Estimating the Incidence and Economic Cost of Lyme Disease Cases in Canada in the 21st Century with Projected Climate Change.

BACKGROUND: Lyme disease (LD) is emerging in Canada owing to the range expansion of the tick vector Ixodes scapularis (I. scapularis). OBJECTIVES: Our objective was to estimate future LD incidence in Canada, and economic costs, for the 21st century with projected climate change. METHODS: Future regions of climatic suitability for I. scapularis were projected from temperature output of the North American Coordinated Regional Climate Downscaling Experiment regional climate model ensemble using greenhouse gas Representative Concentration Pathways (RCPs) 4.5 and 8.5. Once regions became climatically suitable for ticks, an algorithm derived from tick and LD case surveillance data projected subsequent increasing LD incidence. Three scenarios (optimistic, intermediate, and pessimistic) for maximum incidence at endemicity were selected based on LD surveillance, and underreporting estimates, from the United States. Health care and productivity cost estimates of LD cases were obtained from the literature. RESULTS: Projected annual LD cases for Canada ranged from 120,000 to >500,000 by 2050. Variation in incidence was mostly due to the maximum incidence at endemicity selected, with minor contributions from variations among climate models and RCPs. Projected annual costs were substantial, ranging from CA$0.5 billion to $2.0 billion a year by 2050. There was little difference in projected incidence and economic cost between RCPs, and from 2050 to 2100, because projected climate up to 2050 is similar for RCP4.5 and RCP8.5 (mitigation of greenhouse gas emissions captured in RCP4.5 does not impact climate before the 2050s) and by 2050 the most densely populated areas of the study region are projected to be climatically suitable for ticks. CONCLUSIONS: Future incidence and economic costs of LD in Canada are likely to be substantial, but uncertainties remain. Because densely populated areas of Canada are projected to become endemic under conservative climate change scenarios, mitigation of greenhouse gas emissions is unlikely to provide substantial health co-benefits for LD. https://doi.org/10.1289/EHP13759.

Predicting malaria risk considering vector control interventions under climate change scenarios.

Many studies have projected malaria risks with climate change scenarios by modelling one or two environmental variables and without the consideration of malaria control interventions. We aimed to predict the risk of malaria with climate change considering the influence of rainfall, humidity, temperatures, vegetation, and vector control interventions (indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN)). We used negative binomial models based on weekly malaria data from six facility-based surveillance sites in Uganda from 2010-2018, to estimate associations between malaria, environmental variables and interventions, accounting for the non-linearity of environmental variables. Associations were applied to future climate scenarios to predict malaria distribution using an ensemble of Regional Climate Models under two Representative Concentration Pathways (RCP4.5 and RCP8.5). Predictions including interaction effects between environmental variables and interventions were also explored. The results showed upward trends in the annual malaria cases by 25% to 30% by 2050s in the absence of intervention but there was great variability in the predictions (historical vs RCP 4.5 medians [Min-Max]: 16,785 [9,902-74,382] vs 21,289 [11,796-70,606]). The combination of IRS and LLIN, IRS alone, and LLIN alone would contribute to reducing the malaria burden by 76%, 63% and 35% respectively. Similar conclusions were drawn from the predictions of the models with and without interactions between environmental factors and interventions, suggesting that the interactions have no added value for the predictions. The results highlight the need for maintaining vector control interventions for malaria prevention and control in the context of climate change given the potential public health and economic implications of increasing malaria in Uganda.

Differential Influence of Environmental Factors on Malaria Due to Vector Control Interventions in Uganda.

BACKGROUND: Few studies have explored how vector control interventions may modify associations between environmental factors and malaria. METHODS: We used weekly malaria cases reported from six public health facilities in Uganda. Environmental variables (temperature, rainfall, humidity, and vegetation) were extracted from remote sensing sources. The non-linearity of environmental variables was investigated, and negative binomial regression models were used to explore the influence of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) on associations between environmental factors and malaria incident cases for each site as well as pooled across the facilities, with or without considering the interaction between environmental variables and vector control interventions. RESULTS: An average of 73.3 weekly malaria cases per site (range: 0-597) occurred between 2010 and 2018. From the pooled model, malaria risk related to environmental variables was reduced by about 35% with LLINs and 63% with IRS. Significant interactions were observed between some environmental variables and vector control interventions. There was site-specific variability in the shape of the environment-malaria risk relationship and in the influence of interventions (6 to 72% reduction in cases with LLINs and 43 to 74% with IRS). CONCLUSION: The influence of vector control interventions on the malaria-environment relationship need to be considered at a local scale in order to efficiently guide control programs.

