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Background: During the COVID-19 pandemic, seasonal influenza virus circulation was heavily suppressed worldwide. In Australia, since the virus re-emerged in 2022, shifts in seasonal influenza patterns have been observed. Both the 2022 and 2023 seasons started earlier than pre-pandemic norms and were categorised as moderate to severe, highlighting the renewed importance of prevention strategies for seasonal influenza. Methods: We analysed influenza notification data from the Australian National Notifiable Diseases Surveillance System (2012–2022) and virological surveillance data from the FluNet database (2012–2023). Using generalised additive models, we compared predicted weekly influenza case counts during 2020–2022 with observed counts. Epidemic weeks were detected using a negative binomial threshold, and epidemic onset was estimated with a Bayesian Poisson count detection algorithm. Trends in epidemic magnitude and onset timing across influenza virus types and subtypes were compared for pre-, during, and post-COVID-19 periods. Results: Seasonal influenza activity was nearly absent in 2020 and 2021 but rebounded significantly in 2022 and 2023. Epidemic detection confirmed suppressed seasonal influenza circulation during the pandemic. While influenza A subtypes returned to pre-pandemic onset timings in 2022, influenza B exhibited a significantly delayed onset. The 2022 and 2023 seasons were moderate to severe, with earlier-than-average season starts, underscoring the ongoing changes in influenza dynamics post-pandemic. Conclusions: This study provided a detailed analysis of the disruptions and subsequent shifts in seasonal influenza patterns in Australia during and after the COVID-19 pandemic. The rapid resurgence of influenza activity in 2022 and 2023, combined with altered onset timings, highlights the importance of ongoing surveillance and adaptive forecasting models to address the evolving complexity of influenza epidemiology in the post-pandemic era.

Abstract The last decade has seen major advances and growth in internet-based surveillance for infectious diseases through advanced computational capacity, growing adoption of smart devices, increased availability of Artificial Intelligence (AI), alongside environmental pressures including climate and land use change contributing to increased threat and spread of pandemics and emerging infectious diseases. With the increasing burden of infectious diseases and the COVID-19 pandemic, the need for developing novel technologies and integrating internet-based data approaches to improving infectious disease surveillance is greater than ever. In this systematic review, we searched the scientific literature for research on internet-based or digital surveillance for influenza, dengue fever and COVID-19 from 2013 to 2023. We have provided an overview of recent internet-based surveillance research for emerging infectious diseases (EID), describing changes in the digital landscape, with recommendations for future research directed at public health policymakers, healthcare providers, and government health departments to enhance traditional surveillance for detecting, monitoring, reporting, and responding to influenza, dengue, and COVID-19.

Background: Several studies have examined the effect of non-pharmaceutical interventions (NPIs) on COVID-19 and other infectious diseases in Australia and globally. However, to our knowledge none have sufficiently explored their impact on other infectious diseases with robust time series model. In this study, we aimed to use Bayesian Structural Time Series model (BSTS) to systematically assess the impact of NPIs on 64 National Notifiable Infectious Diseases (NNIDs) by conducting a comprehensive and comparative analysis across eight disease categories within each Australian state and territory, as well as nationally. Methods: Monthly data on 64 NNIDs from eight categories were obtained from the Australian National Notifiable Disease Surveillance System. The incidence rates for each infectious disease in 2020 were compared with the 2015–2019 average and then with the expected rates in 2020 using a BSTS model. The study investigated the causal effects of 2020 interventions and analysed the impact of government policy restrictions at the national level from January 2020 to December 2022. Results: During the COVID-19 pandemic interventions in Australia, there was a 38 % (95 % Credible Interval [CI] [9 %, 54 %]) overall relative reduction in incidence reported across all disease categories compared to the 2015–2019 average. Significant reductions were observed in bloodborne diseases: 20 % (95 % CI [10 %, 29 %]), respiratory diseases: 79 % (95 % CI [52 %, 91 %]), and zoonoses: 8 % (95 % CI [1 %, 17 %]). Conversely, vector-borne diseases increased by 9 % over the same period. Reductions and intervention effects varied by state and territory, with higher policy stringency linked to fewer cases for some diseases. Conclusions: COVID-19 NPIs also impacted the transmission of other infectious diseases, with varying effects across regions reflecting diverse outcomes in response strategies throughout Australia. The findings could inform public health strategies and provide scientific evidence to support the development of early warning systems for future disease outbreaks.

