PDF(Pubmed)
Abstract：
BACKGROUND: The delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway.
METHODS: We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.
RESULTS: In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2-4% of AGI in Norway is attributable to drinking tap water.
CONCLUSIONS: This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.
METHODS: We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.
RESULTS: In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2-4% of AGI in Norway is attributable to drinking tap water.
CONCLUSIONS: This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.
摘要：
背景：安全饮用水的提供具有很高的公共卫生相关性，可持续发展目标（SDG6）。一些预防行动减轻了高收入国家与传染病有关的负担；然而，水源中的污染，消毒不充分,和前提管道，随着人们越来越意识到入侵饮用水分配系统，代表与饮用水消耗有关的胃肠道疾病的危险因素。由于病人不太可能寻求自我限制的胃肠道感染的医疗保健，因此预计会低估水传播感染的散发性病例。因此，关于水传播疾病真正负担的知识很少。本研究的主要目的是评估挪威与饮用自来水相关的胃肠道疾病的风险。
方法：我们进行了一项为期12个月的前瞻性队列研究，根据随机选择，在邀请后通过电话采访招募参与者。在启动电子调查之后，每月进行12次SMS问卷调查，以收集有关参与者特征和饮用自来水的信息（每天0.2L眼镜的数量），发病率,与胃肠道疾病相关的持续时间和症状。使用线性混合效应模型分析了饮用水暴露与急性胃肠道疾病（AGI）风险结果之间的关联。年龄,性别,教育水平和饮用水供应规模被确定为潜在的混杂因素,并纳入调整后的模型.
结果：总计，9,946人参加了这项队列研究，占所有受邀参与者的11.5%。根据每人和每月的数据(99,446个月提交)，AGI报告为5,508人-月（每100人-月5.5）。在819人-月中报告了严重的AGI（每100人-月0.8）。我们的研究估计，挪威2-4％的AGI归因于饮用自来水。
结论：这是挪威最大的队列研究，评估了与挪威饮用自来水量有关的自我报告的胃肠道感染负担。数据表明，水性AGI目前在挪威不是负担，但是这些发现需要谨慎使用。需要强调的是，必须继续努力和投资维持挪威的饮用水供应，以解决零星水媒病例的低负担问题，并防止今后爆发疫情。
方法：我们进行了一项为期12个月的前瞻性队列研究，根据随机选择，在邀请后通过电话采访招募参与者。在启动电子调查之后，每月进行12次SMS问卷调查，以收集有关参与者特征和饮用自来水的信息（每天0.2L眼镜的数量），发病率,与胃肠道疾病相关的持续时间和症状。使用线性混合效应模型分析了饮用水暴露与急性胃肠道疾病（AGI）风险结果之间的关联。年龄,性别,教育水平和饮用水供应规模被确定为潜在的混杂因素,并纳入调整后的模型.
结果：总计，9,946人参加了这项队列研究，占所有受邀参与者的11.5%。根据每人和每月的数据(99,446个月提交)，AGI报告为5,508人-月（每100人-月5.5）。在819人-月中报告了严重的AGI（每100人-月0.8）。我们的研究估计，挪威2-4％的AGI归因于饮用自来水。
结论：这是挪威最大的队列研究，评估了与挪威饮用自来水量有关的自我报告的胃肠道感染负担。数据表明，水性AGI目前在挪威不是负担，但是这些发现需要谨慎使用。需要强调的是，必须继续努力和投资维持挪威的饮用水供应，以解决零星水媒病例的低负担问题，并防止今后爆发疫情。
