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Evolutionary pathogen change is presumed to have been a dominant factor behind the 7\n                      <jats:sup>th \u201c<\/jats:sup>\n                      <jats:italic>El Tor\u201d<\/jats:italic>\n                      pandemic, but little is known to support this hypothesis for preceding pandemics. The role of anomalous climate in facilitating strain replacements has never been assessed. The question is of relevance to guide the understanding of infectious disease emergence today and in the context of climate change.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/principal findings<\/jats:title>\n                    <jats:p>\n                      We investigate the roles of climate and putative strain variation for the 6\n                      <jats:sup>th<\/jats:sup>\n                      cholera pandemic (1899\u20131923) using newly assembled historical records for climate variables and cholera deaths in provinces of former British India. We compare this historical pandemic with the 7\n                      <jats:sup>th<\/jats:sup>\n                      (\n                      <jats:italic>El Tor<\/jats:italic>\n                      ) one and with the temporary emergence of the\n                      <jats:italic>O139<\/jats:italic>\n                      strain in Bangladesh and globally. With statistical methods for nonlinear time series analysis, we examine the regional synchrony of outbreaks and associations of the disease with regional temperature and rainfall, and with the El Ni\u00f1o Southern Oscillation (ENSO). To establish future expectations and evaluate climate anomalies accompanying historical strain replacements, climate projections are generated with multi-model climate simulations for different 50-year periods.\n                    <\/jats:p>\n                    <jats:p>\n                      The 6\n                      <jats:sup>th<\/jats:sup>\n                      cholera pandemic featured the striking synchronisation of cholera outbreaks over Bengal during the El Ni\u00f1o event of 1904\u201307, following the invasion of the Bombay Presidency with a delay of a few years. Accompanying anomalous weather conditions are similar to those related to ENSO during strain replacements and pandemic expansions into Africa and South America in the late 20\n                      <jats:sup>th<\/jats:sup>\n                      century. Rainfall anomalies of 1904\u201305 at the beginning of the large cholera anomaly fall in the 99th percentile of simulated changes for the regional climate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions\/significance<\/jats:title>\n                    <jats:p>Evolutionary pathogen change can act synergistically with climatic conditions in the emergence and propagation of cholera strains. Increased climate variability and extremes under global warming provide windows of opportunity for emerging pathogens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0012275","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T13:20:56Z","timestamp":1722518456000},"page":"e0012275","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Strain variation and anomalous climate synergistically influence cholera pandemics"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4843-6180","authenticated-orcid":true,"given":"Xavier","family":"Rod\u00f3","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno Jan","family":"Bouma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miquel-\u00c0ngel","family":"Rodr\u00edguez-Arias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manojit","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"De Yebra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desislava","family":"Petrova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markel","family":"Garc\u00eda-D\u00edez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Pascual","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"pntd.0012275.ref001","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1056\/NEJMoa1204927","article-title":"Cholera surveillance during the Haiti epidemic\u2014the first 2 years","volume":"368","author":"EJ Barzilay","year":"2013","journal-title":"N Engl J Med"},{"key":"pntd.0012275.ref002","doi-asserted-by":"crossref","first-page":"654","DOI":"10.4269\/ajtmh.13-0208","article-title":"Cholera Serosurvey Working Group. 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