Correlation of High Seawater Temperature with Vibrio and Shewanella Infections, Denmark, 2010–2018

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V ibrio and Shewanella spp.bacteria cause a variety of human infections, including wound infections, ear infections, septicemia, and gastroenteritis (1).Domestically acquired Vibrio and Shewanella infections occur only sporadically in countries in northern Europe because the coastal seawater temperature tends to be too cold to support growth and high bacterial pathogen concentration levels (2,3).However, the warming of low-salinity coastal waters of the Baltic Sea has promoted the growth of Vibrio and Shewanella spp.and consequently increased the risk of disease for humans exposed to such seawater (4).In the unusually warm summer of 1994 in Denmark, several V. vulnificus and S. algae infections were seen among patients who reported bathing in seawater (5,6).Furthermore, during 2014-2018, more than 1,055 cases of vibriosis were reported in northern Europe countries, including Denmark (7).Considering the annual increase in infections during recent summer seasons in Denmark and the recurring heatwaves across Europe, this emerging public health threat requires more investigation to provide decision-makers with evidence for action.The aim of our nationwide study was to describe the distribution of Vibrio and Shewanella infections in Denmark during 2010-2018 and investigate a possible correlation between infections and sea surface temperature. The StudyWe studied cases of Vibrio and Shewanella infections during 2010-2018 in the summer months in Denmark (June to August); in the decade spanning 2010-2020, 2018 was the warmest registered summer in the country.We obtained information about the cases from the Danish Microbiology Database, a national database containing all clinical microbiology reports from Denmark (8).We extracted identification results, confirmed by matrixassisted laser desorption/ionization time-of-flight mass spectrometry, on Vibrio and Shewanella spp.cultured from blood, wound swabs, deep soft tissue, ear, trachea, urine, and feces as well as information about date of sampling.We also extracted the person identification number of each patient studied from Denmark's Central Person Registry (CPR) (9).Clinical patient information was not available, but sample types were used as a proxy for type of infection.We registered cases by month per patient (Appendix 1, https://wwwnc.cdc.gov/EID/article/29/3/22-1568-App1.pdf).We counted the number of cases by calendar year and stratified them by the genus of isolated bacterial pathogen.Using the CPR number, we eliminated duplicate positive results.By linking to data from the CPR register, we retrieved information on address of residence for each case at the time of sampling.We performed geomapping and geocoding in QGIS 1.8.0 Lisboa (https://www.qgis.org)for the spatial analysis of Shewanella and Vibrio cases and plotting of number of infections per municipality, which we further interpreted based on seawater salinity in the mapped areas.We obtained sea surface temperatures of Correlation of High Seawater Temperature with Vibrio and Shewanella Infections,

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