Reading Part B

Part  B  :  Multiple  Choice  Questions       Time  Limit:  20~25  Minutes  

 
Infectious  Diseases  and  Climatic  Influences  
 
Authors:  Bernard  Cazelles,  Simon  Hales  
Source:  Public  Library  of  Open  Science  
 
Paragraph  1  
Complex  dynamic  relationships  between  humans,  pathogens,  and  the  
environment  lead  to  the  emergence  of  new  diseases  and  the  re-­‐emergence  of  old  
ones.  Due  to  concern  about  the  impact  of  increasing  global  climate  variability  
and  change,  many  recent  studies  have  focused  on  relationships  between  
infectious  disease  and  climate.    
 
Paragraph  2  
Climate  can  be  an  important  determinant  of  vector-­‐borne  disease  epidemics:  
geographic  and  seasonal  patterns  of  infectious  disease  incidence  are  often,  
though  not  always,  driven  by  climate  factors.  Mosquito-­‐  borne  diseases,  such  as  
malaria,  dengue  fever,  and  Ross  River  virus,  typically  show  strong  seasonal  and  
geographic  patterns,  as  do  some  intestine  diseases.  These  patterns  are  
unsurprising,  given  the  influence  of  climate  on  pathogen  replication,  vector  and  
disease  reservoir  populations,  and  human  societies.  In  Sweden,  a  trend  toward  
milder  winters  and  early  spring  arrival  may  be  implicated  in  an  increased  
incidence  of  tick-­‐borne  encephalitis.  The  recent  resurgence  of  malaria  in  the  East  
African  highlands  may  be  explained  by  increasing  temperatures  in  that  region.  
However,  as  yet  there  are  relatively  few  studies  showing  clear  climatic  
influences  on  infectious  diseases  at  interannual  or  longer  timescales.  
 
Paragraph  3  
The  semi-­‐regular  El  Niño  climate  cycle,  centred  on  the  Pacific  Ocean,  has  an  
important  influence  on  interannual  climate  patterns  in  many  parts  of  the  world.  
This  makes  El  Niño  an  attractive,  albeit  imperfect,  analogue  for  the  effects  of  
global  climate  change.  In  Peru,  daily  admissions  for  diarrhoea  increased  by  more  
than  2-­‐fold  during  an  El  Niño  event,  compared  with  expected  trends  based  on  the  
previous  five  years.  There  is  evidence  of  a  relationship  between  El  Niño  and  the  
timing  of  cholera  epidemics  in  Peru  and  Bangladesh;  of  ciguatera  in  the  Pacific  
islands;  of  Ross  River  virus  epidemics  in  Australia;  and  of  dengue  and  malaria  
epidemics  in  several  countries.  The  onset  of  meningococcal  meningitis  in  Mali  is  
associated  with  large-­‐scale  atmospheric  circulation.  
 
Paragraph  4  
These  studies  were  performed  mostly  at  country  scale,  reflecting  the  availability  
of  data  sources  and,  perhaps,  the  geographically  local  effects  of  El  Niño  on  
climate.  In  part  because  of  this  geographic  “patchiness”  of  the  epidemiological  
evidence,  the  identification  of  climatic  factors  in  infectious  disease  dynamics,  and  
the  relative  importance  of  the  different  factors,  remains  controversial.  For  
example,  it  has  been  suggested  that  climate  trends  are  unlikely  to  contribute  to  
the  timing  of  dengue  epidemics  in  Thailand.  However,  recent  work  has  shown  a  
strong  but  transient  association  between  dengue  incidence  and  El  Niño  in  

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 Reading Part B

Thailand.  This  association  may  possibly  be  caused  by  a  “pacemaker-­‐like”  effect  
in  which  intrinsic  disease  dynamics  interact  with  climate  variations  driven  by  El  
Niño  to  propagate  travelling  waves  of  infection.    
 
 
 
