scholarly journals An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application

2006 ◽  
Vol 4 (S2) ◽  
pp. 201-240 ◽  
Author(s):  
Michael Messner ◽  
Susan Shaw ◽  
Stig Regli ◽  
Ken Rotert ◽  
Valerie Blank ◽  
...  
Keyword(s):  
Drinking Water ◽  
Environmental Protection Agency ◽  
Water System ◽  
Credible Interval ◽  
The United States ◽  
Water Systems ◽  
Epidemiologic Studies ◽  
Incidence Rates ◽  
Waterborne Disease ◽  
Public Water Systems

In this paper, the US Environmental Protection Agency (EPA) presents an approach and a national estimate of drinking water related endemic acute gastrointestinal illness (AGI) that uses information from epidemiologic studies. There have been a limited number of epidemiologic studies that have measured waterborne disease occurrence in the United States. For this analysis, we assume that certain unknown incidence of AGI in each public drinking water system is due to drinking water and that a statistical distribution of the different incidence rates for the population served by each system can be estimated to inform a mean national estimate of AGI illness due to drinking water. Data from public water systems suggest that the incidence rate of AGI due to drinking water may vary by several orders of magnitude. In addition, data from epidemiologic studies show AGI incidence due to drinking water ranging from essentially none (or less than the study detection level) to a rate of 0.26 cases per person-year. Considering these two perspectives collectively, and associated uncertainties, EPA has developed an analytical approach and model for generating a national estimate of annual AGI illness due to drinking water. EPA developed a national estimate of waterborne disease to address, in part, the 1996 Safe Drinking Water Act Amendments. The national estimate uses best available science, but also recognizes gaps in the data to support some of the model assumptions and uncertainties in the estimate. Based on the model presented, EPA estimates a mean incidence of AGI attributable to drinking water of 0.06 cases per year (with a 95% credible interval of 0.02–0.12). The mean estimate represents approximately 8.5% of cases of AGI illness due to all causes among the population served by community water systems. The estimated incidence translates to 16.4 million cases/year among the same population. The estimate illustrates the potential usefulness and challenges of the approach, and provides a focus for discussions of data needs and future study designs. Areas of major uncertainty that currently limit the usefulness of the approach are discussed in the context of the estimate analysis.

scholarly journals Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

2010 ◽  
Vol 23 (3) ◽  
pp. 507-528 ◽  
Author(s):  
Gunther F. Craun ◽  
Joan M. Brunkard ◽  
Jonathan S. Yoder ◽  
Virginia A. Roberts ◽  
Joe Carpenter ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Distribution System ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
Outbreak Detection ◽  
Waterborne Disease ◽  
Public Water Systems ◽  
Annual Proportion

SUMMARY Since 1971, the CDC, EPA, and Council of State and Territorial Epidemiologists (CSTE) have maintained the collaborative national Waterborne Disease and Outbreak Surveillance System (WBDOSS) to document waterborne disease outbreaks (WBDOs) reported by local, state, and territorial health departments. WBDOs were recently reclassified to better characterize water system deficiencies and risk factors; data were analyzed for trends in outbreak occurrence, etiologies, and deficiencies during 1971 to 2006. A total of 833 WBDOs, 577,991 cases of illness, and 106 deaths were reported during 1971 to 2006. Trends of public health significance include (i) a decrease in the number of reported outbreaks over time and in the annual proportion of outbreaks reported in public water systems, (ii) an increase in the annual proportion of outbreaks reported in individual water systems and in the proportion of outbreaks associated with premise plumbing deficiencies in public water systems, (iii) no change in the annual proportion of outbreaks associated with distribution system deficiencies or the use of untreated and improperly treated groundwater in public water systems, and (iv) the increasing importance of Legionella since its inclusion in WBDOSS in 2001. Data from WBDOSS have helped inform public health and regulatory responses. Additional resources for waterborne disease surveillance and outbreak detection are essential to improve our ability to monitor, detect, and prevent waterborne disease in the United States.

scholarly journals Co-Occurrence of Metal Contaminants in United States Public Water Systems in 2013–2015

