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Review: Epidemiological evidence of groundwater contribution to global enteric disease, 1948–2015

Revue: Preuves épidémiologiques de la contribution des eaux souterraines aux maladies entériques au niveau mondial entre 1948 et 2015

Revisión: Evidencia epidemiológica de la contribución del agua subterránea a la enfermedad entérica global, 1948–2015

回顾:地下水对全球肠道疾病的贡献流行冰雪证据

Revisão: Evidência epidemiologicada contribuição das águas subterrâneas para doença entérica global, 1948–2015

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Abstract

Globally, approximately 2.2 billion people rely on groundwater for daily consumption. It is widely accepted that groundwater is more pristine than surface water but while this assumption is frequently the case, groundwater is not ubiquitously free of contaminants; accordingly, this presumption can result in an unfounded and potentially hazardous sense of security among owners, operators and users. The current paper presents a review of published literature providing epidemiological evidence of the contribution of groundwater to global human enteric infection. An emphasis is placed on enteric pathogens transmitted via the faecal-oral route, and specifically those associated with acute gastrointestinal illness (AGI). The review identified 649 published groundwater outbreaks globally between 1948 and 2013 and several epidemiological studies that show there is an increased risk of AGI associated with the consumption of untreated groundwater. The review identified that the following five pathogens were responsible for most outbreaks: norovirus, Campylobacter, Shigella, Hepatitis A and Giardia. Crudely, the authors estimate that between 35.2 and 59.4 million cases of AGI per year globally could be attributable to the consumption of groundwater. Although groundwater is frequently presumed to be a microbiologically safe source of water for consumption, this review demonstrates that consumers served by an untreated groundwater supply remain at risk to enteric disease. The authors conclude that collaboration between microbiologists, hydrogeologists and epidemiologists is needed to better understand pathogen occurrence, persistence, detection and transport in groundwater as well as build stronger epidemiological evidence documenting the true magnitude of disease associated with groundwater globally.

Résumé

À l’échelle mondiale, environ 2.2 milliards de personnes dépendent de l’eau souterraine pour leur consommation quotidienne. Il est largement admis que les eaux souterraines sont plus pures que les eaux de surface mais alors que c’est fréquemment le cas, les eaux souterraines ne sont pas complétement exemptes de contaminants ; par conséquent, cette présomption peut donner lieu à un sentiment de sécurité infondé et potentiellement dangereux parmi les propriétaires, les exploitants et les usagers. Le présent article présente une revue de la littérature publiée fournissant des preuves épidémiologiques de la contribution des eaux souterraines aux infections entériques des êtres humains au niveau mondial. L’accent est mis sur les pathogènes entériques transmis par voie féco-orale, et plus particulièrement ceux associés à une maladie gastro-intestinale aiguë (AGI). La revue a identifié 649 épidémies liées à l’eau souterraine au niveau mondial entre 1948 et 2913 et plusieurs études épidémiologiques montrant qu’il y a un risque accru d’AGI associé à la consommation d’eau souterraine non traitée. La revue a permis d’identifier que les cinq agents pathogènes suivants étaient responsables de la plupart des épidémies : norovirus, Campylobacter, Shigella, Hepatite A et Giardia. En gros, les auteurs estiment qu’entre 35.2 et 59.4 millions de cas d’AGI/an dans le monde pourraient être attribuables à la consommation d’eau souterraine. Bien que l’eau souterraine est fréquemment considérée comme étant une source d’eau microbiologiquement sûre pour la consommation, cette revue démontre que les consommateurs desservis par une alimentation en eau souterraine non traitée demeurent exposés aux maladies entériques. Les auteurs concluent que la collaboration, entre les microbiologistes, les hydrogéologues et les épidémiologistes est indispensable pour mieux comprendre la présence, la persistance, la détection et le transport des agents pathogènes dans les eaux souterraines ainsi que pour établir des preuves épidémiologiques plus solides documentant la véritable ampleur des maladies associées aux eaux souterraines au niveau mondial.

Resumen

A nivel mundial, aproximadamente 2.2 millones de personas dependen del agua subterránea para el consumo diario. Es ampliamente aceptado que el agua subterránea es más prístina que el agua superficial, pero si bien esta suposición es frecuente, el agua subterránea no está libre de contaminantes; Por consiguiente, esta presunción puede dar lugar a una sensación de seguridad infundada y potencialmente peligrosa entre los propietarios, los operadores y los usuarios. El presente documento presenta una revisión de la literatura publicada que proporciona evidencias epidemiológicas de la contribución del agua subterránea a la infección humana entérica global. Se hace hincapié en los patógenos entéricos transmitidos por la vía fecal oral, y específicamente los asociados con las enfermedades gastrointestinales agudas (AGI). La revisión identificó 649 brotes publicados relacionados con el agua subterránea a nivel mundial entre 1948 y 2013 y varios estudios epidemiológicos que muestran que hay un mayor riesgo de AGI asociado con el consumo de agua subterránea no tratada. La revisión identificó que los siguientes cinco patógenos fueron responsables de la mayoría de los brotes: norovirus, Campylobacter, Shigella, Hepatitis A y Giardia. Crudamente, los autores estiman que entre 35.2 y 59.4 millones de casos de AGI/año a nivel mundial podrían atribuirse al consumo de agua subterránea. Aunque se suele presumir que el agua subterránea es una fuente de agua microbiológicamente segura para el consumo, esta revisión demuestra que los consumidores que reciben servicios de suministro de agua subterránea no tratada siguen expuestos a enfermedades entéricas. Los autores concluyen que la colaboración entre microbiólogos, hidrogeólogos y epidemiólogos es necesaria para comprender mejor la presencia, la persistencia, la detección y el transporte de patógenos en el agua subterránea, así como para construir pruebas epidemiológicas más sólidas que documenten la verdadera magnitud de la enfermedad asociada al agua subterránea a nivel mundial.