Abstract BackgroundChina has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. ObjectiveThe purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. MethodsData from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. ResultsIn China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (RPRP ConclusionsDespite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.

Abstract Background Optimal climatic conditions for dengue vector mosquito species may play a significant role in dengue transmission. We previously developed a species-specific Suitable Conditions Index (SCI) for Aedes aegypti and Aedes albopictus, respectively. These SCIs rank geographic locations based on their climatic suitability for each of these two dengue vector species and theoretically define parameters for transmission probability. The aim of the study presented here was to use these SCIs together with socio-environmental factors to predict dengue outbreaks in the real world. Methods A negative binomial regression model was used to assess the relationship between vector species-specific SCI and autochthonous dengue cases after accounting for potential confounders in Guangdong, China. The potential interactive effect between the SCI for Ae. albopictus and the SCI for Ae. aegypti on dengue transmission was assessed. Results The SCI for Ae. aegypti was found to be positively associated with autochthonous dengue transmission (incidence rate ratio: 1.06, 95% confidence interval: 1.03, 1.09). A significant interaction effect between the SCI of Ae. albopictus and the SCI of Ae. aegypti was found, with the SCI of Ae. albopictus significantly reducing the effect of the SCI of Ae. aegypti on autochthonous dengue cases. The difference in SCIs had a positive effect on autochthonous dengue cases. Conclusions Our results suggest that dengue fever is more transmittable in regions with warmer weather conditions (high SCI for Ae. aegypti). The SCI of Ae. aegypti would be a useful index to predict dengue transmission in Guangdong, China, even in dengue epidemic regions with Ae. albopictus present. The results also support the benefit of the SCI for evaluating dengue outbreak risk in terms of vector sympatry and interactions in the absence of entomology data in future research. Graphical Abstract

Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006–2012 as the baseline, future costings for 2026–2032 and 2046–2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006–2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8–129.1 million AUD in 2026–2032, and 174.1–190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.

Abstract Background Pacific Island countries, many of which are low- and middle-income countries, have some of the highest rates of diet-related non-communicable diseases (DR-NCDs) globally. These countries also face some of the earliest and most significant impacts of climate change. Several pathways between climate change and DR-NCDs have been described in the literature; however, the scope is broad and lacks context specificity. This paper uses a case study of one Pacific Island country, Vanuatu, to investigate links between climate change and DR-NCDs. Methods An ethnographic qualitative research approach was used to share the lived experiences of community participants and to explore and contrast these with the perspectives of key informants at the national level. Data collection comprised thirty-two semi-structured interviews and community fieldwork in two villages using a mix of methods, including group workshops, informal conversations, and observations. Reflexive thematic analysis was conducted on both data sets. Results This study found that DR-NCDs are a prominent health concern for ni-Vanuatu people and that structural determinants, including climate change, are the main driving forces for increased DR-NCD risk in the country. However, there was a lack of understanding of the links between climate change and DR-NCDs both at the community and national levels. Structural factors, such as social determinants and climate change, constrained individual and community agency in making optimal food and health choices and promoted the nutrition transition in Vanuatu. Despite the critical role of social determinants and climate change in driving DR-NCD risk, the responsibility for prevention and treatment was considered to rest mainly with the individual. A systems approach is advocated to grasp the complexity and interrelatedness of the causes of DR-NCD risk. Conclusions The interaction of structural determinants creates food and health environments that amplify the risk, burden, and consequences of DR-NCDs. It is recommended that the DR-NCD narrative in Vanuatu be re-framed with an emphasis on the range of structural determinants of DR-NCD risk. This will serve to enhance individual and collective agency to not only make healthy food and other behavioural choices but also to exercise agency to transform the structures in a culturally appropriate way.

Since the beginning of the COVID-19 pandemic in early 2020, global efforts to respond to and control COVID-19 have varied widely with some countries, including Australia, successfully containing local transmission, and minimising negative impacts to health and economies. Over this time, global awareness of climate variability due to climate change and the risk factors for emerging infectious diseases transmission has increased alongside an understanding of the inextricable relationship between the health of the environment, humans, and animals. Overall, the global response to the current pandemic suggests there is an urgent need for a One Health approach in controlling and preventing future pandemics, through developing integrated, dynamic, spatiotemporal early warning systems based on a One Health approach for emerging infectious diseases.

