Ligon Grant, Bartram Jamie
The Water Institute and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
Int J Environ Res Public Health. 2016 May 27;13(6):527. doi: 10.3390/ijerph13060527.
Waterborne disease outbreaks attributed to various pathogens and drinking water system characteristics have adversely affected public health worldwide throughout recorded history. Data from drinking water disease outbreak (DWDO) reports of widely varying breadth and depth were synthesized to investigate associations between outbreak attributes and human health impacts. Among 1519 outbreaks described in 475 sources identified during review of the primarily peer-reviewed, English language literature, most occurred in the U.S., the U.K. and Canada (in descending order). The outbreaks are most frequently associated with pathogens of unknown etiology, groundwater and untreated systems, and catchment realm-associated deficiencies (i.e., contamination events). Relative frequencies of outbreaks by various attributes are comparable with those within other DWDO reviews, with water system size and treatment type likely driving most of the (often statistically-significant at p < 0.05) differences in outbreak frequency, case count and attack rate. Temporal analysis suggests that while implementation of surface (drinking) water management policies is associated with decreased disease burden, further strengthening of related policies is needed to address the remaining burden attributed to catchment and distribution realm-associated deficiencies and to groundwater viral and disinfection-only system outbreaks.
在有记录的历史中，由各种病原体和饮用水系统特征导致的水源性疾病暴发在全球范围内对公众健康产生了不利影响。综合了来自广度和深度差异很大的饮用水疾病暴发（DWDO）报告的数据，以调查暴发特征与人类健康影响之间的关联。在对主要为同行评审的英文文献进行综述期间确定的475个来源中描述的1519次暴发中，大多数发生在美国、英国和加拿大（按降序排列）。这些暴发最常与病因不明的病原体、地下水和未处理系统以及集水区相关的缺陷（即污染事件）有关。各种特征的暴发相对频率与其他DWDO综述中的频率相当，水系统规模和处理类型可能是导致暴发频率、病例数和发病率差异（通常在p<0.05时具有统计学意义）的主要原因。时间分析表明，虽然地表水（饮用水）管理政策的实施与疾病负担的降低有关，但仍需要进一步加强相关政策，以应对集水区和配水领域相关缺陷以及地下水病毒和仅消毒系统暴发造成的剩余负担。