Assessment of simulations of a polar low with the Canadian Regional Climate Model.

Polar lows (PLs), which are intense maritime polar mesoscale cyclones, are associated with severe weather conditions. Due to their small size and rapid development, PL forecasting remains a challenge. Convection-permitting models are adequate to forecast PLs since, compared to coarser models, they provide a better representation of convection as well as surface and near-surface processes. A PL that formed over the Norwegian Sea on 25 March 2019 was simulated using the convection-permitting Canadian Regional Climate Model version 6 (CRCM6/GEM4, using a grid mesh of 2.5 km) driven by the reanalysis ERA5. The objectives of this study were to quantify the impact of the initial conditions on the simulation of the PL, and to assess the skill of the CRCM6/GEM4 at reproducing the PL. The results show that the skill of the CRCM6/GEM4 at reproducing the PL strongly depends on the initial conditions. Although in all simulations the synoptic environment is favourable for PL development, with a strong low-level temperature gradient and an upper-level through, only the low-level atmospheric fields of three of the simulations lead to PL development through baroclinic instability. The two simulations that best captured the PL represent a PL deeper than the observed one, and they show higher temperature mean bias compared to the other simulations, indicating that the ocean surface fluxes may be too strong. In general, ERA5 has more skill than the simulations at reproducing the observed PL, but the CRCM6/GEM4 simulation with initialisation time closer to the genesis time of the PL reproduces quite well small scale features as low-level baroclinic instability during the PL development phase.

Climate change alone cannot explain boreal caribou range recession in Quebec since 1850.

The contraction of species range is one of the most significant symptoms of biodiversity loss worldwide. While anthropogenic activities and habitat alteration are major threats for several species, climate change should also be considered. For species at risk, differentiating the effects of human disturbances and climate change on past and current range transformations is an important step towards improved conservation strategies. We paired historical range maps with global atmospheric reanalyses from different sources to assess the potential effects of recent climate change on the observed northward contraction of the range of boreal populations of woodland caribou (Rangifer tarandus caribou) in Quebec (Canada) since 1850. We quantified these effects by highlighting the discrepancies between different southern limits of the caribou's range (used as references) observed in the past and reconstitutions obtained through the hindcasting of the climate conditions within which caribou are currently found. Hindcasted southern limits moved ~105 km north over time under all reanalysis datasets, a trend drastically different from the ~620 km reported for observed southern limits since 1850. The differences in latitudinal shift through time between the observed and hindcasted southern limits of distribution suggest that caribou range recession should have been only 17% of what has been observed since 1850 if recent climate change had been the only disturbance driver. This relatively limited impact of climate reinforces the scientific consensus stating that caribou range recession in Quebec is mainly caused by anthropogenic drivers (i.e. logging, development of the road network, agriculture, urbanization) that have modified the structure and composition of the forest over the past 160 years, paving the way for habitat-mediated apparent competition and overharvesting. Our results also call for a reconsideration of past ranges in models aiming at projecting future distributions, especially for endangered species.

Respiratory and Otolaryngology Symptoms Following the 2019 Spring Floods in Quebec.

BACKGROUND: Although floods may have important respiratory health impacts, few studies have examined this issue. This study aims to document the long-term impacts of the spring floods of 2019 in Quebec by (1) describing the population affected by the floods; (2) assessing the impacts on the respiratory system according to levels of exposure; and (3) determining the association between stressors and respiratory health. METHODS: A population health survey was carried out across the six most affected regions 8-10 months post-floods. Data were collected on self-reported otolaryngology (ENT) and respiratory symptoms, along with primary and secondary stressors. Three levels of exposure were examined: flooded, disrupted and unaffected. RESULTS: One in ten respondents declared being flooded and 31.4% being disrupted by the floods. Flooded and disrupted participants reported significantly more ENT symptoms (adjusted odds ratio (aOR): 3.18; 95% CI: 2.45-4.14; aOR: 1.76; 95% CI: 1.45-2.14) and respiratory symptoms (aOR: 3.41; 95% CI: 2.45-4.75; aOR: 1.45; 95% CI: 1.10-1.91) than the unaffected participants. All primary stressors and certain secondary stressors assessed were significantly associated with both ENT and respiratory symptoms, but no "dose-response" gradient could be observed. CONCLUSION: This study highlights the long-term adverse effects of flood exposure on respiratory health.

