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Effects of climate changes and road exposure on the rapidly rising legionellosis incidence rates in the United States.

ABSTRACT: Legionellosis is an infection acquired through inhalation of aerosols that are contaminated with environmental bacteria Legionella spp. The bacteria require warm temperature for proliferation in bodies of water and moist soil. The legionellosis incidence in the United States has been rising rapidly in the past two decades without a clear explanation. In the meantime, the US has recorded consecutive years of above-norm temperature since 1997 and precipitation surplus since 2008. The present study analyzed the legionellosis incidence in the US during the 20-year period of 1999 to 2018 and correlated with concurrent temperature, precipitation, solar ultraviolet B (UVB) radiation, and vehicle mileage data. The age-adjusted legionellosis incidence rates rose exponentially from 0.40/100,000 in 1999 (with 1108 cases) to 2.69/100,000 in 2018 (with 9933 cases) at a calculated annual increase of 110%. In regression analyses, the rise correlated with an increase in vehicle miles driven and with temperature and precipitation levels that have been above the 1901-2000 mean since 1997 and 2008, respectively, suggesting more road exposure to traffic-generated aerosols and promotive effects of anomalous climate. Remarkably, the regressions with cumulative anomalies of temperature and precipitation were robust (R2 ≥ 0.9145, P ≤ 4.7E-11), implying possible changes to microbial ecology in the terrestrial and aquatic environments. An interactive synergy between annual precipitation and vehicle miles was also found in multiple regressions. Meanwhile, the bactericidal UVB radiation has been decreasing, which also contributed to the rising incidence in an inverse correlation. The 2018 legionellosis incidence peak corresponded to cumulative effects of the climate anomalies, vast vehicle miles (3,240 billion miles, 15904 km per capita), record high precipitation (880.1 mm), near record low UVB radiation (7488 kJ/m2), and continued above-norm temperature (11.96°C). These effects were examined and demonstrated in California, Florida, New Jersey, Ohio, and Wisconsin, states that represent diverse incidence rates and climates. The incidence and above-norm temperature both rose most in cold Wisconsin. These results suggest that warming temperature and precipitation surplus have likely elevated the density of Legionella bacteria in the environment, and together with road exposure explain the rapidly rising incidence of legionellosis in the United States. These trends are expected to continue, warranting further research and efforts to prevent infection.

SUBMITTER: Han XY

PROVIDER: S-EPMC8061983 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Legionellosis, an infection caused by the environmental bacteria Legionella spp., has become a significant public health problem in the United States in recent years; however, among the states, the incidence rates vary widely without a clear explanation. This study examined environmental effects on the 2014-to-2016 average annual legionellosis incidence rates in the U.S. states through correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours. The continental states west of ∼95°W showed low incidence rates of 0.51 to 1.20 cases per 100,000 population, which corresponded to low precipitation, below 750 mm annually. For the eastern states, where precipitation was higher, solar effects were prominent and mixed, leading to wide incidence variation. Robust regressions suggested a dividing line at 40°N: north of this line, rising temperature, mainly from solar heat, raised legionellosis incidence to a peak of 4.25/100,000 in Ohio; south of the line, intensifying sunlight in terms of high UV indices and long sunshine hours prevailed to limit incidence gradually to 0.99/100,000 in Louisiana. On or near the 40°N line were 15 eastern states that had leading legionellosis incidence rates of >2.0/100,000. These states all showed modest environmental parameters. In contrast, the frigid climate in Alaska and the strong year-round solar UV in Hawaii explained the lowest U.S. incidences, 0.14/100,000 and 0.47/100,000, respectively, in these states. The findings of solar and climate effects explain the wide variation of legionellosis incidence rates in the United States and may offer insights into the potential exposure to and prevention of infection.IMPORTANCE Legionellosis, caused by the environmental bacteria Legionella spp., has become a significant public health problem in the United States in recent years, with ∼6,000 cases annually. The present study showed, through a series of correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours, that these environmental conditions strongly influence the legionellosis incidence rates across the United States in mixed and dynamic fashions. The incidence rates varied remarkably by region, with the highest in Ohio and New York and the lowest in Alaska. A precipitation threshold above 750 mm was required for elevated legionellosis activity. Regression models and dividing lines between regions were established to show the promotive effect of temperature, as well as the inhibitive effects of solar UV and sunshine hours. These findings explain the wide variation of legionellosis incidence rates in the United States. They may also offer insights into potential exposure to and prevention of infection.

Project description:PurposeRecent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus (HPV) infection, but empirical evidence is lacking.Patients and methodsHPV status was determined for all 271 oropharyngeal cancers (1984-2004) collected by the three population-based cancer registries in the Surveillance, Epidemiology, and End Results (SEER) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping (Inno-LiPA), HPV16 viral load, and HPV16 mRNA expression. Trends in HPV prevalence across four calendar periods were estimated by using logistic regression. Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonrandom selection and to calculate incidence trends. Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses.ResultsHPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay (P trend < .05). For example, HPV prevalence by Inno-LiPA increased from 16.3% during 1984 to 1989 to 71.7% during 2000 to 2004. Median survival was significantly longer for HPV-positive than for HPV-negative patients (131 v 20 months; log-rank P < .001; adjusted hazard ratio, 0.31; 95% CI, 0.21 to 0.46). Survival significantly increased across calendar periods for HPV-positive (P = .003) but not for HPV-negative patients (P = .18). Population-level incidence of HPV-positive oropharyngeal cancers increased by 225% (95% CI, 208% to 242%) from 1988 to 2004 (from 0.8 per 100,000 to 2.6 per 100,000), and incidence for HPV-negative cancers declined by 50% (95% CI, 47% to 53%; from 2.0 per 100,000 to 1.0 per 100,000). If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.ConclusionIncreases in the population-level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection.

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Effects of climate changes and road exposure on the rapidly rising legionellosis incidence rates in the United States.

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