The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community

SUMMARYThe drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1–5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4–9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

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Estimating the burden of acute gastrointestinal illness due toGiardia, Cryptosporidium, Campylobacter, E. coliO157 and norovirus associated with private wells and small water systems in Canada

Epidemiology and Infection ◽

10.1017/s0950268815002071 ◽

2015 ◽

Vol 144 (7) ◽

pp. 1355-1370 ◽

Cited By ~ 41

Author(s):

H. M. MURPHY ◽

M. K. THOMAS ◽

P. J. SCHMIDT ◽

D. T. MEDEIROS ◽

S. McFADYEN ◽

...

Keyword(s):

Public Health ◽

Drinking Water ◽

Developed Countries ◽

Water Systems ◽

Gastrointestinal Illness ◽

Health Concern ◽

Small Community ◽

Water Supplies ◽

Acute Gastrointestinal Illness ◽

Small Water

SUMMARYWaterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually – this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA ofGiardia, Cryptosporidium, Campylobacter, E. coliO157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and private well water in Canada, this research supports the use of QMRA as an effective source attribution tool when there is a lack of randomized controlled trial data to evaluate the public health risk of an exposure source. QMRA is also a powerful tool for identifying existing knowledge gaps on the national scale to inform future surveillance and research efforts.

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Cryptosporidium outbreaks associated with swimming pools

Environmental Health Review ◽

10.5864/d2014-011 ◽

2014 ◽

Vol 57 (01) ◽

pp. 3-8 ◽

Cited By ~ 4

Author(s):

Steven Lam ◽

Bhairavi Sivaramalingam ◽

Harshani Gangodawilage

Keyword(s):

Public Education ◽

Swimming Pool ◽

Gastrointestinal Illness ◽

Public Health Issue ◽

Recreational Water ◽

Infectious Agents ◽

Swimming Pools ◽

Acute Gastrointestinal Illness ◽

And Training ◽

Water Borne

Acute gastrointestinal illness is a common and preventable public health issue. Exposure to recreational water, such as in swimming pools, is a risk factor for acute gastrointestinal illness. Serious outbreaks of water-borne diseases in Canada are rare but can pose a significant threat to human health. Cryptosporidium is one of the most common infectious agents causing pool-related outbreaks. Pool fouling, lack of education and training, inadequate pool structures, and lack of disinfection equipment have been linked to outbreaks of Cryptosporidium. To minimize the burden of swimming pool related outbreaks, interventions should include pool structure alterations, increased surveillance and reporting of swimming pool associated diseases, and public education regarding the risk of swimming pool infections.

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Risk of Viral Acute Gastrointestinal Illness from Nondisinfected Drinking Water Distribution Systems

Environmental Science & Technology ◽

10.1021/es3015925 ◽

2012 ◽

Vol 46 (17) ◽

pp. 9299-9307 ◽

Cited By ~ 30

Author(s):

Elisabetta Lambertini ◽

Mark A. Borchardt ◽

Burney A. Kieke ◽

Susan K. Spencer ◽

Frank J. Loge

Keyword(s):

Drinking Water ◽

Distribution Systems ◽

Water Distribution ◽

Water Distribution Systems ◽

Gastrointestinal Illness ◽

Drinking Water Distribution Systems ◽

Acute Gastrointestinal Illness ◽

Drinking Water Distribution

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The burden of self-reported acute gastrointestinal illness in Italy: a retrospective survey, 2008–2009

Epidemiology and Infection ◽

10.1017/s0950268811002020 ◽

2011 ◽

Vol 140 (7) ◽

pp. 1193-1206 ◽

Cited By ~ 29

Author(s):

G. SCAVIA ◽

F. BALDINELLI ◽

L. BUSANI ◽

A. CAPRIOLI

Keyword(s):

Medical Care ◽

Incidence Rate ◽

Telephone Survey ◽

Case Definition ◽

Gastrointestinal Illness ◽

Care Seeking ◽

Acute Gastrointestinal Illness ◽

Factors Associated ◽

Duration Of Illness ◽

Children And Young Adults

SUMMARYA retrospective telephone survey (n=3490) was conducted in Italy between 2008 and 2009 to estimate the occurrence of self-reported acute gastrointestinal illness (AGI) and to describe subjects' recourse to healthcare, using a symptom-based case definition. Three hundred and ten AGI cases were identified. The annual incidence rate was 1·08 episodes/person-year (95% confidence interval 0·90–1·14). The proportion of subjects consulting physicians was 39·5% while only 0·3% submitted a specimen for laboratory investigation. Risk factors for AGI and medical care-seeking were identified using logistic regression analysis. Females, children and young adults had a significantly higher incidence rate of AGI. Factors associated with medical care-seeking were age <10 years, presence of fever, diarrhoea, and duration of illness >3 days. Our results provide a relevant contribution towards estimating the global burden of AGI using standard methods that ensure a good level of comparability with other studies.

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