Article courtesy of Elisabetta Lambertini, Mark A. Borchardt, Burney A. Kieke, Jr. , Susan K. Spencer, and Frank J. Loge | July 27, 2012 | American Chemical Society | Shared as educational material only
§ Author Present Address
Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, One Shields Ave., Davis, CA 95616.
Author Present Address
USDA − Agricultural Research Service, 2615 Yellowstone Dr., Marshfield, WI 54449.
Acute gastrointestinal illness (AGI) resulting from pathogens directly entering the piping of drinking water distribution systems is insufficiently understood. Here, we estimate AGI incidence from virus intrusions into the distribution systems of 14 nondisinfecting, groundwater-source, community water systems. Water samples for virus quantification were collected monthly at wells and households during four 12-week periods in 2006–2007. Ultraviolet (UV) disinfection was installed on the communities’ wellheads during one study year; UV was absent the other year. UV was intended to eliminate virus contributions from the wells and without residual disinfectant present in these systems, any increase in virus concentration downstream at household taps represented virus contributions from the distribution system (Approach 1). During no-UV periods, distribution system viruses were estimated by the difference between well water and household tap virus concentrations (Approach 2). For both approaches, a Monte Carlo risk assessment framework was used to estimate AGI risk from distribution systems using study-specific exposure–response relationships. Depending on the exposure–response relationship selected, AGI risk from the distribution systems was 0.0180–0.0661 and 0.001–0.1047 episodes/person-year estimated by Approaches 1 and 2, respectively. These values represented 0.1–4.9% of AGI risk from all exposure routes, and 1.6–67.8% of risk related to drinking water exposure. Virus intrusions into nondisinfected drinking water distribution systems can contribute to sporadic AGI.
2 Materials and Methods
|exposure-response model by virus type and age group||βo||β||var(βo)b||var(β)b||cov(βo, β)b||p-valuec|
|all viruses – all agesa||–5.4195||7.534 × 10–2||9.720 × 10–3||1.966 × 10–3||–9.646 × 10–4||0.0977|
|all viruses – adultsa||–5.4539||1.715 × 10–1||1.593 × 10–2||3.999 × 10–3||–2.094 × 10–3||0.0101|
|enterovirus – adultsa||–5.4080||2.920 × 10–1||2.294 × 10–2||1.665 × 10–2||–2.361 × 10–3||0.0296|
|norovirus GI – all ages||–5.4271||1.723 × 10–1||1.543 × 10–3||2.250 × 10–3||–7.976 × 10–4||0.0006|
|norovirus GI – adults||–5.4214||2.557 × 10–1||3.487 × 10–3||4.471 × 10–3||–1.770 × 10–3||0.0003|
|norovirus GI – children ≤12 years||–5.4300||1.205 × 10–1||1.277 × 10–3||2.022 × 10–3||–6.680 × 10–4||0.0098|
|norovirus GI – children <5 years||–4.9855||1.826 × 10–1||3.271 × 10–3||5.432 × 10–3||–1.826 × 10–3||0.0165|
Virus concentrations were pooled into four sets: concentrations in tap water and in groundwater post-UV during UV periods (Approach 1); in tap water and groundwater during no-UV periods (Approach 2). Samples excluded from the analysis, primarily those collected during short-term chlorination, are reported in the SI, as is also the effect of data exclusions on the risk analysis outcomes.
|virus group||approach||sampling location||meana (gc/L)||mediana (gc/L)||SDVb (gc/L)||maximum (gc/L)||% positive samples|
|Approach 1a||Approach 2a|
|exposure–response model||median (AGI episodes/person-yr)||standard deviation (AGI episodes/person-yr)||percent of risk distribution >1:10 000 infection/yearb||median (AGI episodes/person-yr)||standard deviation (AGI episodes/person-yr)||percent of risk distribution >1:10 000 infection/yearb|
|norovirus GI, all-ages||0.0235||0.113||59.1||0.0559||0.313||63.5|
|norovirus GI, adults||0.0359||0.173||59.3||0.0846||0.516||63.6|
|norovirus GI, children ≤12||0.0180||0.094||58.0||0.0430||0.220||62.7|
|norovirus GI, children <5||0.0431||0.234||57.7||0.1047||0.577||62.7|
The authors declare no competing financial interest.
The Wisconsin WAHTER Study (Water And Health Trial for Enteric Risks) was funded by USEPA STAR grant R831630. We thank the study communities for their participation and support. Technical assistance from Phillip Bertz, Carla Rottscheit, Sandy Strey, and Matt Volenec at the Marshfield Clinic Research Foundation is gratefully acknowledged. Halona Leung, UC-Davis, produced the visual abstract.
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