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. 2018 Nov 14;15(11):2551.
doi: 10.3390/ijerph15112551.

Impact of Drinking Water Quality on the Development of Enteroviral Diseases in Korea

Yadav P Joshi  1   2   3 , Jong-Hun Kim  4 , Ho Kim  5 , Hae-Kwan Cheong  6
Affiliations

Impact of Drinking Water Quality on the Development of Enteroviral Diseases in Korea

Yadav P Joshi et al. Int J Environ Res Public Health. .

Abstract

Enterovirus diseases are fecal-orally transmitted, and its transmission may be closely related with the drinking water quality and other environmental factors. This study aimed to assess the association between environmental factors including drinking water quality and the incidence of enteroviral diseases in metropolitan provinces of Korea. Using monthly number of hand-foot-mouth disease (HFMD), aseptic meningitis (AM) and acute hemorrhage conjunctivitis (AHC) cases, generalized linear Poisson model was applied to estimate the effects of environmental factors on the monthly cases. An increase of mean temperature was associated with an increase of enteroviral diseases at 0⁻2 months lag, while an increase of turbidity was associated with increase in HFMD at 1 month lag and a decrease in AHC. An increase of residual chlorine in municipal drinking water was associated with a decrease in HFMD and AHC 2 and 3 months later. An increase of pH was associated with a maximum increase in AM 3 months later. The meta-analysis revealed the effects of the provincial and pooled variation in percent change of risks of environmental factors on HFMD, AM, and AHC cases at specific selected lags. This study suggests that the drinking water quality is one of the major determinants on enteroviral diseases.

Keywords: Poisson regression; enteroviruses; meta-analysis; temperature; water quality parameters.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Map of geographical areas of Korea showing the six metropolitan provinces studied for model. The left panel shows the study sites in Korea map, and the right panel highlights the location of Korea in Asia.
Figure 2
Figure 2
Monthly and yearly distributions of (A) HFMD, (B) AM, and (C) AHC cases with environmental factors in seven metropolitan provinces of Korea from 2010 to 2015. HFMD: hand-foot-mouth disease, AM: aseptic meningitis, AHC: acute hemorrhagic conjunctivitis.
Figure 3
Figure 3
Poisson regression model showing associations between environmental variables and the monthly number of (A) HFMD, (B) AM, and (C) AHC cases from 2010 to 2015 in seven metropolitan provinces of Korea. † Monthly average of mean temperature (°C); ‡ monthly average of turbidity (NTU), § monthly average of residual chlorine (mg/L) and ‡ monthly average pH (mg/L). HFMD: hand-foot-mouth disease, AM: aseptic meningitis, AHC: acute hemorrhagic conjunctivitis.
Figure 4
Figure 4
Percent change risk and meta-analysis for (A) HFMD, (B) AM, and (C) AHC cases from 2010 to 2015 in seven metropolitan provinces of Korea. HFMD: hand-foot-mouth disease, AM: aseptic meningitis, AHC: acute hemorrhagic conjunctivitis.
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