.S. Global Change Research Program, and the Electric Power Research Institute. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsors.

    Library of Congress Cataloging-in-Publication Data

    Under the weather : climate, ecosystems, and infectious disease / National Research Council Division on Earth and Life Studies Board on Atmospheric Sciences and Climate Committee on Climate, Ecosystems, Infectious Disease, and Human Health.

    p. cm.

    Includes bibliographical references and index.

    ISBN 0-309-07278-6

    1. Medical climatology. 2. Epidemiology. 3. Communicable diseases.

    I. National Research Council (U.S.). Committee on Climate, Ecosystems, Infectious Disease, and Human Health.

    RA793 .U53 2001

    616.9'88—dc21

    2001001905

    Additional copies of this report are available from:

    National Academy Press
    2101 Constitution Avenue, NW
    Box 285
    Washington, D.C. 20055
    800-624-6242
    202-334-3313 (in the Washington metropolitan area)
    www.nap.edu

    Cover: Images on the cover were obtained from the Centers for Disease Control and Prevention "Public Health Image Library" at http://phil.cdc.gov/phil/default.asp and the NOAA Photo Library at: http://www.photolib.noaa.gov.

    Copyright 2001 by the National Academy of Sciences. All rights reserved.

    Printed in the United States of America

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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    THE NATIONAL ACADEMIES

    National Academy of Sciences
    National Academy of Engineering
    Institute of Medicine
    National Research Council

    The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

    The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.

    The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

    The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Page v

    COMMITTEE ON CLIMATE, ECOSYSTEMS, INFECTIOUS DISEASE, AND HUMAN HEALTH

    Members

    DONALD BURKE (Chair), Johns Hopkins University, Baltimore, Maryland

    ANN CARMICHAEL, Indiana University, Bloomington

    DANA FOCKS, U.S. Department of Agriculture, Gainesville, Florida

    DARRELL JAY GRIMES, University of Southern Mississippi, Ocean Springs

    JOHN HARTE, University of California, Berkeley

    SUBHASH LELE, University of Alberta, Canada

    PIM MARTENS, Maastricht University, Netherlands

    JONATHAN MAYER, University of Washington, Seattle

    LINDA MEARNS, National Center for Atmospheric Research, Boulder, Colorado

    ROGER PULWARTY, University of Colorado, Boulder

    LESLIE REAL, Emory University, Atlanta, Georgia

    CHESTER ROPELEWSKI, International Research Institute for Climate Prediction, Palisades, New York

    JOAN ROSE, University of South Florida, St. Petersburg

    ROBERT SHOPE, University of Texas Medical Branch, Galveston

    JOANNE SIMPSON, NASA Goddard Space Flight Center, Greenbelt, Maryland

    MARK WILSON, University of Michigan, Ann Arbor

    NRC Staff

    LAURIE GELLER, Study Director

    SUSAN ROBERTS, Program Officer

    JONATHAN DAVIS, Program Officer

    TENECIA BROWN, Senior Program Assistant

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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    BOARD ON ATMOSPHERIC SCIENCES AND CLIMATE

    The Board on Atmospheric Sciences and Climate (BASC) was established by the NRC to advance understanding of the earth's atmosphere and climate, to help apply this knowledge to benefit the public, and to advise the federal government on problems and programs within the Board's areas of expertise. The BASC assisted in the development and oversight of the CEIDH study.

    ERIC J. BARRON (Chair), Pennsylvania State University, University Park

    SUSAN K. AVERY, Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder

    HOWARD B. BLUESTEIN, University of Oklahoma, Norman

    STEVEN F. CLIFFORD, National Oceanic and Atmospheric Administration, Boulder, Colorado

    GEORGE L. FREDERICK, Radian Electronic Systems, Austin, Texas

    MARVIN A. GELLER, State University of New York, Stony Brook

    CHARLES E. KOLB, Aerodyne Research, Inc., Billerica, Massachusetts

    JUDITH L. LEAN, Naval Research Laboratory, Washington, D.C.

    ROGER A. PIELKE, JR., National Center for Atmospheric Research, Boulder, Colorado

    MICHAEL J. PRATHER, University of California, Irvine

    ROBERT T. RYAN, WRC-TV, Washington, D.C.