Background Vector surveillance is an essential public health tool to aid in the prediction and prevention of mosquito borne diseases. This study compared spatial and temporal trends of vector surveillance indices for Aedes vectors in the southern Philippines, and assessed potential links between vector indices and climate factors. Methods We analysed routinely collected larval and pupal surveillance data from residential areas of 14 cities and 51 municipalities during 2013–2018 (House, Container, Breteau and Pupal Indices), and used linear regression to explore potential relationships between vector indices and climate variables (minimum temperature, maximum temperature and precipitation). Results We found substantial spatial and temporal variation in monthly Aedes vector indices between cities during the study period, and no seasonal trend apparent. The House (HI), Container (CI) and Breteau (BI) Indices remained at comparable levels across most surveys (mean HI = 15, mean CI = 16, mean BI = 24), while the Pupal Productivity Index (PPI) was relatively lower in most months (usually below 5) except for two main peak periods (mean = 49 overall). A small proportion of locations recorded high values across all entomological indices in multiple surveys. Each of the vector indices were significantly correlated with one or more climate variables when matched to data from the same month or the previous 1 or 2 months, although the effect sizes were small. Significant associations were identified between minimum temperature and HI, CI and BI in the same month (R2 = 0.038, p = 0.007; R2 = 0.029, p = 0.018; and R2 = 0.034, p = 0.011, respectively), maximum temperature and PPI with a 2-month lag (R2 = 0.031, p = 0.032), and precipitation and HI in the same month (R2 = 0.023, p = 0.04). Conclusions Our findings indicated that larval and pupal surveillance indices were highly variable, were regularly above the threshold for triggering vector control responses, and that vector indices based on household surveys were weakly yet significantly correlated with city-level climate variables. We suggest that more detailed spatial and temporal analyses of entomological, climate, socio-environmental and Aedes-borne disease incidence data are necessary to ascertain the most effective use of entomological indices in guiding vector control responses, and reduction of human disease risk. Author summary In areas which regularly experience outbreaks of mosquito-borne diseases, such as dengue, mosquito abundance and climate are two influencing factors which are often explored for their ability to aid prediction of and response to outbreaks. In 65 areas of the southern Philippines which regularly report dengue outbreaks, we compared trends in four different indicators of Aedes mosquito abundance during a 6-year period. We also compared data for Aedes indicators with climate data from the same areas. We found that patterns in Aedes mosquito abundance were highly variable over time and did not appear to have a distinct seasonal trend. The four different indicators of mosquito abundance each had weak yet significant relationships with different climate variables. We propose that further studies should explore additional types of data such as epidemiological and socio-environmental data for their value in assisting public health responses to Aedes-borne disease outbreaks.

Abstract Using social media for health purposes has attracted much attention over the past decade. Given the challenges of population ageing and changes in national health profile and disease patterns following the epidemiologic transition, researchers and policy-makers should pay attention to the potential of social media in chronic disease surveillance, management and support. This commentary overviews the evidence base for this inquiry and outlines the key challenges to research laying ahead. The authors provide concrete suggestions and recommendations for developing a research agenda to guide future investigation and action on this topic.

It has been widely recognised that the threats to human health from global environmental changes (GECs) are increasing in the Anthropocene epoch, and urgent actions are required to tackle these pressing challenges. A scoping review was conducted to provide an overview of the nine planetary boundaries and the threats to population health posed by human activities that are exceeding these boundaries in the Anthropocene. The research progress and key knowledge gaps were identified in this emerging field. Over the past three decades, there has been a great deal of research progress on health risks from climate change, land-use change and urbanisation, biodiversity loss and other GECs. However, several significant challenges remain, including the misperception of the relationship between human and nature; assessment of the compounding risks of GECs; strategies to reduce and prevent the potential health impacts of GECs; and uncertainties in fulfilling the commitments to the Paris Agreement. Confronting these challenges will require rigorous scientific research that is well-coordinated across different disciplines and various sectors. It is imperative for the international community to work together to develop informed policies to avert crises and ensure a safe and sustainable planet for the present and future generations.

