The University of North Carolina, Chapel Hill, Department of Environmental Sciences and Engineering, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, USA.
Suez, Centre International de Recherche sur l'Eau et l'Environnement (CIRSEE), 38 rue du President Wilson, 78230, Le Pecq, France.
Int J Hyg Environ Health. 2018 May;221(4):714-726. doi: 10.1016/j.ijheh.2018.04.001. Epub 2018 Apr 6.
Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, can help drinking water suppliers to proactively identify potential risks and implement preventive barriers that improve safety. Few studies have investigated long-term impacts of WSPs, such as changes in drinking water quality or public health; however, some evidence from high-income countries associates WSP implementation with a reduction in diarrheal disease. To validate the previously observed linkages between WSPs and health outcomes, this time series study examined site-specific relationships between water-related exposures and acute gastroenteritis rates at three locations in France and Spain, including the role of WSP status. Relationships between control or exposure variables and health outcomes were tested using Poisson regression within generalized additive models. Controls included suspected temporal trends in disease reporting. Exposures included temperature, precipitation, raw water quality, and finished water quality (e.g., turbidity, free chlorine). In France, daily acute gastroenteritis cases were tracked using prescription reimbursements; Spanish data aggregated monthly acute gastroenteritis hospital visits. The models identified several significant relationships between indicators of exposure and acute gastroenteritis. Lag times of 6-9 days (including transit time) were most relevant for hydrological indicators (related to precipitation, runoff, and flow) at the two French sites, indicative of viral pathogens. Flush events (defined as surface runoff after a two-week antecedent dry period) linked to nonpoint source pollution were associated with a 10% increase in acute gastroenteritis rates at one location supplied by surface water. Acute gastroenteritis rates were positively associated with elevated turbidity average or maximum values in finished water at locations supplied by both surface and groundwater, by about 4% per 1-NTU increase in the two-week moving average of daily maxima or about 10% per 0.1 NTU increase in the prior month's average value. In some cases, risk appeared to be mitigated by WSP-related treatment interventions. Our results suggest drinking water exposure is associated with some potentially preventable gastrointestinal illness risk in high-income regions.
水安全计划（WSPs）自 2004 年以来一直受到世界卫生组织的推荐，可以帮助饮用水供应商主动识别潜在风险并实施预防性措施，从而提高安全性。很少有研究调查 WSP 的长期影响，例如饮用水质量或公共卫生的变化；然而，一些来自高收入国家的证据表明，WSP 的实施与腹泻病的减少有关。为了验证之前观察到的 WSP 与健康结果之间的联系，本时间序列研究在法国和西班牙的三个地点，检查了与水暴露有关的特定地点的关系与急性肠胃炎发病率之间的关系，包括 WSP 状况的作用。使用广义加性模型中的泊松回归检验控制或暴露变量与健康结果之间的关系。控制包括疾病报告的可疑时间趋势。暴露包括温度、降水、原水质量和出水质量（例如浊度、游离氯）。在法国，使用处方报销跟踪每日急性肠胃炎病例；西班牙数据汇总了每月急性肠胃炎住院就诊情况。该模型确定了暴露指标与急性肠胃炎之间的几个显著关系。在法国的两个地点，与水文指标（与降水、径流和流量有关）相关的暴露的滞后时间为 6-9 天（包括传输时间），这表明与病毒病原体有关。与非点源污染有关的冲洗事件（定义为两周前干燥期后表面径流）与一个由地表水供水的地点的急性肠胃炎发病率增加 10%有关。急性肠胃炎发病率与地表水和地下水供水地点的出水浊度平均值或最大值呈正相关，每两周每日最大值移动平均值增加 1NTU 约增加 4%，前一个月的平均值增加 0.1NTU 约增加 10%。在某些情况下，风险似乎通过与 WSP 相关的治疗干预而降低。我们的结果表明，在高收入地区，饮用水暴露与一些潜在可预防的胃肠道疾病风险有关。
