Equivalency of risk for a modified health endpoint: a case from recreational water epidemiology studies

BMC Public Health

Alfred P Dufour²  Timothy J Wade¹  Larry J Wymer² 

[1] United States Environmental Protection Agency, National Health Effects Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA;United States Environmental Protection Agency, National Exposure Research Laboratory, 26 W. Martin Luther King Drive, Cincinnati, OH 45268, USA

关键词: Epidemiological study;    Gastrointestinal illness;    Swimming-related illness;    Recreational water quality;   

Others  :  1162222
DOI  :  10.1186/1471-2458-13-459

 received in 2012-11-13, accepted in 2013-04-30,  发布年份 2013

【 摘 要 】

Background

The United States Environmental Protection Agency (USEPA) and its predecessors have conducted three distinct series of epidemiological studies beginning in 1948 on the relationship between bathing water quality and swimmers’ illnesses. Keeping pace with advances in microbial technologies, these studies differed in their respective microbial indicators of water quality. Another difference, however, has been their specific health endpoints. The latest round of studies, the National Epidemiological Assessment of Recreational (NEEAR) Water studies initiated in 2002, used a case definition, termed “NEEAR GI illness” (NGI), for gastrointestinal illness corresponding closely to classifications employed by contemporary researchers, and to that proposed by the World Health Organization. NGI differed from the previous definition of “highly credible gastrointestinal illness” (HCGI) upon which the USEPA’s 1986 bathing water criteria had been based, primarily by excluding fever as a prerequisite.

Methods

Incidence of NGI from the NEEAR studies was compared to that of HCGI from earlier studies. Markov chain Monte Carlo method was used to estimate the respective beta binomial probability densities for NGI and HCGI establish credible intervals for the risk ratio of NGI to HCGI.

Results

The ratio of NGI risk to that of HCGI is estimated to be 4.5 with a credible interval 3.2 to 7.7.

Conclusions

A risk level of 8 HCGI illnesses per 1000 swimmers, as in the 1986 freshwater criteria, would correspond to 36 NGI illnesses per 1000 swimmers. Given a microbial DNA-based (qPCR) water quality vs. risk relationship developed from the NEEAR studies, 36 NGI per 1000 corresponds to a geometric mean of 475 qPCR cell-equivalents per 100 ml.