Abstract Background Bangkok plays a central role in the commerce of Thailand. This study aimed to characterize the district-level spatial-temporal patterns of dengue in Thailand and explore if a dengue peak in Bangkok led the peaks of dengue in other Thai provinces. Methods Monthly dengue data at district level in Thailand from January 2004 to December 2017 were obtained and used to assess the spatial and seasonal patterns of dengue in Thailand. As our seasonal decomposition and cross-correlation analyses showed that dengue in Bangkok peaked in November, which was a few months after the dengue peak in most other provinces, we used a time-series generalized linear model to explore if there was another province in which the dengue case number was most predictive of dengue case numbers in other Thai provinces. Results The highest district-level annual dengue incidence rates (per 10,000) in the three time periods (i.e. 2004–2008, 2009–2013 and 2014–2017) were 58.08 (Samphanthawong), 85.93 (Mueang Krabi), and 66.60 (Mae Sariang), respectively. Dengue incidence rates in the western part of Northern Thailand, southern part of Central Thailand, southern part of Eastern Thailand, and Southern Thailand were higher than in other regions. Dengue in most districts of Thailand peaked in June, July or August, but dengue peaks in all districts of Bangkok occurred in November. The number of dengue cases in Nakhon Ratchasima was most predictive of the number of dengue cases in other provinces in Thailand by a one-month lag. Conclusions Our results suggest that the dengue peak in Bangkok did not lead the peaks of dengue in other Thai provinces. Future research exploring how changes in socio-ecological factors (e.g. road network and climate factors) in Nakhon Ratchasima have affected the transmission of dengue in Thailand might shed some new light on the prevention and control of dengue.

Abstract Objective: Public preparedness for natural hazard events is low. With worsening severe weather events due to climate change, public health policy and practices must evolve to more effectively engage communities. This study's findings identify and suggest new strategic public health policies to shift the practice of all‐hazards preparedness into routine, everyday life. Methods: Semi‐structured interviews, focus groups and Thematic Analysis were used to investigate the interactions between participant groups: emergency responders and animal owners. Results: Three policies designed to improve human safety and well‐being are proposed and discussed. These are (i) a new system of workplace leave, (ii) an innovative regime of financial incentives for fire‐ready properties, and (iii) review of the use of firebreaks on farms and rural blocks. Conclusion: Policies proposed in this research aim to proactively narrow the awareness‐preparedness gap and build adaptive capacity to minimise risk to human health in all‐hazards contexts. Further research could evaluate the efficacy of trialled public policy. Implications for public health: These new policies seek to contribute to establishing and maintaining a culture of preparedness as a routine aspect of everyday life, and thus promote and protect public health in the short, medium and long terms.

Vanuatu, a Pacific Small Island Developing State, has high exposure to climate extremes, such as tropical cyclones and interannual rainfall variability, which can have devastating short- and long-term impacts on food and nutrition security (FNS). This paper presents local experiences of the effects of climate extremes on FNS in Vanuatu through a case study of two recent events: Tropical Cyclone Pam (2015) and an El Niño-induced drought (2015–2017). A qualitative research approach, using a range of data collection methods, was used to document people's lived experiences in two villages in Vanuatu. This study found that climate extremes affected the FNS of people in the two study villages directly, with effects on gardens and food production, and indirectly, by exacerbating the nutrition transition, a shift away from traditional diets energy-dense imported food that is already progressing in Vanuatu. These effects undermine long-term FNS and health. Climate extremes also eroded food-related cultural practices and traditions and constrained local agency to make food choices. The magnitude and extent of these impacts, however, are influenced by structural vulnerabilities and local resiliencies. The adaptive capacity and resilience of communities needs to be strengthened in a way that allows people to exercise agency in their responses to climate extremes and to promote FNS, including cultural acceptability and food preferences, and long-term health.

Severe COVID-19 cases place immediate pressure on hospital resources. To assess this, we analysed survival duration in the first 39 fatal cases in Wuhan, China. Time from onset and hospitalization to death declined rapidly, from ~40 to 7 days, and ~25 to 4 days, respectively, in the outbreak’s first month.

