Community-Randomized Intervention Trial with UV Disinfection for Estimating the Risk of Pediatric Illness from Municipal Groundwater ConsumptionEPA Grant Number: R831630
Title: Community-Randomized Intervention Trial with UV Disinfection for Estimating the Risk of Pediatric Illness from Municipal Groundwater Consumption
Investigators: Borchardt, Mark , Belongia, Edward , Kieke, Amy , Kieke, Burney , Loge, Frank
Current Investigators: Borchardt, Mark , Belongia, Edward , Kieke, Burney , Loge, Frank
Institution: Marshfield Clinic Research Foundation , Washington State University
EPA Project Officer: Klieforth, Barbara I
Project Period: January 1, 2005 through December 31, 2007 (Extended to December 31, 2009)
Project Amount: $2,289,169
RFA: Microbial Risk in Drinking Water (2003) RFA Text | Recipients Lists
Research Category: Drinking Water , Water , Health Effects
The goal of this study is to estimate the risk of childhood febrile and gastrointestinal illnesses associated with drinking municipal water from a groundwater source. The risk estimate will be partitioned into two separate components— illness attributable to contaminated groundwater and illness attributable to vulnerabilities in the water distribution system.
Approximately 50% of all waterborne disease outbreaks in the US are related to contaminated groundwater, and national surveys have shown that approximately 30% of drinking water wells are contaminated with human pathogenic viruses. However, it is unknown whether these microbial contaminants are responsible for a significant fraction of endemic (i.e., non-outbreak) illness or if they are effectively inactivated by standard disinfection practices. The primary objective of this study is to estimate the attributable risk for acute gastrointestinal illness (AGI) and febrile illness (FI) for children who drink municipal water in communities that use chlorinated or unchlorinated groundwater. A secondary objective is to determine if there is an association between the drinking water concentration of viruses on the EPA Contaminate Candidate List (CCL) and community rates of AGI and FI.
The study design is a community-randomized intervention trial with a cross-over component. Seven intervention communities will have UV disinfection reactors installed at all their wellheads and seven control communities will continue their current disinfection practices. Active surveillance for AGI and FI will be conducted among children in participating households for six months. The intervention and control communities will then cross-over, with removal of UV reactors from the original intervention communities and installation of reactors in the original control communities. All communities will be tracked for another six-month period. Each community will serve as its own control in a matched analysis of illness rates. Households with children 12 months to 12 years old will be eligible to participate with a target sample size of 62 households per community. An adult in each household will complete a weekly health status survey for each eligible child. Stool specimens from children with AGI will be analyzed for bacterial, protozoan, and viral pathogens. Water samples obtained monthly from all wellheads and 10 households in every community will be analyzed quantitatively for pathogenic viruses using fluorescence-based real-time PCR. Attributable risk due to source water will be calculated as the difference in illness incidence between control and intervention periods. Risk due to the distribution system will be estimated using a risk-assessment approach based on measured virus concentrations.
The use of group-randomized design with multiple communities will provide a valid and representative measure of risk to help guide policies for safe drinking water. The results will also address the public health significance of water contamination with four viruses on the EPA CCL, noroviruses, adenoviruses 40/41, coxsackievirus, and echovirus.