Dynamics of nosocomial SARS-CoV-2 transmissions: Facing the challenge of variants of concern in a Brazilian reference hospital.

The hospital environment can be considered a high risk for the occurrence of SARS-CoV-2 transmission outbreaks, either for health professionals who are directly involved in the care of suspected or confirmed cases of the disease, or for patients, for being in an environment more vulnerable to the acquisition of nosocomial infections. In this molecular epidemiology study, we aimed to analyze the occurrence and transmission dynamics of SARS-CoV-2 in outbreaks and local chains of transmission in a large tertiary teaching hospital in southern Brazil, in addition to verifying circulating strains and their epidemiological relation in the local context, from September 21, 2020 to October 5, 2021. Positive samples involved in COVID-19 clusters or outbreaks were analyzed using clinical, epidemiological and genomic data. Different lineages and sublineages among patients in the same room were observed. Most patients had their first clinical manifestation, evidence of suspicion, and diagnostic confirmation within 7-14 days or >14 days after hospital admission. The patients who have contact with confirmed cases of COVID-19 spent, on average, 6.28 days in the same environment until the positive test. There was a significant association between the outcome and the number of vaccine doses (p < 0.05), where those who received two doses presented a lower occurrence of death. There was a total replacement of variant of concern (VOC) Gamma by VOC Delta from August 2021 at the study site. Although the epidemiological analysis indicates nosocomial infections, through genomic sequencing, it was established that most of the hospital outbreaks had different origins. These findings highlight the utility of integrating epidemiological and genomic data to identify possible routes of viral entry and dissemination.

The burden of occupational injury attributable to high temperatures in Australia, 2014-19: a retrospective observational study.

OBJECTIVES: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat-attributable occupational injury in Australia. STUDY DESIGN, SETTING: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014-19, based on Safe Work Australia (work-related traumatic injury fatalities and workers' compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta-analysis of climate zone-specific risk data. MAIN OUTCOME MEASURE: Burden of heat-attributable occupational injuries as disability-adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen-Geiger climate zone, and by state and territory. RESULTS: During 2014-19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury-related DALYs were attributable to heat (2.3% of occupational injury-related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat-attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat-attributable occupational injury-related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). CONCLUSION: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry-based policies are needed to safeguard workplace health and safety, particularly in heat-exposed industries, such as agriculture, transport, and construction.

Current and projected heatwave-attributable occupational injuries, illnesses, and associated economic burden in Australia.

INTRODUCTION: The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. MATERIALS AND METHODS: Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065). RESULTS: The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. DISCUSSION: Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.

HIV-1 genetic diversity and transmitted drug resistance to integrase strand transfer inhibitors among recently diagnosed adults in Porto Alegre, South Brazil.

OBJECTIVES: The HIV-1 genetic diversity and the presence of transmitted drug resistance mutations (TDRMs) against integrase strand transfer inhibitors (INSTIs) were assessed sequencing samples of antiretroviral (ARV)-naive HIV-1-infected individuals from South Brazil. METHODS: Viral RNA from 42 ART-naive individuals was submitted to complete HIV-1 integrase gene amplification by RT-PCR and sequencing. RESULTS: Viral strains carrying TDRMs against INSTIs were not detected in the present study. However, the polymorphisms L74M and L74I were each observed in 4.8% of the individuals. These accessory mutations have been reported as putative causes of TDRMs in ART with raltegravir, but only when associated with additional major mutations. When submitted to HIV-1 subtyping, 50% were classified as subtype C, 21% as recombinant BC, 19% as subtype B, 4.8% as subtype F1 and 4.8% as recombinant CF1. CONCLUSIONS: All 42 ARV-naive individuals were apparently susceptible to INSTIs, included in the Brazilian therapeutic guideline since 2009. To the best of our knowledge, this is the first study to evaluate TDRMs against INSTIs in Brazil. The most prevalent HIV-1 subtypes were subtype C, followed by the recombinant BC and subtype B, which is in agreement with previous studies. However, the presence of subtype F1 and recombinant CF1 reported herein was not observed in previous studies.