    MARK R. SCHOEBERL, NASA Goddard Space Flight Center, Greenbelt, Maryland

    JOANNE SIMPSON, NASA Goddard Space Flight Center, Greenbelt, Maryland

    THOMAS F. TASCIONE, Sterling Software, Inc., Bellevue, Nebraska

    ROBERT A. WELLER, Woods Hole Oceanographic Institution, Woods Hole, Massachusetts

    ERIC F. WOOD, Princeton University, Princeton, New Jersey

    Ex Officio Members

    DONALD S. BURKE, Johns Hopkins University, Baltimore, Maryland

    DARA ENTEKHABI, Massachusetts Institute of Technology, Cambridge

    MARIO MOLINA, Massachusetts Institute of Technology, Cambridge

    EUGENE M. RASMUSSON, University of Maryland, College Park

    EDWARD S. SARACHIK, University of Washington, Seattle

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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NRC Staff

ELBERT W. (JOE) FRIDAY, JR., Director

LAURIE S. GELLER, Program Officer

ALEXANDRA ISERN, Program Officer

PETER A. SCHULTZ, Senior Program Officer

VAUGHAN C. TUREKIAN, Program Officer

DIANE L. GUSTAFSON, Administrative Assistant

ROBIN MORRIS, Financial Associate

TENECIA A. BROWN, Senior Project Assistant

CARTER W. FORD, Project Assistant

Page viii Cite
Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Acknowledgment of Reviewers

This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the authors and the NRC in making the published report as sound as possible and to ensure that it meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:

William E. Gordon, Rice University, Houston, Texas

Nicholas Graham, Scripps Institution of Oceanography, San Diego, California

Donald A. Henderson, Johns Hopkins University, Baltimore, Maryland

Joshua Lederberg, The Rockefeller University, New York

Simon Levin, Princeton University, Princeton, New Jersey

Mercedes Pascual, University of Michigan, Ann Arbor

Roger Pielke, Jr., National Center for Atmospheric Research, Boulder, Colorado

Arthur Reingold, University of California, Berkeley

Peter B. Rhines, University of Washington, Seattle

David J. Rogers, University of Oxford, England

Mary Wilson, Harvard University, Cambridge, Massachusetts

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Lynn Goldman (Johns Hopkins University) appointed by the Division on Earth and Life Studies, and Gilbert Omenn (University of Michigan) appointed by the NRC's Report Review Committee, who were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Page xi

Preface

Over the past several years, scientists, public health officials, and policy makers have become increasingly interested in understanding how the emergence and spread of infectious diseases could be affected by environmental factors, particularly variations in climate. In September 1995 the Institute of Medicine/ National Academy of Sciences and the National Science and Technology Council held a Conference on Human Health and Global Climate Change. Following this event, an interagency discussion group met several times and decided that a more in-depth exploration of this issue was needed, and thus plans were developed for this study on climate, ecosystems, infectious diseases, and health (CEIDH).

Support for this study was provided by the U.S. Environmental Protection Agency, the Centers for Disease Control and Prevention, the National Science Foundation, the National Aeronautics and Space Administration, the National Oceanic and Atmospheric Administration, the U.S. Geological Survey, U.S. Global Change Research Program, and the Electric Power Research Institute.

The study committee, consisting of 16 people from a broad range of disciplinary backgrounds, was appointed in January 1999; see Appendix A for biographical details on the committee members. Over the course of the next 18 months, six meetings were held, where the committee received briefings from federal agency representatives, talked with experts on a wide variety of topics relevant to the study, and worked on this report. See Appendix B for a detailed list of the discussion topics and speakers at the meetings.

While this study was under way, several other assessment activities related to the issue of climate and health were being carried out, for instance, by the American Academy of Microbiology, the U.S. Global Change Research Pro

Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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gram, and the Intergovernmental Panel on Climate Change. The CEIDH committee has followed the progress of these other activities, and in fact some committee members participated in them. However, the committee's final deliberations, and the recommendations and conclusions contained in this report, were developed independently of these other activities.

As the report title implies, this study explores the linkages among climate, ecosystems, infectious diseases, and human health. This study is global in scope; the committee considered infectious disease threats not only to the United States, but also to populations around the world. The study focuses only on the issue of infectious diseases, but it should be noted that there are many ways that climate and weather can affect human health, including the direct physical impacts of temperature extremes and severe storms, and the respiratory effects of heat-exacerbated air pollution.

