Waterborne Infectious Diseases Associated with Exposure to Tropical Cyclonic Storms in the United States, 1996–2018

In the United States, tropical cyclones cause destructive flooding that can lead to adverse health outcomes. Storm-driven flooding contaminates environmental, recreational, and drinking water sources, but few studies have examined its effects on specific infections over time. In this study, we used 23 years of tropical cyclone exposure and case data to assess the effects of storms on 6 waterborne diseases in a conditional quasi-Poisson model. We separately defined storm exposure for windspeed, rainfall, and proximity to the storm track. We found that exposure to storm-related rainfall was associated with an increase in Shiga-toxin producing Escherichia coli infections 1 week after storms, and an increase in Legionnaires’ disease 2 weeks after storms. Cryptosporidiosis cases increased during storm weeks but declined over ensuing weeks. Cyclones are a risk to public health that will likely become more serious with climate change and aging water infrastructure systems.

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