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Impact of Temperature and Rainfall on Typhoid/Paratyphoid Fever in Taizhou, China: Effect Estimation and Vulnerable Group Identification
ABSTRACT.
The impact of temperature and rainfall on the occurrence of typhoid/paratyphoid fever are not fully understood. This study aimed to characterize the effect of daily ambient temperature and total rainfall on the incidence of typhoid/paratyphoid in a sub-tropical climate city of China and to identify the vulnerable groups for disease prevention. Daily notified typhoid/paratyphoid fever cases and meteorological data for Taizhou from 2005 to 2013 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. Distributed lag nonlinear model was used to quantify the association between daily mean temperature, total rainfall, and typhoid/paratyphoid fever. Subgroup analyses by gender, age, and occupation were conducted to identify the vulnerable groups. A total of 625 typhoid fever cases and 1,353 paratyphoid fever cases were reported during the study period. An increased risk of typhoid fever was detected with the increase of temperature (Each 2°C rise resulted in 6%, 95% [confidence interval] CI: 2–10% increase in typhoid cases), while the increased risk was associated with the higher temperature for paratyphoid (the highest cumulative risk of temperature was 33.40 [95% CI: 12.23–91.19] at 33°C). After the onset of mild precipitation, the relative risk of typhoid fever increased in a short-lasting and with a 13–26 days delay, and the risk was no significant after the continuous increase of precipitation (the highest cumulative risk of rainfall was 24.96 [95% CI: 4.54–87.21] at 100 mm). Whereas the risk of paratyphoid fever was immediate and long lasting, and increase rapidly with the increase of rainfall (each 100 mm increase was associated with 26% increase in paratyphoid fever cases). Significant temperature-typhoid/paratyphoid fever and rainfall-typhoid/paratyphoid fever associations were found in both genders and those aged 0–4 years old, 15–60 years old, farmers, and children. Characterized with a lagged, nonlinear, and cumulative effect, high temperature and rainfall could increase the risk of typhoid/paratyphoid fever in regions with a subtropical climate. Public health interventions such as early warning and community health education should be taken to prevent the increased risk of typhoid/paratyphoid fever, especially for the vulnerable groups.
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Author Notes
These authors contributed equally to this article and share the first authorship.
Disclosure: This study was approved by the Ethical Review Committee of Public Health of Shandong University (approval no. 20120501).
Financial support: This work was supported by the Special Foundation of Basic Science and Technology Resources Survey of Ministry of Science and Technology (Grant No. 2017FY101202) and the National Basic Research Program of China (973 Program) (Grant No. 2012CB955502).
Authors’ addresses: Qi Gao and Baofa Jiang, Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, People’s Republic of China, and Shandong University Climate Change and Health Center, Cheeloo College of Medicine, Jinan, Shandong Province, People’s Republic of China, E-mails: gqi6835@126.com and bjiang@sdu.edu.cn. Zhidong Liu, Department of Personnel, Qilu Hospital of Shandong University, Jinan, Province, People’s Republic of China, E-mail: liuzhidong3105@163.com. Jianjun Xiang, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia, and School of Public Health, Fujian Medical University, Fuzhou, People’s Republic of China, E-mail: jianjun.xiang@adelaide.edu.au. Ying Zhang, School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia, E-mail: ying.zhang@sydney.edu.au. Michael Xiaoliang Tong and Peng Bi, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia, E-mails: michael.tong@adelaide.edu.au and peng.bi@adelaide.edu.au. Shuzi Wang, Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, People’s Republic of China, E-mail: wangshuzi830@163.com. Yiwen Zhang, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, People’s Republic of China, E-mail: zhangyiwen@mail.sdu.edu.cn. Qiyong Liu, Shandong University Climate Change and Health Center, Cheeloo College of Medicine, Jinan, Shandong Province, People’s Republic of China, and State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China, E-mail: liuqiyong@icdc.cn.