2006 Progress Report: Community-Randomized Intervention Trial with UV Disinfection for Estimating the Risk of Pediatric Illness from Municipal Groundwater Consumption

EPA 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, Burney , Loge, Frank
Institution: Marshfield Clinic Research Foundation , Washington State University
EPA Project Officer: Hiscock, Michael
Project Period: January 1, 2005 through December 31, 2007 (Extended to December 31, 2009)
Project Period Covered by this Report: January 1, 2006 through December 31,2006
Project Amount: $2,289,169
RFA: Microbial Risk in Drinking Water (2003) RFA Text |  Recipients Lists
Research Category: Drinking Water , Water , Health Effects


  1. Estimate the attributable risk for acute gastrointestinal illness (AGI) and febrile illness from drinking municipal water in communities that use non-disinfected groundwater.
  2. Partition the attributable risk for AGI and febrile illness into two components, risk related to contaminated source waters and risk related to water distribution systems.
  3. Determine if there is an association between virus concentration in water (e.g., adenoviruses 40/41, coxsackievirus, echovirus, and noroviruses) and community illness rates.

Progress Summary:

After spending the first year preparing to launch the full study, the Year 2 activities focused primarily on data collection.  All data collection plans were implemented as described in the original proposal. 

The first surveillance period began on April 10, 2006, and continued for 12 weeks until June 2, 2006.  Every week the study families completed their health diaries and mailed them to the study team.  The health data were entered into a database as it arrived daily, and all study families were tracked in real-time for their compliance in submitting the diaries.  Families that were 1 week late with their submissions received a phone call reminder from a study coordinator.  Families that did not return any forms received a letter dropping them from the study.  Significant effort was spent ensuring that all health diaries were returned in a timely manner. 

During the 12-week surveillance period, water samples for virus analyses were collected three times, approximately monthly, from each of the 14 study communities.  Samples were taken from the drinking water wells, immediately following UV disinfection at the wellhead if the community was subject to the UV intervention, and at six to eight households per community to represent the distribution system water quality.  All samples were processed and archived for later analysis.

At the end of the 12-week period, the water superintendents of the 14 communities completed a survey in which they reported events and activities related to the operation and maintenance of the drinking water distribution system in their community.  Data were also collected on the volume of water pumped from each well.   

TThe second 12-week surveillance period began September 4, 2006, and ended November 26, 2006.  Surveillance and water sampling were not conducted in the summer months.  In the second period, the same data collection efforts as the first period were performed.  In addition, every study subject submitted saliva specimens at the beginning of the period and every 4 weeks thereafter for a total of four specimens per study subject.  Depending on funding availability, the saliva specimens will be analyzed for enterovirus seroconversion. Enrolled into the study by the beginning of the first surveillance period were 1,786 people from 673 households in the 14 study communities.  Of the study subjects, 636 were adults and 1,150 were children between the ages of 6 months and 12 years old.  On December 31, 2006, after the two surveillance periods had been completed there remained enrolled in the study 1,363 people (875 children and 488 adults) in 522 households.  Reasons for study dropout included moving from the study community, divorce, and simply no longer interested in participating. 

In conjunction with data collection, there has been substantial effort in constructing the databases and tracking and coding systems for ensuring data quality.  For every month of surveillance, there are approximately 6,000 health diaries, 1,500 saliva specimens, and 160 water samples that must be coded and tracked.  All data management systems were quickly established and are operating successfully. 

Another time-consuming activity has been the cleaning and maintenance of the 17 UV disinfection reactors installed on the wellheads of the eight communities selected for the UV intervention in this first phase of the study design.  In some communities the UV reactors have operated flawlessly since they were installed. Other communities have high levels of iron and manganese in their wells, which can foul the UV lamps and reduce the UV dose below the 50 mJ/cm2 target.

In summary, Year 2 was a time of intensive data collection.  All study plans have been implemented and are on schedule. 

Future Activities:

In the early part of Year 3, the crossover phase of the community intervention design will be implemented in which the UV disinfection reactors will transferred from the intervention to the control communities so the controls become the interventions and the interventions become the controls. There will then be two more 12-week surveillance periods conducted at the same time of year as the surveillance periods in Year 3. At the same time as the crossover, a second enrollment effort will commence to enroll young children in the study families that were too young to be eligible during the 2006 enrollment period. In addition to the data collection activities, we will begin to analyze the water samples for human enteric viruses by quantitative RT-PCR and cell culture.

Journal Articles:

No journal articles submitted with this report: View all 26 publications for this project

Supplemental Keywords:

epidemiology, human health, pathogens,, RFA, Scientific Discipline, INTERNATIONAL COOPERATION, Water, Environmental Chemistry, Health Risk Assessment, Drinking Water, Environmental Engineering, microbial contamination, microbial risk assessment, monitoring, real time analysis, aquatic organisms, other - risk assessment, early warning, UV disinfection, children, municipal groundwater, water quality, drinking water contaminants, drinking water system

Relevant Websites:

Principal Investigator Profile http://www.marshfieldclinic.org/nfmc/pages/default.aspx?page=InvestigatorDetails&id=3 Exit
Marshfield Clinic Research Foundation http://marshfieldclinic.org/research/pages/index.aspx Exit

Progress and Final Reports:

Original Abstract
  • 2005 Progress Report
  • 2007 Progress Report
  • 2008 Progress Report
  • Final