Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.3.1.4 Projected Impacts on Waterborne Diseases ====

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''Climate change will contribute to additional deaths and mortality due to diarrhoeal diseases in the absence of adaptation'' ( ''medium confidence'' ) ''(see Figure 7.8).'' Risk factors for future excess deaths due to diarrhoeal diseases are highly mediated by future levels of socioeconomic development and adaptation. An additional 1°C increase in mean average temperature is expected to result in a 7% (95% CI, 3–10%) increase in all-cause diarrhoea ( [[#Carlton--2016|Carlton et al., 2016]] ), an 8% (95% CI, 5–11%) increase in the incidence of diarrheic ''E. coli'' ( [[#Philipsborn--2016|Philipsborn et al., 2016]] ) and a 3–11% increase in deaths attributable to diarrhoea ( [[#WHO--2014|WHO, 2014]] ) ''.'' WHO Quantitative Risk Assessments for the effects of climate change on selected causes of death for the 2030s and 2050s project that overall deaths from diarrhoea should fall due to socioeconomic development but that the effect of climate change under higher emission scenarios could cause an additional 48,000 deaths in children aged under 15 years in 2030 and 33,000 deaths for 2050, particularly in Africa and parts of Asia. In Ecuador, projected increases in rainfall variability and heavy rainfall events may increase diarrhoea burden in urban regions ( [[#Deshpande--2020|Deshpande et al., 2020]] ). A limit in the assessable literature is a lack of studies in the highest risk areas ( [[#Liang--2017|Liang and Gong, 2017]] ; [[#UNEP--2018|UNEP, 2018]] ).

''Climate change is expected to increase future health risks associated with a range of other WBDs and parasites, with effects varying by region'' ( ''medium confidence'' ) ''.'' WBDs attributable to protozoan parasites including ''Cryptosporidium'' spp. and ''Giardia duodenalis (intestinalis)'' are expected to increase in Africa due to increasing temperatures and drought ( [[#Ahmed--2018|Ahmed et al., 2018]] ; [[#Efstratiou--2017|Efstratiou et al., 2017]] ). Recent data suggest a poleward expansion of ''Vibrios'' to areas with no previous incidence, particularly in mid- to high-latitude regions in areas where rapid warming is taking place ( [[#Baker-Austin--2017|Baker-Austin et al., 2017]] ). The number of ''Vibrio'' -induced diarrhoea cases yr –1 increased in past decades in the Baltic Sea region, and the projected risk of vibriosis will increase in northern areas, where waters are expected to become warmer and more saline due to reduced precipitation and have higher chlorophyll concentrations ( [[#Escobar--2015|Escobar et al., 2015]] ; [[#Semenza--2017|Semenza et al., 2017]] ).

''The risk of Campylobacteriosis and other enteric pathogens could rise in regions where heavy precipitation events or flooding are projected to increase'' ( ''medium confidence'' ) ''.'' In Europe, the risk of Campylobacteriosis and diseases caused by other enteric pathogens could rise in regions where precipitation or extreme flooding are projected to increase (European Environment Agency, 2017), although incidence rates may be further mediated by seasonal social activities ( [[#Rushton--2019|Rushton et al., 2019]] ; [[#Williams--2015b|Williams et al., 2015b]] ). Accelerated releases of dissolved organic matter to inland and coastal waters through increases in precipitation are expected to reduce the potential for solar ultraviolet inactivation of pathogens and increase risks for associated WBDs ( [[#Williamson--2017|Williamson et al., 2017]] ). The combined relative risk for waterborne campylobacteriosis, salmonellosis and diseases due to Verotoxin-producing ''Escherichia coli'' was estimated to be 1.1 (i.e., a 10% increase) for every 1°C in mean annual temperature, while by the 2080s, under RCP8.5, annual rates of cryptosporidiosis and giardiasis could rise by approximately 16% due to more severe precipitation events ( [[#Brubacher--2020|Brubacher et al., 2020]] ; [[#Chhetri--2019|Chhetri et al., 2019]] ).

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