Gargano J W, Adam E A, Collier S A, Fullerton K E, Feinman S J, Beach M J
Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
J Water Health. 2017 Jun;15(3):438-450. doi: 10.2166/wh.2017.301.
Diseases spread by water are caused by fecal-oral, contact, inhalation, or other routes, resulting in illnesses affecting multiple body systems. We selected 13 pathogens or syndromes implicated in waterborne disease outbreaks or other well-documented waterborne transmission (acute otitis externa, Campylobacter, Cryptosporidium, Escherichia coli (E. coli), free-living ameba, Giardia, Hepatitis A virus, Legionella (Legionnaires' disease), nontuberculous mycobacteria (NTM), Pseudomonas-related pneumonia or septicemia, Salmonella, Shigella, and Vibrio). We documented annual numbers of deaths in the United States associated with these infections using a combination of death certificate data, nationally representative hospital discharge data, and disease-specific surveillance systems (2003-2009). We documented 6,939 annual total deaths associated with the 13 infections; of these, 493 (7%) were caused by seven pathogens transmitted by the fecal-oral route. A total of 6,301 deaths (91%) were associated with infections from Pseudomonas, NTM, and Legionella, environmental pathogens that grow in water system biofilms. Biofilm-associated pathogens can cause illness following inhalation of aerosols or contact with contaminated water. These findings suggest that most mortality from these 13 selected infections in the United States does not result from classical fecal-oral transmission but rather from other transmission routes.
通过水传播的疾病是由粪口传播、接触传播、吸入传播或其他途径引起的，会导致影响多个身体系统的疾病。我们选择了13种与水源性疾病暴发或其他有充分记录的水源性传播相关的病原体或综合征（急性外耳道炎、弯曲杆菌、隐孢子虫、大肠杆菌、自由生活阿米巴、贾第虫、甲型肝炎病毒、军团菌（军团病）、非结核分枝杆菌、假单胞菌相关肺炎或败血症、沙门氏菌、志贺氏菌和弧菌）。我们结合死亡证明数据、全国代表性医院出院数据和特定疾病监测系统（2003 - 2009年），记录了美国每年与这些感染相关的死亡人数。我们记录了每年与这13种感染相关的6939例总死亡；其中，493例（7%）由通过粪口途径传播的7种病原体引起。共有6301例死亡（91%）与假单胞菌、非结核分枝杆菌和军团菌感染相关，这些是在水系统生物膜中生长的环境病原体。与生物膜相关的病原体可在吸入气溶胶或接触受污染水后导致疾病。这些发现表明，在美国，这13种选定感染导致的大多数死亡并非由经典的粪口传播引起，而是由其他传播途径导致。
