{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:22:28Z","timestamp":1777486948502,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003669","name":"Korea Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["2018-P1404-00"],"award-info":[{"award-number":["2018-P1404-00"]}],"id":[{"id":"10.13039\/501100003669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Shigellosis is a major diarrheal disease in low- and middle-income countries. Although the incidence of such diseases in South and Southeast Asia has been associated with climate fluctuations linked to the El Ni\u00f1o\u2013Southern Oscillation (ENSO), the impact of ENSO on shigellosis infections remains unknown. Data reported to being infected with shigellosis while traveling abroad from 2004 to 2017 were obtained from the Korea Centers for Disease Control and Prevention. We investigated the relationship between the Oceanic Ni\u00f1o Index (ONI) and Indian Ocean Dipole Mode Index and the relative risk of shigellosis in outbound travelers using distributed lag linear and non-linear models. From 2004 to 2017, 87.1% of imported shigellosis was infected in South and Southeast Asian countries. The relative risk of imported shigellosis infection in outbound travelers increased as the ONI decreased. In the association with the five-month cumulative ONI, the relative risk of infection continuously increased as the La Ni\u00f1a index gained strength. Climate fluctuations associated with the La Ni\u00f1a phenomenon in South and Southeast Asian countries can lead to issues in sanitation and water safety. Our findings suggest that the decreasing trend in the ONI is associated with an increased incidence of shigellosis in these countries.<\/jats:p>","DOI":"10.3390\/ijerph18010211","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T09:35:23Z","timestamp":1609320923000},"page":"211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of El Ni\u00f1o\/La Ni\u00f1a on the Number of Imported Shigellosis Cases in the Republic of Korea, 2004\u20132017"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-5180","authenticated-orcid":false,"given":"Jong-Hun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jisun","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ho-Jang","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Dankook University College of Medicine, Cheonan 31116, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2758-9399","authenticated-orcid":false,"given":"Hae-Kwan","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S0140-6736(17)33296-8","article-title":"Shigellosis","volume":"391","author":"Kotloff","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"491","DOI":"10.4269\/ajtmh.14-0804","article-title":"Shigellosis in Subjects with Traveler\u2019s Diarrhea Versus Domestically Acquired Diarrhea: Implications for Antimicrobial Therapy and Human Immunodeficiency Virus Surveillance","volume":"93","author":"Toro","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/01.qco.0000185987.02878.6e","article-title":"Current concepts in travelers\u2019 diarrhea: Epidemiology, antimicrobial resistance and treatment","volume":"18","author":"Okhuysen","year":"2005","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Von Seidlein, L., Kim, D.R., Ali, M., Lee, H., Wang, X., Thiem, V.D., Canh, D.G., Chaicumpa, W., Agtini, M.D., and Hossain, A. (2006). A multicentre study of Shigella diarrhoea in six Asian countries: Disease burden, clinical manifestations, and microbiology. PLoS Med., 3.","DOI":"10.1371\/journal.pmed.0030353"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2174\/1872213X13666190514105054","article-title":"Travelers\u2019 Diarrhea: A Clinical Review","volume":"13","author":"Leung","year":"2019","journal-title":"Recent Pat. Inflamm. Allergy Drug Discov."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"609","DOI":"10.4269\/ajtmh.2009.80.609","article-title":"Global etiology of travelers\u2019 diarrhea: Systematic review from 1973 to the present","volume":"80","author":"Shah","year":"2009","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/S0140-6736(03)14695-8","article-title":"El Ni\u00f1o and health","volume":"362","author":"Kovats","year":"2003","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"136702","DOI":"10.1016\/j.scitotenv.2020.136702","article-title":"Impact of climate change on dysentery: Scientific evidences, uncertainty, modeling and projections","volume":"714","author":"Wu","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12901","DOI":"10.1073\/pnas.182203999","article-title":"ENSO and cholera: A nonstationary link related to climate change?","volume":"99","author":"Rodo","year":"2002","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Martinez, P.P., Reiner, R.C., Cash, B.A., Rod\u00f3, X., Mondal, M.S., Roy, M., Yunus, M., Faruque, A.S., Huq, S., and King, A.A. (2017). Cholera forecast for Dhaka, Bangladesh, with the 2015\u20132016 El Nino: Lessons learned. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172355"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1017\/S0950268809990203","article-title":"Relationship of cholera incidence to El Nino and solar activity elucidated by time-series analysis","volume":"138","author":"Ohtomo","year":"2010","journal-title":"Epidemiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1126\/science.289.5485.1766","article-title":"Cholera dynamics and El Nino-Southern Oscillation","volume":"289","author":"Pascual","year":"2000","journal-title":"Science"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cash, B.A., Rodo, X., Emch, M., Yunus, M., Faruque, A.S., and Pascual, M. (2014). Cholera and shigellosis: Different epidemiology but similar responses to climate variability. