Climate changes, environment and infection: Facts, scenarios and growing awareness from the public health community within Europe
Climate changes, environment and infection: Facts, scenarios and growing awareness from the public health community within Europe
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DOI：
10.1016/j.anaerobe.2011.05.016
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发表时间：
2011-12-01
期刊：
影响因子：
2.3
通讯作者：
Charvalos, Ekatherina
中科院分区：
文献类型：
--
作者：
Bezirtzoglou, Christos;Dekas, Konstantinos;Charvalos, Ekatherina
气候变化是当前全球关注的一个问题，尽管对其原因及其影响的程度和重要性仍存在争议，但它似乎可能会影响欧洲残留感染和输入性感染的发生率和流行率。气候主要影响传染病的范围，而天气则影响爆发的时间和强度。气候变化情景包括随着变暖而改变的传染病分布以及与极端天气相关的疫情爆发的变化。气候变化对欧洲健康的最大影响并非来自媒介传播的传染病。这并不意味着欧洲不会出现此类健康影响。由于变暖，一些媒介传播疾病或其传播媒介的海拔范围已经发生变化。此外，更强烈的天气事件也为传染病的爆发创造了条件：大雨离开昆虫繁殖地，驱赶啮齿动物离开洞穴，并污染清洁水系统。蚊媒寄生虫病和病毒性疾病的发病率是对气候最敏感的疾病之一。气候变化通过改变媒介的地理范围和缩短病原体潜伏期来影响疾病传播，与气候相关的海面温度和水位升高将导致水传播传染病和毒素相关疾病的发病率更高，例如霍乱和海鲜中毒。最近的霍乱病例从肯尼亚输入到欧洲，这一事实证明了世界各地的气候变化对欧洲的影响，肯尼亚流行病的蔓延与起源于太平洋的厄尔尼诺现象有关。异常气候变化导致的人类迁徙和卫生基础设施的破坏可能间接导致疾病传播。紫外线辐射增加导致人体免疫系统发生变化，以及农产品变化导致营养不良，这可能会进一步加剧人类对感染的易感性。欧洲发生的各种极端天气事件对公共健康产生了影响。 2007 年意大利爆发的虫媒基孔肯雅病毒就是欧盟必须警惕应对的新健康威胁的一个例子。此外，洪水对健康的影响与钩端螺旋体病和弯曲杆菌肠炎病例过多有关。捷克共和国发生洪水后已报道了此类例子。同样，英国隐孢子虫病的增加也与洪水有关。欧盟也已论证了与蜱传脑炎和疟疾相关的媒介分布变化。 2008 年 6 月意大利最近报道的一例疑似本土感染的疟疾病例表明，疟疾很容易重新传入该地区的几个国家。 2010 年 5 月，希腊发生了另一起疟疾病例，影响的是一名居住在林区的年轻人，该病例是由希腊疾病控制中心 KEELPNO 报告的。最新的这一病例是否会被认为与意大利的病例密切相关？如果是，那么公共卫生服务部门应该制定计划来应对可能的蜱传疾病。热浪是造成死亡的重要原因，对死亡率的影响也很重要。随着热浪变得更加严重，预计 2003 年法国因热浪造成的死亡将会重演。然而，热浪对传染病传播和严重程度的影响尚未阐明。最后，科学挑战包括阐明气候变化和极端天气条件对感染传播和结果的影响、人类免疫系统的变化和感染反应、疫情爆发情景、动植物健康和公共卫生准备。应对与气候变化相关的健康和感染问题的欧洲行动计划由欧盟委员会不同级别、不同总干事共同制定。简而言之，在欧盟内部，以下关于人类、动物和植物健康的要点被视为优先事项： * 加强这三个卫生部门（人类、动物、植物）服务之间的合作； * 制定极端天气情况下的行动计划，以便做好更好的准备并以最佳方式做出反应； * 收集有关气候变化风险的更可靠信息，同时保持国际合作，特别是与世界卫生组织的合作，因为会员国之间的合作需要更加有效； * 付出额外的努力来确定最有效的措施； * 加强动物疫病监测和控制。欧盟委员会决定更加重视气候变化及其对健康的影响，同时意识到气候变化是许多疾病的根源。 (C) 2011 Elsevier Ltd. 保留所有权利。
Climate change is a current global concern and, despite continuing controversy about the extent and importance of causes and of its effects, it seems likely that it will affect the incidence and prevalence of both residual and imported infections in Europe. Climate affects mainly the range of infectious diseases, whereas weather affects the timing and intensity of outbreaks. Climate change scenarios include a change distribution of infectious diseases with warming and changes in outbreaks associated with weather extremes. The largest health impact from climate change for Europe doesn't come from vector borne infectious diseases. This does not mean that these types of health impacts will not arise in Europe. The ranges of several vector-borne diseases or their vectors are already changing in altitude due to warming. In addition, more intense weather events create conditions conductive to outbreaks of infectious diseases: Heavy rains leave insect breeding sites, drive rodents from burrows, and contaminate clean water systems. The incidence of mosquito-borne parasitic and viral diseases, are among those diseases most sensitive to climate. Climate change affect disease transmission by shifting the vector's geographic range and by shortening the pathogen incubation period, climate-related increases in temperature in sea surface and level would lead to higher incidence of waterborne infectious and toxin-related illnesses, such as cholera and seafood intoxication. Climate changes all around the world with impact in Europe are demonstrated by