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Published in: BMC Infectious Diseases 1/2017

Open Access 01-12-2017 | Research article

A controlled survey of less typical long-term consequences after an extensive waterborne epidemic

Authors: Janne Laine, Outi Laine, Jukka Lumio, Jaakko Antonen, Salla Toikkanen, Mikko J. Virtanen, Markku Kuusi, the Pirkanmaa Waterborne Outbreak Study Group

Published in: BMC Infectious Diseases | Issue 1/2017

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Abstract

Background

Extensive backflow of treated wastewater caused household water contamination in a Finnish town in 2007. The drinking water of 9 500 residents became heavily polluted with faecal microbes, resulting in a large gastroenteritis epidemic. Cases of reactive arthritis, milder joint symptoms and prolonged gastrointestinal symptoms were observed after the outbreak. A follow-up survey was performed to study less familiar long-term health consequences within a year from the outbreak.

Methods

The contaminated group comprised a sample of residents of the area with polluted water supply (N = 323) and the control group a sample of residents in a nearby municipality (N = 186). The presence of 20 general symptoms or complaints was inquired by a mail survey. Quarterly prevalence of each symptom or complaint was measured. Twelve of these proceeded to further analysis.

Results

The response rate was 53% (323/615) in the contaminated group and 54% (186/343) in the control group. Rash, eye irritation, heartburn and weight loss were more prevalent in the contaminated group during the first year quarter. In the last year quarter, only eye irritation was significantly more common in the contaminated group.

