Säve-Söderbergh Melle, Åkesson Agneta, Simonsson Magnus, Toljander Jonas
Science Division, Swedish Food Agency, 751 26 Uppsala, Sweden; Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.
Environ Int. 2020 Apr;137:105575. doi: 10.1016/j.envint.2020.105575. Epub 2020 Feb 18.
There are indications that drinking water may contribute to endemic gastrointestinal illness (GII) even when the drinking water quality meets current standards, but the knowledge is limited. In this population-based prospective study, we assessed if changes in municipal drinking water production affected the GII incidence, by collecting self-reported GII episodes among the population in two municipalities during calendar time-specific inter-annual periods. About 2600 adults in central Sweden and 2600 adults (including 700 households with children aged 0-9 years) in Southwest Sweden, were followed during a baseline and a follow-up period in 2012-2016. Monthly reports of episodes and symptoms of GII were collected by SMS. The following drinking water related changes were assessed: Change 1 (adults); a municipality with a groundwater treatment, changed to a different groundwater source with UV treatment; Change 2 (adults); a municipality with a surface water treatment changed to a groundwater source with UV treatment; and Change 3a (adults) and 3b (children): a municipality with a surface water treatment changed to a new surface water source, having a treatment with a higher pathogen reduction. We observed no evidence that changes in raw water source and/or improved pathogen removal in the drinking water treatment affected the risk of GII among adults. Among children aged 0-9 years participating in Change 3b, we observed a 24% relative risk reduction in GII incidence. These results suggest that improved water treatment may reduce the disease burden of GII in children even in settings in which water treatment efficacy meets current quality standards.
有迹象表明，即使饮用水质量符合现行标准，饮用水也可能导致地方性胃肠道疾病（GII），但这方面的知识有限。在这项基于人群的前瞻性研究中，我们通过收集两个城市特定日历年度期间人群中自我报告的GII发作情况，评估城市饮用水生产的变化是否会影响GII发病率。在2012 - 2016年的基线期和随访期，对瑞典中部约2600名成年人以及瑞典西南部2600名成年人（包括700户有0 - 9岁儿童的家庭）进行了跟踪。通过短信收集GII发作和症状的月度报告。评估了以下与饮用水相关的变化：变化1（成年人）：一个进行地下水处理的城市改为采用紫外线处理的不同地下水源；变化2（成年人）：一个进行地表水处的城市改为采用紫外线处理的地下水源；变化3a（成年人）和变化3b（儿童）：一个进行地表水处的城市改为新的地表水水源，其处理工艺对病原体的去除率更高。我们没有发现证据表明原水水源的变化和/或饮用水处理中病原体去除的改善会影响成年人患GII的风险。在参与变化3b的0 - 9岁儿童中，我们观察到GII发病率相对风险降低了24%。这些结果表明，即使在水处理效果符合现行质量标准的情况下，改善水处理也可能降低儿童GII的疾病负担。
