Vulnerability to climate-driven pathogen-specific diarrheal diseases: secondary analysis from the Global Enteric Multicenter Study and Vaccine Impact on Diarrhea in Africa follow-up.

The identification of climate-related risk factors for pathogen-specific diarrhea is critical for building resilience in high-risk and low-resource settings. Here we performed secondary analysis of published data from the Global Enteric Multicenter Study (GEMS) and Vaccine Impact on Diarrhea in Africa (VIDA) follow-up. We used daily counts of rotavirus, Shigella, Cryptosporidium, and enterotoxigenic E. coli producing heat stable toxin from two case-control studies of moderate-to-severe diarrhea (MSD) in The Gambia, Kenya and Mali (n = 9378). Using Random forests we identify influential climate and vulnerability factors for predicting pathogen presence. Accounting for time trends, our Zero-inflated Poisson models found that associations between weather and MSD were modified by socio-economic factors including transportation, television ownership, electricity access, and introduction of the rotavirus vaccine, but these were site- and pathogen-specific. Our study provides evidence that socio-demographic-associated vulnerability factors are correlated with variable pathogen-specific disease risks.