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107223"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.envres.2006.03.005","article-title":"El Nino Southern Oscillation (ENSO) and dysentery in Shandong province, China","volume":"103","author":"Zhang","year":"2007","journal-title":"Environ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Colston, J., Paredes Olortegui, M., Zaitchik, B., Penataro Yori, P., Kang, G., Ahmed, T., Bessong, P., Mduma, E., Bhutta, Z., and Shrestha, P.S. (2020). Pathogen-Specific Impacts of the 2011\u20132012 La Nina-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17020487"},{"key":"ref_16","unstructured":"Korea Tourism Organization (2020, May 10). Statistics of Major Destinations for National Overseas Tourists. Available online: https:\/\/kto.visitkorea.or.kr\/kor\/notice\/data\/statis\/profit\/board\/view.kto?id=430985&isNotice=false&instanceId=294&rnum=46."},{"key":"ref_17","unstructured":"Asia-Pacific Economic Cooperation (APEC) Climate Center (2020, May 10). Climate Indices. Available online: https:\/\/www.apcc21.org\/ser\/indic.do?lang=en."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1002\/sim.5963","article-title":"Modeling exposure-lag-response associations with distributed lag non-linear models","volume":"33","author":"Gasparrini","year":"2014","journal-title":"Stat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v043.i08","article-title":"Distributed Lag Linear and Non-Linear Models in R: The Package dlnm","volume":"43","author":"Gasparrini","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1038\/43854","article-title":"A dipole mode in the tropical Indian Ocean","volume":"401","author":"Saji","year":"1999","journal-title":"Nature"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1126\/science.1132588","article-title":"ENSO as an integrating concept in Earth science","volume":"314","author":"McPhaden","year":"2006","journal-title":"Science"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hrudya, P.H., Varikoden, H., and Vishnu, R. (2020). A review on the Indian summer monsoon rainfall, variability and its association with ENSO and IOD. Meteorol. Atmos. Phys.","DOI":"10.1007\/s00703-020-00734-5"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16105","DOI":"10.1038\/srep16105","article-title":"Impacts of El Nino Southern Oscillation and Indian Ocean Dipole on dengue incidence in Bangladesh","volume":"5","author":"Banu","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hashizume, M., Chaves, L.F., Faruque, A.S., Yunus, M., Streatfield, K., and Moji, K. (2013). A differential effect of Indian Ocean dipole and El Nino on cholera dynamics in Bangladesh. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0060001"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5798","DOI":"10.1038\/s41467-019-13584-6","article-title":"El Nino-Southern oscillation and under-5 diarrhea in Botswana","volume":"10","author":"Heaney","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s40249-017-0325-z","article-title":"Seasonal and geographical distribution of bacillary dysentery (shigellosis) and associated climate risk factors in Kon Tam Province in Vietnam from 1999 to 2013","volume":"6","author":"Lee","year":"2017","journal-title":"Infect. Dis. Poverty"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1017\/S0950268805003985","article-title":"Sentinel surveillance for international Shigella by a quarantine station in Japan","volume":"133","author":"Taniguchi","year":"2005","journal-title":"Epidemiol. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s11908-009-0008-4","article-title":"Travelers as a sentinel population: Use of sentinel networks to inform pretravel and posttravel evaluation","volume":"11","author":"Leder","year":"2009","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_29","first-page":"1","article-title":"Surveillance for travel-related disease\u2014GeoSentinel Surveillance System, United States, 1997\u20132011","volume":"62","author":"Harvey","year":"2013","journal-title":"Morb. Mortal. Wkly. Rep. Surveill. Summ."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fukusumi, M., Arashiro, T., Arima, Y., Matsui, T., Shimada, T., Kinoshita, H., Arashiro, A., Takasaki, T., Sunagawa, T., and Oishi, K. (2016). Dengue Sentinel Traveler Surveillance: Monthly and Yearly Notification Trends among Japanese Travelers, 2006\u20132014. PLoS Negl. Trop. Dis., 19.","DOI":"10.1371\/journal.pntd.0004924"},{"key":"ref_31","unstructured":"Wendling, Z.A., Emerson, J.W., de Sherbinin, A., Esty, D.C., and Levy, M.A. (2020, May 10). 2018 Environmental Performance Index. Available online: https:\/\/epi.envirocenter.yale.edu\/epi-indicator-report\/H2O."},{"key":"ref_32","unstructured":"United Nations World Tourism Organization (2020, May 10). Global and Regional Tourism Performance. Available online: https:\/\/www.unwto.org\/global-and-regional-tourism-performance."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/1\/211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:47:45Z","timestamp":1760179665000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/1\/211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,30]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["ijerph18010211"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18010211","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,30]]}}}