{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:03:03Z","timestamp":1789542183231,"version":"build-2803163510"},"reference-count":64,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"ABSTRACT.<\/jats:title>\nConjunctivitis outbreaks can herald pandemics. However, their relationships with weather and air pollution factors are not well understood. Kathmandu in Nepal has defined wet\u2013dry seasons and lies in a bowl-shaped valley that traps air pollutants with levels many-folds higher than recommended by World Health Organization (WHO). From 2021 to 2023, we collected conjunctival samples from patients with presumed infectious conjunctivitis in Kathmandu, Nepal, for pathogen identification. With publicly available weather and air quality databases, we assessed the relationship between environmental factors and the prevalence of different pathogen types by performing binary logistic regression model building and cosinor regression analysis. High precipitation was associated with an increased odds of RNA virus infection (odds ratio [OR] = 1.82; 95% CI = 1.24\u20132.72; P<\/jats:italic> = 0.003), whereas higher ozone levels were associated with decreased odds of RNA virus infections (OR = 0.46; 95% CI = 0.29\u20130.69; P<\/jats:italic> <0.001). The odds of bacterial infection increased 4.2-fold for every 1 SD \u00b5<\/jats:italic>g\/m3<\/jats:sup> increase in ozone (SD = 11 \u00b5<\/jats:italic>g\/m3<\/jats:sup>; 95% CI = 1.75\u201311.67; P<\/jats:italic> <0.001), and the odds of fungal infection increased 1.62-fold for every 1 SD \u00b5<\/jats:italic>g\/m3<\/jats:sup> increase in nitric oxide (SD = 0.97 \u00b5<\/jats:italic>g\/m3<\/jats:sup>; 95% CI = 1.02\u20132.49; P<\/jats:italic> = 0.041). Cases associated with different taxa peaked at different times: pre-monsoon season for bacteria, during monsoon season for RNA viruses, and post-monsoon season for fungi. Our results suggest the importance and varying influence of local climate and air quality conditions on the etiology of conjunctivitis.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0053","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T16:07:51Z","timestamp":1753200471000},"page":"908-916","source":"Crossref","is-referenced-by-count":3,"title":["Weather, Air Pollution, and Seasonality: Predictors of Pathogen-Associated Conjunctivitis Outbreaks in Kathmandu Valley, Nepal"],"prefix":"10.4269","volume":"113","author":[{"given":"Meenu","family":"Chaudhary","sequence":"first","affiliation":[{"name":"B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Yan","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeeta","family":"Sitaula","sequence":"additional","affiliation":[{"name":"B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Maharajgunj Medical Campus, Tribhuvan University, Kathmandu, Nepal;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Zhong","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindi","family":"Chen","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Ouimette","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Abraham","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Yu","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Chang","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Hintewirth","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin F.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"},{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"McLeod","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis C.","family":"Porco","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"},{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California;"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Deiner","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Shantha","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Lietman","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"},{"name":"Institute for Global Health Sciences, University of California San Francisco, San Francisco, California;"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerami D.","family":"Seitzman","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy","family":"Doan","sequence":"additional","affiliation":[{"name":"Francis I Proctor Foundation, University of California San Francisco, San Francisco, California;"},{"name":"Department