Abstract
BackgroundPackaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety.ObjectivesTo assess the microbial safety of packaged water, examine differences between regions, country incomes, packaged water types, and compare packaged water with other water sources.MethodsWe performed a systematic review and meta-analysis. Articles published in English, French, Portuguese, Spanish and Turkish, with no date restrictions were identified from online databases and two previous reviews. Studies published before April 2014 that assessed packaged water for the presence of Escherichia coli, thermotolerant or total coliforms were included provided they tested at least ten samples or brands.ResultsA total of 170 studies were included in the review. The majority of studies did not detect fecal indicator bacteria in packaged water (78/141). Compared to packaged water from upper-middle and high-income countries, packaged water from low and lower-middle-income countries was 4.6 (95% CI: 2.6–8.1) and 13.6 (95% CI: 6.9–26.7) times more likely to contain fecal indicator bacteria and total coliforms, respectively. Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17–0.58) and total coliforms (OR = 0.10, 95%CI: 0.05, 0.22). Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption.ConclusionsPolicymakers and regulators should recognize the potential benefits of packaged water in providing safer water for consumption at and away from home, especially for those who are otherwise unlikely to gain access to a reliable, safe water supply in the near future. To improve the quality of packaged water products they should be integrated into regulatory and monitoring frameworks.
Highlights
The consumption of bottled water is a long-standing tradition in many European countries, and in recent decades consumption of bottled water has spread to other upper-middle and high-income countries (UM/HICs) for various reasons including taste, perceived health benefits, convenience, and concerns over the quality of municipal supplies [1,2]
Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17–0.58) and total coliforms (OR = 0.10, 95% CI: 0.05, 0.22)
Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption
Summary
The consumption of bottled water is a long-standing tradition in many European countries, and in recent decades consumption of bottled water has spread to other upper-middle and high-income countries (UM/HICs) for various reasons including taste, perceived health benefits, convenience, and concerns over the quality of municipal supplies [1,2]. Use of improved drinking water sources has increased globally but according to the Joint Monitoring Programme (JMP) of WHO and UNICEF, 52% of people in developing regions do not have piped water on-premises, with the proportion rising to 82% in least developed countries (WHO/UNICEF 2014). These households collect water from sources outside the household, which results in a loss of time and energy [7].
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