Acute gastrointestinal illness following a prolonged community-wide water emergency

Abstract

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

Associations between Self-Reported Gastrointestinal Illness and Water System Characteristics in Community Water Supplies in Rural Alabama: A Cross-Sectional Study

“…Low water pressure and intermittent service provide opportunities for contaminant intrusion [ 26 ], resulting in microbial contamination and potentially increased risk for GII. Recent evidence from a documented water emergency in Alabama also found an association between self-reported GII and loss of water pressure and water service [ 27 ].…”

“…Further, respondents may not always be well informed about GII symptoms for other members of the household, especially other adults. Access to health care is limited in this underserved region [ 33 ] and other, potentially useful triangulating health data were unavailable at the time of study, a limitation noted in other studies of waterborne disease risk from similar settings [ 34 , 35 ] including from rural Alabama [ 27 ]. In another study from the same dataset [ 10 ], we reported that water pressure data were consistent between self-report and as-measured using pressure gauges at the time of sampling, though independent verification for other important measures we report are unavailable.…”

Emergency Department Visits for Acute Gastrointestinal Illness After a Major Water Pipe Break in 2010

“…This study adds to the existing literature on how disturbances in the drinking water system may play a role in disease transmission in the U.S. Aside from community-wide water emergencies, wet weather events (e.g., precipitation, flooding) have also been associated with increased gastrointestinal illness. 17,31,32,[47][48][49][50] In addition, water pipes can become vulnerable with aging infrastructures and extreme temperature fluctuations. 16,51 Understanding the different risk factors involved can help water utilities and health departments establish and improve preparedness and response plans.…”

Infrastructure Disruptions: How Instability Breeds Household Vulnerability

“…A case study from Alabama, US, looks at the effect of a freeze-related water emergency on diarrheal and respiratory illnesses. The researchers find a significantly higher risk of contracting diarrhea for households experiencing water disruptions and low water pressure and prevalence increases with the length of disruption (Gargano et al, 2015). The diarrhea outbreak in Milwaukee which affected 403,000 individuals, was caused by a filtration system that malfunctioned after a heavy storm releasing the bacteria Cryptosporidium oocysts in the water distribution system (Hoxie et al, 1997;Mac Kenzie et al, 1994).…”