2021 ◽  
Vol 18 (15) ◽  
pp. 7884
Author(s):  
Alesha K. Thompson ◽  
Michele M. Monti ◽  
Matthew O. Gribble
Keyword(s):  
United States ◽  
Drinking Water ◽  
Water System ◽  
The United States ◽  
Water Systems ◽  
System Level ◽  
Metal Contaminants ◽  
Total Chromium ◽  
Geometric Means ◽  
Public Water Systems

The United States Environmental Protection Agency monitors contaminants in drinking water and consolidates these results in the National Contaminant Occurrence Database. Our objective was to assess the co-occurrence of metal contaminants (total chromium, hexavalent chromium, molybdenum, vanadium, cobalt, and strontium) over the years 2013–2015. We used multilevel Tobit regression models with state and water system-level random intercepts to predict the geometric mean of each contaminant occurring in each public water system, and estimated the pairwise correlations of predicted water system-specific geometric means across contaminants. We found that the geometric means of vanadium and total chromium were positively correlated both in large public water systems (r = 0.45, p < 0.01) and in small public water systems (r = 0.47, p < 0.01). Further research may address the cumulative human health impacts of ingesting more than one contaminant in drinking water.

scholarly journals Assessing clarity of message communication for mandated USEPA drinking water quality reports

2015 ◽  
Vol 14 (2) ◽  
pp. 223-235 ◽  
Author(s):  
Katherine Phetxumphou ◽  
Siddhartha Roy ◽  
Brenda M. Davy ◽  
Paul A. Estabrooks ◽  
Wen You ◽  
...  
Keyword(s):  
Water Quality ◽  
Drinking Water ◽  
Environmental Protection Agency ◽  
Water System ◽  
System Size ◽  
The United States ◽  
National Sample ◽  
Evaluation Tool ◽  
Index Index ◽  
State Of The Science

The United States Environmental Protection Agency mandates that community water systems (CWSs), or drinking water utilities, provide annual consumer confidence reports (CCRs) reporting on water quality, compliance with regulations, source water, and consumer education. While certain report formats are prescribed, there are no criteria ensuring that consumers understand messages in these reports. To assess clarity of message, trained raters evaluated a national sample of 30 CCRs using the Centers for Disease Control Clear Communication Index (Index) indices: (1) Main Message/Call to Action; (2) Language; (3) Information Design; (4) State of the Science; (5) Behavioral Recommendations; (6) Numbers; and (7) Risk. Communication materials are considered qualifying if they achieve a 90% Index score. Overall mean score across CCRs was 50 ± 14% and none scored 90% or higher. CCRs did not differ significantly by water system size. State of the Science (3 ± 15%) and Behavioral Recommendations (77 ± 36%) indices were the lowest and highest, respectively. Only 63% of CCRs explicitly stated if the water was safe to drink according to federal and state standards and regulations. None of the CCRs had passing Index scores, signaling that CWSs are not effectively communicating with their consumers; thus, the Index can serve as an evaluation tool for CCR effectiveness and a guide to improve water quality communications.

scholarly journals A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes

2007 ◽  
Vol 12 (1) ◽  
pp. 153-163 ◽  
Author(s):  
Deana M. Manassaram ◽  
Lorraine C. Backer ◽  
Deborah M. Moll
Keyword(s):  
Drinking Water ◽  
Animal Studies ◽  
The United States ◽  
Epidemiologic Studies ◽  
Maternal Exposure ◽  
Sufficient Evidence ◽  
Current Standard ◽  
Epidemiologic Evidence ◽  
Reproductive Effects ◽  
Public Water Systems

In this review, we present an update on maternal exposure to nitrates in drinking water in relation to possible adverse reproductive and developmental effects, and discuss nitrates in drinking water in the United States. The current standard for nitrates in drinking water is based on retrospective studies and approximates a level that protects infants from methemoglobinemia, but no safety factor is built into the standard. The current standard applies only to public water systems. Animal studies have found adverse reproductive effects resulting from higher doses of nitrate or nitrite. The epidemiologic evidence of a direct exposure-response relationship between drinking water nitrate level and adverse reproductive effect is still not clear. However, some reports have suggested an association between exposure to nitrates in drinking water and spontaneous abortions, intrauterine growth restriction, and various birth defects. Uncertainties in epidemiologic studies include the lack of individual exposure assessment that would rule out confounding of the exposure with some other cause. We conclude that the current literature does not provide sufficient evidence of a causal relationship between exposure to nitrates in drinking water and adverse reproductive effects.