COVID-19 is causing a significant burden on medical and healthcare resources globally due to high numbers of hospitalisations and deaths recorded as the pandemic continues. This research aims to assess the effects of climate factors (i.e., daily average temperature and average relative humidity) on effective reproductive number of COVID-19 outbreak in Wuhan, China during the early stage of the outbreak. Our research showed that effective reproductive number of COVID-19 will increase by 7.6% (95% Confidence Interval: 5.4% ~ 9.8%) per 1°C drop in mean temperature at prior moving average of 0–8 days lag in Wuhan, China. Our results indicate temperature was negatively associated with COVID-19 transmissibility during early stages of the outbreak in Wuhan, suggesting temperature is likely to effect COVID-19 transmission. These results suggest increased precautions should be taken in the colder seasons to reduce COVID-19 transmission in the future, based on past success in controlling the pandemic in Wuhan, China.

BACKGROUND:Dengue is a mosquito-borne viral disease and its transmission is closely linked to climate. We aimed to review available information on the projection of dengue in the future under climate change scenarios. METHODS:Using five databases (PubMed, ProQuest, ScienceDirect, Scopus and Web of Science), a systematic review was conducted to retrieve all articles from database inception to 30th June 2019 which projected the future of dengue under climate change scenarios. In this review, "the future of dengue" refers to disease burden of dengue, epidemic potential of dengue cases, geographical distribution of dengue cases, and population exposed to climatically suitable areas of dengue. RESULTS:Sixteen studies fulfilled the inclusion criteria, and five of them projected a global dengue future. Most studies reported an increase in disease burden, a wider spatial distribution of dengue cases or more people exposed to climatically suitable areas of dengue as climate change proceeds. The years 1961-1990 and 2050 were the most commonly used baseline and projection periods, respectively. Multiple climate change scenarios introduced by the Intergovernmental Panel on Climate Change (IPCC), including B1, A1B, and A2, as well as Representative Concentration Pathway 2.6 (RCP2.6), RCP4.5, RCP6.0 and RCP8.5, were most widely employed. Instead of projecting the future number of dengue cases, there is a growing consensus on using "population exposed to climatically suitable areas for dengue" or "epidemic potential of dengue cases" as the outcome variable. Future studies exploring non-climatic drivers which determine the presence/absence of dengue vectors, and identifying the pivotal factors triggering the transmission of dengue in those climatically suitable areas would help yield a more accurate projection for dengue in the future. CONCLUSIONS:Projecting the future of dengue requires a systematic consideration of assumptions and uncertainties, which will facilitate the development of tailored climate change adaptation strategies to manage dengue.

Purpose – The extraction of natural resources has long been part of economic development in small islands. The damage to environment and health is extensive, even rendering once productive islands virtually uninhabitable. Rather than providing long-term benefits to the population or to the environment, the culture of “extractivism” – a nonreciprocal approach where resources are removed and used with little care or regard to consequences – has instead left many in far more fragile circumstances, increasingly dependent on external income. The purpose of this paper is to show how continued extractivism in small islands is contributing to global climate change and increasing climate risks to the local communities. Design/methodology/approach – Through a series of case studies, this paper examines the history of extractivism in small islands in Oceania, its contribution to environmental degradation locally and its impacts on health. Findings – It examines how extractivism continues today, with local impacts on environment, health and wellbeing and its much more far-reaching consequences for global climate change and human health. At the same time, these island countries have heightened sensitivity to climate change due to their isolation, poverty and already variable climate, whereas the damage to natural resources, the disruption, economic dependence and adverse health impacts caused by extractivism impart reduced resilience to the new climate hazards in those communities. Practical implications – This paper proposes alternatives to resource extractivism with options for climate compatible development in small islands that are health-promoting and build community resilience in the face of increasing threats from climate change. Originality/value – Extractivism is a new concept that has not previously been applied to understanding health implications of resource exploitation thorough the conduit of climate change. Small-island countries are simultaneously exposed to widespread extractivism, including of materials contributing to global climate change, and are among the most vulnerable to the hazards that climate change brings.