摘要

全世界大约22亿人口依赖地下水用于日常消费。普遍认为,地下水比地表水更纯洁,在使用地下水时尽管情况如此,但地下水并不是完全没有污染物的;因此,这种假定可在拥有者、操作者和使用者中产生未发现的、潜在的安全危险感觉。本文回顾了已经发表的有关地下水对全球人类肠道感染贡献的流行病学证据的文献。重点放在了通过粪便-口途径传播的肠道病原体,特别是那些与急性胃肠疾病相关的肠道病原体。回顾确认了1948年到2013年之间已经发布的全球649次疾病爆发,几项流行病学研究显示,与使用未处理的地下水相关的急性胃肠疾病有增长的风险。回顾确认,以下五种病原体是导致大多数疾病爆发的元凶:诺瓦克病毒、弯曲杆菌、志贺氏杆菌、甲肝和鞭毛虫。作者大致估算每年全球急性胃肠疾病3520万到5940万例是由使用地下水造成的。尽管通常人们认为使用地下水从微生物学上讲很安全,但是回顾展示了使用未处理过的地下水仍然具有患肠道疾病的风险。作者最后认为,需要微生物学家、水文地质学家和流行病专家通力合作,更好地了解地下水中的病原体的发生、存留、检测和传输,以及建立全球性质的、记载着与地下水相关的、更强大的流行病证据。

Resumo

Globalmente, aproximadamente 2.2 bilhões de pessoas dependem das águas subterrâneas para consumo diário. É amplamente aceito que a água subterrânea é mais pura qua a água superficial mas enquanto essa premissa é frequentemente o caso, a água subterrânea não é onipresentemente livre de contaminantes; assim essa suposiçãopode resultar em um infundado e potencialmente perigoso senso de segurança entre os proprietários, operadores e usuários. O presente artigo apresenta uma revisão da literatura publicada fornecendo evidências epidemiológicas da contribuição das águas subterrâneas para a infecção entérica humana global. É dada ênfase aos agentes patogénicos entéricos transmitidos pela via fecal-oral, e especificamente os associados à doença gastrointestinal aguda (DGA). A revisão identificou 649 surtos de água subterrânea publicados globalmente entre 1948 e 2013 e vários estudos epidemiológicos que mostram que há um risco aumentado de AGI associado com o consumo de águas subterrâneas não tratadas. A revisão identificou que os seguintes cinco patógenos foram responsáveis pela maioria dos surtos: norovirus, Campylobacter, Shigella, Hepatitis A e Giardia. Cruamente, os autores estimam que entre 35.2 e 59.4 milhões de casos de DGA/ ano globalmente poderiam ser atribuíveis ao consumo de águas subterrâneas. Embora a água subterrânea seja frequentemente considerada uma fonte de água microbiologicamente segura para o consumo, esta revisão demonstra que os consumidores atendidos por uma fonte de água subterrânea não tratada permanecem em risco de doenças entéricas. Os autores concluem que a colaboração entre microbiologistas, hidrogeólogos e epidemiologistas é necessária para compreender melhor a ocorrência, persistência, detecção e transporte de patógenos nas águas subterrâneas, bem como construir evidências epidemiológicas mais fortes que documentem a verdadeira magnitude da doença associada à água subterrânea globalmente.

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Acknowledgements

The authors would like to thank the reviewers and the editors of Hydrogeology Journal for their valuable comments.

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Authors and Affiliations

  1. Division of Environmental Health, College of Public Health, Temple University, Philadelphia, PA, USA

    Heather M. Murphy & Morgan D. Prioleau

  2. USDA/ USGS Marshfield, Wisconsin, USA

    Mark A. Borchardt

  3. Environmental Health and Sustainability Institute, Dublin Institute of Technology, Dublin, Republic of Ireland

    Paul D. Hynds

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Murphy, H.M., Prioleau, M.D., Borchardt, M.A. et al. Review: Epidemiological evidence of groundwater contribution to global enteric disease, 1948–2015. Hydrogeol J 25, 981–1001 (2017). https://doi.org/10.1007/s10040-017-1543-y

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