PDF(Sci-hub)
Abstract：
Recreational water epidemiology studies are rare in settings with minimal wastewater treatment where risk may be highest, and in tropical settings where warmer temperature influences the ecology of fecal indicator bacteria commonly used to monitor recreational waters. One exception is a 1999 study conducted in São Paulo Brazil. We compared the risk and exposure characteristics of these data with those conducted in the United Kingdom (UK) in the early 1990s that are the basis of the World Health Organization\'s (WHO) guidelines on recreational water risks. We then developed adjusted risk difference models (excess gastrointestinal illness per swimming event) for children (<10 years of age) and non-children (≥10 years of age) across five Brazil beaches. We used these models along with beach water quality data from 2004 to 2015 to assess spatial and temporal trends in water quality and human risk. Risk models indicate that children in Brazil have as much as two times the risk of gastrointestinal illness than non-children. In Brazil, 11.8% of the weekly water samples from 2004 to 2015 exceeded 158 enterococci CFU/100 ml, the highest level of fecal streptococci concentration measured in the UK study. Risks associated with these elevated levels equated to median NEEAR-Gastrointestinal Illness (NGI) risks of 53 and 96 excess cases per 1000 swimmers in non-children and children, respectively. Two of the five beaches appear to drive the overall elevated NGI risks seen during this study. Distinct enteric pathogen profiles that exist in tropical settings as well as in settings with minimal wastewater treatment highlight the importance of regionally specific guideline development.
摘要：
娱乐水流行病学研究在废水处理最少的环境中很少见，在这些环境中，风险可能最高。在热带环境中，温度升高会影响通常用于监测休闲水域的粪便指示细菌的生态。一个例外是1999年在巴西圣保罗进行的一项研究。我们将这些数据的风险和暴露特征与1990年代初在英国（UK）进行的数据进行了比较，这些数据是世界卫生组织（WHO）休闲水风险指南的基础。然后，我们为巴西五个海滩的儿童（<10岁）和非儿童（≥10岁）开发了调整后的风险差异模型（每次游泳事件的胃肠道疾病过多）。我们使用这些模型以及2004年至2015年的海滩水质数据来评估水质和人类风险的时空趋势。风险模型表明，巴西儿童患胃肠道疾病的风险是非儿童的两倍。在巴西,从2004年到2015年，每周11.8％的水样超过158例肠球菌CFU/100ml，英国研究中测得的最高水平的粪便链球菌浓度。与这些升高水平相关的风险相当于非儿童和儿童中每1000名游泳者中53例和96例额外病例的中位NGI风险。分别。在这项研究中，五个海滩中的两个似乎驱动了总体上升高的NGI风险。在热带环境中以及在废水处理最少的环境中存在的独特的肠病原体谱突出了区域特定指南制定的重要性。
