O'Toole Joanne, Sinclair Martha, Gibney Katherine, Leder Karin
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Victoria 3004, Melbourne, Australia E-mail:
J Water Health. 2015 Sep;13(3):662-70. doi: 10.2166/wh.2015.201.
The health-based targets of 1 in 10,000 for infection and 10(-6) disability adjusted life years (DALYs) per person per year are increasingly being considered, or have already been adopted, to define microbial safety targets for water. The aim of this paper is to convey information about how these two targets compare by converting each of the target values to a common metric. The metric chosen for viral (rotavirus and norovirus) and protozoan (Cryptosporidium) reference pathogens is the estimated maximum number of annual drinking water-associated cases of acute diarrhoeal disease tolerated. For the reference bacterial pathogen Campylobacter, sequelae to acute diarrhoeal illness have also been considered in estimating the tolerable number of cases for the DALY target. Also investigated is whether non-compliance with targets would be detected as a waterborne disease outbreak by the health surveillance system in an extreme hypothetical situation whereby all tolerable cases per annum occurred as a single event. The paper highlights that verification of compliance with targets cannot be demonstrated by the absence of reported drinking water-associated outbreaks alone and concludes that introduction of a quantitative health-based outcome for drinking water in Australia would help improve water quality management by providing a common goal directly linked to health outcomes.
越来越多的人开始考虑，或者已经采用了基于健康的指标，即感染率为万分之一，每人每年的伤残调整生命年（DALY）为10的负6次方，来定义水的微生物安全指标。本文的目的是通过将每个指标值转换为一个通用指标，来传达这两个指标如何进行比较的信息。针对病毒（轮状病毒和诺如病毒）和原生动物（隐孢子虫）参考病原体所选择的指标，是每年与饮用水相关的急性腹泻病可耐受病例的估计最大数量。对于参考细菌病原体弯曲杆菌，在估计DALY指标的可耐受病例数时，也考虑了急性腹泻疾病的后遗症。本文还研究了在一种极端假设情况下，即每年所有可耐受病例都作为单一事件发生时，卫生监测系统是否会将未达到指标的情况检测为水源性疾病暴发。本文强调，仅靠没有报告与饮用水相关的疫情，并不能证明符合指标，得出的结论是，在澳大利亚引入基于健康的定量饮用水结果，将有助于通过提供一个直接与健康结果相关的共同目标来改善水质管理。