The influence of the environment and indoor residual spraying on malaria risk in a cohort of children in Uganda.

Studies have estimated the impact of the environment on malaria incidence although few have explored the differential impact due to malaria control interventions. Therefore, the objective of the study was to evaluate the effect of indoor residual spraying (IRS) on the relationship between malaria and environment (i.e. rainfall, temperatures, humidity, and vegetation) using data from a dynamic cohort of children from three sub-counties in Uganda. Environmental variables were extracted from remote sensing sources and averaged over different time periods. General linear mixed models were constructed for each sub-counties based on a log-binomial distribution. The influence of IRS was analysed by comparing marginal effects of environment in models adjusted and unadjusted for IRS. Great regional variability in the shape (linear and non-linear), direction, and magnitude of environmental associations with malaria risk were observed between sub-counties. IRS was significantly associated with malaria risk reduction (risk ratios vary from RR = 0.03, CI 95% [0.03-0.08] to RR = 0.35, CI95% [0.28-0.42]). Model adjustment for this intervention changed the magnitude and/or direction of environment-malaria associations, suggesting an interaction effect. This study evaluated the potential influence of IRS in the malaria-environment association and highlighted the necessity to control for interventions when they are performed to properly estimate the environmental influence on malaria. Local models are more informative to guide intervention program compared to national models.

Zika virus outbreak in Brazil under current and future climate.

INTRODUCTION: Zika virus (ZIKV) is primarily transmitted byAedes aegypti and Aedes albopictus mosquitoes between humans and non-human primates. Climate change may enhance virus reproduction in Aedes spp. mosquito populations, resulting in intensified ZIKV outbreaks. The study objective was to explore how an outbreak similar to the 2016 ZIKV outbreak in Brazil might unfold with projected climate change. METHODS: A compartmental infectious disease model that included compartments for humans and mosquitoes was developed to fit the 2016 ZIKV outbreak data from Brazil using least squares optimization. To explore the impact of climate change, published polynomial relationships between temperature and temperature-sensitive mosquito population and virus transmission parameters (mosquito mortality, development rate, and ZIKV extrinsic incubation period) were used. Projections for future outbreaks were obtained by simulating transmission with effects of projected average monthly temperatures on temperature-sensitive model parameters at each of three future time periods: 2011-2040, 2041-2070, and 2071-2100. The projected future climate was obtained from an ensemble of regional climate models (RCMs) obtained from the Co-Ordinated Regional Downscaling Experiment (CORDEX) that used Representative Concentration Pathways (RCP) with two radiative forcing values, RCP4.5 and RCP8.5. A sensitivity analysis was performed to explore the impact of temperature-dependent parameters on the model outcomes. RESULTS: Climate change scenarios impacted the model outcomes, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the duration of the ZIKV outbreak. Comparing 2070-2100 to 2016, using RCP4.5, the peak incidence was 22,030 compared to 10,473; the time to epidemic peak was 12 compared to 9 weeks, and the outbreak duration was 52 compared to 41 weeks. Comparing 2070-2100 to 2016, using RCP8.5, the peak incidence was 21,786 compared to 10,473; the time to epidemic peak was 11 compared to 9 weeks, and the outbreak duration was 50 compared to 41weeks. The increases are due to optimal climate conditions for mosquitoes, with the mean temperature reaching 28 °C in the warmest months. Under a high emission scenario (RCP8.5), mean temperatures extend above optimal for mosquito survival in the warmest months. CONCLUSION: Outbreaks of ZIKV in locations similar to Brazil are expected to be more intense with a warming climate. As climate change impacts are becoming increasingly apparent on human health, it is important to quantify the effect and use this knowledge to inform decisions on prevention and control strategies.

