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Review
. 2016 May 27;13(6):527.
doi: 10.3390/ijerph13060527.

Literature Review of Associations Among Attributes of Reported Drinking Water Disease Outbreaks

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Free PMC article
Review

Literature Review of Associations Among Attributes of Reported Drinking Water Disease Outbreaks

Grant Ligon et al. Int J Environ Res Public Health. .
Free PMC article

Abstract

Waterborne disease outbreaks attributed to various pathogens and drinking water system characteristics have adversely affected public health worldwide throughout recorded history. Data from drinking water disease outbreak (DWDO) reports of widely varying breadth and depth were synthesized to investigate associations between outbreak attributes and human health impacts. Among 1519 outbreaks described in 475 sources identified during review of the primarily peer-reviewed, English language literature, most occurred in the U.S., the U.K. and Canada (in descending order). The outbreaks are most frequently associated with pathogens of unknown etiology, groundwater and untreated systems, and catchment realm-associated deficiencies (i.e., contamination events). Relative frequencies of outbreaks by various attributes are comparable with those within other DWDO reviews, with water system size and treatment type likely driving most of the (often statistically-significant at p < 0.05) differences in outbreak frequency, case count and attack rate. Temporal analysis suggests that while implementation of surface (drinking) water management policies is associated with decreased disease burden, further strengthening of related policies is needed to address the remaining burden attributed to catchment and distribution realm-associated deficiencies and to groundwater viral and disinfection-only system outbreaks.

Keywords: attack rate; case count; drinking water supply; outbreak; water system deficiency; waterborne disease.

Figures

Figure A1
Figure A1
Distribution and correlation of outbreak log10 case count (a) and attack rate (b) with year.
Figure 1
Figure 1
Source counts obtained after each of the three major stages of literature review (circular arrow represents addition of new full text-reviewed sources from reference lists of prior full text-reviewed sources).
Figure 2
Figure 2
Distribution of outbreaks by case count.
Figure 3
Figure 3
Pathogen type outbreak frequency for all recorded decades (a) and log10 decadal case count for 1970s–2000+; (b) by source type (SW is surface water, GW is groundwater).
Figure 3
Figure 3
Pathogen type outbreak frequency for all recorded decades (a) and log10 decadal case count for 1970s–2000+; (b) by source type (SW is surface water, GW is groundwater).
Figure 4
Figure 4
Treatment type outbreak frequency for all recorded decades (a) and log10 decadal case count for 1970s–2000+; (b) by source type (SW is surface water, GW is groundwater).
Figure 4
Figure 4
Treatment type outbreak frequency for all recorded decades (a) and log10 decadal case count for 1970s–2000+; (b) by source type (SW is surface water, GW is groundwater).
Figure 5
Figure 5
Deficiency realm outbreak frequency for all recorded decades (a) and log10 decadal case count for 1970s–2000+; (b) by source type (SW is surface water, GW is groundwater).

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