the fact that recent cases of cholera have been imported to Europe from Kenya, where spreading epidemic has been linked to the El Nino phenomenon, originated from the Pacific Ocean. Human migration and damage to health infrastructures from aberrant climate changes could indirectly contribute to disease transmission. Human susceptibility to infections might be further compounded by alterations in the human immune system caused by increased exposure to ultraviolet radiation and malnutrition due to alterations in agricultural products. Different kind of incidents in Europe with extreme weather events demonstrated effects on public health. The recent outbreak of the insect-borne Chikungunya virus in Italy in 2007 is an example of the kind of new health threat that the EU must be vigilant to confront. In addition, health effects of flooding, have been related to an excess cases of leptospirosis and campylobacter enteritis. Such examples have been demonstrated reported after flooding in the Czech Republic. Similarly, an increase of cryptosporidiosis in the United Kingdom has been related to flooding. Changing vector distributions associated with tickborne encephalitis and malaria have also been dempostrated in EU. A recently reported case of malaria in Italy in June 2008, suspected to be indigenously acquired, has shown how easily malaria could be reintroduced into several countries in the region. Another case of malaria in Greece in May 2010 affecting a young man living in a forestry region was claimed at KEELPNO-the Greek Center for disease control. Would this latest case be considered closely related to the one from Italy? If yes, then Public Health Services should elaborate plans to affront possible tickborne diseases. Heat waves are important causes of mortality on mortality are important. The deaths seen in France in 2003 from a heat wave are projected to be repeated, as heat waves become more severe.However, heat waves impacts on the transmission and severity of infectious diseases have not been elucidted. Finally scientific challenges include the elucudation of climate changes and extreme weather condition impact on infection transmission and outcome, human immune system changes and infection response, outbreak scenarios, animal and plant health and public health preparedness. European action plans to affront climate changes related health and infection problems are developed by the EU Commission at different levels and jointly by different DGs. In a few words within the EU the following points on human, animal and plant health are considered a priority: * Strengthening cooperation between the services of these three branches of health (human, animals, plants); * Developing action plans in the event of extreme weather conditions, in order to be better prepared and to react in the best way; * Gathering more reliable information on the risks of climate change whilst maintaining international cooperation, in particular with the WHO, as cooperation beyond that between Member States will be required to be more effective; * Providing additional effort to identify the most effective measures; * Improving the surveillance and the control of the animal diseases. The European Commission has decided to consider climate change, and the consequences it has on health, with greater importance whilst being aware that it is at the root of numerous diseases. (C) 2011 Elsevier Ltd. All rights reserved.