Napier Melanie D, Haugland Richard, Poole Charles, Dufour Alfred P, Stewart Jill R, Weber David J, Varma Manju, Lavender Jennifer S, Wade Timothy J
U.S. Environmental Protection Agency, Office of Research and Development, National Health and Environmental Effects Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA.
Environ Health. 2017 Oct 2;16(1):103. doi: 10.1186/s12940-017-0308-3.
Fecal indicator bacteria used to assess illness risks in recreational waters (e.g., Escherichia coli, Enterococci) cannot discriminate among pollution sources. To address this limitation, human-associated Bacteroides markers have been proposed, but the risk of illness associated with the presence of these markers in recreational waters is unclear. Our objective was to estimate associations between human-associated Bacteroides markers in water and self-reported illness among swimmers at 6 U.S. beaches spanning 2003-2007.
We used data from a prospectively-enrolled cohort of 12,060 swimmers surveyed about beach activities and water exposure on the day of their beach visit. Ten to twelve days later, participants reported gastroinestinal, diarrheal, and respiratory illnesses experienced since the visit. Daily water samples were analyzed for the presence of human-associated Bacteroides genetic markers: HF183, BsteriF1, BuniF2, HumM2. We used model-based standardization to estimate risk differences (RD) and 95% confidence intervals (CI). We assessed whether the presence of Bacteroides markers were modifiers of the association between general Enterococcus and illness among swimmers using interaction contrast.
Overall we observed inconsistent associations between the presence of Bacteroides markers and illness. There was a pattern of increased risks of gastrointestinal (RD = 1.9%; 95% CI: 0.1%, 3.7%), diarrheal (RD = 1.3%; 95% CI: -0.2%, 2.7%), and respiratory illnesses (RD = 1.1%; 95% CI: -0.2%, 2.5%) associated with BsteriF1. There was no evidence that Bacteroides markers acted as modifiers of Enterococcus and illness. Patterns were similar when stratified by water matrix.
Quantitative measures of fecal pollution using Bacteroides, rather than presence-absence indicators, may be necessary to accurately assess human risk specific to the presence of human fecal pollution.
用于评估娱乐水域疾病风险的粪便指示菌（如大肠杆菌、肠球菌）无法区分污染源。为解决这一局限性，有人提出了与人类相关的拟杆菌属标志物，但这些标志物在娱乐水域中的存在与疾病风险之间的关系尚不清楚。我们的目标是估计2003年至2007年期间美国6个海滩的游泳者中，水中与人类相关的拟杆菌属标志物与自我报告疾病之间的关联。
我们使用了一个前瞻性招募的队列中12,060名游泳者的数据，这些游泳者在海滩访问当天接受了关于海滩活动和水暴露情况的调查。10至12天后，参与者报告了自访问以来经历的胃肠道、腹泻和呼吸道疾病。对每日水样进行分析，以检测与人类相关的拟杆菌属基因标志物：HF183、BsteriF1、BuniF2、HumM2。我们使用基于模型的标准化方法来估计风险差异（RD）和95%置信区间（CI）。我们使用交互对比评估拟杆菌属标志物的存在是否是游泳者中总肠球菌与疾病之间关联的调节因素。
总体而言，我们观察到拟杆菌属标志物的存在与疾病之间的关联不一致。与BsteriF1相关的胃肠道疾病（RD = 1.9%；95% CI：0.1%，3.7%）、腹泻（RD = 1.3%；95% CI：-0.2%，2.7%）和呼吸道疾病（RD = 1.1%；95% CI：-0.2%，2.5%）风险有增加的趋势。没有证据表明拟杆菌属标志物是肠球菌与疾病之间关联的调节因素。按水基质分层时模式相似。
使用拟杆菌属而非存在-缺失指标对粪便污染进行定量测量，可能是准确评估人类粪便污染存在所特有的人类风险所必需的。
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