of Ophthalmology, University of California San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int Health","first-page":"468","article-title":"Heterogenous pathogen profile associated with acute conjunctivitis in Nepal","volume":"16","author":"Chaudhary","year":"2024"},{"key":"b2","series-title":"JNMA J Nepal Med Assoc","first-page":"24","article-title":"Acute conjunctivitis among patients visiting the outpatient department of ophthalmology in a tertiary care centre","volume":"62","author":"Shrestha","year":"2024"},{"key":"b3","series-title":"Curr Med Res Opin","first-page":"1953","article-title":"Acute conjunctivitis: Truth and misconceptions","volume":"25","author":"O\u2019Brien","year":"2009"},{"key":"b4","series-title":"JAMA","first-page":"1721","article-title":"Conjunctivitis: A systematic review of diagnosis and treatment","volume":"310","author":"Azari","year":"2013"},{"key":"b5","article-title":"Conjunctivitis Spreading Fast Hinting at National Outbreak.","author":"Adhikari","year":"2023"},{"key":"b6","doi-asserted-by":"crossref","DOI":"10.1101\/2023.10.11.23296878","article-title":"Genomic Insights into the 2023 Outbreak of Acute Hemorrhagic Conjunctivitis in Pakistan: Identification of Coxsackievirus A24 Variant Through Next Generation Sequencing.","author":"Haider","year":"2023"},{"key":"b7","series-title":"Infect Disord Drug Targets","first-page":"e190724232040","article-title":"India\u2019s pink-eye mystery: Decoding the 2023 conjunctivitis outbreak","volume":"25","author":"Paul","year":"2024"},{"key":"b8","series-title":"BMC Ophthalmol","first-page":"13","article-title":"Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States","volume":"9","author":"Smith","year":"2009"},{"key":"b9","series-title":"Emerg Infect Dis","first-page":"168","article-title":"Costs of conjunctivitis outbreak, Reunion Island, France","volume":"24","author":"Filleul","year":"2018"},{"key":"b10","series-title":"Nepal Med Coll J","first-page":"59","article-title":"Acute hemorrhagic conjunctivitis epidemic\u20142003 in Nepal","volume":"5","author":"Gurung","year":"2003"},{"key":"b11","series-title":"Kathmandu Univ Med J (KUMJ)","first-page":"69","article-title":"Bacterial conjunctivitis and of antibiotics in Dhulikhel Hospital-Kathmandu University Hospital","volume":"9","author":"Sthapit","year":"2011"},{"key":"b12","series-title":"Toxicol Sci","first-page":"3","article-title":"Air pollution and respiratory infections: The past, present, and future","volume":"192","author":"Monoson","year":"2023"},{"key":"b13","series-title":"Environ Health Perspect","first-page":"47009","article-title":"Long-term exposure to fine particle elemental components and natural and cause-specific mortality\u2014A pooled analysis of eight European cohorts within the ELAPSE Project","volume":"129","author":"Chen","year":"2021"},{"key":"b14","series-title":"Am J Respir Crit Care Med","first-page":"1429","article-title":"Long-term air pollution exposure and pneumonia-related mortality in a large pooled European cohort","volume":"205","author":"Liu","year":"2022"},{"key":"b15","series-title":"Invest Ophthalmol Vis Sci","first-page":"429","article-title":"Relationship between air pollution and outpatient visits for nonspecific conjunctivitis","volume":"53","author":"Chang","year":"2012"},{"key":"b16","series-title":"J Expo Sci Environ Epidemiol","first-page":"533","article-title":"Population study on chronic and acute conjunctivitis associated with ambient environment in urban and rural areas","volume":"22","author":"Chiang","year":"2012"},{"key":"b17","series-title":"Sci Rep","first-page":"10091","article-title":"Correlation between air pollution and prevalence of conjunctivitis in South Korea using analysis of public big data","volume":"12","author":"Nam","year":"2022"},{"key":"b18","series-title":"Sci Rep","first-page":"18205","article-title":"Air pollution significantly associated with severe ocular allergic inflammatory diseases","volume":"9","author":"Miyazaki","year":"2019"},{"key":"b19","series-title":"Environ Res","first-page":"54","article-title":"The state of scientific evidence on air pollution and human health in Nepal","volume":"124","author":"Gurung","year":"2013"},{"key":"b20","article-title":"Government of Nepal Office of the Prime Minister