Yellow fever virus outbreak in Brazil under current and future climate.

INTRODUCTION: Yellow fever (YF) is primarily transmitted by Haemagogus species of mosquitoes. Under climate change, mosquitoes and the pathogens that they carry are expected to develop faster, potentially impacting the case count and duration of YF outbreaks. The aim of this study was to determine how YF virus outbreaks in Brazil may change under future climate, using ensemble simulations from regional climate models under RCP4.5 and RCP8.5 scenarios for three time periods: 2011-2040 (short-term), 2041-2070 (mid-term), and 2071-2100 (long-term). METHODS: A compartmental model was developed to fit the 2017/18 YF outbreak data in Brazil using least squares optimization. To explore the impact of climate change, temperature-sensitive mosquito parameters were set to change over projected time periods using polynomial equations fitted to their relationship with temperature according to the average temperature for years 2011-2040, 2041-2070, and 2071-2100 for climate change scenarios using RCP4.5 and RCP8.5, where RCP4.5/RCP8.5 corresponds to intermediate/high radiative forcing values and to moderate/higher warming trends. A sensitivity analysis was conducted to determine how the temperature-sensitive parameters impacted model results, and to determine how vaccination could play a role in reducing YF in Brazil. RESULTS: Yellow fever case projections for Brazil from the models varied when climate change scenarios were applied, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the outbreak duration. Overall, a decrease in YF cases and outbreak duration was observed. Comparing the observed incidence in 2017/18 to the projected incidence in 2070-2100, for RCP4.5, the cumulative case incidence decreased from 184 to 161, and the outbreak duration decreased from 21 to 20 weeks. For RCP8.5, the peak case incidence decreased from 184 to 147, and the outbreak duration decreased from 21 to 17 weeks. The observed decrease was primarily due to temperature increasing beyond that suitable for Haemagogus mosquito survival. CONCLUSIONS: Climate change is anticipated to have an impact on mosquito-borne diseases. We found outbreaks of YF may reduce in intensity as temperatures increase in Brazil; however, temperature is not the only factor involved with disease transmission. Other factors must be explored to determine the attributable impact of climate change on mosquito-borne diseases.

Current and Projected Distributions of Aedes aegypti and Ae. albopictus in Canada and the U.S.

BACKGROUND: Aedes aegypti and Ae. albopictus are mosquito vectors of more than 22 arboviruses that infect humans. OBJECTIVES: Our objective was to develop regional ecological niche models for Ae. aegypti and Ae. albopictus in the conterminous United States and Canada with current observed and simulated climate and land-use data using boosted regression trees (BRTs). METHODS: We used BRTs to assess climatic suitability for Ae. albopictus and Ae. aegypti mosquitoes in Canada and the United States under current and future projected climates. RESULTS: Models for both species were mostly influenced by minimum daily temperature and demonstrated high accuracy for predicting their geographic ranges under the current climate. The northward range expansion of suitable niches for both species was projected under future climate models. Much of the United States and parts of southern Canada are projected to be suitable for both species by 2100, with Ae. albopictus projected to expand its range north earlier this century and further north than Ae. aegypti. DISCUSSION: Our projections suggest that the suitable ecological niche for Aedes will expand with climate change in Canada and the United States, thus increasing the risk of Aedes-transmitted arboviruses. Increased surveillance for these vectors and the pathogens they carry would be prudent. https://doi.org/10.1289/EHP5899.

Predicted Northward Expansion of the Geographic Range of the Tick Vector Amblyomma americanum in North America under Future Climate Conditions.