Understanding current and projected emergency department presentations and associated healthcare costs in a changing thermal climate in Adelaide, South Australia.

BACKGROUND: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. METHODS: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs). RESULTS: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. CONCLUSIONS: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.

Genomic epidemiology of SARS-CoV-2 in Esteio, Rio Grande do Sul, Brazil.

BACKGROUND: Brazil is the third country most affected by Coronavirus disease-2019 (COVID-19), but viral evolution in municipality resolution is still poorly understood in Brazil and it is crucial to understand the epidemiology of viral spread. We aimed to track molecular evolution and spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Esteio (Southern Brazil) using phylogenetics and phylodynamics inferences from 21 new genomes in global and regional context. Importantly, the case fatality rate (CFR) in Esteio (3.26%) is slightly higher compared to the Rio Grande do Sul (RS) state (2.56%) and the entire Brazil (2.74%). RESULTS: We provided a comprehensive view of mutations from a representative sampling from May to October 2020, highlighting two frequent mutations in spike glycoprotein (D614G and V1176F), an emergent mutation (E484K) in spike Receptor Binding Domain (RBD) characteristic of the B.1.351 and P.1 lineages, and the adjacent replacement of 2 amino acids in Nucleocapsid phosphoprotein (R203K and G204R). E484K was found in two genomes from mid-October, which is the earliest description of this mutation in Southern Brazil. Lineages containing this substitution must be subject of intense surveillance due to its association with immune evasion. We also found two epidemiologically-related clusters, including one from patients of the same neighborhood. Phylogenetics and phylodynamics analysis demonstrates multiple introductions of the Brazilian most prevalent lineages (B.1.1.33 and B.1.1.248) and the establishment of Brazilian lineages ignited from the Southeast to other Brazilian regions. CONCLUSIONS: Our data show the value of correlating clinical, epidemiological and genomic information for the understanding of viral evolution and its spatial distribution over time. This is of paramount importance to better inform policy making strategies to fight COVID-19.

Low circulation of Influenza A and coinfection with SARS-CoV-2 among other respiratory viruses during the COVID-19 pandemic in a region of southern Brazil.

With the arrival of coronavirus disease 2019 (COVID-19) in Brazil in February 2020, several preventive measures were taken by the population aiming to avoid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection including the use of masks, social distancing, and frequent hand washing then, these measures may have contributed to preventing infection also by other respiratory viruses. Our goal was to determine the frequencies of Influenza A and B viruses (FLUAV/FLUBV), human mastadenovirus C (HAdV-C), Enterovirus 68 (EV-68), and rhinovirus (RV) besides SARS-CoV-2 among hospitalized patients suspect of COVID-19 with cases of acute respiratory disease syndrome (ARDS) in the period of March to December 2020 and to detect possible coinfections among them. Nucleic acid detection was performed using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) in respiratory samples using naso-oropharyngeal swabs and bronchoalveolar lavage. A total of 418 samples of the 987 analyzed (42.3%) were positive for SARS-CoV-2, 16 (1.62%) samples were positive for FLUAV, no sample was positive for FLUBV or EV-68, 67 (6.78%) samples were positive for HAdV-C, 55 samples were positive for RV 1/2 (26.3%) and 37 for RV 2/2 (13.6%). Coinfections were also detected, including a triple coinfection with SARS-CoV-2, FLUAV, and HAdV-C. In the present work, a very low frequency of FLUV was reported among hospitalized patients with ARDS compared to the past years, probably due to preventive measures taken to avoid COVID-19 and the high influenza vaccination coverage in the region in which this study was performed.

Occupational heat stress and economic burden: A review of global evidence.

BACKGROUND: The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. METHODS: Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. RESULTS: Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years. CONCLUSIONS: The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.

Public health professionals' perceptions of the capacity of China's CDCs to address emerging and re-emerging infectious diseases.