An important goal of this report is to help the different groups of researchers involved in climate and infectious disease studies gain a more realistic understanding of the current capabilities and limitations of each other's fields. For instance, climatologists need to understand that epidemiological data from many parts of the world are highly limited or nonexistent, and a great deal of effort will be needed to improve this situation. In turn, epidemiologists and other health professionals need to understand the considerable uncertainties associated with many aspects of climate forecasting. Improving this mutual understanding will help ensure that future research activities are effectively designed, and that all involved have realistic expectations about the feasibility of climate-based disease early warning systems.

The primary intended audiences for this report are the scientists and program managers responsible for planning and carrying out future research on this topic. However, this issue is certainly of interest to a wider audience, and thus the committee attempted to write a report that would be accessible to people from a broad range of educational and professional backgrounds.

Page xiii Cite
Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Contents

EXECUTIVE SUMMARY 1
1 INTRODUCTION 8
2 CLIMATE AND INFECTIOUS DISEASES: THE PAST AS PROLOGUE 12
    Origins of Environmental Medicine, 12
    The Early Merger of Meteorology and Medicine, 13
    Meteorology Becomes an Independent Discipline, 15
    Medical Environmentalism Without Meteorology, 16
    Twentieth Century Teleconnections, 17
3 LINKAGES BETWEEN CLIMATE, ECOSYSTEMS, AND INFECTIOUS DISEASE 20
    Weather and Climate: Background Concepts, 20
    Infectious Disease Dynamics: Background Concepts, 28
    Weather/Climate Influences on Infectious Diseases: An Overview, 33
    Other Factors that Affect Infectious Disease Dynamics, 39
4 CLIMATE INFLUENCES ON SPECIFIC DISEASES 45
    Dengue, 45
    Malaria, 48
    St. Louis Encephalitis, 49
    Rift Valley Fever, 50
Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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    Hantavirus, 51
    Lyme, 52
    Influenza, 54
    Cryptosporidium, 56
    Cholera and other Vibrios, 57
5 ANALYTICAL APPROACHES FOR STUDYING CLIMATE/DISEASE LINKAGES 59
    Observational and Experimental Studies, 59
    Mathematical Modeling, 63
    Risk Assessment Frameworks, 68
    Integrated Assessment, 71
    Surveillance/Observational Data Needs, 73
6 TEMPORAL AND SPATIAL SCALING: AN ECOLOGICAL PERSPECTIVE 80
    Biological Effects of Observed Climate Variability, 80
    Confounding Influences on Ecological Forecasting, 82
7 TOWARDS THE DEVELOPMENT OF DISEASE EARLY WARNING SYSTEMS 86
    Developing Effective Early Warning Systems, 87
    Examples of the Use of Climate Forecasts, 97
8 KEY FINDINGS AND RECOMMENDATIONS 103
ACRONYMS/ABBREVIATIONS 109
GLOSSARY 110
REFERENCES 115
APPENDIX A:     BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS 127
APPENDIX B:     SPEAKERS/PRESENTATIONS AT THE COMMITTEE MEETINGS 132
INDEX 137
Suggested Citation:"Front Matter." National Research Council. 2001. Under the Weather: Climate, Ecosystems, and Infectious Disease. Washington, DC: The National Academies Press. doi: 10.17226/10025.
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Since the dawn of medical science, people have recognized connections between a change in the weather and the appearance of epidemic disease. With today's technology, some hope that it will be possible to build models for predicting the emergence and spread of many infectious diseases based on climate and weather forecasts. However, separating the effects of climate from other effects presents a tremendous scientific challenge.

Can we use climate and weather forecasts to predict infectious disease outbreaks? Can the field of public health advance from "surveillance and response" to "prediction and prevention?" And perhaps the most important question of all: Can we predict how global warming will affect the emergence and transmission of infectious disease agents around the world?

Under the Weather evaluates our current understanding of the linkages among climate, ecosystems, and infectious disease; it then goes a step further and outlines the research needed to improve our understanding of these linkages. The book also examines the potential for using climate forecasts and ecological observations to help predict infectious disease outbreaks, identifies the necessary components for an epidemic early warning system, and reviews lessons learned from the use of climate forecasts in other realms of human activity.

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