Paragraph  5  
A  new  study  on  cutaneous  leishmaniasis  by  Chaves  and  Pascual  also  provides  
fresh  evidence  of  a  relationship  between  climate  and  vector-­‐borne  disease.  
Chaves  and  Pascual  use  a  range  of  mathematical  tools  to  illustrate  a  clear  
relationship  between  climatic  variables  and  the  dynamics  of  cutaneous  
leishmaniasis,  a  skin  infection  transmitted  by  sandflies.  In  Costa  Rica,  cutaneous  
leishmaniasis  displays  three-­‐year  cycles  that  coincide  with  those  of  El  Niño.  
Chaves  and  Pascual  use  this  newly  demonstrated  association  to  enhance  the  
forecasting  ability  of  their  models  and  to  predict  the  epidemics  of  leishmaniasis  
up  to  one  year  ahead.  Interestingly,  El  Niño  was  a  better  predictor  of  disease  
than  temperature,  possibly  because  this  large-­‐scale  index  integrates  numerous  
environmental  processes  and  so  is  a  more  biologically  relevant  measure  than  
local  temperature.  As  the  authors  note,  the  link  between  El  Niño  and  epidemics  
of  leishmaniasis  might  be  explained  by  large-­‐scale  climate  effects  on  population  
susceptibility.  Susceptibility,  in  turn,  may  be  related  to  lack  of  specific  immunity  
or  poor  nutritional  status,  both  of  which  are  plausibly  influenced  by  climate.  
 
Paragraph  6  
Chaves  and  Pascual  have  identified  a  robust  relationship  between  climate  and  
disease,  with  changes  over  time  in  average  incidence  and  in  cyclic  components.  
The  dynamics  of  cutaneous  leishmaniasis  evolve  coherently  with  climatic  
variables  including  temperature  and  El  Niño  indices,  demonstrating  a  strong  
association  between  these  variables,  particularly  after  1996.  Long-­‐term  changes  
in  climate,  human  demography,  and  social  features  of  human  populations  have  
large  effects  on  the  dynamics  of  epidemics  as  underlined  by  the  analyses  of  some  
large  datasets  on  whooping  cough  and  measles.  Another  illuminating  example  is  
the  transient  relationship  between  cholera  prevalence  and  El  Niño  oscillations.  
In  Bangladesh,  early  in  the  20th  century,  cholera  and  El  Niño  appeared  
unrelated,  yet  a  strong  association  emerged  in  1980–2001.  Transient  
relationships  between  climate  and  infectious  disease  may  be  caused  by  
interactions  between  climate  and  intrinsic  disease  mechanisms  such  as  
temporary  immunity.  If  population  susceptibility  is  low,  even  large  increases  in  
transmission  potential  due  to  climate  forcing  will  not  result  in  a  large  epidemic.  
 
Paragraph  7  
A  deeper  understanding  of  infectious  disease  dynamics  is  important  in  order  to  
forecast,  and  perhaps  forestall,  the  effects  of  dramatic  global  social  and  
environmental  changes.  Conventional  statistical  methods  may  fail  to  reveal  
a  relationship  between  climate  and  health  when  discontinuous  associations  are  
present.  Because  classical  methods  quantify  average  associations  over  the  entire  
dataset,  they  may  not  be  adequate  to  decipher  long-­‐term  but  discontinuous  
relationships  between  environmental  exposures  and  human  health.  On  the  other  
hand,  relationships  between  climate  and  disease  could  signal  problems  for  
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 Reading Part B

disease  prediction.  Unless  all  important  effects  are  accounted  for,  dynamic  
forecast  models  may  prove  to  have  a  limited  shelf  life.  !  
 
Part B : Multiple Choice Questions
1. According to paragraph 2, which of the following is true?
a. The incidence of infectious diseases is rarely caused by climatic
factors.
b. Seasonal variations and geography always lead to increases in
mosquito borne diseases.
c. An increase in the rate of tick-borne encephalitis has been caused by
milder winters and early arrival spring in Sweden.
d. Malaria may have reappeared in East African highlands due to higher
temperatures.

2. Which of the following would be the most appropriate heading for the
paragraph 2?
a. The link between global warming and disease epidemics .
b. The strong relationship between climate and outbreaks of disease.
c. The unexpected influence of climate on infectious diseases.
d. The need for further research into climate change and infectious
diseases.

3. Which of the following is closest in meaning to the expression relatively

few?
a. comparatively few
b. several
c. quite a few
d. three

4. In paragraph 3, which of the following is not true?

a. In Peru, the El Nino event led to increased rates of diarrhoea .
b. El-Nino has a significant yearly effect on global climate patterns.
c. Outbreaks of cholera in Bangladesh and Peru can be linked to El Nino.
d. Meningococcal meningitis in Mali is influenced by weather patterns.

5. The main point the author wishes to raise in paragraph 4 is………….

a. Despite differing opinions, there is strong current evidence linking
climate factors and infectious disease.
b. There is insufficient data to determine how significant climatic factors
are on infectious disease.
c. The link between climate trends and disease epidemics is still
inconclusive.
d. There is no connection between climatic trends and dengue fever in
Thailand.