BACKGROUND: China's capacity to control and prevent emerging and re-emerging infectious diseases is critical to the nation's population health. This study aimed to explore the capacity of Centers for Disease Control and Prevention (CDCs) in China to deal with infectious diseases now and in the future. METHODS: A survey was conducted in 2015 among 973 public health professionals at CDCs in Beijing and four provinces, to assess their capacity to deal with emerging and re-emerging infectious diseases. RESULTS: Although most professionals were confident with the current capacity of CDCs to cope with outbreaks, nearly all indicated more funding was required to meet future challenges. Responses indicated that Yunnan Province faced more challenges than Anhui, Henan and Liaoning Provinces in being completely prepared and able to deal with outbreaks. Participants aged 20-39 years were more likely than those aged 40 and over to believe strategies such as interdisciplinary and international collaborations for disease surveillance and control, would assist capacity building. CONCLUSION: The capacity of China's CDCs to deal with infectious diseases was excellent. However, findings suggest it is imperative to increase the number of skilled CDC staff, financial support, and strengthen county level staff training and health education programs.

Impact of post-tanning chemicals on the pollution load of tannery wastewater.

The leather industry uses a large amount of chemicals to transform a raw hide into finished leather. Chemicals are not fully taken up by leather and thus end up in tannery wastewater. Physicochemical and toxicological characterization of tannery effluents has been widely assessed. However, the characterization of processing chemicals and their relation to the pollution load of effluents remains unknown. Thus, this study aimed to assess a physicochemical and cytotoxic characterization of chemicals used in the leather post-tanning process and to evaluate the contribution of each chemical to the pollution load of raw wastewater. This study was performed using a leather post-tanning formulation applied by a large tannery located in Brazil. Deacidulation agents caused high conductivity and dissolved solids in wastewater. Retanning agents (natural and synthetic tannins) were responsible for the largest inorganic pollution load, and synthetic tannins were more toxic than natural ones. Fatliquoring agents released the highest chemical oxygen demand load in wastewater and they were the chemical group that presented the highest toxicity. Fixing agent and black dye provided inorganic pollution load to wastewater, and nitrogen pollution of wastewater was mainly related to the neutralizing retanner and the black dye.

Changes in behavioral and neuronal parameters by alcohol, cigarette, or their combined use in rats.

Few studies have explored the effects of the combined use of alcohol and cigarette in humans, despite its prevalence. Here we evaluated the effect of isolated and combined use on behaviors and neuronal parameters in rats. Male adult rats were divided into alcohol (AL, 2 g/kg, by oral gavage), cigarette smoke (TB, six cigarettes, by inhalation), combined use (ALTB), or control (CT, water by oral gavage and environmental air) groups, treated twice a day (09.00 and 14.00 h). After 4 weeks, the rats were tested in the open field for behavioral analysis and euthanized for brain volume estimation and counting of neurons in the hippocampus. All treatments increased locomotion, and this behavior was higher in the ALTB than TB group. Latency to exit from the central area was lower in the ALTB than in the AL or CT groups. Rearing behavior increased in TB and decreased in AL and ALTB rats. Combined ALTB rats significantly increased their grooming behavior. Only the AL group showed decreased neuron counts and increased brain volume. Our results show that the isolated and combined uses of alcohol and cigarette smoke have diverse effects on behavioral and neuronal parameters in rats after long-term treatment.

The effects of ambient temperatures on the risk of work-related injuries and illnesses: Evidence from Adelaide, Australia 2003-2013.

BACKGROUND: The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited. OBJECTIVES: To examine the occupational injury and illness risk profiles for hot and cold conditions. METHODS: Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model. RESULTS: The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures. CONCLUSION: Days of very high temperatures were associated with the greatest risks of occupational injuries; whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies.

Heatwave and work-related injuries and illnesses in Adelaide, Australia: a case-crossover analysis using the Excess Heat Factor (EHF) as a universal heatwave index.

