03040nas a2200313   4500000000100000008004100001653001000042653002600052653002400078653001100102653001800113653001400131653002200145653001500167653002300182653002600205100001100231700001400242700001400256700000900270700001300279700001200292245007800304856009000382300001000472490000600482520222400488022001402712       2012                            d10awater10aSocioeconomic Factors10aModels, Statistical10aHumans10aGlobal health10aGeography10aDisease Outbreaks10aDemography10aDatabases, Factual10aCommunicable Diseases1 aYang K1 aLeJeune J1 aAlsdorf D1 aLu B1 aShum C K1 aLiang S00aGlobal distribution of outbreaks of water-associated infectious diseases.  uhttp://journals.plos.org/plosntds/article/asset?id=10.1371%2Fjournal.pntd.0001483.PDF  ae14830 v63 a<p><strong>BACKGROUND: </strong>Water plays an important role in the transmission of many infectious diseases, which pose a great burden on global public health. However, the global distribution of these water-associated infectious diseases and underlying factors remain largely unexplored.</p>

<p><strong>METHODS AND FINDINGS: </strong>Based on the Global Infectious Disease and Epidemiology Network (GIDEON), a global database including water-associated pathogens and diseases was developed. In this study, reported outbreak events associated with corresponding water-associated infectious diseases from 1991 to 2008 were extracted from the database. The location of each reported outbreak event was identified and geocoded into a GIS database. Also collected in the GIS database included geo-referenced socio-environmental information including population density (2000), annual accumulated temperature, surface water area, and average annual precipitation. Poisson models with Bayesian inference were developed to explore the association between these socio-environmental factors and distribution of the reported outbreak events. Based on model predictions a global relative risk map was generated. A total of 1,428 reported outbreak events were retrieved from the database. The analysis suggested that outbreaks of water-associated diseases are significantly correlated with socio-environmental factors. Population density is a significant risk factor for all categories of reported outbreaks of water-associated diseases; water-related diseases (e.g., vector-borne diseases) are associated with accumulated temperature; water-washed diseases (e.g., conjunctivitis) are inversely related to surface water area; both water-borne and water-related diseases are inversely related to average annual rainfall. Based on the model predictions, "hotspots" of risks for all categories of water-associated diseases were explored.</p>

<p><strong>CONCLUSIONS: </strong>At the global scale, water-associated infectious diseases are significantly correlated with socio-environmental factors, impacting all regions which are affected disproportionately by different categories of water-associated infectious diseases.</p>
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