BACKGROUND: The geographic range of the tick Amblyomma americanum, a vector of diseases of public health significance such as ehrlichiosis, has expanded from the southeast of the United States northward during the 20th century. Recently, populations of this tick have been reported to be present close to the Canadian border in Michigan and New York states, but established populations are not known in Canada. Previous research suggests that changing temperature patterns with climate change may influence tick life cycles and permit northward range expansion of ticks in the northern hemisphere. OBJECTIVES: We aimed to estimate minimal temperature conditions for survival of A. americanum populations at the northern edge of the tick's range and to investigate the possibility of range expansion of A. americanum into northern U.S. states and southern Canada in the coming decades. METHODS: A simulation model of the tick A. americanum was used, via simulations using climate data from meteorological stations in the United States and Canada, to estimate minimal temperature conditions for survival of A. americanum populations at the northern edge of the tick's range. RESULTS: The predicted geographic scope of temperature suitability [≥3,285 annual cumulative degree days (DD) >0°C] included most of the central and eastern U.S. states east of longitude 110°W, which is consistent with current surveillance data for the presence of the tick in this region, as well as parts of southern Quebec and Ontario in Canada. Regional climate model output raises the possibility of northward range expansion into all provinces of Canada from Alberta to Newfoundland and Labrador during the coming decades, with the greatest northward range expansion (up to 1,000km by the year 2100) occurring under the greenhouse gas (GHG) emissions of Representative Concentration Pathway (RCP) 8.5. Predicted northward range expansion was reduced by approximately half under the reduced GHG emissions of RCP4.5. DISCUSSION: Our results raise the possibility of range expansion of A. americanum into northern U.S. states and southern Canada in the coming decades, and conclude that surveillance for this tick, and the diseases it transmits, would be prudent. https://doi.org/10.1289/EHP5668.

Assessment of the Probability of Autochthonous Transmission of Chikungunya Virus in Canada under Recent and Projected Climate Change.

BACKGROUND: Chikungunya virus (CHIKV) is a reemerging pathogen transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The ongoing Caribbean outbreak is of concern due to the potential for infected travelers to spread the virus to countries where vectors are present and the population is susceptible. Although there has been no autochthonous transmission of CHIKV in Canada, there is concern that both Ae. albopictus and CHIKV will become established, particularly under projected climate change. We developed risk maps for autochthonous CHIKV transmission in Canada under recent (1981­2010) and projected climate (2011­2040 and 2041­2070). METHODS: The risk for CHIKV transmission was the combination of the climatic suitability for CHIKV transmission potential and the climatic suitability for the presence of Ae. albopictus; the former was assessed using a stochastic model to calculate R0 and the latter was assessed by deriving a suitability indicator (SIG) that captures a set of climatic conditions known to influence the ecology of Ae. albopictus. R0 and SIG were calculated for each grid cell in Canada south of 60°N, for each time period and for two emission scenarios, and combined to produce overall risk categories that were mapped to identify areas suitable for transmission and the duration of transmissibility. FINDINGS: The risk for autochthonous CHIKV transmission under recent climate is very low with all of Canada classified as unsuitable or rather unsuitable for transmission. Small parts of southern coastal British Columbia become progressively suitable with short-term and long-term projected climate; the duration of potential transmission is limited to 1­2 months of the year. INTERPRETATION: Although the current risk for autochthonous CHIKV transmission in Canada is very low, our study could be further supported by the routine surveillance of Ae. albopictus in areas identified as potentially suitable for transmission given our uncertainty on the current distribution of this species in Canada. https://doi.org/10.1289/EHP669

Quantitative and qualitative assessment of the impact of climate change on a combined sewer overflow and its receiving water body.

Projections from the Canadian Regional Climate Model (CRCM) for the southern part of the province of Québec, Canada, suggest an increase in extreme precipitation events for the 2050 horizon (2041-2070). The main goal of this study consisted in a quantitative and qualitative assessment of the impact of the 20 % increase in rainfall intensity that led, in the summer of 2013, to overflows in the "Rolland-Therrien" combined sewer system in the city of Longueuil, Canada. The PCSWMM 2013 model was used to assess the sensitivity of this overflow under current (2013) and future (2050) climate conditions. The simulated quantitative variables (peak flow, Q(CSO), and volume discharged, VD) served as the basis for deriving ecotoxicological risk indices and event fluxes (EFs) transported to the St. Lawrence (SL) River. Results highlighted 15 to 500% increases in VD and 13 to 148% increases in Q(CSO) by 2050 (compared to 2013), based on eight rainfall events measured from May to October. These results show that (i) the relationships between precipitation and combined sewer overflow variables are not linear and (ii) the design criteria for current hydraulic infrastructure must be revised to account for the impact of climate change (CC) arising from changes in precipitation regimes. EFs discharged into the SL River will be 2.24 times larger in the future than they are now (2013) due to large VDs resulting from CC. This will, in turn, lead to excessive inputs of total suspended solids (TSSs) and tracers for numerous urban pollutants (organic matter and nutrients, metals) into the receiving water body. Ecotoxicological risk indices will increase by more than 100% by 2050 compared to 2013. Given that substantial VDs are at play, and although CC scenarios have many sources of uncertainty, strategies to adapt this drainage network to the effects of CC will have to be developed.

