Climate change and waterborne diseases in temperate regions: a systematic review

Risk of waterborne diseases (WBDs) persists in temperate regions. The extent of influence of climate-related factors on the risk of specific WBDs in a changing climate and the projections of future climate scenarios on WBDs in temperate regions are unclear. A systematic review was conducted to identify specific waterborne pathogens and diseases prevalent in temperate region literature and transmission cycle associations with a changing climate. Projections of WBD risk based on future climate scenarios and models used to assess future disease risk were identified. Seventy-five peer-reviewed full-text articles for temperate regions published in the English language were included in this review after a search of Scopus and Web of Science databases from 2010 to 2023. Using thematic analysis, climate-related drivers impacting WBD risk were identified. Risk of WBDs was influenced mostly by weather (rainfall: 22% and heavy rainfall: 19%) across the majority of temperate regions and hydrological (streamflow: 50%) factors in Europe. Future climate scenarios suggest that WBD risk is likely to increase in temperate regions. Given the need to understand changes and potential feedback across fate, transport and exposure pathways, more studies should combine data-driven and process-based models to better assess future risks using model simulations.