Modeling the combined influence of host dispersal and waterborne fate and transport on pathogen spread in complex landscapes.

Environmental models, often applied to questions on the fate and transport of chemical hazards, have recently become important in tracing certain environmental pathogens to their upstream sources of contamination. These tools, such as first order decay models applied to contaminants in surface waters, offer promise for quantifying the fate and transport of pathogens with multiple environmental stages and/or multiple hosts, in addition to those pathogens whose environmental stages are entirely waterborne. Here we consider the fate and transport capabilities of the human schistosome Schistosoma japonicum, which exhibits two waterborne stages and is carried by an amphibious intermediate snail host. We present experimentally-derived dispersal estimates for the intermediate snail host and fate and transport estimates for the passive downstream diffusion of cercariae, the waterborne, human-infective parasite stage. Using a one dimensional advective transport model exhibiting first-order decay, we simulate the added spatial reach and relative increase in cercarial concentrations that dispersing snail hosts contribute to downstream sites. Simulation results suggest that snail dispersal can substantially increase the concentrations of cercariae reaching downstream locations, relative to no snail dispersal, effectively putting otherwise isolated downstream sites at increased risk of exposure to cercariae from upstream sources. The models developed here can be applied to other infectious diseases with multiple life-stages and hosts, and have important implications for targeted ecological control of disease spread.

Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China.

OBJECTIVE: To estimate the disease burden attributable to unsafe water and poor sanitation and hygiene in China, to identify high-burden groups and to inform improvement measures. METHODS: The disease burden attributable to unsafe water and poor sanitation and hygiene in China was estimated for diseases resulting from exposure to biologically contaminated soil and water (diarrhoeal disease, helminthiases and schistosomiasis) and vector transmission resulting from inadequate management of water resources (malaria, dengue and Japanese encephalitis). The data were obtained from China's national infectious disease reporting system, national helminthiasis surveys and national water and sanitation surveys. The fraction of each health condition attributable to unsafe water and poor sanitation and hygiene in China was estimated from data in the Chinese and international literature. FINDINGS: In 2008, 327 million people in China lacked access to piped drinking water and 535 million lacked access to improved sanitation. The same year, unsafe water and poor sanitation and hygiene accounted for 2.81 million disability-adjusted life years (DALYs) and 62,800 deaths in the country, and 83% of the attributable burden was found in children less than 5 years old. Per capita DALYs increased along an east-west gradient, with the highest burden in inland provinces having the lowest income per capita. CONCLUSION: Despite remarkable progress, China still needs to conduct infrastructural improvement projects targeting provinces that have experienced slower economic development. Improved monitoring, increased regulatory oversight and more government transparency are needed to better estimate the effects of microbiologically and chemically contaminated water and poor sanitation and hygiene on human health.

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience.

BACKGROUND: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems. OBJECTIVES: We explored possible explanations for the lack of work on adaptive capacity, outline climate-health challenges that may lie outside public health's coping range, and consider changes in practice that could increase public health's adaptive capacity. METHODS: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity. DISCUSSION: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health's adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting. CONCLUSIONS: Increasing public health capacity will be necessary for certain climate-health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.