Arnold Benjamin F, Wade Timothy J, Benjamin-Chung Jade, Schiff Kenneth C, Griffith John F, Dufour Alfred P, Weisberg Stephen B, Colford John M
Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
Am J Public Health. 2016 Sep;106(9):1690-7. doi: 10.2105/AJPH.2016.303279. Epub 2016 Jul 26.
To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden.
We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures.
Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden.
The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.
提供与娱乐用水接触相关的肠胃炎风险和疾病负担的汇总估计值，并确定儿童是否具有更高的风险和负担。
我们合并了来自美国各地海洋和淡水海滩的13个前瞻性队列的个体参与者数据（n = 84411）。我们在接触后10天内测量了发病结果：腹泻、胃肠道疾病、日常活动（工作、上学、度假）缺失以及就医情况。我们估计了结果与两种接触之间的关系：全身浸入式游泳和水中肠球菌属粪便指示菌水平。我们还估计了与这些接触相关的人群归因风险。
用水接触占腹泻发作的21%和日常活动缺失的9%，但与导致就医的肠胃炎无关。0至4岁和5至10岁的儿童接触水的情况最多，水质水平与疾病之间的关联更强，并且占可归因疾病负担的比例最大。
幼儿中较高的肠胃炎风险和相关负担提供了重要的新信息，可为未来旨在保护公众健康的娱乐用水质量指南提供参考。
