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Waterborne outbreaks: a public health concern for rural municipalities with unchlorinated drinking water distribution systems

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Abstract

Objectives

The objective of this study is to describe an important waterborne outbreak of gastrointestinal illness observed in a rural municipality of Quebec.

Methods

A population-based retrospective cohort study was conducted to identify risk factors associated with acute gastroenteritis. Indirect surveillance data were used to estimate the extent and the resolution of the epidemic.

Results

The cohort consisted of 140 randomly selected individuals of whom 22 met the illness case definition (15.7% attack rate). The epidemic curve was similar to the evolution of antidiarrheal products sold by the only pharmacy in town and calls made to the Health Info Line. Bivariate analysis led to identifying five risk factors of gastrointestinal illness: consumption of municipal water, contact with someone with acute gastroenteritis (within and outside of the household), contact with a child in daycare, and being less than 35 years of age. Drinking municipal water had the highest risk ratio (RR = 24.31; 95% CI = 1.50–393.4). Drinking water from a private artesian well was a protective factor (RR = 0.28; 95% CI = 0.09–0.90).

Conclusion

This study highlighted that managing the risks associated with the consumption of untreated drinking water remains an important public health challenge, particularly in small rural municipalities vulnerable to climate variability.

Résumé

Objectif

L’objectif de cette étude est de décrire une éclosion de gastroentérite aigüe d’origine hydrique survenue dans une municipalité rurale du Québec.

Méthode

Une étude de cohorte populationnelle rétrospective a été réalisée pour identifier des facteurs de risque associés au développement des gastroentérites aigües. Des données de surveillance indirecte ont été utilisées pour estimer l’étendue de la situation épidémique.

Résultats

La cohorte a été constituée de 140 individus sélectionnés aléatoirement, dont 22 répondaient à la définition de cas (taux d’attaque 15,7 %). La courbe épidémique a suivi une évolution semblable à celle de la vente de produits antidiarrhéiques vendus dans la seule pharmacie de la municipalité et aux appels faits au service Info-Santé. Des analyses bivariées ont permis d’identifier cinq facteurs de risque de gastroentérite aigüe : consommation de l’eau municipale, contact avec quelqu’un atteint de gastroentérite aiguë (dans et hors de la maisonnée), contact avec un enfant en garderie et avoir moins de 35 ans. Le fait de boire de l’eau de la municipalité non traitée a été le facteur ayant le rapport de risque le plus élevé (RR = 24,31; IC 95% = 1,50-393,4). Boire de l’eau d’un puit artésien privé a été un facteur protecteur (RR = 0,28; IC 95% = 0,09-0,90).

Conclusion

Cette étude a mis en évidence que la gestion des risques associés à la consommation de l’eau non traitée reste un défi important de santé publique, particulièrement pour les petites municipalités rurales où il existe une vulnérabilité liée aux variations climatiques.

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Acknowledgements

The authors acknowledge the assistance and support of all of the persons involved in the management of this outbreak investigation, including Dr. Patrick Levallois who collaborated in our study as a senior environmental health advisor. A special thanks to the staff at the Direction de santé publique de Chaudière-Appalaches and the Institut national de santé publique du Québec.

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Correspondence to Julio C. Soto.

Ethics declarations

This investigation was conducted in accordance with the legal mandate granted to public health authorities by Quebec’s Public Health Act (R.S.Q., chapter S-2.2. Article 1. Updated July 1, 2018). The authors who were part of the investigation team were legally appointed by the director of public health of the affected region to act under this mandate that endorses the main principles of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research 2018). The study did not directly involve subjects but rather the events that happened to them and these were reported by the people who gave their oral informed consent to participate in the investigation at the time of the interviewer’s phone call. Participants had the right to refuse to answer any questions and to abandon the investigation at any time. Parents or legal guardians gave consent for children under the age of 14 years.

All data were treated confidentially and analyzed without nominal identification. Authorized personnel with access to the databank were bound by oaths to comply with the confidentiality standards. Data and measures relating to manipulation, analysis, storage, and eventual destruction have been and will be processed according to the Institut national de santé publique du Québec information, protection, and security policy (PO-04-2014).

Conflict of interest

The authors declare that they have no conflict of interest.

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Soto, J.C., Barakat, M., Drolet, MJ. et al. Waterborne outbreaks: a public health concern for rural municipalities with unchlorinated drinking water distribution systems. Can J Public Health 111, 433–442 (2020). https://doi.org/10.17269/s41997-020-00300-x

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  • DOI: https://doi.org/10.17269/s41997-020-00300-x

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