scholarly journals Review of perchlorate occurrence in large public drinking water systems in the United States of America

2018 ◽  
Vol 19 (3) ◽  
pp. 681-694
Author(s):  
Steven J. Luis ◽  
Elizabeth A. Miesner ◽  
Clarissa L. Enslin ◽  
Keith Heidecorn
Keyword(s):  
United States ◽  
Decision Making ◽  
Drinking Water ◽  
Environmental Protection Agency ◽  
The United States ◽  
Water Systems ◽  
Contaminant Monitoring ◽  
Public Drinking Water ◽  
Regulatory Bodies ◽  
Public Drinking

Abstract When deciding whether or not to regulate a chemical, regulatory bodies often evaluate the degree to which the public may be exposed by evaluating the chemical's occurrence in food and drinking water. As part of its decision-making process, the United States Environmental Protection Agency (USEPA) evaluated the occurrence of perchlorate in public drinking water by sampling public water systems (PWSs) as part of the first implementation of the Unregulated Contaminant Monitoring Rule (UCMR 1) between 2001 and 2005. The objective of this paper is to evaluate the current representativeness of the UCMR 1 dataset. To achieve this objective, publicly available sources were searched to obtain updated perchlorate data for the majority of large PWSs with perchlorate detections under UCMR 1. Comparison of the updated and UCMR 1 perchlorate datasets shows that the UCMR 1 dataset is no longer representative because the extent and degree of occurrence has decreased since implementation of UCMR 1. Given this finding, it seems appropriate for regulatory bodies engaged in decision-making processes over several years to periodically re-evaluate the conditions that prompted the regulatory effort, thereby ensuring that rules and regulations address actual conditions of concern.

scholarly journals Incidence of waterborne lead in private drinking water systems in Virginia

2015 ◽  
Vol 13 (3) ◽  
pp. 897-908 ◽  
Author(s):  
Kelsey J. Pieper ◽  
Leigh-Anne H. Krometis ◽  
Daniel L. Gallagher ◽  
Brian L. Benham ◽  
Marc Edwards
Keyword(s):  
Public Health ◽  
Drinking Water ◽  
Environmental Protection Agency ◽  
Public Health Problem ◽  
Blood Lead ◽  
The United States ◽  
Water Systems ◽  
National Public Health ◽  
Lead Source ◽  
Drinking Water Systems

Although recent studies suggest contamination by bacteria and nitrate in private drinking water systems is of increasing concern, data describing contaminants associated with the corrosion of onsite plumbing are scarce. This study reports on the analysis of 2,146 samples submitted by private system homeowners. Almost 20% of first draw samples submitted contained lead concentrations above the United States Environmental Protection Agency action level of 15 μg/L, suggesting that corrosion may be a significant public health problem. Correlations between lead, copper, and zinc suggested brass components as a likely lead source, and dug/bored wells had significantly higher lead concentrations as compared to drilled wells. A random subset of samples selected to quantify particulate lead indicated that, on average, 47% of lead in the first draws was in the particulate form, although the occurrence was highly variable. While flushing the tap reduced lead below 15 μg/L for most systems, some systems experienced an increase, perhaps attributable to particulate lead or lead-bearing components upstream of the faucet (e.g., valves, pumps). Results suggest that without including a focus on private as well as municipal systems it will be very difficult to meet the existing national public health goal to eliminate elevated blood lead levels in children.

scholarly journals A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0141646 ◽  
Author(s):  
Wendy Pons ◽  
Ian Young ◽  
Jenifer Truong ◽  
Andria Jones-Bitton ◽  
Scott McEwen ◽  
...  
Keyword(s):  
United States ◽  
Systematic Review ◽  
Drinking Water ◽  
Disease Outbreaks ◽  
The United States ◽  
Water Systems ◽  
Waterborne Disease ◽  
Drinking Water Systems

scholarly journals Investment Risks for Water Projects

2013 ◽  
Vol 1 (1) ◽  
pp. 69-83
Author(s):  
Sharlene Leurig
Keyword(s):  
Environmental Protection Agency ◽  
Local Economic Development ◽  
Waste Water Treatment ◽  
The United States ◽  
Water Systems ◽  
Bond Market ◽  
Army Corps ◽  
Municipal Bond ◽  
Bureau Of Reclamation ◽  
Public Water Systems