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 Reading Part B

6. According to paragraph 5 which of the following statements is correct?

a. Outbreaks of cutaneous leishmaniasis in Costa Rica correspond with El
Nino events.
b. The mathematical tools used by Chaves and Pascual demonstrate the
link between sandflies and cutaneous leishmaniasis.
c. Research by Chaves and Pascual will allow for annual prediction of
leishmaniasis outbreaks.
d. El Nino is an accurate predictor disease due its complexity and
biological relevance.

7. Which of the following is closest in meaning to the word plausibly?

a. definitely
b. possibly
c. regularly
d. occasionally

8. According to paragraph 6, which of the following statements is correct?

a. The relationship between climate and disease is constant.
b. Outbreaks of cholera appear to be unrelated to El Nino patterns.
c. The dynamics of epidemics are affected by changes in population,
society and weather.
d. Large epidemics rarely occur due to climate changes.

9. Which of the following is closest in meaning to transient relationship?

a. Strong relationship
b. Long term relationship
c. Close relationship
d. Non-permanent relationship

10. In paragraph 7, which of the following statements is most correct?

a. There may be weaknesses in orthodox statistical methods.
b. The dynamics of infectious diseases in well understood.
c. The data measuring long term relationships between human health and
environmental exposure is inadequate.
d. Relationships between climate and disease will make disease
prediction difficult.

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 Reading Part B

Answer  Key    
1.  d  2.  b  3.  a  4.  b  5.  a  6.  a  7.b  8.  c  9.  d  10.  a  
Question  1  
a) Incorrect:  Not  rarely,  often  
b) Incorrect:    Not  mentioned  
c) Incorrect:  may  be  implicated,  not  has  lead  
d) Correct:  (synonym  resurgence=reappearance)  key  word  may  
Question  2  
a) Incorrect:  global  warming  not  mentioned  
b) Correct:  (synonym  disease  epidemics=outbreaks  of  disease)  important  determinant=strong  
relationship  
c) Incorrect:  Opposite  is  true  
d) Incorrect:  True  fact  but  a  detail  not  the  main  idea  
Question  3  
a) Correct  
b) Incorrect    
c) Incorrect    
d) Incorrect    
Question  4  
a) Incorrect:  True:  diarrhoea  increased  by  more  than  2-­‐fold  during  an  El  Niño  event  
b) Correct:  Not  true  as  the  effects  are  semi-­‐regular/interannual  i.e  between  years  not  yearly  
c) Incorrect:  True:  There  is  evidence  of  a  relationship  between  El  Niño  and  the  timing  of  cholera  
epidemics  in  Peru  and  Bangladesh  
d) Incorrect:  True:  The  onset  of  meningococcal  meningitis  in  Mali  is  associated  with  large-­‐scale  
atmospheric  circulation    
Question  5  
a) Correct:  The  author  is  trying  demonstrate  that  there  is  a  clear  link  between  climate  factors  
and  infectious  disease.  Key  words  However  &  synonym:  current=recent  
b) Incorrect:  While  this  may  be  true,  it  s  not  the  authors  main  point  
c) Incorrect  :  as  in  B  
d) Incorrect  
Question  6  
a) Correct:  (synonym  coincide=correspond)  
b) Incorrect:  incorrect  meaning  
c) Incorrect:  not  annually,  one  year  ahead  
d) Incorrect:  not  given,  it  is  a  better  predictor  than  temperature  
Question  7  
a) Incorrect  
b) Correct  
c) Incorrect  
d) Incorrect  
Question  8  
a) Incorrect:  not  constant,  changes  over  time  
b) Incorrect:  This  was  a  past  opinion,  not  now  
c) Correct:  similar  meaning  
d) Incorrect:  Incomplete  information  
 Question  9  
a) Incorrect  
b) Incorrect  
c) Incorrect  
d) Correct  
Question  10  
a) Correct:  (synonyms  conventional=orthodox  &  may  be  short  comings=may  fail)  
b) Incorrect:  no,  deeper  understanding  is  important  
c) Incorrect:  Not  the  data,  the  methods  
d) Incorrect:  Degrees  of  certainty:  Could  not  will  

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 Reading Part B

Infectious Diseases and Climatic Influences

Bernard Cazelles, Simon Hales

Paragraph 1
Complex dynamic relationships between humans, pathogens, and the environment
lead to the emergence of new diseases and the re-emergence of old ones. Due to
concern about the impact of increasing global climate variability and change, many
recent studies have focused on relationships between infectious disease and climate.

