Menu Close

Cholera and Shigellosis: Different Epidemiology but Similar Responses to Climate Variability


Cash, Benjamin A.; Rodo, Xavier; Emch, Michael E.; Yunus, Mohammad; Faruque, Abu Syed Golam; & Pascual, Mercedes (2014). Cholera and Shigellosis: Different Epidemiology but Similar Responses to Climate Variability. PLOS ONE, 9(9), e107223. PMCID: PMC4168003


BACKGROUND: Comparative studies of the associations between different infectious diseases and climate variability, such as the El Nino-Southern Oscillation, are lacking. Diarrheal illnesses, particularly cholera and shigellosis, provide an important opportunity to apply a comparative approach. Cholera and shigellosis have significant global mortality and morbidity burden, pronounced differences in transmission pathways and pathogen ecologies, and there is an established climate link with cholera. In particular, the specific ecology of Vibrio cholerae is often invoked to explain the sensitivity of that disease to climate.
METHODS AND FINDINGS: The extensive surveillance data of the International Center for Diarrheal Disease Research, Bangladesh are used here to revisit the known associations between cholera and climate, and to address their similarity to previously unexplored patterns for shigellosis. Monthly case data for both the city of Dhaka and a rural area known as Matlab are analyzed with respect to their association with El Nino and flooding. Linear correlations are examined between flooding and cumulative cases, as well as for flooding and El Nino. Rank-correlation maps are also computed between disease cases in the post-monsoon epidemic season and sea surface temperatures in the Pacific. Similar climate associations are found for both diseases and both locations. Increased cases follow increased monsoon flooding and increased sea surface temperatures in the preceding winter corresponding to an El Nino event.
CONCLUSIONS: The similarity in association patterns suggests a systemic breakdown in population health with changing environmental conditions, in which climate variability acts primarily through increasing the exposure risk of the human population. We discuss these results in the context of the on-going debate on the relative importance of the environmental reservoir vs. secondary transmission, as well as the implications for the use of El Nino as an early indicator of flooding and enteric disease risk.


Reference Type

Journal Article

Year Published


Journal Title



Cash, Benjamin A.
Rodo, Xavier
Emch, Michael E.
Yunus, Mohammad
Faruque, Abu Syed Golam
Pascual, Mercedes