293 - Wet-bulb globe temperature is associated with higher risk of invasive CNS infection: a nested case-control study in Bangladesh.

Publication Number: 2283.293

Maitreyi Mazumdar, Boston Children's Hospital, Boston, MA, United States; Caroline Sarpy, Boston Children's Hospital, Boston, MA, United States; Xingyan Wang, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Narayan Chandra. Saha, National Institute of Neurosciences, Dhaka, Dhaka, Bangladesh; Sudipta Kumer Mukherjee, National Institute of Neurosciences and Hospital(NINS&H), Dhaka, Dhaka, Bangladesh; Sheikh Muhammad Ekramullah, National Institute of Neurosciences & Hospital, Dhaka, Dhaka, Bangladesh; Ariful Islam, National Institute of Neurosciences & Hospital, Dhaka, Dhaka, Bangladesh; Yamin Shahriar Chowdhury, National Institute of Neurosciences, Dhaka, Dhaka, Bangladesh; D.M. Arman, National Institute of neurosciences, Dhaka, Dhaka, Bangladesh; Mohammad Monir Hossain, national institute of neurosciences and hospital, dhaka, Dhaka, Dhaka, Bangladesh; Nazmul Haque, National Institute of Neurosciences,Dhaka Banglasesh, dhaka, Dhaka, Bangladesh; Md. Nafaur Rahman, National Institute of Neurosciences & Hospital, Dhaka, Dhaka, Bangladesh; Ansar Uddin Ahmed, National Institute of Neurosciences & Hospital, Dhaka, Dhaka, Dhaka, Bangladesh; Md. Ziauddin, national institute of neurosciences and hospital, dhaka, dhaka, Dhaka, Bangladesh; Suchanda Sultana Hafiza, Pediatrict Neurosurgery Research Committee, National Institute of Neurosciences and Hospital, Dhaka, Dhaka, Bangladesh; Diana F. Gomberg, Boston Children's Hospital, Boston, MA, United States; Arnav C. Ghosh, Boston Children's Hospital, Winchester, MA, United States

Background: Climate change threatens the health of children in low-and middle-income countries. Higher temperatures due to climate change have been reported to increase the risk of central nervous system (CNS) infections in adults. However, there is a lack of studies that have been conducted in children. Children may be especially vulnerable because of their immature blood-brain barriers and developing immune and thermoregulation systems.

Objective: To assess the association between wet-bulb globe temperature (WGBT), a measure of experienced temperature, and invasive CNS infection(encephalitis, meningitis, or meningoencephalitis) among children in Bangladesh.

Design/Methods: We conducted a nested case-control study using a cohort of children (age 18 years and younger) who presented for evaluation in the outpatient clinics of the National Institute of Neurosciences & Hospital (NINS&H), a large government-run referral hospital in Dhaka, Bangladesh from February to September 2025. Cases were children who were diagnosed by a physician with encephalitis, meningitis or meningoencephalitis and cases were ascertained by review of medical records. Controls were children seen in the same clinic who did not receive these diagnoses. The study was approved by the human subjects research committees at BCH and NINS&H.

We estimated relative risks using a distributed lag non-linear model with a 5-day lag effect where the predictor was WBGT controlling for potential confounders which included sex, age, and district. We estimated district-specific relative risk by comparing the temperature in 0.5°C increments to the district-specific averages.

Results: We collected data from 17,395 patient visits and identified 195 cases of invasive CNS infection. Over 37% of the cases were from the Dhaka district. The average case patient age was six years and 39% of cases were female. The range of average temperatures in the districts was between 25.9°C and 27.6°C. We found that in Dhaka, the relative risk (RR) of invasive CNS infection was 1.53 (95% CI: 1.05, 2.22) for 28°C compared to Dhaka’s average temperature which was 27.3°C. In the northwestern areas of the country, we observed the highest relative risks of invasive CNS infection. IN the Gaibandha district, for example, the RR of invasive CNS infection was of 2.51 (95% CI: 1.11, 5.65) for 28°C compared to the district’s average temperature.

Conclusion(s): High WBGTs are associated with higher risk of invasive CNS infection among children in Bangladesh.