Abstract Background Protection Motivation Theory (PMT) was developed by Rogers in 1975, to describe how individuals are motivated to react in a self-protective way towards a perceived health threat. Rogers expected the use of PMT to diversify over time, which has proved true over four decades. The purpose of this paper is to explore how PMT can be used and expanded to inform and improve public safety strategies in natural hazards. As global climate change impacts on the Australian environment, natural hazards seem to be increasing in scale and frequency, and Emergency Services’ public education campaigns have necessarily escalated to keep pace with perceived public threat. Of concern, is that the awareness-preparedness gap in residents’ survival plans is narrowing disproportionately slowly compared to the magnitude of resources applied to rectify this trend. Practical applications of adaptable social theory could be used to help resolve this dilemma. Discussion PMT has been used to describe human behaviour in individuals, families, and the parent-child unit. It has been applied to floods in Europe and wildfire and earthquake in the United States. This paper seeks to determine if an application of PMT can be useful for achieving other-directed human protection across a novel demographic spectrum in natural hazards, specifically, animal owners and emergency responders in bushfire emergencies. These groups could benefit from such an approach: owners to build and fortify their response- and self-efficacy, and to help translate knowledge into safer behaviour, and responders to gain a better understanding of a diverse demographic with animal ownership as its common denominator, and with whom they will be likely to engage in contemporary natural hazard management. Mutual collaboration between these groups could lead to a synergy of reciprocated response efficacy, and safer, less traumatic outcomes. Summary Emergency services’ community education programs have made significant progress over the last decade, but public safety remains suboptimal while the magnitude of the awareness-preparedness gap persists. This paper examines an expanded, other-directed application of PMT to expand and enhance safer mitigation and response behaviour strategies for communities threatened by bushfire, which may ultimately help save human life.

BACKGROUND:Many studies have shown associations between rising temperatures, El Niño events and dengue incidence, but the effect of sustained periods of extreme high temperatures (i.e., heatwaves) on dengue outbreaks has not yet been investigated. This study aimed to compare the short-term temperature-dengue associations during different dengue outbreak periods, estimate the dengue cases attributable to temperature, and ascertain if there was an association between heatwaves and dengue outbreaks in Hanoi, Vietnam. METHODOLOGY/PRINCIPAL FINDINGS:Dengue outbreaks were assigned to one of three categories (small, medium and large) based on the 50th, 75th, and 90th percentiles of distribution of weekly dengue cases during 2008-2016. Using a generalised linear regression model with a negative binomial link that controlled for temporal trends, temperature variation, rainfall and population size over time, we examined and compared associations between weekly average temperature and weekly dengue incidence for different outbreak categories. The same model using weeks with or without heatwaves as binary variables was applied to examine the potential effects of extreme heatwaves, defined as seven or more days with temperatures above the 95th percentile of daily temperature distribution during the study period. This study included 55,801 dengue cases, with an average of 119 (range: 0 to 1454) cases per week. The exposure-response relationship between temperature and dengue risk was non-linear and differed with dengue category. After considering the delayed effects of temperature (one week lag), we estimated that 4.6%, 11.6%, and 21.9% of incident cases during small, medium, and large outbreaks were attributable to temperature. We found evidence of an association between heatwaves and dengue outbreaks, with longer delayed effects on large outbreaks (around 14 weeks later) than small and medium outbreaks (4 to 9 weeks later). Compared with non-heatwave years, dengue outbreaks (i.e., small, moderate and large outbreaks combined) in heatwave years had higher weekly number of dengue cases (p

Introduction: Bushfires are an escalating natural hazard worldwide. This requires developing and implementing new strategies to narrow the bushfire awareness-preparedness gap and improve human safety in the medium to long terms. Redirecting adverse decision-making to achieve positive outcomes in a fire situation is a social imperative given the high human, economic and environmental cost of a serious fire. This paper explores underlying aetiologies that influence decision-making processes in natural hazard emergencies through the lenses of the emergency responder - animal owner interface and Protection Motivation Theory. Method: Data were collected using semi-structured interviews and focus group discussions, and analysed using theoretically-independent Thematic Analysis (TA). Three themes with direct relevance to decision-making were actively identified: (i) observing the influence of social microclimate; (ii) maladaptive response choices (iii) adaptive response choices. A fourth, dynamic risk assessment, is common to each. These themes generated three main organisational- and socially-mediated pathways for improving bushfire preparedness and human safety. Conclusion: By exploring how decision-making is influenced at the emergency responder-animal owner interface, this study proposes potentially useful strategic concepts for medium-to long-term improvement in public bushfire preparedness and disaster risk reduction. These include (i) understanding the complexities and synergism of various social microclimates, (ii) organisational collaboration and resource sharing, and (iii) creating a rewarding environment favouring safe response choices. The findings suggested in this paper aim to develop a safer environment for all inhabitants in areas at risk of bushfire, and other natural hazards.

Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios—Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 °C) over the study period 2012–2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6–7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%–6.3% and 4.4%–5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.

Dengue is a public health concern in northern Queensland, Australia. This study aimed to explore spatial and temporal characteristics of dengue cases in Queensland, and to identify high-risk areas after a 2009 dengue outbreak at fine spatial scale and thereby help in planning resource allocation for dengue control measures. Notifications of dengue cases for Queensland at Statistical Local Area (SLA) level were obtained from Queensland Health for the period 2010 to 2015. Spatial and temporal analysis was performed, including plotting of seasonal distribution and decomposition of cases, using regression models and creating choropleth maps of cumulative incidence. Both the space-time scan statistic (SaTScan) and Geographical Information System (GIS) were used to identify and visualise the space-time clusters of dengue cases at SLA level. A total of 1,773 dengue cases with 632 (35.65%) autochthonous cases and 1,141 (64.35%) overseas acquired cases were satisfied for the analysis in Queensland during the study period. Both autochthonous and overseas acquired cases occurred more frequently in autumn and showed a geographically expanding trend over the study period. The most likely cluster of autochthonous cases (Relative Risk, RR = 54.52, p

Background: Climate change is recognised as having a ‘multiplier effect’ on food insecurity and adverse health experiences of communities in the Pacific region. Islands are especially at risk due to their limited land availability, population pressures and, in the case of atolls, their low-lying topography making them vulnerable to sea level rise. Aim: This review examines the literature describing the relationship between climate change, food security and health in Kiribati. Method: A narrative review was conducted, looking at both peer-reviewed and non-peer-reviewed literature available online from 1 January 2008 to 14 August 2018, the search date. Sources from three databases of peer-reviewed literature, Google and additional sources from reference lists were included in the review. Results: Thirty-seven items were included in this review. These show climate change is having a noticeable impact on food security and health in Kiribati. Four themes were identified from the literature that provide different perspectives to the problem outlined. Conclusion: Climate change is a pressing concern for the government of Kiribati and communities alike, and yet the problem is worsening, not improving. Further research is required to look at effective policies and cultural perspectives to address this problem.

Abstract Objective: To identify differences in patterns of adverse health behaviours among people with type 2 diabetes according to country or region of birth. Methods: Population‐based study of 23,112 individuals with type 2 diabetes aged 45 years and older, from New South Wales, Australia. Self‐reported questionnaire data and logistic regression models were used to estimate odds ratios for adverse health behaviours according to country or region of birth, adjusted for confounding factors. Results: People with diabetes born in the Middle East and in the United Kingdom (UK) were more likely to be current smokers than those born in Australian, while those from Asia were less likely to be smokers. Relative to Australian‐born people with diabetes, those born in the Middle East were more likely to have insufficient physical activity, while those born in Oceania, North West Europe and the UK were less likely. People with diabetes from Asia, North Africa, the Middle East and Sub‐Saharan Africa were less likely to consume alcohol than those born in Australia, but people born in the UK were slightly more likely to consume alcohol. People with diabetes born in the UK, Asia, and North Africa were more likely than those born in Australia to have an inadequate intake of fruit and vegetables. Conclusion: Adverse health behaviours among people with type 2 diabetes varied markedly according to country or region of birth. Promoting smoking cessation and increasing physical activity levels among people with diabetes who were born in Middle Eastern countries are clear priorities.

Background : Australia has a hot climate with maximum summer temperatures in its major cities frequently exceeding 35°C. Although ‘heat waves’ are an annual occurrence, the associated heat-related deaths among vulnerable groups, such as older people, suggest that Australians could be better prepared to deal with extreme heat. Objective : To understand ways in which a vulnerable sub-population adapt their personal behaviour to cope with heat within the context of Australians’ relationship with heat. Design : We draw upon scientific, historical and literary sources and on a set of repeat interviews in the suburbs of Western Sydney with eight older participants and two focus group discussions. We discuss ways in which this group of older people modifies their behaviour to adapt to heat, and reflect on manifestations of Australians’ ambivalence towards heat. Results : Participants reported a number of methods for coping with extreme heat, including a number of methods of personal cooling, changing patterns of daily activity and altering dietary habits. The use of air-conditioning was near universal, but with recognition that increasing energy costs may become more prohibitive over time. Conclusions : While a number of methods are employed by older people to stay cool, these may become limited in the future. Australians’ attitudes may contribute to the ill-health and mortality associated with excessive heat.