and Council of Ministers.","year":"2023"},{"key":"b21","author":"Haq","year":"2008"},{"key":"b22","author":"Shah","year":"1997"},{"key":"b23","author":"Pradhan","year":"2012"},{"key":"b24","series-title":"Clim Change","first-page":"17","article-title":"Amplified drought trends in Nepal increase the potential for Himalayan wildfires","volume":"176","author":"Pokharel","year":"2023"},{"key":"b25","series-title":"Environ Adv","first-page":"100493","article-title":"The effect of wildfires on air quality in Kathmandu, Nepal","volume":"15","author":"Kuikel","year":"2024"},{"key":"b26"},{"key":"b27","series-title":"Atmos Environ","first-page":"1249","article-title":"Atmospheric turbidity over Kathmandu valley","volume":"36","author":"Sapkota","year":"2002"},{"key":"b28","series-title":"Atmos Environ","first-page":"8623","article-title":"Seasonal PM10 dynamics in Kathmandu Valley","volume":"42","author":"Aryal","year":"2008"},{"key":"b29","series-title":"Atmos Res","first-page":"105623","article-title":"Particulate matter variability in Kathmandu based on in-situ measurements, remote sensing, and reanalysis data","volume":"258","author":"Becker","year":"2021"},{"key":"b30","series-title":"Front Sustain Cities","first-page":"672428","article-title":"Assessment of health impact of PM2.5 exposure by using WRF-Chem model in Kathmandu Valley, Nepal","volume":"3","author":"Tuladhar","year":"2021"},{"key":"b31","author":"Lamichhane","year":"2023"},{"key":"b32","series-title":"Aerosol Air Qual Res","first-page":"3088","article-title":"Variability of anthropogenic gases: Nitrogen oxides, sulfur dioxide, ozone and ammonia in Kathmandu Valley, Nepal","volume":"16","author":"Kiros","year":"2016"},{"key":"b33","series-title":"Atmos Chem Phys","first-page":"11949","article-title":"Variations in surface ozone and carbon monoxide in the Kathmandu Valley and surrounding broader regions during SusKat-ABC field campaign: Role of local and regional sources","volume":"18","author":"Bhardwaj","year":"2018"},{"key":"b34","series-title":"Atmos Environ","first-page":"334","article-title":"Air quality trends of the Kathmandu Valley: A satellite, observation and modeling perspective","volume":"201","author":"Mahapatra","year":"2019"},{"key":"b35","series-title":"Atmos Chem Phys","first-page":"13957","article-title":"Seasonal variation of ozone and black carbon observed at Paknajol, an urban site in the Kathmandu Valley, Nepal","volume":"15","author":"Putero","year":"2015"},{"key":"b36","series-title":"Environ Monit Assess","first-page":"684","article-title":"Quantifying effects of meteorological parameters on air pollution in Kathmandu valley through regression models","volume":"194","author":"Shrestha","year":"2022"},{"key":"b37","series-title":"Environ Res","first-page":"42","article-title":"Modeling the intraurban variation in nitrogen dioxide in urban areas in Kathmandu Valley, Nepal","volume":"155","author":"Gurung","year":"2017"},{"key":"b38","series-title":"J Environ Public Health","first-page":"1504591","article-title":"The threat of ambient air pollution in Kathmandu, Nepal","volume":"2018","author":"Saud","year":"2018"},{"key":"b39","series-title":"Microbiol Res","first-page":"2247","article-title":"Enteroviruses, respiratory syncytial virus and seasonal coronaviruses in influenza-like illness cases in Nepal","volume":"15","author":"Shrestha","year":"2024"},{"key":"b40","series-title":"Ophthalmology","first-page":"1090","article-title":"Unbiased pathogen detection and host gene profiling for conjunctivitis","volume":"126","author":"Lalitha","year":"2019"},{"key":"b41","series-title":"J Open Source Softw","first-page":"1035","article-title":"nasapower: A NASA POWER global meteorology, surface solar energy and climatology data client for R","volume":"3","author":"Sparks","year":"2018"},{"key":"b42","article-title":"Accuracy and Quality of Weather Data\u2014Openweathermap.","year":"2024"},{"key":"b43","series-title":"Ann Transl Med","first-page":"111","article-title":"Model building strategy for logistic regression: Purposeful selection","volume":"4","author":"Zhang","year":"2016"},{"key":"b44","series-title":"Stat Med","first-page":"2409","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002"},{"key":"b45","article-title":"R: A Language and Environment for Statistical Computing."