2007 Progress Report: Drinking Water Quality and Emergency Visits for Gastroenteritis in Atlanta

EPA Grant Number: R831629
Title: Drinking Water Quality and Emergency Visits for Gastroenteritis in Atlanta
Investigators: Tolbert, Paige , Amirtharajah, A. , Flanders, Dana , Hooper, Stuart , Klein, Mitchel , Moe, Christine L. , Singer, Philip C. , Tinker, Sarah , Uber, Jim
Institution: University of North Carolina at Chapel Hill , Emory University , Georgia Institute of Technology , University of Cincinnati
Current Institution: Emory University , Georgia Institute of Technology , University of Cincinnati , University of North Carolina at Chapel Hill
EPA Project Officer: Page, Angela
Project Period: September 1, 2004 through August 31, 2007 (Extended to August 31, 2008)
Project Period Covered by this Report: September 1, 2006 through August 31,2007
Project Amount: $1,223,366
RFA: Microbial Risk in Drinking Water (2003) RFA Text |  Recipients Lists
Research Category: Drinking Water , Water , Health Effects


The objective of this research is to assess the relationship between drinking water quality and the incidence of gastrointestinal (GI) illness and develop an estimate for the proportion of endemic GI illness that can be attributed to water quality degradation within the distribution system. The research takes advantage of an extensive database containing information on emergency department (ED) visits in the 20-county Atlanta-metro area from 1993 through 2004. Water quality data are assembled from a variety of sources within the five-county Atlanta-metro area. The relationship between drinking water quality and GI illness is being examined by temporal and spatial analyses of counts of ED visits for GI complaints with levels of estimated water quality, both in the general population and in susceptible subpopulations. The modifying effect of the drinking water distribution system on the quality of water measured as it is leaving the treatment plant is being examined. The impact of treatment changes on water quality and levels of endemic GI illness in Atlanta is being considered. The proportion of risk for GI illness attributable to microbial contamination at the treatment plant and within the distribution system will be estimated. The impact of measurement error on these analyses will also be estimated.

Progress Summary:

In the third year of the grant, we completed the primary analyses addressing the majority of our research aims, which were to:  
Assess the association between rates of ED visits for GI illness and estimated residence times of drinking water serving the study area;
Assess heterogeneity in the rates of ED visits for GI illness among the service areas of different drinking water treatment plants;
Assess the temporal association between daily counts of ED visits for GI illness and drinking water turbidity;
Assess whether changes in drinking water treatment practices over time were reflected in changes in drinking water quality or the incidence of GI illness;
Assess the association between drinking water quality and GI illness among susceptible subgroups;
Estimate the population attributable fraction of ED visits for GI illness due to microbial contamination of drinking water.
Results of these analyses have been presented at major conferences and multiple manuscripts are in preparation or in the process of submission. Distribution system modeling to produce estimates of water residence time (water age) has been completed for two utilities, and is ongoing for an additional utility. We held a series of meetings with the participating utilities in October 2007 to present our results and obtain their feedback.

Future Activities:

In the next year (Year 4), we will perform the following activities: (1) complete estimation of water residence time using hydraulic models from additional utility; (2) conduct secondary and sensitivity analyses to additionally address study aims; (3) continue to disseminate results of the research through presentations and the submission of manuscripts for publication in peer-reviewed journals.

Journal Articles on this Report : 1 Displayed | Download in RIS Format

Other project views: All 13 publications 2 publications in selected types All 2 journal articles
Type Citation Project Document Sources
Journal Article Tinker SC, Moe CL, Klein M, Flanders WD, Uber J, Amirtharajah A, Singer P, Tolbert PE. Drinking water turbidity and emergency department visits for gastrointestinal illness in Atlanta, 1993-2004. Journal of Exposure Science & Environmental Epidemiology 2010;20(1):19-28. R831629 (2007)
R831629 (Final)
R829213 (Final)
R830376 (2006)
  • Abstract from PubMed
  • Full-text: Nature Publishing Group-Full Text HTML
  • Abstract: Nature Publishing Group-Abstract
  • Other: Nature Publishing Group-PDF
  • Supplemental Keywords:

    RFA, Health, Scientific Discipline, INTERNATIONAL COOPERATION, Water, POLLUTANTS/TOXICS, Environmental Chemistry, Health Risk Assessment, Epidemiology, Risk Assessments, Drinking Water, Microorganisms, groundwater disinfection, health effects, microbial contamination, bacteria, human health effects, waterborne disease, other - risk assessment, Atlanta, treatment, human exposure, microbial effects, water quality, microbial risk, water disinfection, groundwater contamination, dietary ingestion exposures, drinking water contaminants, drinking water treatment, human health, gastrointestinal health, groundwater, gastrointestinal health effects

    Progress and Final Reports:

    Original Abstract
  • 2005 Progress Report
  • 2006 Progress Report
  • Final Report