Current and future burden from Lyme disease in Québec as a result of climate change.

Context: Environmental changes will foster the spread of Ixodes scapularis ticks and increase the incidence of Lyme disease in Québec in the coming years. The objective of this study is to estimate the epidemiological and clinical burden and part of the current economic burden of Lyme disease in Québec and to estimate the number of cases expected by 2050. Methods: Cases of Lyme disease reported in Québec from 2015 to 2019 were used to describe their demographic, geographical and clinical characteristics and the cost of their initial care. Three incidence rate scenarios were then developed to estimate the number of cases expected by 2050, based on demographic and climate projections. Results: From 2016 to 2019, 1,473 cases of Lyme disease were reported in Québec. Over 90% of those cases were acquired in two regions of southern Québec (Estrie and Montérégie), while the individuals infected were residents from all over Québec. The average age of cases is 44 years and 66% of infections were at the localized stage, the first stage of Lyme disease. The cost of initial care is estimated at an average of $182 CAN per patient ($47 CAN at the localized stage and $443 CAN at the disseminated stage). According to projections, over 95% of the Québec population will live in a climate zone conducive to the establishment of ticks by 2050, with a number of cases acquired in Québec being 1.3 to 14.5 times higher than in 2019, depending on the incidence rate scenario used. Conclusion: The epidemiological burden is concentrated primarily in southern Québec, but the clinical and economic burden is already distributed throughout the province. The projections for 2050 should help the regions of Québec adapt and optimize public health protection measures.

Exposure to excessive heat and impacts on labour productivity linked to cumulative CO2 emissions.

Cumulative CO2 emissions are a robust predictor of mean temperature increase. However, many societal impacts are driven by exposure to extreme weather conditions. Here, we show that cumulative emissions can be robustly linked to regional changes of a heat exposure indicator, as well as the resulting socioeconomic impacts associated with labour productivity loss in vulnerable economic sectors. We estimate historical and future increases in heat exposure using simulations from eight Earth System Models. Both the global intensity and spatial pattern of heat exposure evolve linearly with cumulative emissions across scenarios (1% CO2, RCP4.5 and RCP8.5). The pattern of heat exposure at a given level of global temperature increase is strongly affected by non-CO2 forcing. Global non-CO2 greenhouse gas emissions amplify heat exposure, while high local emissions of aerosols could moderate exposure. Considering CO2 forcing only, we commit ourselves to an additional annual loss of labour productivity of about 2% of total GDP per unit of trillion tonne of carbon emitted. This loss doubles when adding non-CO2 forcing of the RCP8.5 scenario. This represents an additional economic loss of about 4,400 G$ every year (i.e. 0.59 $/tCO2), varying across countries with generally higher impact in lower-income countries.