Benjamin F Arnold1, Timothy J Wade1, Jade Benjamin-Chung1, Kenneth C Schiff1, John F Griffith1, Alfred P Dufour1, Stephen B Weisberg1, John M Colford1. 1. Benjamin F. Arnold, Jade Benjamin-Chung, and John M. Colford Jr are with the Division of Epidemiology, School of Public Health, University of California, Berkeley. Timothy J. Wade is with the US Environmental Protection Agency (EPA), National Health and Environmental Effects Research Laboratory, Research Triangle Park, NC. Kenneth C. Schiff, John F. Griffith, and Stephen B. Weisberg are with the Southern California Coastal Water Research Project, Costa Mesa, CA. Alfred P. Dufour is with the US EPA, National Exposure Research Laboratory, Cincinnati, OH.
Abstract
OBJECTIVES: To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. METHODS: We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. RESULTS: Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. CONCLUSIONS: The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.
OBJECTIVES: To provide summary estimates of gastroenteritis risks and illness burden associated with recreational water exposure and determine whether children have higher risks and burden. METHODS: We combined individual participant data from 13 prospective cohorts at marine and freshwater beaches throughout the United States (n = 84 411). We measured incident outcomes within 10 days of exposure: diarrhea, gastrointestinal illness, missed daily activity (work, school, vacation), and medical visits. We estimated the relationship between outcomes and 2 exposures: body immersion swimming and Enterococcus spp. fecal indicator bacteria levels in the water. We also estimated the population-attributable risk associated with these exposures. RESULTS:Water exposure accounted for 21% of diarrhea episodes and 9% of missed daily activities but was unassociated with gastroenteritis leading to medical consultation. Children aged 0 to 4 and 5 to 10 years had the most water exposure, exhibited stronger associations between levels of water quality and illness, and accounted for the largest attributable illness burden. CONCLUSIONS: The higher gastroenteritis risk and associated burden in young children presents important new information to inform future recreational water quality guidelines designed to protect public health.
Authors: Vincent M Yau; Kenneth C Schiff; Benjamin F Arnold; John F Griffith; Joshua S Gruber; Catherine C Wright; Timothy J Wade; Susan Burns; Jacqueline M Hayes; Charles McGee; Mark Gold; Yiping Cao; Alexandria B Boehm; Stephen B Weisberg; John M Colford Journal: Water Res Date: 2014-03-29 Impact factor: 11.236
Authors: John M Colford; Timothy J Wade; Kenneth C Schiff; Catherine C Wright; John F Griffith; Sukhminder K Sandhu; Susan Burns; Mark Sobsey; Greg Lovelace; Stephen B Weisberg Journal: Epidemiology Date: 2007-01 Impact factor: 4.822
Authors: John M Colford; Kenneth C Schiff; John F Griffith; Vince Yau; Benjamin F Arnold; Catherine C Wright; Joshua S Gruber; Timothy J Wade; Susan Burns; Jacqueline Hayes; Charles McGee; Mark Gold; Yiping Cao; Rachel T Noble; Richard Haugland; Stephen B Weisberg Journal: Water Res Date: 2012-02-02 Impact factor: 11.236
Authors: Timothy J Wade; Rebecca L Calderon; Kristen P Brenner; Elizabeth Sams; Michael Beach; Richard Haugland; Larry Wymer; Alfred P Dufour Journal: Epidemiology Date: 2008-05 Impact factor: 4.822
Authors: Samuel Dorevitch; Preethi Pratap; Meredith Wroblewski; Daniel O Hryhorczuk; Hong Li; Li C Liu; Peter A Scheff Journal: Environ Health Perspect Date: 2011-10-26 Impact factor: 9.031
Authors: Adam C Levine; Karen J O'Connell; David Schnadower; T John M VanBuren; Prashant Mahajan; Katrina F Hurley; Phillip Tarr; Cody S Olsen; Naveen Poonai; Suzanne Schuh; Elizabeth C Powell; Ken J Farion; Robert E Sapien; Cindy G Roskind; Alexander J Rogers; Seema Bhatt; Serge Gouin; Cheryl Vance; Stephen B Freedman Journal: J Pediatr Gastroenterol Nutr Date: 2022-02-03 Impact factor: 3.288
Authors: Stephanie DeFlorio-Barker; Dawn Holman; Robert Landolfi; Benjamin F Arnold; John M Colford; Stephen B Weisberg; Kenneth C Schiff; Elizabeth A Sams; Timothy J Wade Journal: Prev Med Date: 2020-03-03 Impact factor: 4.018
Authors: Andrey I Egorov; Shannon M Griffin; Honorine D Ward; Kevin Reilly; G Shay Fout; Timothy J Wade Journal: Water Res Date: 2018-05-23 Impact factor: 11.236
Authors: Jade Benjamin-Chung; Benjamin F Arnold; Timothy J Wade; Kenneth Schiff; John F Griffith; Alfred P Dufour; Stephen B Weisberg; John M Colford Journal: Epidemiology Date: 2017-09 Impact factor: 4.822
Authors: Benjamin F Arnold; Kenneth C Schiff; Ayse Ercumen; Jade Benjamin-Chung; Joshua A Steele; John F Griffith; Steven J Steinberg; Paul Smith; Charles D McGee; Richard Wilson; Chad Nelsen; Stephen B Weisberg; John M Colford Journal: Am J Epidemiol Date: 2017-10-01 Impact factor: 4.897
Authors: Anne F C Leonard; Andrew Singer; Obioha C Ukoumunne; William H Gaze; Ruth Garside Journal: Int J Epidemiol Date: 2018-04-01 Impact factor: 7.196
Authors: Melanie D Napier; Richard Haugland; Charles Poole; Alfred P Dufour; Jill R Stewart; David J Weber; Manju Varma; Jennifer S Lavender; Timothy J Wade Journal: Environ Health Date: 2017-10-02 Impact factor: 5.984
Authors: Stephen P Luby; Mahbubur Rahman; Benjamin F Arnold; Leanne Unicomb; Sania Ashraf; Peter J Winch; Christine P Stewart; Farzana Begum; Faruqe Hussain; Jade Benjamin-Chung; Elli Leontsini; Abu M Naser; Sarker M Parvez; Alan E Hubbard; Audrie Lin; Fosiul A Nizame; Kaniz Jannat; Ayse Ercumen; Pavani K Ram; Kishor K Das; Jaynal Abedin; Thomas F Clasen; Kathryn G Dewey; Lia C Fernald; Clair Null; Tahmeed Ahmed; John M Colford Journal: Lancet Glob Health Date: 2018-01-29 Impact factor: 26.763
Authors: Stephanie DeFlorio-Barker; Benjamin F Arnold; Elizabeth A Sams; Alfred P Dufour; John M Colford; Steven B Weisberg; Kenneth C Schiff; Timothy J Wade Journal: J Expo Sci Environ Epidemiol Date: 2017-11-08 Impact factor: 5.563