PURPOSE: Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature. METHODS: Work-related injuries and illnesses were identified from two administrative data sources: workers' compensation claims and work-related ambulance call-outs for the years 2003-2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers' compensation claims, and work-related ambulance call-outs. RESULTS: There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10-1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01-1.30), indoor industries (RR 1.09, 95% CI 1.01-1.17), males (RR 1.13, 95% CI 1.03-1.23) and laborers (RR 1.21, 95% CI 1.04-1.39). CONCLUSIONS: Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.

Perceptions of malaria control and prevention in an era of climate change: a cross-sectional survey among CDC staff in China.

BACKGROUND: Though there was the significant decrease in the incidence of malaria in central and southwest China during the 1980s and 1990s, there has been a re-emergence of malaria since 2000. METHODS: A cross-sectional survey was conducted amongst the staff of eleven Centers for Disease Control and Prevention (CDC) in China to gauge their perceptions regarding the impacts of climate change on malaria transmission and its control and prevention. Descriptive analysis was performed to study CDC staff's knowledge, attitudes, perceptions and suggestions for malaria control in the face of climate change. RESULTS: A majority (79.8%) of CDC staff were concerned about climate change and 79.7% believed the weather was becoming warmer. Most participants (90.3%) indicated climate change had a negative effect on population health, 92.6 and 86.8% considered that increasing temperatures and precipitation would influence the transmission of vector-borne diseases including malaria. About half (50.9%) of the surveyed staff indicated malaria had re-emerged in recent years, and some outbreaks were occurring in new geographic areas. The main reasons for such re-emergence were perceived to be: mosquitoes in high-density, numerous imported cases, climate change, poor environmental conditions, internal migrant populations, and lack of health awareness. CONCLUSIONS: This study found most CDC staff endorsed the statement that climate change had a negative impact on infectious disease transmission. Malaria had re-emerged in some areas of China, and most of the staff believed that this can be managed. However, high densities of mosquitoes and the continuous increase in imported cases of malaria in local areas, together with environmental changes are bringing about critical challenges to malaria control in China. This study contributes to an understanding of climate change related perceptions of malaria control and prevention amongst CDC staff. It may help to formulate in-house training guidelines, community health promotion programmes and policies to improve the capacity of malaria control and prevention in the face of climate change in China.

Association between dengue fever incidence and meteorological factors in Guangzhou, China, 2005-2014.

This study aims to (1) investigate the associations between climatic factors and dengue; and (2) identify the susceptible subgroups. De-identified daily dengue cases in Guangzhou for 2005-2014 were obtained from the Chinese Center for Disease Control and Prevention. Weather data were downloaded from the China Meteorological Data Sharing Service System. Distributed lag non-linear models (DLNM) were used to graphically demonstrate the three-dimensional temperature-dengue association. Generalised estimating equation models (GEE) with piecewise linear spline functions were used to quantify the temperature-dengue associations. Threshold values were estimated using a broken-stick model. Middle-aged and older people, people undertaking household duties, retirees, and those unemployed were at high risk of dengue. Reversed U-shaped non-linear associations were found between ambient temperature, relative humidity, extreme wind velocity, and dengue. The optimal maximum temperature (Tmax) range for dengue transmission in Guangzhou was 21.6-32.9°C, and 11.2-23.7°C for minimum temperature (Tmin). A 1°C increase of Tmax and Tmin within these ranges was associated with 11.9% and 9.9% increase in dengue at lag0, respectively. Although lag effects of temperature were observed for up to 141 days for Tmax and 150 days for Tmin, the maximum lag effects were observed at 32 days and 39 days respectively. Average relative humidity was negatively associated with dengue when it exceeded 78.9%. Maximum wind velocity (>10.7m/s) inhibited dengue transmission. Climatic factors had significant impacts on dengue in Guangzhou. Lag effects of temperature on dengue lasted the local whole epidemic season. To reduce the likely increasing dengue burden, more efforts are needed to strengthen the capacity building of public health systems.

Perceptions of capacity for infectious disease control and prevention to meet the challenges of dengue fever in the face of climate change: A survey among CDC staff in Guangdong Province, China.

