title: Acute gastrointestinal illness following a prolonged community-wide water emergency.
abstract: The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1-5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4-9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.
authors.affiliation: Epidemic Intelligence Service,CDC,Atlanta,GA,USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Gargano
authors.affiliation: Epidemic Intelligence Service,CDC,Atlanta,GA,USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Freeland
authors.affiliation: Office of Public Health Preparedness and Response,CDC,Atlanta,GA,USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Morrison
authors.affiliation: Alabama Department of Public Health,Montgomery,AL,USA.
authors.forename: K
authors.initials: K
authors.lastname: Stevens
authors.affiliation: National Center for Environmental Health,CDC,Atlanta,GA,USA.
authors.forename: L
authors.initials: L
authors.lastname: Zajac
authors.affiliation: Center for Global Health,CDC,Atlanta,GA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Wolkon
authors.affiliation: Center for Global Health,CDC,Atlanta,GA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Hightower
authors.affiliation: National Center for Environmental Health,CDC,Atlanta,GA,USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Miller
authors.affiliation: National Center for Emerging and Zoonotic Diseases,CDC,Atlanta,GA,USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Brunkard
mesh_terms: D000407:Alabama / Q000453:epidemiology; D003080:Cold Temperature; D003625:Data Collection / Q000379:methods; D004196:Disease Outbreaks; D060766:Drinking Water; D004630:Emergencies; D005191:Family Characteristics; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors
chemical_list: D060766:Drinking Water
keywords: Infectious disease epidemiology; investigation; public health; water-borne infections