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. 2015 Jun 9;54(3):194-203.
doi: 10.1515/sjph-2015-0028. eCollection 2015 Sep.

Drinking Water Quality and the Geospatial Distribution of Notified Gastro-Intestinal Infections

Eva Grilc  1 , Ivanka Gale  2 , Aleš Veršič  3 , Tina Žagar  4 , Maja Sočan  1
Affiliations

Drinking Water Quality and the Geospatial Distribution of Notified Gastro-Intestinal Infections

Eva Grilc et al. Zdr Varst. .

Abstract
in English, Slovenian

Introduction: Even brief episodes of fecal contamination of drinking water can lead directly to illness in the consumers. In water-borne outbreaks, the connection between poor microbial water quality and disease can be quickly identified. The impact of non-compliant drinking water samples due to E. coli taken for regular monitoring on the incidence of notified acute gastrointestinal infections has not yet been studied.

Methods: The objective of this study was to analyse the geographical distribution of notified acute gastrointestinal infections (AGI) in Slovenia in 2010, with hotspot identification. The second aim of the study was to correlate the fecal contamination of water supply system on the settlement level with the distribution of notified AGI cases. Spatial analysis using geo-information technology and other methods were used.

Results: Hot spots with the highest proportion of notified AGI cases were mainly identified in areas with small supply zones. The risk for getting AGI was drinking water contaminated with E. coli from supply zones with 50-1000 users: RR was 1.25 and significantly greater than one (p-value less than 0.001).

Conclusion: This study showed the correlation between the frequency of notified AGI cases and non-compliant results in drinking water monitoring.

Uvod: Tudi kratkotrajna obdobja fekalne kontaminacije pitne vode lahko pri uporabnikih povzročijo bolezen. Povezavo med slabo mikrobiološko kvaliteto pitne vode in boleznijo lahko hitro odkrijemo med hidričnimi izbruhi. Vpliv zaradi prisotnosti E.coli neskladnih vodnih vzorcev, odvzetih v okviru rednega monitoringa, na incidence akutnih gastroenterokolitisov še ni raziskan.

Metode: Cilj raziskave je bil analizirati geografsko razporeditev prijavljenih akutnih gastroenterokolitisov (AGI) v Sloveniji v letu 2010 in določiti mesta, kjer se ti kopičijo. Drugi cilj raziskave je bil ugotoviti, ali obstaja korelacija med fekalno kontaminacijo vodnih virov in porazdelitvijo prijavljenih primerov AGI. V ta namen smo naredili prostorsko analizo ter uporabili geoinformacijsko tehnologijo in druge metode.

Rezultati: Mesta kopičenja z najvišjim deležem prijavljenih primerov AGI so na območjih z majhnimi vodooskrbnimi sistemi. Tveganje, da zbolimo za AGI, če smo pili vodo, kontaminirano z E.coli, na vodooskrbnih območjih s 50–1000 uporabniki, je znašalo 1,25 in je bilo signifikantno višje od 1 (p ≤ 0,001).

Zaključek: Raziskava je pokazala korelacijo med pogostostjo prijavljenih primerov AGI in neskladnimi vzorci pitne vode v okviru monitoringa pitne vode.

Keywords: GIS; acute gastrointestinal infections; drinking water monitoring; fecal pollution of drinking water; quality of drinking water; surveillance.

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Figures

Figure 1
Figure 1
The flowchart of the data (notified acute gastrointestinal infection cases and the results of drinking water monitoring) exclusion and linking. * Patients living in a settlement not linked to a supply zone are supplied with the drinking water from an individual water supply system serving less than 50 users, and, therefore, they were not included in the analysis. However, there is the possibility of a supply zone having users in more than one village, and there is not a sampling point in all villages. The available data does not provide adequate information to link a supply zone to such a village. The Register of public water supply systems could not be used to more precisely determine the residence of the remaining patients from the first note, and, thus, we were unable to link them to the supply zones. Such a procedure could not be automated, and it requires a lot of manual work due to the non-connectivity of the databases. ** For 17 out of 1204 patients with AGI who were checked manually to identify the supply zone, the zone could not be recognized, and they were, therefore, excluded from the analysis.
Figure 2
Figure 2
Map 1. The spatial distribution of notified AGI cases (the proportion of inhabitants with AGI per settlement) in 2010 in Slovenia.
Figure 3
Figure 3
Map 2. The results of the monitoring of drinking water quality and the geographical distribution of notified AGI cases.
See this image and copyright information in PMC

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