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      The correlation between three teleconnections and leptospirosis incidence in the Kandy District, Sri Lanka, 2004–2019


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          Leptospirosis is a bacterial zoonosis. Leptospirosis incidence (LI) in Sri Lanka is high. Infected animals excrete leptospires into the environment via their urine. Survival of leptospires in the environment until they enter into a person and several other factors that influence leptospirosis transmission are dependent upon local weather. Past studies show that rainfall and other weather parameters are correlated with the LI in the Kandy district, Sri Lanka. El Ni ño Southern Oscillation (ENSO), ENSO Modoki, and the Indian Ocean Dipole (IOD) are teleconnections known to be modulating rainfall in Sri Lanka. There is a severe dearth of published studies on the correlations between indices of these teleconnections and LI.


          We acquired the counts of leptospirosis cases notified and midyear estimated population data of the Kandy district from 2004 to 2019, respectively, from weekly epidemiology reports of the Ministry of Health and Department of Census and Statistics of Sri Lanka. We estimated weekly and monthly LI of Kandy. We obtained weekly and monthly teleconnection indices data for the same period from the National Oceanic and Atmospheric Administration (NOAA) of the USA and Japan Agency for Marine-Earth Science and Technology (JAMSTEC). We performed wavelet time series analysis to determine correlations with lag periods between teleconnection indices and LI time series. Then, we did time-lagged detrended cross-correlation analysis (DCCA) to verify wavelet analysis results and to find the magnitudes of the correlations detected.


          Wavelet analysis displayed indices of ENSO, IOD, and ENSO Modoki were correlated with the LI of Kandy with 1.9–11.5-month lags. Indices of ENSO showed two correlation patterns with Kandy LI. Time-lagged DCCA results show all indices of the three teleconnections studied were significantly correlated with the LI of Kandy with 2–5-month lag periods.


          Results of the two analysis methods generally agree indicating that ENSO and IOD modulate LI in Kandy by modulating local rainfall and probably other weather parameters. We recommend further studies about the ENSO Modoki and LI correlation in Sri Lanka. Monitoring for extreme teleconnection events and enhancing preventive measures during lag periods can blunt LI peaks that may follow.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s41182-021-00325-z.

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          Most cited references37

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          Global Morbidity and Mortality of Leptospirosis: A Systematic Review

          Background Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status. Methodology/Principal Findings We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa. Conclusions/Significance Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.
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            Detrended cross-correlation analysis: a new method for analyzing two nonstationary time series.

            Here we propose a new method, detrended cross-correlation analysis, which is a generalization of detrended fluctuation analysis and is based on detrended covariance. This method is designed to investigate power-law cross correlations between different simultaneously recorded time series in the presence of nonstationarity. We illustrate the method by selected examples from physics, physiology, and finance.
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              Increased frequency of extreme Indian Ocean Dipole events due to greenhouse warming.

              The Indian Ocean dipole is a prominent mode of coupled ocean-atmosphere variability, affecting the lives of millions of people in Indian Ocean rim countries. In its positive phase, sea surface temperatures are lower than normal off the Sumatra-Java coast, but higher in the western tropical Indian Ocean. During the extreme positive-IOD (pIOD) events of 1961, 1994 and 1997, the eastern cooling strengthened and extended westward along the equatorial Indian Ocean through strong reversal of both the mean westerly winds and the associated eastward-flowing upper ocean currents. This created anomalously dry conditions from the eastern to the central Indian Ocean along the Equator and atmospheric convergence farther west, leading to catastrophic floods in eastern tropical African countries but devastating droughts in eastern Indian Ocean rim countries. Despite these serious consequences, the response of pIOD events to greenhouse warming is unknown. Here, using an ensemble of climate models forced by a scenario of high greenhouse gas emissions (Representative Concentration Pathway 8.5), we project that the frequency of extreme pIOD events will increase by almost a factor of three, from one event every 17.3 years over the twentieth century to one event every 6.3 years over the twenty-first century. We find that a mean state change--with weakening of both equatorial westerly winds and eastward oceanic currents in association with a faster warming in the western than the eastern equatorial Indian Ocean--facilitates more frequent occurrences of wind and oceanic current reversal. This leads to more frequent extreme pIOD events, suggesting an increasing frequency of extreme climate and weather events in regions affected by the pIOD.

                Author and article information

                Trop Med Health
                Trop Med Health
                Tropical Medicine and Health
                BioMed Central (London )
                26 May 2021
                26 May 2021
                : 49
                : 43
                [1 ]The Teaching (General) Hospital–Peradeniya, Peradeniya, Sri Lanka
                [2 ]GRID grid.502855.f, ISNI 0000 0004 4654 6228, Lanka Hydraulic Institute, ; Moratuwa, Sri Lanka
                [3 ]GRID grid.11139.3b, ISNI 0000 0000 9816 8637, Faculty of Engineering, , University of Peradeniya, ; Peradeniya, Sri Lanka
                Author information
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                : 16 February 2021
                : 27 April 2021
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                leptospirosis,teleconnections,enso,iod,enso modoki,sri lanka,ssta,wavelet analysis,dcca
                leptospirosis, teleconnections, enso, iod, enso modoki, sri lanka, ssta, wavelet analysis, dcca


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