Revisiting Cholera-Climate Teleconnections in the Native Homeland: ENSO and other Extremes through the Regional Hydroclimatic Drivers

Cholera is a global disease, with significantly large outbreaks occurring since the 1990s, notably in Sub-Saharan Africa and South Asia and recently in Haiti, in the Caribbean. Critical knowledge gaps remain in the understanding of the annual recurrence in endemic areas and the nature of epidemic outbreaks, especially those that follow extreme hydroclimatic events. Teleconnections with large-scale climate phenomena affecting regional scale hydroclimatic drivers of cholera dynamics remain largely unexplained. For centuries, the Bengal delta region has been strongly influenced by the asymmetric availability of water in the rivers Ganges and the Brahmaputra. As these two major rivers are known to have strong contrasting affects on local cholera dynamics in the region, we argue that the role of El Nino-Southern Oscillation (ENSO), Indian Ocean Dipole (IOD), or other phenomena needs to be interpreted in the context of the seasonal role of individual rivers and subsequent impact on local environmental processes, not as a teleconnection having a remote and unified effect. We present a modified hypothesis that the influences of large-scale climate phenomena such as ENSO and IOD on Bengal cholera can be explicitly identified and incorporated through regional scale hydroclimatic drivers. Here, we provide an analytical review of the literature addressing cholera and climate linkages and present hypotheses, based on recent evidence, and quantification on the role of regional scale hydroclimatic drivers of cholera. We argue that the seasonal changes in precipitation and temperature, and resulting river discharge in the GBM basin region during ENSO and IOD events have a dominant combined effect on the endemic persistence and the epidemic vulnerability to cholera outbreaks in spring and fall seasons, respectively, that is stronger than the effect of localized hydrological and socio-economic sensitivities in Bangladesh. In addition, systematic identification of underlying seasonal hydroclimatic drivers will allow us to harness the inherent system memory of these processes to develop early warning systems and strengthen prevention measures.