Abstract
BackgroundThis study sought to identify whether elevated risk of infectious intestinal disease (IID) exists in contaminated small water supply consumers compared with consumers drinking from small supplies complying with current standards and whether this effect is modified by age.Methodology and Principal FindingsA prospective cohort study of 611 individuals receiving small supplies in England was conducted. Water supplies received sanitary inspection and examination for indicator bacteria and participants maintained a daily record of IID. Regression modeling with generalized estimating equations that included interaction terms between age and indicators of fecal pollution was performed. Crude IID prevalence was 9·3 days with symptoms/1000 person days (95%CI: 8·4, 10·1) and incidence was 3·2 episodes/1000 person days (95%CI, 2·7, 3·7) or 1·2 episodes per person year. Although there was no overall association between IID risk and indicator presence, there was strong interaction between age and indicator presence. In children under ten, relative risk (RR) of IID in those drinking from enterococci contaminated supplies was 4.8 (95%CI: 1.5, 15.3) for incidence and 8.9 (95%CI: 2.8, 27.5) for prevalence. In those aged 10 to 59, IID risk was lower but not statistically significant.ConclusionsContaminated small water supplies pose a substantial risk of IID to young children who live in homes reliant on these supplies. By contrast older children and adults do not appear to be at increased risk. Health care professionals with responsibility for children living in homes provided by very small water supplies should make parents aware of the risk.
Highlights
In 2009 the committees on environmental health and on infectious diseases of the American Academy of Pediatrics published a technical report entitled ‘‘Drinking water from private wells and risks to children’’ [1]
Contaminated small water supplies pose a substantial risk of intestinal disease (IID) to young children who live in homes reliant on these supplies
Health care professionals with responsibility for children living in homes provided by very small water supplies should make parents aware of the risk
Summary
In 2009 the committees on environmental health and on infectious diseases of the American Academy of Pediatrics published a technical report entitled ‘‘Drinking water from private wells and risks to children’’ [1]. In that report the authors quite rightly raised concerns about the risks to children’s health from both microbiological and chemical agents when they take their drinking water from very small water supplies, especially from wells. The study reported in this paper was designed to provide further quantitative evidence of the risks from such supplies to all consumers but children especially. In the UK these small supplies are often referred to as private water supplies (PWS) and some 50,000 PWS serve an estimated 1% of the UK population [2]. In the United States waters are not classified in the same way, but an estimated 125,126 very small water systems (supplying 25 to 500 people) provide water to over 14 million people with many more supplies serving less than 25 people [5]. This study sought to identify whether elevated risk of infectious intestinal disease (IID) exists in contaminated small water supply consumers compared with consumers drinking from small supplies complying with current standards and whether this effect is modified by age
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