title: Quantitative microbial risk assessment of cryptosporidiosis and giardiasis from very small private water supplies.
abstract: This article reports a quantitative microbial risk assessment of the risk of Giardia and Cryptosporidium in very small private water supplies. Both pathogens have been implicated in causing outbreaks of waterborne disease associated with such supplies, though the risk of endemic disease is not known. For exposure assessments, we used existing data to derive regression equations describing the relationships between the concentration of these pathogens and Escherichia coli in private water supplies. Pathogen concentrations were then estimated using national surveillance data of E. coli in private water supplies in England and France. The estimated risk of infection was very high with the median annual risk being of the order of 25-28% for Cryptosporidium and 0.4% to 0.7% for Giardia, though, in the poorer quality supplies the risk could be much higher. These risks are substantially greater than for public water supplies and well above the risk considered tolerable. The observation that observed infection rates are generally much lower may indicate increased immunity in people regularly consuming water from private supplies. However, this increased immunity is presumed to derive from increased disease risk in young children, the group most at risk from severe disease.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK. Paul.Hunter@uea.ac.uk
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hunter
authors.forename: Marianna Anderle
authors.initials: MA
authors.lastname: de Sylor
authors.forename: Helen L
authors.initials: HL
authors.lastname: Risebro
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Nichols
authors.forename: David
authors.initials: D
authors.lastname: Kay
authors.forename: Philippe
authors.initials: P
authors.lastname: Hartemann
mesh_terms: D000818:Animals; D001499:Bayes Theorem; D003457:Cryptosporidiosis / Q000453:epidemiology; D003458:Cryptosporidium / Q000302:isolation & purification*; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000302:isolation & purification; D005872:Giardia / Q000302:isolation & purification*; D005873:Giardiasis / Q000453:epidemiology; D018570:Risk Assessment; D014881:Water Supply