BACKGROUND: Dengue fever is an important climate-sensitive mosquito-borne viral disease that poses a risk to half the world's population. The disease is a major public health issue in China where in 2014 a major outbreak occurred in Guangdong Province. This study aims to gauge health professionals' perceptions about the capacity of infectious disease control and prevention to meet the challenge of dengue fever in the face of climate change in Guangdong Province, China. METHODS: A cross-sectional questionnaire survey was administered among staff in the Centers for Disease Control and Prevention (CDCs) in Guangdong Province. Data analysis was undertaken using descriptive methods and logistic regression. RESULTS: In total, 260 questionnaires were completed. Most participants (80.7%) thought climate change would have a negative effect on population health, and 98.4% of participants reported dengue fever had emerged or re-emerged in China in recent years. Additionally, 74.9% of them indicated that the capability of the CDCs to detect infectious disease outbreak/epidemic at an early stage was excellent; 86.3% indicated laboratories could provide diagnostic support rapidly; and 83.1% believed levels of current staff would be adequate in the event of a major outbreak. Logistic regression analysis showed higher levels of CDCs were perceived to have better capacity for infectious disease control and prevention. Only 26.8% of participants thought they had a good understanding of climate change, and most (85.4%) thought they needed more information about the health impacts of climate change. Most surveyed staff suggested the following strategies to curb the public health impact of infectious diseases in relation to climate change: primary prevention measures, strengthening the monitoring of infectious diseases, the ability to actively forecast disease outbreaks by early warning systems, and more funding for public health education programs. CONCLUSION: Vigilant disease and vector surveillance, preventive practice and health promotion programs will likely be significant in addressing the threat of dengue fever in the future. Further efforts are needed to strengthen the awareness of climate change among health professionals, and to promote relevant actions to minimize the health burden of infectious diseases in a changing climate. Results will be critical for policy makers facing the current and future challenges associated with infectious disease prevention and control in China.

Workers' perceptions of climate change related extreme heat exposure in South Australia: a cross-sectional survey.

BACKGROUND: Occupational exposure to extreme heat without sufficient protection may not only increase the risk of heat-related illnesses and injuries but also compromise economic productivity. With predictions of more frequent and intense bouts of hot weather, workplace heat exposure is presenting a growing challenge to workers' health and safety. This study aims to investigate workers' perceptions and behavioural responses towards extreme heat exposure in a warming climate. METHODS: A cross-sectional questionnaire survey was conducted in 2012 in South Australia among selected outdoor industries. Workers' heat risk perceptions were measured in the following five aspects: concerns about heat exposure, attitudes towards more training, policy and guideline support, the adjustment of work habits, and degree of satisfaction of current preventive measures. Bivariate and multivariate logistic regression analyses were used to identify factors significantly associated with workers' heat perceptions. RESULTS: A total of 749 respondents participated in this survey, with a response rate of 50.9 %. A little more than half (51.2 %) of respondents were moderately or very much concerned about workplace heat exposure. Factors associated with workers' heat concerns included age, undertaking very physically demanding work, and the use of personal protective equipment, heat illness history, and injury experience during hot weather. Less than half (43.4 %) of the respondents had received heat-related training. Workers aged 25-54 years and those with previous heat-related illness/injury history showed more supportive attitudes towards heat-related training. The provision of cool drinking water was the most common heat prevention measure. A little more than half (51.4 %) of respondents were satisfied with the current heat prevention measures. About two-thirds (63.8 %) of respondents agreed that there should be more heat-related regulations and guidelines for working during very hot weather. More than two-thirds (68.8 %) of the respondents were willing to adjust their current work habits to adapt to the likely increasing extreme heat, especially those with previous heat illness experience. CONCLUSIONS: The findings suggest a need to strengthen workers' heat risk awareness and refine current heat prevention strategies in a warming climate. Further heat educational programmes and training should focus on those undertaking physically demanding work outdoors, in particular young workers and those over 55 years with low education levels.

Extreme heat and occupational heat illnesses in South Australia, 2001-2010.