},{"key":"b46","article-title":"_logistf: Firth\u2019s Bias-Reduced Lsogistic Regression_: R Package.","author":"Georg Heinze","year":"2023"},{"key":"b47","doi-asserted-by":"crossref","DOI":"10.32614\/CRAN.package.GLMMcosinor","article-title":"GLMMcosinor: Fit a Cosinor Model Using a Generalized Mixed Modeling Framework.","author":"Parsons","year":"2024"},{"key":"b48","series-title":"J Stat Softw","first-page":"1","article-title":"TMB: Automatic differentiation and Laplace approximation","volume":"70","author":"Kristensen","year":"2016"},{"key":"b49","series-title":"Bioinformatics","first-page":"1208","article-title":"CircaCompare: A method to estimate and statistically support differences in mesor, amplitude and phase, between circadian rhythms","volume":"36","author":"Parsons","year":"2020"},{"key":"b50","series-title":"Microbiol Spectr","first-page":"e0055121","article-title":"Viral and atypical bacterial detection in young Nepalese children hospitalized with severe pneumonia","volume":"9","author":"Mathisen","year":"2021"},{"key":"b51","series-title":"PNAS Nexus","first-page":"pgac032","article-title":"El Ni\u00f1o southern oscillation, monsoon anomaly, and childhood diarrheal disease morbidity in Nepal","volume":"1","author":"Adams","year":"2022"},{"key":"b52","series-title":"Epidemiol Infect","first-page":"78","article-title":"Rainfall, household crowding, and acute respiratory infections in the tropics","volume":"140","author":"Murray","year":"2012"},{"key":"b53","series-title":"J AWWA","first-page":"77","article-title":"Climate and waterborne disease outbreaks","volume":"92","author":"Rose","year":"2000"},{"key":"b54","series-title":"Commun Biol","first-page":"992","article-title":"Moisture modulates soil reservoirs of active DNA and RNA viruses","volume":"4","author":"Wu","year":"2021"},{"key":"b55","series-title":"Cornea","first-page":"1123","article-title":"Seasonal trends of microbial keratitis in South India","volume":"31","author":"Lin","year":"2012"},{"key":"b56","series-title":"Am J Trop Med Hyg","first-page":"1397","article-title":"Seasonal and temporal trends of infectious keratitis in northern Vietnam","volume":"109","author":"Cao","year":"2023"},{"key":"b57","series-title":"Indian J Ophthalmol","first-page":"1048","article-title":"Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India","volume":"67","author":"Kumar","year":"2019"},{"key":"b58","article-title":"Nepal\u2019s Paddy Harvest Hits Record High for Fourth Straight Year.","author":"Prasain","year":"2025"},{"key":"b59","series-title":"New Phytol","first-page":"1553","article-title":"Humidity and high temperature are important for predicting fungal disease outbreaks worldwide","volume":"234","author":"Romero","year":"2022"},{"key":"b60","series-title":"Proc Natl Acad Sci USA","first-page":"12814","article-title":"High diversity of fungi in air particulate matter","volume":"106","author":"Fr\u00f6hlich-Nowoisky","year":"2009"},{"key":"b61","article-title":"Conjunctivitis PPP 2023.","year":"2023"},{"key":"b62","series-title":"Arch Soc Esp Oftalmol (Engl Ed)","first-page":"569","article-title":"Vittaforma Corneae keratoconjunctivitis: An emerging pathology among travelers returning from Southeast Asia","volume":"95","author":"Arnalich-Montiel","year":"2020"},{"key":"b63","series-title":"Cureus","first-page":"e49247","article-title":"Successful treatment of microsporidial keratoconjunctivitis (MKC) with a combination of topical voriconazole 1% and gatifloxacin 0.5%: A large case series of 29 patients","volume":"15","author":"Ramatchandirane","year":"2023"},{"key":"b64","series-title":"Eye (Lond)","first-page":"747","article-title":"Outbreak of microsporidial keratoconjunctivitis with rugby sport due to soil exposure","volume":"27","author":"Kwok","year":"2013"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p908.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p908.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p908.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:30:32Z","timestamp":1759339832000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p908.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":64,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0053","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}