From the aSchool of Public Health, University of California, Berkeley, Berkeley, CA; bEnvironmental Protection Agency, National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC; cSouthern California Coastal Water Research Project Authority, Costa Mesa, CA; and dUnited States Environmental Protection Agency, National Exposure Research Laboratory, Cincinnati, OH.
Epidemiology. 2017 Sep;28(5):644-652. doi: 10.1097/EDE.0000000000000681.
Coliphages have been proposed as indicators of fecal contamination in recreational waters because they better mimic the persistence of pathogenic viruses in the environment and wastewater treatment than fecal indicator bacteria. We estimated the association between coliphages and gastrointestinal illness and compared it with the association with culturable enterococci.
We pooled data from six prospective cohort studies that enrolled coastal beachgoers in California, Alabama, and Rhode Island. Water samples were collected and gastrointestinal illness within 10 days of the beach visit was recorded. Samples were tested for enterococci and male-specific and somatic coliphages. We estimated cumulative incidence ratios (CIR) for the association between swimming in water with detectable coliphage and gastrointestinal illness when human fecal pollution was likely present, not likely present, and under all conditions combined. The reference group was unexposed swimmers. We defined continuous and threshold-based exposures (coliphage present/absent, enterococci >35 vs. ≤35 CFU/100 ml).
Under all conditions combined, there was no association between gastrointestinal illness and swimming in water with detectable coliphage or enterococci. When human fecal pollution was likely present, coliphage and enterococci were associated with increased gastrointestinal illness, and there was an association between male-specific coliphage level and illness that was somewhat stronger than the association between enterococci and illness. There were no substantial differences between male-specific and somatic coliphage.
Somatic coliphage and enterococci had similar associations with gastrointestinal illness; there was some evidence that male-specific coliphage had a stronger association with illness than enterococci in marine waters with human fecal contamination.
噬菌体已被提议作为娱乐水中粪便污染的指示物，因为它们比粪便指示细菌更能模拟环境和废水处理中致病性病毒的持久性。我们评估了噬菌体与胃肠道疾病之间的关联，并将其与可培养肠球菌的关联进行了比较。
我们汇总了六项前瞻性队列研究的数据，这些研究招募了加利福尼亚州、阿拉巴马州和罗得岛州沿海海滩游客。采集水样，并记录海滩访问后 10 天内的胃肠道疾病。对肠球菌和男性特异性噬菌体和体细胞噬菌体进行了检测。当人类粪便污染可能存在、不太可能存在以及在所有情况下，我们估计了游泳水中可检测到噬菌体与胃肠道疾病之间关联的累积发病率比（CIR）。游泳者未暴露于参考组。我们定义了连续和基于阈值的暴露（噬菌体存在/不存在，肠球菌>35 vs. ≤35 CFU/100ml）。
在所有情况下，游泳水中可检测到噬菌体或肠球菌与胃肠道疾病之间均无关联。当人类粪便污染可能存在时，噬菌体和肠球菌与胃肠道疾病的增加有关，并且男性特异性噬菌体水平与疾病之间存在关联，这种关联比肠球菌与疾病之间的关联略强。男性特异性噬菌体和体细胞噬菌体之间没有实质性差异。
体细胞噬菌体和肠球菌与胃肠道疾病有相似的关联；在人类粪便污染的海洋水中，有证据表明男性特异性噬菌体与肠球菌相比与疾病的关联更强。
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