Department of Infection Control and Preparedness, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, Oslo, 0213, Norway.
Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway.
BMC Public Health. 2024 Aug 5;24(1):2107. doi: 10.1186/s12889-024-19607-2.
The delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway.
We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.
In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2-4% of AGI in Norway is attributable to drinking tap water.
This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.
安全饮用水的供应具有很高的公共卫生相关性，这反映在可持续发展目标（SDG6）中。在高收入国家，几项预防措施已经降低了与传染病相关的负担；然而，水源污染、消毒不足、管道系统陈旧，以及人们越来越意识到饮用水分配系统的入侵是与饮用水相关的胃肠道疾病的危险因素。由于患有自限性胃肠道感染的人不太可能寻求医疗保健，因此预计与饮用水有关的水源性感染的零星病例报告不足。因此，关于水源性疾病实际负担的知识仍然有限。本研究的主要目的是估计与饮用挪威自来水中胃肠道疾病相关的风险。
我们进行了一项为期 12 个月的前瞻性队列研究，通过随机选择的电话访谈招募参与者。在启动电子调查后，我们每月通过 12 条短信问卷收集参与者特征和饮用自来水（每天 0.2 升玻璃杯的数量）、发病率、持续时间和与胃肠道疾病相关的症状的信息。使用线性混合效应模型分析饮用自来水暴露与急性胃肠道疾病（AGI）风险的关系。年龄、性别、教育水平和饮用水供应规模被确定为潜在的混杂因素，并包含在调整后的模型中。
共有 9946 人参加了这项队列研究，占所有受邀参与者的 11.5%。根据每人每月的数据（99446 份每月提交），报告了 5508 人/月（5.5/100 人/月）的 AGI。报告了 819 人/月（0.8/100 人/月）的严重 AGI。我们的研究估计，挪威有 2-4%的 AGI 归因于饮用自来水。
这是挪威最大的队列研究，估计了与挪威饮用自来水量相关的自我报告胃肠道感染的负担。数据表明，目前在挪威，水源性 AGI 不是一个负担，但需要谨慎使用这些发现。需要强调的是，必须继续努力并投资于维护挪威的饮用水供应，以解决零星水源病例的低负担并防止未来的爆发。
