Pediatric Emergency Department Visits for Diarrheal Illness Increased After Release of Undertreated Sewage

Redman, Ryan L.; Nenn, Cheryl; Eastwood, Daniel; Gorelick, Marc H.

doi:10.1542/peds.2007-0283

Cited by 14 publications

(29 citation statements)

References 9 publications

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“…A recent study conducted in Chennai, India, estimated an increased cumulative risk ratio for hospital admissions for GI illness for the 15-day period following an extreme precipitation event (≥ 90th percentile) was 1.60 (95% CI: 1.29, 1.98) ( Bush et al 2014 ). Previous work on the effect of precipitation on GI illness has also demonstrated stronger associations in the most vulnerable age subpopulations, children and the elderly ( Bush et al 2014 ; Drayna et al 2010 ; Redman et al 2007 ). For the exposed–drinking water region, our age-stratified results demonstrated associations in children < 5 years of age, children of 5–19, and the elderly (≥ 65 years) that were stronger than the association in the adult (20–64 years) group.…”

Section: Discussionmentioning

confidence: 94%

Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003–2007

Jagai

Wang

et al. 2015

Environ Health Perspect

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BackgroundCombined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change.ObjectivesThe aim of this study was to assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed in the presence of CSOs.MethodsFor the study period 2003–2007, time series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: a) CSOs impacting drinking water sources, b) CSOs impacting recreational waters, c) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥ 90th and ≥ 95th percentile) and extreme (≥ 99th percentile) precipitation events, controlling for temperature and long-term time trends.ResultsThe association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.ConclusionsThe rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for GI illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.CitationJagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015. Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: an analysis of Massachusetts data, 2003–2007. Environ Health Perspect 123:873–879; http://dx.doi.org/10.1289/ehp.1408971

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Section: Discussionmentioning

confidence: 94%

Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003–2007

Jagai

Wang

et al. 2015

Environ Health Perspect

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“…Data regarding sewage release events during the study period were obtained from the Milwaukee Metropolitan Sewerage District and Milwaukee Riverkeeper (formerly Friends of Milwaukee’s Rivers) (Milwaukee Riverkeeper, unpublished data; Milwaukee Metropolitan Sewerage District, unpublished data; Redman et al 2007). …”

Section: Methodsmentioning

confidence: 99%

“…An indicator variable containing discrete values flags the occurrence of an event affecting the response series. Thus for each of eight sewage releases, an indicator variable was created taking effect 3–6 days after the sewage release (Redman et al 2007). Based on clinical considerations, the possible effects of winter months, which constitute the typical rotavirus season (December, January, February, and March), were treated as an intervention in a similar way.…”

Section: Methodsmentioning

confidence: 99%

“…During periods of heavy rainfall, water quality may be adversely affected in several ways: contamination of surface or groundwater sources by storm water runoff from impermeable or saturated surfaces, introducing fecal contaminants including bacteria, protozoa, and viruses; cross-contamination due to infiltration and inflow between sewage and water pipes, especially in areas with aging water infrastructure; and release of sewage into local waterways because of sewage overflows or bypass (Atherholt et al 1998; Borchardt et al 2003; Miossec et al 2000; Reynolds et al 2008; Wellings et al 1975). We previously observed an association between sewage bypass and acute gastrointestinal illness (AGI) in children (Redman et al 2007). However, the relationship between rainfall and AGI in the absence of sewage release and in the absence of disease outbreaks reported to public health officials has not been as well described.…”

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confidence: 99%

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Association between Rainfall and Pediatric Emergency Department Visits for Acute Gastrointestinal Illness

Drayna

McLellan²,

Simpson

et al. 2010

Environ Health Perspect

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117

102

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BackgroundMicrobial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known.ObjectivesWe hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems.MethodsWe conducted a retrospective time series analysis of visits to the Children’s Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1–7 days.ResultsA total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0–56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months.ConclusionsWe observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association.

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“…However, investigators have estimated that up to 12 % of cases of gastroenteritis in the USA may be due to waterborne disease [5][6][7]. Contamination of water sources may occur in a variety of ways : point sources of pollution; non-point sources such as storm water run-off or contamination of wells or distribution pipes in areas of old infrastructure ; and sewage release into waterways in the form of combined or sanitary sewer overflows or sewage blending [7][8][9]. Any of these factors can introduce human pathogens into ground-or surface-water sources, with potential health risks.…”

Section: Introductionmentioning

confidence: 99%

Water use and acute diarrhoeal illness in children in a United States metropolitan area

et al. 2010

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We examined the association between water exposures and acute diarrhoeal illness (ADI) in children under non-outbreak conditions in a major US metropolitan area. We used a nested case-control study of children seen in an urban/suburban emergency department. Cases were those seen for a complaint of diarrhoea, while controls were age-matched children with a non-gastrointestinal complaint. Parents of subjects completed a validated water-use survey. Stratum-specific adjusted odds ratios (aOR) were calculated for the three main water effects: water source [surface vs. ground (well)], drinking-water type (tap vs. bottled), and use of water filters. Of 2472 subjects, 45% drank mostly or only bottled water. Well-water use was associated with increased odds of ADI compared to surface water [aOR 1·38, 95% confidence interval (CI) 1·01-1·87]. Use of bottled water did not affect the odds of ADI in well-water users, but increased the odds of ADI for surface-water users (aOR 1·27, 95% CI 1·02-1·57). We conclude that well-water use and bottled-water use are associated with increased odds of ADI in children.

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Pediatric Emergency Department Visits for Diarrheal Illness Increased After Release of Undertreated Sewage

Abstract: Emergency department visits for diarrheal illness increased significantly after 2 events of release of partially treated sewage into area waterways. These data suggest a potentially harmful effect of such practices.

Cited by 14 publications

References 9 publications

Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003–2007

Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003–2007

Association between Rainfall and Pediatric Emergency Department Visits for Acute Gastrointestinal Illness

Water use and acute diarrhoeal illness in children in a United States metropolitan area

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