Page i

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.



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Page i 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.

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Page ii 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

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Page iii 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.

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Page iv

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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

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Page vi 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

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Page vii 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

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Page viii

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Page ix 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

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Page x 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.

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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

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Page xii 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.

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Page xiii 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

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Page xiv     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