Unlike most of the developed world, where investor-owned water systems serve the majority of the population, the United States relies mostly on water provided by public systems. To a great extent, these systems were financed through the taxation authority of the federal government—the iconic Hoover Dam only one of the many hundreds of pipelines and reservoirs built by agencies such as the Bureau of Reclamation and Army Corps of Engineers for the benefit of local economic development. Similarly, many of the drinking and waste- water treatment facilities in operation today were built to help communities comply with the federal Safe Drinking Water Act and Clean Water Act and financed in large part by federal dollars distributed through the Environmental Protection Agency, sometimes leveraged by state revolving loan funds. What of our public water systems has not been paid for by federal or state tax dollars has been debt-financed through the tax-exempt municipal bond market. Of the $3.7 trillion municipal bond market,1 roughly 10% is debt issued by water and wastewater systems to build, repair and expand water infrastructure.

scholarly journals A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States

2006 ◽  
Vol 4 (S2) ◽  
pp. 71-88 ◽  
Author(s):  
John M. Colford ◽  
Sharon Roy ◽  
Michael J. Beach ◽  
Allen Hightower ◽  
Susan E. Shaw ◽  
...  
Keyword(s):  
United States ◽  
Drinking Water ◽  
The United States ◽  
Water Systems ◽  
Epidemiologic Studies ◽  
Other Information ◽  
Public Drinking Water ◽  
Public Drinking ◽  
Intervention Trials ◽  
Drinking Water Systems

The incidence of acute gastrointestinal illness (AGI) attributable to public drinking water systems in the United States cannot be directly measured but must be estimated based on epidemiologic studies and other information. The randomized trial is one study design used to evaluate risks attributable to drinking water. In this paper, we review all published randomized trials of drinking water interventions in industrialized countries conducted among general immunocompetent populations. We then present an approach to estimating the incidence (number of cases) of AGI attributable annually to drinking water. To develop a national estimate, we integrate trial results with the estimated incidence of AGI using necessary assumptions about the estimated number of residents consuming different sources of drinking water and the relative quality of the water sources under different scenarios. Using this approach we estimate there to be 4.26–11.69 million cases of AGI annually attributable to public drinking water systems in the United States. We believe this preliminary estimate should be updated as new data become available.

Associations of Community Water Lead Concentrations with Hemoglobin Concentrations and Erythropoietin-Stimulating Agent Use among Patients with Advanced CKD

2021 ◽  
pp. ASN.2020091281
Author(s):  
John Danziger ◽  
Kenneth J. Mukamal ◽  
Eric Weinhandl
Keyword(s):  
United States ◽  
Drinking Water ◽  
Kidney Disease ◽  
The United States ◽  
Water Systems ◽  
Adverse Outcomes ◽  
Content Type ◽  
Community Water Systems ◽  
Community Water ◽  
Lead Levels

BackgroundAlthough patients with kidney disease may be particularly susceptible to the adverse health effects associated with lead exposure, whether levels of lead found commonly in drinking water are associated with adverse outcomes in patients with ESKD is not known.MethodsTo investigate associations of lead in community water systems with hemoglobin concentrations and erythropoietin stimulating agent (ESA) use among incident patients with ESKD, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information System (documenting average 90th percentile lead concentrations in community water systems during 5 years before dialysis initiation, according to city of residence) with patient-level data from the United States Renal Data System.ResultsAmong 597,968 patients initiating dialysis in the United States in 2005 through 2017, those in cities with detectable lead levels in community water had significantly lower pre-ESKD hemoglobin concentrations and more ESA use per 0.01 mg/L increase in 90th percentile water lead. Findings were similar for the 208,912 patients with data from the first month of ESKD therapy, with lower hemoglobin and higher ESA use per 0.01 mg/L higher lead concentration. These associations were observed at lead levels below the EPA threshold (0.015 mg/L) that mandates regulatory action. We also observed environmental inequities, finding significantly higher water lead levels and slower declines over time among Black versus White patients.ConclusionsThis first nationwide analysis linking EPA water supply records to patient data shows that even low levels of lead that are commonly encountered in community water systems throughout the United States are associated with lower hemoglobin levels and higher ESA use among patients with advanced kidney disease.

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