Review Review Potential Influence of Climate Change on Vector-Borne and Zoonotic Diseases: A and Proposed Research Plan James N. Mills, Kenneth L. Gage, and Ali S. Khan National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Background : Because of complex interactions of climate variables at the levels of the pathogen, vector, and host, the potential influence of climate change on vector-borne and zoonotic diseases (VBZDs) is poorly understood and difficult to predict. Climate effects on the nonvector-borne zoonotic diseases are especially obscure and have received scant treatment. o Bjectiv : We described known and potential effects of climate change on VBZDs and proposed specific studies to increase our understanding of these effects. The nonvector-borne zoonotic diseases have received scant treatment and are emphasized in this paper. d at : We used a review of the existing literature and extrapolations from osurce nad ysnthei observations of short-term climate variation to suggest potential impacts of climate change on VBZDs. Using public health priorities on climate change, published by the Centers for Disease Control and Prevention, we developed six specific goals for increasing understanding of the inter- action between climate and VBZDs and for improving capacity for predicting climate change effects on incidence and distribution of VBZDs. words c onclusi : Climate change may affect the incidence of VBZDs through its effect on four prin- cipal characteristics of host and vector populations that relate to pathogen transmission to humans: geographic distribution, population density, prevalence of infection by zoonotic pathogens, and the pathogen load in individual hosts and vectors. These mechanisms may interact with each other and with other factors such as anthropogenic disturbance to produce varying effects on pathogen transmission within host and vector populations and to humans. Because climate change effects on most VBZDs act through wildlife hosts and vectors, understanding these effects will require multi- disciplinary teams to conduct and interpret ecosystem-based studies of VBZD pathogens in host and vector populations and to identify the hosts, vectors, and pathogens with the greatest potential to affect human populations under climate change scenarios. k ey : anthropogenic disturbance, climate change, infectious diseases, reservoir, vector, vector-borne disease, wildlife, zoonotic disease. Environ Health Perspect 118:1507–1514 (2010). doi:10.1289/ehp.0901389 [Online 24 June 2010] The concept that weather and climate are linked to the incidence of infectious diseases in humans has been recognized since the time of Hippocrates (National Research Council 2001). Understanding the link between cli- mate and disease has increasing urgency. According to the Intergovernmental Panel on Climate Change (IPCC 2007), warm- ing of the earth’s climate is “unequivocal.” Global changes already documented include increased global surface temperature, rising sea level, decreased arctic and alpine snow and ice, and evidence of plants and animals responding to these changes by moving to higher elevations or closer to the poles. Precipitation has increased in some parts of the world while decreasing in others. These changes are predicted to continue into the foreseeable future (IPCC 2007). Climate change is predicted to have a variety of impacts on human health, many of which have been extensively reviewed (Confalonieri et al. 2007; Ebi et al. 2006, 2008; Frumkin et al. 2008; Patz and Olson 2006). Some of these effects are easily intu- ited: increasing temperatures will likely increase the incidence of heat-related mortal- ity (and decrease the risk mortality from cold exposure); increased drought will result in increased food and water shortages, whereas more frequent and more severe heavy pre- cipitation events will increase the incidence of flood-related injuries and deaths, water- and food-borne illness, and other infectious, respi- ratory, and skin diseases. Another class of potential impacts on human health often cited as a consequence of climate change is less direct, less intuitive, and less predictable: Those caused by infectious diseases acquired by humans from invertebrate and vertebrate animals—the vector-borne and zoonotic diseases (VBZDs). Zoonotic diseases are those caused by pathogens that are transmitted between vertebrate animals and humans. Vector-borne diseases are those for which the pathogen is transmitted to or among humans by an arthropod vector. Zoonotic diseases may be vector borne (trans- mitted to humans from a vertebrate res- ervoir by an arthropod vector such as Lyme disease) or nonvector borne [transmitted to humans by direct or indirect contact with the vertebrate host without the participation of an arthropod vector such as hantavirus pul- monary syndrome (HPS)]. Vector-borne dis- eases, in turn, may be zoonotic, as in the Lyme disease example, or nonzoonotic (transmit- ted by an arthropod vector from human to Environmental Health Perspectives • volume 118 | number 11 | November 2010 human without the involvement of a non- human reservoir such as malaria). We have used the inclusive term “VBZD” to include all three possible categories [for additional defi- nitions, examples, and background informa- tion, see Table 1 and Supplemental Material (doi:10.1289/ehp.0901389)]. Making predic- tions concerning the effects of VBZDs adds additional complexity to forecasts. Although understanding the transmission of any infec- tious pathogen requires knowledge of the inter- actions between the pathogen and humans, in the case of VBZDs we must also under- stand the interactions of the pathogen with the arthropod vector and with the vertebrate host. Thus, a complete understanding of VBZDs requires in-depth knowledge of the ecology and natural history of the host or vector (Gage et al. 2008; Mills and Childs 1998). In this article, we have proposed four pri- mary mechanisms by which climate change is likely to affect pathogen, host, and vector populations; summarized current evidence that these mechanisms affect host and vector populations; and assessed how these effects are likely to influence human health. We also have attempted to identify important gaps in our knowledge and have suggested studies that are needed to fill those gaps and provide reliable information about the ultimate effects of climate change on VBZDs. Expected Changes If climate change is to affect the frequency of VBZDs through acting on nonhuman hosts, vectors, and pathogens, it is likely to act by one (or a combination) of four pri- mary mechanisms: a) range shifts in host or vector distribution that bring these hosts and vectors into contact with new human populations; b) changes in the population Address correspondence to J.N. Mills, Centers for Disease Control and Prevention (MS G-14), 1600 Clifton Rd., Atlanta, GA 30333 USA. Telephone: (404) 539-7993. Fax: (404) 639-1509. E-mail: WildlifeDisease@gmail.com. Supplemental Material is available online (doi:10.1289/ehp.0901389 via http://dx.doi.org/). We thank C. Manning for assistance with graphics and B. Ellis and P. Rollin for discussions and com- ments that improved the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily repre- sent the views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The authors declare they have no actual or potential competing financial interests. Received 26 August 2009; accepted 24 June 2010. 1507