Epidemiology and Infection

Systematic Review

Weather and infection

Extreme water-related weather events and waterborne disease

K. F. CANNa1 c1, D. Rh. THOMASa1, R. L. SALMONa1, A. P. WYN-JONESa2 and D. KAYa2

a1 Communicable Disease Surveillance Centre, Public Health Wales, Temple of Peace and Health, Cathays Park, Cardiff, UK

a2 IGES, Aberystwyth University, Aberystwyth, UK


Global climate change is expected to affect the frequency, intensity and duration of extreme water-related weather events such as excessive precipitation, floods, and drought. We conducted a systematic review to examine waterborne outbreaks following such events and explored their distribution between the different types of extreme water-related weather events. Four medical and meteorological databases (Medline, Embase, GeoRef, PubMed) and a global electronic reporting system (ProMED) were searched, from 1910 to 2010. Eighty-seven waterborne outbreaks involving extreme water-related weather events were identified and included, alongside 235 ProMED reports. Heavy rainfall and flooding were the most common events preceding outbreaks associated with extreme weather and were reported in 55·2% and 52·9% of accounts, respectively. The most common pathogens reported in these outbreaks were Vibrio spp. (21·6%) and Leptospira spp. (12·7%). Outbreaks following extreme water-related weather events were often the result of contamination of the drinking-water supply (53·7%). Differences in reporting of outbreaks were seen between the scientific literature and ProMED. Extreme water-related weather events represent a risk to public health in both developed and developing countries, but impact will be disproportionate and likely to compound existing health disparities.

(Received October 12 2011)

(Revised June 26 2012)

(Accepted July 11 2012)

(Online publication August 09 2012)

Key words

  • Climate – impact of;
  • water-borne infections


c1 Author for correspondence: Miss K. F. Cann, CDSC, Temple of Peace and Health, Cathays Park, Cardiff CF10 3NW, UK. (Email: Kimberley.cann@wales.nhs.uk)