be affected by climate change in the future (Table 1). Leptospirosis (56%) and crypto‑ sporidiosis (40%) were cited by the largest number of respondents (Table 1, Figure 3A,B). However, respondents from only 3 countries (Finland, Romania, and Sweden) reported increases of waterb‑orne diseases over the last decade (data not shown). Drinking water sup‑ plies in Europe can be regarded as a potential source of vulnerability to climate change; for example, the extent of the vulnerability may be determined by whether access is via pub‑ lic (e.g., municipal) or private water systems. Respondents indicated that the proportion of their population using private drinking water sources were 1–10% in 12 countries, 11–20% in 2 countries, 21–40% in 2 countries, and > 40% in 1 country. Responses were miss‑ ing for 9 countries. In all 5 countries that had > 11% of private drinking water sources, experts considered the country to be at risk of waterb‑orne outbreaks from climate change. Approximately three‑fourths of country experts believed that food‑ borne infections will be affected by climate change (Table 1). During the most recent survey, the majority Affected Not affected Borreliosis of country experts listed salmonellosis (60%), campylobacteriosis (54%), and enterovirus infections (50%) as likely to be affected by climate change in the future (Figure 3C,D). Nearly onet‑hird (9 of 28) of country experts reported an observable increase of foodb‑orne diseases over the last decade, but few attrib‑ uted the food‑borne disease outbreaks to cli ‑ mate change (data not shown). Planning and preparedness. Only 9 of 27 respondents indicated that their countries had completed a national assessment specifi‑ cally focused on the potential health impacts of climate change (Table 3, Figure 4A). Coverage of infectious diseases by the assess‑ ment was reported to be extensive, adequate, or minimal by 4, 3, and 2 respondents, respec‑ tively. However, in 14 of 25 countries where adaptation initiatives had been completed or started, the National Climate Change Team/ Committee included consideration of the infec‑ tious disease health risks of climate change (Figure 4B). The accuracy of this particular response was verified through a review of all fifth submitted National Communications to the UNFCCC provided by each member Climate change vulnerability mapping state from the end of 2009 to the end of 2010 (UNFCCC 2010). A 100% concordance was found between the statements of the experts regarding the health contents of the UNFCC communications and the actual contents of these reports. National preparedness measures reported by the government officials are listed in Table 3, and an assessment of the effective‑ ness of institutions that monitor and provide health services for infectious diseases is provided in Figure 5. Seventeen countries reported plans to respond to the potential threats from climate change–sensitive infectious diseases through surveillance, monitoring, regulations, resource allocation, or communication strategies. Surveillance activities. Several member states reported national, regional, or local surveillance activities (e.g., sentinel or cluster surveillance) for diseases they consider to be climate sensitive in addition to routine surveil‑ lance for EUr‑eportable communicable diseases (European Commission 1999). For exam‑ ple, five countries (Czech Republic, France, Hungary, Latvia, and Norway) reported sur‑ veillance of TBE, one of them since 1953; four countries (Czech Republic, France, Latvia, and TBE Changes in Geographic distribution Seasonality Altitude Latitude No change No data N 0 175 350 700 1,050 1,400 Kilometers N 0 175 350 700 1,050 1,400 Kilometers 0 175 350 700 1,050 1,400 Kilometers Hantavirus Leishmaniasis N N 0 175 350 700 1,050 1,400 Kilometers Figure 1. Responses from national infectious disease experts from EEA countries, 2009–2010, as to whether specific vector­borne diseases would be affected or not affected by climate change. (A) Borreliosis (Lyme disease). (B) TBE. (C) Hantavirus infections. (D) Leishmaniasis. Data are based on the following survey ques­ tion on future infectious disease risks in a changing climate: “Which infectious diseases do you think climate change will most affect in your country?” Environmental Health Perspectives • volume 120 | number 3 | March 2012 387