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Jonathan A. Patz, MD, MPH; Paul R. Epstein, MD, MPH; Thomas A. Burke, PhD, MPH; John M. Balbus, MD, MPH

JAMA. 1996;275(3):217-223.

Abstract
Climatic factors influence the emergence and reemergence of infectious diseases, in addition to multiple human, biological, and ecological determinants. Climatologists have identified upward trends in global temperatures and now estimate an unprecedented rise of 2.0°C by the year 2100. Of major concern is that these changes can affect the introduction and dissemination of many serious infectious diseases.

The incidence of mosquito-borne diseases, including malaria, dengue, and viral encephalitides, are among those diseases most sensitive to climate. Climate change would directly affect disease transmission by shifting the vector's geographic range and increasing reproductive and biting rates and by shortening the pathogen incubation period. Climate-related increases in sea surface temperature and sea level can lead to higher incidence of water-borne infectious and toxin-related illnesses, such as cholera and shellfish poisoning. Human migration and damage to health infrastructures from the projected increase in climate variability could indirectly contribute to disease transmission. Human susceptibility to infections might be further compounded by malnutrition due to climate stress on agriculture and potential alterations in the human immune system caused by increased flux of ultraviolet radiation.

Analyzing the role of climate in the emergence of human infectious diseases will require interdisciplinary cooperation among physicians, climatologists, biologists, and social scientists. Increased disease surveillance, integrated modeling, and use of geographically based data systems will afford more anticipatory measures by the medical community. Understanding the linkages between climatological and ecological change as determinants of disease emergence and redistribution will ultimately help optimize preventive strategies.

(JAMA. 1995;275:217-223)

Author Affiliations
From the Departments of Molecular Microbiology and Immunology (Dr Patz) and Health Policy (Dr Burke), Johns Hopkins School of Hygiene and Public Health, Baltimore, Md; Department of Medicine, Harvard Medical School, Boston, Mass (Dr Epstein); and Division of Occupational and Environmental Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr Balbus).

Footnotes
Reprint requests to Department of Molecular Microbiology and Immunology, Johns Hopkins School of Hygiene and Public Health, 615 N Wolfe St, Baltimore, MD 21205-2179 (Dr Patz).

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