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and Italy by trade

SOURCE: Adapted from Chretien and Linthicum (2007), IOM (2003), and Peters and Linthicum (1994).

SOURCE: Adapted from Chretien and Linthicum (2007), IOM (2003), and Peters and Linthicum (1994).

contributed to the RVF epidemic in East Africa in 2006. In coastal Kenya in 2004, the availability of vector breeding sites (i.e., unprotected domestic water stores) appears to have facilitated the emergence of chikungunya fever. In developing early warning systems for outbreaks linked to extreme weather, consideration of the nonclimatic facilitating factors may enable more precise identification of populations at risk, with better targeting of risk communication.

The RVF and chikungunya fever outbreaks also suggest the need for infectious disease early warning systems to integrate with other natural disaster prediction and response programs. In both of these epidemics, climatic conditions facilitating disease emergence and transmission had other public health effects as well. Flooding in the Horn of Africa during late 2006-early 2007 affected more than 1 million people (WHO, 2007b), destroying homes, livestock, and crops; displacing families; causing hygiene breakdown and water-borne disease epidemics; and obstructing delivery of aid (Save the Children, 2007). Drought in Kenya during 2004 contributed to massive crop failure and food shortages. Coastal areas (where the chikungunya fever epidemics occurred) were particularly affected, since rainfall was well below normal during 2003 and the areas lacked community-based mechanisms for emergency intervention because they had not recently experienced severe drought (UN, 2004).

There are few operational early warning systems for climate-linked epidemics (WHO, 2004). But there is potential for developing such systems—WHO

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