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      Effect of drinking water source on associations between gastrointestinal illness and heavy rainfall in New Jersey

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          Abstract

          Gastrointestinal illness (GI) has been associated with heavy rainfall. Storm events and periods of heavy rainfall and runoff can result in increased microbiological contaminants in raw water. Surface water supplies are open to the environment and runoff can directly influence the presence of contaminants. A time-stratified bi-directional case-crossover study design was used to estimate associations of heavy rainfall and hospitalizations for GI. Cases of GI were identified as in-patient hospitalization with a primary diagnosis of infectious disease associated diarrhea [ICD-9 codes: specified gastrointestinal infections 001–009.9 or diarrhea 787.91] among the residents of New Jersey from 2009 to 2013 resulting in a final sample size of 47,527 cases. Two control days were selected on the same days of the week as the case day, within fixed 21-day strata. Conditional logistic regression was used to estimate odds ratios controlling for temperature and humidity. To determine potential effect modification estimates were stratified by season (warm or cold) and drinking water source (groundwater, surface water, or ‘other’ category). Stratified analyses by drinking water source and season identified positive associations of rainfall and GI hospitalizations in surface water systems during the warm season with no lag (OR = 1.12, 95% CI 1.05–1.19) and a 2-day lag (OR = 1.09, 95% CI 1.03–1.16). Positive associations in ‘Other’ water source areas (served by very small community water systems, private wells, or unknown) during the warm season with a 4-day lag were also found. However, there were no statistically significant positive associations in groundwater systems during the warm season. The results suggest that water systems with surface water sources can play an important role in preventing GI hospitalizations during and immediately following heavy rainfall. Regulators should work with water system providers to develop system specific prevention techniques to limit the impact of heavy rainfall on public health.

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          Most cited references33

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          The Association Between Extreme Precipitation and Waterborne Disease Outbreaks in the United States, 1948–1994

          Rainfall and runoff have been implicated in site-specific waterborne disease outbreaks. Because upward trends in heavy precipitation in the United States are projected to increase with climate change, this study sought to quantify the relationship between precipitation and disease outbreaks. The US Environmental Protection Agency waterborne disease database, totaling 548 reported outbreaks from 1948 through 1994, and precipitation data of the National Climatic Data Center were used to analyze the relationship between precipitation and waterborne diseases. Analyses were at the watershed level, stratified by groundwater and surface water contamination and controlled for effects due to season and hydrologic region. A Monte Carlo version of the Fisher exact test was used to test for statistical significance. Fifty-one percent of waterborne disease outbreaks were preceded by precipitation events above the 90th percentile (P = .002), and 68% by events above the 80th percentile (P = .001). Outbreaks due to surface water contamination showed the strongest association with extreme precipitation during the month of the outbreak; a 2-month lag applied to groundwater contamination events. The statistically significant association found between rainfall and disease in the United States is important for water managers, public health officials, and risk assessors of future climate change.
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            The influence of climate variation and change on diarrheal disease in the Pacific Islands.

            Freshwater resources are a high-priority issue in the Pacific region. Water shortage is a serious problem in many small island states, and many depend heavily on rainwater as the source of their water. Lack of safe water supplies is an important factor in diarrheal illness. There have been no previous studies looking specifically at the relationship between climate variability and diarrhea in the Pacific region. We carried out two related studies to explore the potential relationship between climate variability and the incidence of diarrhea in the Pacific Islands. In the first study, we examined the average annual rates of diarrhea in adults, as well as temperature and water availability from 1986 to 1994 for 18 Pacific Island countries. There was a positive association between annual average temperature and the rate of diarrhea reports, and a negative association between water availability and diarrhea rates. In the second study, we examined diarrhea notifications in Fiji in relation to estimates of temperature and rainfall, using Poisson regression analysis of monthly data for 1978-1998. There were positive associations between diarrhea reports and temperature and between diarrhea reports and extremes of rainfall. These results are consistent with previous research and suggest that global climate change is likely to exacerbate diarrheal illness in many Pacific Island countries.
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              Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents.

              Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 March 2017
                2017
                : 12
                : 3
                : e0173794
                Affiliations
                [001]Environmental and Occupational Health Surveillance Program, New Jersey Department of Health, Trenton, NJ, United States of America
                National Sun Yat-sen University, TAIWAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: JAG.

                • Data curation: JAG.

                • Formal analysis: JAG JAF.

                • Investigation: JAG.

                • Methodology: JAG JAF.

                • Project administration: JAG.

                • Resources: JAG.

                • Software: JAG.

                • Supervision: JAG JAF.

                • Validation: JAF.

                • Visualization: JAG.

                • Writing – original draft: JAG.

                • Writing – review & editing: JAF.

                Article
                PONE-D-16-18298
                10.1371/journal.pone.0173794
                5345866
                28282467
                f5641f4d-ec21-465e-a44f-3be857519dbd
                © 2017 Gleason, Fagliano

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 May 2016
                : 27 February 2017
                Page count
                Figures: 1, Tables: 3, Pages: 13
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Earth Sciences
                Atmospheric Science
                Meteorology
                Rain
                Earth Sciences
                Hydrology
                Surface Water
                Ecology and Environmental Sciences
                Natural Resources
                Water Resources
                People and places
                Geographical locations
                North America
                United States
                New Jersey
                Social Sciences
                Sociology
                Social Stratification
                Earth Sciences
                Seasons
                Research and Analysis Methods
                Research Design
                Survey Research
                Census
                People and Places
                Population Groupings
                Age Groups
                Custom metadata
                Data are available to investigators who obtain approval for human subjects research for use of the data by the Rowan University Institutional Review board which serves as the New Jersey Department of Health IRB of record. Rachel Hammond ( rachel.hammond@ 123456doh.nj.gov ) of NJDOH serves as the department's Ethics Liaison and as the contact for the Data Privacy Council.

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                Uncategorized

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