OBJECTIVES: This study aims to examine the epidemiological characteristics of occupational heat illnesses in South Australia, to quantify the association between ambient temperature and occupational heat illnesses, and to investigate the impact of heatwaves on occupational heat illnesses. METHODS: Workers' compensation claims data and weather data were obtained from SafeWork South Australia and the Bureau of Meteorology, respectively, for 2001-2010. Time series analysis with generalised estimation equation models and linear spline functions was used to quantify the temperature-heat illness claims association. A case-crossover design was applied to investigate the impact of heatwaves on occupational heat illnesses. RESULTS: There were 306 heat illness claims during the study period, with an incidence rate of 4.5 per 100,000 employees. The overall risk of occupational heat illness was positively associated with maximum temperature (Tmax), especially when Tmax was over the threshold of 35.5 °C. One degree increase of Tmax was associated with a 12.7% (incidence rate ratio 1.127, 95% CI 1.067 to 1.190) increase of occupational heat illness claims. During heatwave periods, the risk of occupational heat illness was about 4-7 times higher than that of non-heatwave periods. CONCLUSIONS: There is a need to develop or refine current heat-related regulations and guidelines to minimise the risk of occupational heat illnesses in vulnerable workers in a warming climate.

Association between high temperature and work-related injuries in Adelaide, South Australia, 2001-2010.

OBJECTIVES: (1) To investigate the association between temperature and work-related injuries and (2) to identify groups of workers at high risk of work-related injuries in hot environments in Adelaide, South Australia. METHODS: Workers' compensation claims in Adelaide, South Australia for 2001-2010 were used. The relationship between temperature and daily injury claims was estimated using a generalised estimating equation model. A piecewise linear spline function was used to quantify the effect of temperature on injury claims below and above thresholds. RESULTS: Overall, a 1°C increase in maximum temperature between 14.2°C and 37.7°C was associated with a 0.2% increase in daily injury claims. Specifically, the incidence rate ratios (IRRs) for male workers and young workers aged ≤24 were (1.004, 95% CI 1.002 to 1.006) and (1.005, 95% CI 1.002 to 1.008), respectively. Significant associations were also found for labourers (IRR 1.005, 95% CI 1.001 to 1.010), intermediate production and transport workers (IRR 1.003, 95% CI 1.001 to 1.005) and tradespersons (IRR 1.002, 95% CI 1.001 to 1.005). Industries at risk were agriculture, forestry and fishing (IRR 1.007, 95% CI 1.001 to 1.013), construction (IRR 1.006, 95% CI 1.002 to 1.011), and electricity, gas and water (IRR 1.029, 95% CI 1.002 to 1.058). CONCLUSIONS: There is a significant association between injury claims and temperature in Adelaide, South Australia, for certain industries and groups. Relevant adaptation and prevention measures are required at both policy and practice levels to address occupational exposure to high temperatures.

The impact of heatwaves on workers' health and safety in Adelaide, South Australia.

This study aims to investigate the impact of heatwaves on worker's health and safety; to identify workers at higher risk of prevalent illnesses and injuries due to heatwaves; and to provide evidence for policy-makers and service providers. South Australian workers' compensation claims data for 2001-2010 were transformed into time series format, merged with meteorological data and analysed using generalized estimating equation (GEE) models. For total injury claims there was no significant difference detected between heatwave and non-heatwave periods. However, for outdoor industries, daily claims increased significantly by 6.2% during heatwaves. Over-represented in hot weather were male labourers and tradespersons aged ≥ 55 years, and those employed in 'agriculture, forestry and fishing' and 'electricity, gas and water'. Occupational burns, wounds, lacerations, and amputations as well as heat illnesses were significantly associated with heatwaves. Similarly, moving objects, contact with chemicals, and injuries related to environmental factors increased significantly during heatwaves, especially among middle-aged and older male workers. With the predicted increase of extremely hot weather, there is a need for relevant adaptation and prevention measures at both practice and policy levels for vulnerable work groups.