目标:在美国,总体上,低收入农村地区违反饮用水法规的行为最高,尤其是在阿巴拉契亚中部。然而,饮用水使用数据,质量,阿巴拉契亚农村地区的相关健康结果有限。我们试图评估居住在阿巴拉契亚弗吉尼亚州农村地区的个人的公共和私人饮用水源以及水传播病原体暴露的相关风险因素。
方法:我们进行了调查并收集了自来水,瓶装水,以及弗吉尼亚州西南部(与肯塔基州和田纳西州接壤)两个相邻农村县的低收入家庭的唾液样本。测试水样的pH值,温度,电导率,总大肠菌群,大肠杆菌,游离氯,硝酸盐,氟化物,重金属,和特定的病原体靶标。分析唾液样品对潜在水传播感染的抗体反应。我们还与家庭分享了水分析结果。
结果:我们登记了33个家庭(83个人),82%(n=27)使用公用事业供水,18%使用私人水井(n=3)或泉水(n=3)。58%(n=19)的家庭收入低于2万美元/年。在33%(n=11)家庭的水样中检测到总的大肠杆菌,大肠杆菌占12%,都有井或弹簧(n=4),和气单胞菌,弯曲杆菌,9%的肠杆菌,所有泉水(n=3)。有10%的人报告腹泻(n=8),但与大肠杆菌检测无关。34%(n=15)的唾液样品对隐孢子虫具有可检测的抗体反应。,C.jeuni,和戊型肝炎在控制协变量和聚类后,在有化粪池系统和直管的家庭中,个体检测抗体的可能性显著较高(风险比=3.28,95CI=1.01~10.65).
结论:据我们所知,这是第一个收集和分析饮用水样本的研究,唾液样本,并报告了阿巴拉契亚中部低收入家庭的健康结果数据。我们的研究结果表明,该地区的公用事业供水总体上是安全的,没有公用事业供水或下水道的低收入家庭中的个人对水传播病原体的暴露较高。
OBJECTIVE: In the US, violations of drinking water regulations are highest in lower-income rural areas overall, and particularly in Central Appalachia. However, data on drinking water use, quality, and associated health outcomes in rural Appalachia are limited. We sought to assess public and private drinking water sources and associated risk factors for waterborne pathogen exposures for individuals living in rural regions of Appalachian Virginia.
METHODS: We administered surveys and collected tap water, bottled water, and saliva samples in lower-income households in two adjacent rural counties in southwest Virginia (bordering Kentucky and Tennessee). Water samples were tested for pH, temperature, conductivity, total coliforms, E. coli, free chlorine, nitrate, fluoride, heavy metals, and specific pathogen targets. Saliva samples were analyzed for antibody responses to potentially waterborne infections. We also shared water analysis results with households.
RESULTS: We enrolled 33 households (83 individuals), 82% (n = 27) with utility-supplied water and 18% with private wells (n = 3) or springs (n = 3). 58% (n = 19) reported household incomes of <$20,000/year. Total coliforms were detected in water samples from 33% (n = 11) of homes, E. coli in 12%, all with wells or springs (n = 4), and Aeromonas, Campylobacter, and Enterobacter in 9%, all spring water (n = 3). Diarrhea was reported for 10% of individuals (n = 8), but was not associated with E. coli detection. 34% (n = 15) of saliva samples had detectable antibody responses for Cryptosporidium spp., C. jejuni, and Hepatitis E. After controlling for covariates and clustering, individuals in households with septic systems and straight pipes had significantly higher likelihoods of antibody detection (risk ratios = 3.28, 95%CI = 1.01-10.65).
CONCLUSIONS: To our knowledge, this is the first study to collect and analyze drinking water samples, saliva samples, and reported health outcome data from low-income households in Central Appalachia. Our findings indicate that utility-supplied water in this region was generally safe, and individuals in low-income households without utility-supplied water or sewerage have higher exposures to waterborne pathogens.