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2006 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: 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
Project Period Covered by this Report: September 1, 2005 through August 31, 2006
Project Amount: $1,223,366
RFA: Microbial Risk in Drinking Water (2003)
Research Category: Health Effects , Drinking Water

Description:

Objective:

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 hospital 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, both during normal operation and during failures in the water transport system, 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 also will be estimated.

Progress Summary:

In the second year of the grant, we completed water quality and ED data collection and compiled the analytical dataset. Water quality data were obtained for all 10 major drinking water treatment plants serving the study area from 1993 through 2004. Data collected include daily measures of water usage and production; raw and filtered water quality, including turbidity; and finished water quality measurements, including chlorine residual. We also collected data on water quality measures taken from the distribution system on a regular basis, including chlorine residual for all sampling sites and coliform levels and/or heterotrophic plate counts from some sampling sites. We completed collection of ED data from the Atlanta-metro area, compiling a dataset containing data for 12 years, from 1993 through 2004. Forty-one of 42 hospitals serving the greater 20-county metro area have contributed data. The database has been updated to include case groups for GI illness. These data have been cleaned and are prepared for analysis.

Distribution system modeling is in progress. In November 2005, we met with 2 of the 5 utilities with available hydraulic models. Each utility explained the details of its model to the study team and provided us with the actual model. We remain in frequent contact with the utilities regarding details and questions about the hydraulic models. Water age estimates for one of these utilities have been completed and the estimates from the other model currently are being compiled. The remaining three utilities with available hydraulic models will be contacted for meetings in the near future and a similar protocol will be followed for obtaining and working with their models.

Epidemiological analyses addressing the research aims of the protocol are in progress. We have presented results from these analyses at national and international conferences, and manuscripts for publication are being prepared.

Future Activities:

In the next year (Year 3), we will perform the following activities: (1) complete estimation of water age using hydraulic models; (2) complete analysis assessing the association between estimated water age and other measures of pathogen intrusion vulnerability and ED visits for GI illness; (3) complete analysis assessing the association between drinking water treatment plant and ED visits for GI illness; (4) complete analysis assessing the association between measured water quality parameters and ED visits for GI illness; (5) assess susceptible subpopulations; (6) assess measurement error; and (7) continue to prepare publications and presentations to disseminate results of the research.

Journal Articles:

No journal articles submitted with this report: View all 3 publications for this project

Supplemental Keywords:

water, drinking water, exposure, risk, health effects, human health, population, sensitive populations, children, elderly, pathogens, dose-response, public policy, socioeconomic, epidemiology, modeling, Georgia, GA, , POLLUTANTS/TOXICS, ENVIRONMENTAL MANAGEMENT, Water, INTERNATIONAL COOPERATION, Scientific Discipline, Health, RFA, PHYSICAL ASPECTS, Risk Assessment, Drinking Water, Risk Assessments, Health Risk Assessment, Physical Processes, Epidemiology, Environmental Chemistry, Microorganisms, bacteria, drinking water contaminants, exposure assessment, treatment, water quality, Atlanta, health effects, gastrointestinal health, groundwater, human health risk, groundwater disinfection, dietary ingestion exposures, human health effects, water disinfection, other - risk assessment, waterborne disease, groundwater contamination, drinking water treatment, microbial risk, exposure, microbial contamination, human health, gastrointestinal health effects, human exposure

Progress and Final Reports:
2005 Progress Report
Original Abstract

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The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.

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