Abstract Objective: Country of birth (COB) is an important determinant of health risks and outcomes. Despite the widespread use of hospital morbidity data for research, little is known about the quality of COB recording in these data. This study validated the recording of 40 COBs in Australian hospital morbidity data and identified factors associated with the recording accuracy. Methods: Questionnaire data from the 45 and Up Study were linked to records from the NSW Admitted Patient Data Collection (APDC), yielding linked records for 39,559 overseas‐born people. Measures of agreement between self‐reported COB from the 45 and Up Study (‘gold standard’) and COB as recorded in the APDC were calculated and logistic regression analysis was used to explore predictors of correct recording of COB. Results: On average, 81% of APDC records for overseas‐born people had the correct COB recorded. Sensitivities varied between 61% (Germany) and 99% (Spain). Specificities exceeded 99.5%. Positive predictive values were greater than 90%, except for Hong Kong (72%), Ireland (85%), and Czechoslovakia (89%). Negative predictive values exceedved 98%, except for the United Kingdom (87%). Kappa values indicated good or excellent concordance between self‐reported COB and APDC data (kappa 0.73 or greater). Where inaccurate, COB was mainly recorded as ‘Australia’ or ‘Inadequately described’. COB was recorded with greater accuracy in principal referral hospitals, public hospitals and hospitals in metropolitan areas. Accuracy decreased with duration of residence in Australia, increased with age at immigration, and varied according to COB. Conclusion: COB recording accuracy was generally high but varied according to hospital characteristics, country, and measures of acculturation.

BACKGROUND: While morbidity outcomes for major disease categories during extreme heat have received increasing research attention, there has been very limited investigation at the level of specific disease subcategories. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed daily hospital admissions for cardiovascular (CVD), respiratory (RD), genitourinary (GU) and mental diseases (MD), diabetes (DIA), dehydration (DEH) and 'the effects of heat and light' (HEAT) in Sydney between 1991 and 2009. We further investigated the sensitivity to heat of subcategories within the major disease groups. We defined hot days as those with temperatures in the 95(th) and 99(th) percentiles within the study period. We applied time-stratified case-crossover analysis to compare the hospital admissions on hot days with those on non-hot days matched by day of the week. We calculated the odds ratios (OR) of admissions between the two types of days, accounting for other environmental variables (relative humidity, ozone and particulate matter) and non-environmental trends (public and school holidays). On hot days, hospital admissions increased for all major categories except GU. This increase was not shared homogeneously across all diseases within a major category: within RD, only 'other diseases of the respiratory system' (includes pleurisy or empyema) increased significantly, while admissions for asthma decreased. Within MD, hospital admissions increased only for psychoses. Admissions due to some major categories increased one to three days after a hot day (e.g., DIA, RD and CVD) and on two and three consecutive days (e.g., HEAT and RD). CONCLUSIONS/SIGNIFICANCE: High ambient temperatures were associated with increased hospital admissions for several disease categories, with some within-category variation. Future analyses should focus on subgroups within broad disease categories to pinpoint medical conditions most affected by ambient heat.

Climate change in Ethiopia is occurring against a backdrop of rapid population growth and urbanization, entrenched poverty and a heavy burden of disease, and there is little information on specific health risks with which to approach adaptation planning and strengthen adaptive capacity. Using detailed household surveys (400 households, 1660 individuals, 100% participation) and focus groups in two informal urban communities in the Southern city of Shashemene, we identified locally relevant hazards and found that climate change is likely to intensify existing problems associated with poverty. We also showed that despite their proximity (situated only 1 km apart) the two communities differ in key characteristics that may affect climate change vulnerability and require nuanced approaches to adaptation. Detailed, community-level research is therefore necessary, especially where other sources of data are lacking, to ensure that adaptation activities in the world’s poorest communities address relevant risks.