An alternative method to characterize the surface urban heat island.

An urban heat island (UHI) is a relative measure defined as a metropolitan area that is warmer than the surrounding suburban or rural areas. The UHI nomenclature includes a surface urban heat island (SUHI) definition that describes the land surface temperature (LST) differences between urban and suburban areas. The complexity involved in selecting an urban core and external thermal reference for estimating the magnitude of a UHI led us to develop a new definition of SUHIs that excludes any rural comparison. The thermal reference of these newly defined surface intra-urban heat islands (SIUHIs) is based on various temperature thresholds above the spatial average of LSTs within the city's administrative limits. A time series of images from Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper Plus (ETM+) from 1984 to 2011 was used to estimate the LST over the warm season in Montreal, Québec, Canada. Different SIUHI categories were analyzed in consideration of the global solar radiation (GSR) conditions that prevailed before each acquisition date of the Landsat images. The results show that the cumulative GSR observed 24 to 48 h prior to the satellite overpass is significantly linked with the occurrence of the highest SIUHI categories (thresholds of +3 to +7 °C above the mean spatial LST within Montreal city). The highest correlation (≈0.8) is obtained between a pixel-based temperature that is 6 °C hotter than the city's mean LST (SIUHI + 6) after only 24 h of cumulative GSR. SIUHI + 6 can then be used as a thermal threshold that characterizes hotspots within the city. This identification approach can be viewed as a useful criterion or as an initial step toward the development of heat health watch and warning system (HHWWS), especially during the occurrence of severe heat spells across urban areas.

Recent and projected future climatic suitability of North America for the Asian tiger mosquito Aedes albopictus.

BACKGROUND: Since the 1980s, populations of the Asian tiger mosquito Aedes albopictus have become established in south-eastern, eastern and central United States, extending to approximately 40°N. Ae. albopictus is a vector of a wide range of human pathogens including dengue and chikungunya viruses, which are currently emerging in the Caribbean and Central America and posing a threat to North America. METHODS: The risk of Ae. albopictus expanding its geographic range in North America under current and future climate was assessed using three climatic indicators of Ae. albopictus survival: overwintering conditions (OW), OW combined with annual air temperature (OWAT), and a linear index of precipitation and air temperature suitability expressed through a sigmoidal function (SIG). The capacity of these indicators to predict Ae. albopictus occurrence was evaluated using surveillance data from the United States. Projected future climatic suitability for Ae. albopictus was obtained using output of nine Regional Climate Model experiments (RCMs). RESULTS: OW and OWAT showed >90% specificity and sensitivity in predicting observed Ae. albopictus occurrence and also predicted moderate to high risk of Ae. albopictus invasion in Pacific coastal areas of the Unites States and Canada under current climate. SIG also well predicted observed Ae. albopictus occurrence (ROC area under the curve was 0.92) but predicted wider current climatic suitability in the north-central and north-eastern United States and south-eastern Canada. RCM output projected modest (circa 500 km) future northward range expansion of Ae. albopictus by the 2050s when using OW and OWAT indicators, but greater (600-1000 km) range expansion, particularly in eastern and central Canada, when using the SIG indicator. Variation in future possible distributions of Ae. albopictus was greater amongst the climatic indicators used than amongst the RCM experiments. CONCLUSIONS: Current Ae. albopictus distributions were well predicted by simple climatic indicators and northward range expansion was predicted for the future with climate change. However, current and future predicted geographic distributions of Ae. albopictus varied amongst the climatic indicators used. Further field studies are needed to assess which climatic indicator is the most accurate in predicting regions suitable for Ae. albopictus survival in North America.