Paragraph 2
(2)Climate can be an important determinant of vector-borne disease epidemics:
geographic and seasonal patterns of infectious disease incidence are often, though not
always, driven by climate factors. Mosquito- borne diseases, such as malaria, dengue
fever, and Ross River virus, typically show strong seasonal and geographic patterns,
as do some intestine diseases. These patterns are unsurprising, given the influence of
climate on pathogen replication, vector and disease reservoir populations, and human
societies. In Sweden, a trend toward milder winters and early spring arrival may be
implicated in an increased incidence of tick-borne encephalitis. (1)The recent
resurgence of malaria in the East African highlands may be partly explained by
increasing temperatures in that region. However, as yet there are (3) relatively few
studies showing clear climatic influences on infectious diseases at interannual or
longer timescales.

Paragraph 3
The (4) semi-regular El Niño climate cycle, centred on the Pacific Ocean, has an
important influence on interannual climate patterns in many parts of the world. This
makes El Niño an attractive, albeit imperfect, analogue for the effects of global
climate change. In Peru, daily admissions for diarrhoea increased by more than 2-fold
during an El Niño event, compared with expected trends based on the previous five
years. There is evidence of a relationship between El Niño and the timing of cholera
epidemics in Peru and Bangladesh; of ciguatera in the Pacific islands; of Ross River
virus epidemics in Australia; and of dengue and malaria epidemics in several
countries. The onset of meningococcal meningitis in Mali is associated with large-
scale atmospheric circulation.

Paragraph 4
These studies were performed mostly at country scale, reflecting the availability of
data sources and, perhaps, the geographically local effects of El Niño on climate. In
part because of this geographic “patchiness” of the epidemiological evidence, the
identification of climatic factors in infectious disease dynamics, and the relative
importance of the different factors, remains controversial. For example, it has been
suggested that climate trends are unlikely to contribute to the timing of dengue
epidemics in Thailand. (5)However, recent work has shown a strong but transient
association between dengue incidence and El Niño in Thailand. This association may
possibly be caused by a “pacemaker-like” effect in which intrinsic disease dynamics
interact with climate variations driven by El Niño to propagate travelling waves of
infection.

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 Reading Part B

Paragraph 5
A new study on cutaneous leishmaniasis by Chaves and Pascual also provides fresh
evidence of a relationship between climate and vector-borne disease. Chaves and
Pascual use a range of mathematical tools to illustrate a clear relationship between
climatic variables and the dynamics of cutaneous leishmaniasis, a skin infection
transmitted by sandflies. (6)In Costa Rica, cutaneous leishmaniasis displays three-
year cycles that coincide with those of El Niño. Chaves and Pascual use this newly
demonstrated association to enhance the forecasting ability of their models and to
predict the epidemics of leishmaniasis up to one year ahead. Interestingly, El Niño
was a better predictor of disease than temperature, possibly because this large-scale
index integrates numerous environmental processes and so is a more biologically
relevant measure than local temperature. As the authors note, the link between El
Niño and epidemics of leishmaniasis might be explained by large-scale climate effects
on population susceptibility. Susceptibility, in turn, may be related to lack of specific
immunity or poor nutritional status, both of which are plausibly influenced by
climate.

Paragraph 6
Chaves and Pascual have identified a robust relationship between climate and disease,
with changes over time in average incidence and in cyclic components. The dynamics
of cutaneous leishmaniasis evolve coherently with climatic variables including
temperature and El Niño indices, demonstrating a strong association between these
variables, particularly after 1996. (8)Long-term changes in climate, human
demography, and social features of human populations have large effects on the
dynamics of epidemics as underlined by the analyses of some large datasets on
whooping cough and measles. Another illuminating example is the transient
relationship between cholera prevalence and El Niño oscillations. In Bangladesh,
early in the 20th century, cholera and El Niño appeared unrelated, yet a strong
association emerged in 1980–2001. Transient relationships between climate and
infectious disease may be caused by interactions between climate and intrinsic disease
mechanisms such as temporary immunity. If population susceptibility is low, even
large increases in transmission potential due to climate forcing will not result in a
large epidemic.

Paragraph 7
A deeper understanding of infectious disease dynamics is important in order to
forecast, and perhaps forestall, the effects of dramatic global social and environmental
changes. (10) Conventional statistical methods may fail to reveal
a relationship between climate and health when discontinuous associations are
present. Because classical methods quantify average associations over the entire
dataset, they may not be adequate to decipher long-term but discontinuous
relationships between environmental exposures and human health. On the other hand,
relationships between climate and disease could signal problems for disease
prediction. Unless all important effects are accounted for, dynamic forecast models
may prove to have a limited shelf life. !
 

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