【 授权许可】

   
2013 Wymer et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]American Public Health Association (APHA): Report of the Committee on Bathing Places. Am J Public Health 1922, 12:121-123.
• [2]American Public Health Association (APHA): Report of the Committee on Bathing Places. Am J Public Health 1924, 14:597-602.
• [3]American Public Health Association (APHA): Swimming Pools and Bathing Places. Am J Public Health 1933, 23:40-49.
• [4]American Public Health Association (APHA): Bathing Places. Am J Public Health 1936, 26:209-219.
• [5]American Public Health Association (APHA): Look Forward in the Bathing Place Sanitation Field. Am J Public Health 1940, 30:50-51.
• [6]American Public Health Association (APHA): Recommended Practice for Design, Equipment and Operation of Swimming Pools and Other Public Bathing Places. Washington D.C: Joint Committee on Bathing Places; 1957.
• [7]Stevenson AH: Studies of Bathing Water Quality and Health. Am J Public Health 1953, 43:529-538.
• [8]National Technical Advisory Committee: Federal Water Pollution Control Administration. Washington, DC: Dept. of the Interior, Water Quality Criteria; 1968.
• [9]McCabe LJ: Bathing Water Quality and Health, III Coastal Water, A Study of Bathing Water Quality in Long Island Sound at Westchester County, N.Y. and its Relation to Health of Bathers. Cincinnati, Ohio: US Public Health Service, Division of Water Supply and Pollution Control; 1950.
• [10]Cabelli VJ: Health Effects Criteria for Marine Waters. Research Triangle Park, NC: US Environmental Protection. Agency, EPA-600/1-80-031; 1983.
• [11]Dufour AP: Health for Effects Criteria Fresh Recreational Waters. Research Triangle Park, NC: U.S. Environmental Protection Agency, EPA-600/1-84-004; 1984.
• [12]Dufour AP: Bacterial Indicators of Recreational Water Quality. C J Public Health 1984, 75:49-56.
• [13]Majowicz SE, Hall G, Scallan E, Adak GK, Gauci C, Jones TF, O’Brien SO, Henao O, Sockett PN: A common symptom-based case definition for gastroenteritis. Epidemiol Infect 2008, 136:886-894.
• [14]World Health Organization: WHO Initiative to Estimate the Global Burden of Foodborne Diseases. Geneva, Switzerland; 2007. http://www.who.int/foodsafety/publications/foodborne_disease/burden_nov07/en webcite
• [15]Payment P, Richardson L, Siemiatycki J, Dewar R, Edwardes M, Franco E: A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards. A J Public Health 1991, 81:703-8.
• [16]Payment P, Siemiatycki J, Richardson L, Gilles R, Franco E, Prevost M: A prospective epidemiological study of gastrointestinal health effects due to the consumption of drinking water. Int J Environ Heal R 1997, 7:5-31.
• [17]Colford JM, Wade T, Sandhu S, Wright C, Lee S, Shaw S, Fox K, Burns S, Benker A, Brookhart M, van der Laan M: A randomized, controlled trial of in-home drinking water intervention to reduce gastrointestinal illness. Am J Epidemiol 2005, 161:472-82.
• [18]Haugland RA, Siefring SC, Wymer LJ, Brenner KP, Dufour AP: Comparison of Enterococcus Measurements in Freshwater at Two Recreational Beaches by Quantitative Polymerase Chain Reaction and Membrane Filter Culture Analysis. Water Res 2005, 39:559-568.
• [19]Bae S, Wuertz S: Rapid decay of host-specific Bacteroidales cells in seawater as measured by quantitative PCR with propidium monoaszide. Water Res 2009, 43:4850-4859.
• [20]Enriquez CE, Hurst CJ, Gerba CP: Survival of enteric adenoviruses 40 and 41 in tap, sea and waste water. Water Res 1995, 29(11):2548-2553.
• [21]US Environmental Protection Agency (USEPA): Quality criteria for water. Washington, DC; 1976.
• [22]Kay D: Assessment of Human Health Effects Caused by Bathing. The Epibathe Project: University of Wales Aberystwyth; 2009.
• [23]Anderson KL, Whitlock JE, Harwood VJ: Persistence and differential survival of fecal indicator bacteria in subtropical waters and sediments. Appl Environ Microb 2005, 71(6):3041-3048.
• [24]Lessard EJ, Sieburth JM: Survival of natural sewage populations of enteric bacteria in diffusion and batch chambers in the marine environment. Appl Environ Microb 1983, 45(3):0950-959.
• [25]Wiedenmann A, Kruger P, Dietz K, Lopez-Pila JM, Szewzyk R, Botzenhart K: A randomized controlled trial assessing infectious disease risks from bathing in fresh recreational waters in relation to the concentration of Escherichia coli, intestinal enterococci, Clostridium perfringens and somatic coliphages. Environ Health Persp 2006, 114:228-236.
• [26]van Asperen IA, Medema G, Borgdorff MW, Sprenger MJW, Havelaar AH: Risk of gastroenteritis among triathletes in relation to faecal pollution of fresh waters. Int J Epidemiol 1998, 27:309-315.
• [27]Kay D, Fleisher JM, Salmon RL, Jones F, Wyer MD, Godfree AF, Zelenauch-Jacquotte Z, Shore R: Predicting likelihood of gastroenteritis from sea bathing; results from randomised exposure. Lancet 1994, 344:905-09.
• [28]“Beaches Environmental Assessment and Coastal Health.” Title 33 U.S.Code, Sec. 1251. 2000 edition. 870-877.
• [29]Recreational Water Quality Criteria: see Appendix A: Translation of 1986 Criteria Risk to Equivalent Risk Levels for Use with New Health Data Developed Using Rapid Methods for Measuring Water Quality). (last accessed 3/24/2013. http://water.epa.gov/scitech/swguidance/standards/criteria/health/recreation/index.cfm webcite
• [30]McCulloch CE, Searle SR: Generalized, Linear, and Mixed Models. NY: John Wiley & Sons; 2001.
• [31]Lunn DJ, Thomas A, Best N, Spiegelhalter D: WinBUGS -- a Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000, 10:325-337. http://www.mrc-bsu.cam.ac.uk/bugs/ webcite
• [32]Ntzoufras I: Bayesian Modeling Using WinBUGS. Hoboken, NJ: John Wiley & Sons; 2009.
• [33]Environmental Protection Agency US: Ambient water quality criteria for bacteria −1986, EPA 440/5–86–001. Office of Water, Washington, DC: US Environmental Protection Agency; 1986.
• [34]Wade TJ, Brenner KP SE, Haugland R, Chern E, Beach M, Wymer L, Rankin CC, Love D, Li Q, Noble R, Dufour AP: Rapidly measured indicators of recreational water quality and swimming-associated illness at marine beaches: a prospective cohort study. Environ Health 2010, 9:66. http://www.ehjournal.net/content/9/1/66 webcite BioMed Central Full Text
• [35]Wade TJ, Calderon RL, Brenner KP, Sams E, Beach M, Haugland R, Wymer L, Dufour AP: High sensitivity of children to swimming-associated gastrointestinal illness: results using a rapid assay of recreational water quality. Epidemiology 2008, 19(3):375-383.
• [36]Colford JM, Wade TJ, Schiff KC, Wright CC, Griffith JF, Sandhu SK, Burns S, Sobsey M, Lovelace G, Weisberg SB: Water quality indicators and the risk of illness at beaches with nonpoint sources of fecal contamination. Epidemiology 2007, 18:27-35.
• [37]Altman DG, Bland JM: Interaction revisited: the difference between two estimates. Brit Med J 2003, 326:219.