Conclusion

The excess prevalence of four complaints at the first year quarter can be explained by acute gastroenteritis or intensive water chlorination. The excess prevalence of eye irritation at the fourth year quarter cannot be explained by chlorination anymore but might be a sign of co-existing reactive joint disease. In general, long-term consequences of the outbreak can be considered minor in terms of the surveyed symptoms or complaints.
Literature
2.
go back to reference Mac Kenzie RW, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, et al. A massive oubreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331:161–7.CrossRefPubMed Mac Kenzie RW, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, et al. A massive oubreak in Milwaukee of Cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331:161–7.CrossRefPubMed
3.
go back to reference Novello A. The Washington county fair outbreak report. Albany: New York State Department of Health; 2000. p. 1–108. Novello A. The Washington county fair outbreak report. Albany: New York State Department of Health; 2000. p. 1–108.
4.
go back to reference Garg AX, Pope JE, Thiessen-Philbrook H, Clark WF, Ouimet J. Arthritis risk after acute bacterial gastroenteritis. Rheumatology (Oxford). 2008;47:200–4.CrossRef Garg AX, Pope JE, Thiessen-Philbrook H, Clark WF, Ouimet J. Arthritis risk after acute bacterial gastroenteritis. Rheumatology (Oxford). 2008;47:200–4.CrossRef
5.
go back to reference Hannu T, Kauppi M, Tuomala M, Laaksonen I, Klemets P, Kuusi M. Reactive arthritis following an outbreak of Campylobacter jejuni infection. J Rheumatol. 2004;31:528–30.PubMed Hannu T, Kauppi M, Tuomala M, Laaksonen I, Klemets P, Kuusi M. Reactive arthritis following an outbreak of Campylobacter jejuni infection. J Rheumatol. 2004;31:528–30.PubMed
6.
go back to reference Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins SM. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50. quiz 660.CrossRefPubMed Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins SM. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50. quiz 660.CrossRefPubMed
7.
go back to reference Wensaas KA, Langeland N, Hanevik K, Morch K, Eide GE, Rortveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut. 2012;61:214–9.CrossRefPubMed Wensaas KA, Langeland N, Hanevik K, Morch K, Eide GE, Rortveit G. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut. 2012;61:214–9.CrossRefPubMed
8.
go back to reference Rehn M, Wallensten A, Widerstrom M, Lilja M, Grunewald M, Stenmark S, et al. Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010–2011. BMC Public Health. 2015;15:529.CrossRefPubMedPubMedCentral Rehn M, Wallensten A, Widerstrom M, Lilja M, Grunewald M, Stenmark S, et al. Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010–2011. BMC Public Health. 2015;15:529.CrossRefPubMedPubMedCentral
9.
go back to reference Clark WF, Sontrop JM, Macnab JJ, Salvadori M, Moist L, Suri R, et al. Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study. BMJ. 2010;341:c6020.CrossRefPubMedPubMedCentral Clark WF, Sontrop JM, Macnab JJ, Salvadori M, Moist L, Suri R, et al. Long term risk for hypertension, renal impairment, and cardiovascular disease after gastroenteritis from drinking water contaminated with Escherichia coli O157:H7: a prospective cohort study. BMJ. 2010;341:c6020.CrossRefPubMedPubMedCentral
10.
go back to reference Laine J, Huovinen E, Virtanen MJ, Snellman M, Lumio J, Ruutu P, et al. An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland. Epidemiol Infect. 2011;139:1105–13.CrossRefPubMed Laine J, Huovinen E, Virtanen MJ, Snellman M, Lumio J, Ruutu P, et al. An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland. Epidemiol Infect. 2011;139:1105–13.CrossRefPubMed
11.
go back to reference Huovinen E, Laine J, Virtanen MJ, Snellman M, Hujanen T, Kiiskinen U, et al. Excess healthcare costs of a large waterborne outbreak in Finland. Scand J Public Health. 2013;41:761–6.CrossRefPubMed Huovinen E, Laine J, Virtanen MJ, Snellman M, Hujanen T, Kiiskinen U, et al. Excess healthcare costs of a large waterborne outbreak in Finland. Scand J Public Health. 2013;41:761–6.CrossRefPubMed
12.
go back to reference Laine J, Lumio J, Toikkanen S, Virtanen MJ, Uotila T, Korpela M, et al. The duration of gastrointestinal and joint symptoms after a large waterborne outbreak of gastroenteritis in Finland in 2007--a questionnaire-based 15-month follow-up study. PLoS ONE. 2014;9, e85457.CrossRefPubMedPubMedCentral Laine J, Lumio J, Toikkanen S, Virtanen MJ, Uotila T, Korpela M, et al. The duration of gastrointestinal and joint symptoms after a large waterborne outbreak of gastroenteritis in Finland in 2007--a questionnaire-based 15-month follow-up study. PLoS ONE. 2014;9, e85457.CrossRefPubMedPubMedCentral
13.
go back to reference Laine J, Uotila T, Antonen J, Korpela M, Kujansuu E, Lumio J, et al. Joint symptoms after a large waterborne gastroenteritis outbreak--a controlled, population-based questionnaire study. Rheumatology (Oxford). 2012;51:513–8.CrossRef Laine J, Uotila T, Antonen J, Korpela M, Kujansuu E, Lumio J, et al. Joint symptoms after a large waterborne gastroenteritis outbreak--a controlled, population-based questionnaire study. Rheumatology (Oxford). 2012;51:513–8.CrossRef
14.
go back to reference Uotila T, Antonen J, Laine J, Kujansuu E, Haapala AM, Lumio J, et al. Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland. Scand J Rheumatol. 2011;40:358–62.CrossRefPubMed Uotila T, Antonen J, Laine J, Kujansuu E, Haapala AM, Lumio J, et al. Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland. Scand J Rheumatol. 2011;40:358–62.CrossRefPubMed
15.
go back to reference Uotila TM, Antonen JA, Paakkala AS, Mustonen JT, Korpela MM. Outcome of reactive arthritis after an extensive Finnish waterborne gastroenteritis outbreak: a 1-year prospective follow-up study. Clin Rheumatol. 2013;32:1139–45.CrossRefPubMed Uotila TM, Antonen JA, Paakkala AS, Mustonen JT, Korpela MM. Outcome of reactive arthritis after an extensive Finnish waterborne gastroenteritis outbreak: a 1-year prospective follow-up study. Clin Rheumatol. 2013;32:1139–45.CrossRefPubMed
16.
go back to reference Ford AC, Thabane M, Collins SM, Moayyedi P, Garg AX, Clark WF, et al. Prevalence of uninvestigated dyspepsia 8 years after a large waterborne outbreak of bacterial dysentery: a cohort study. Gastroenterology. 2010;138:1727–36. quiz e12.CrossRefPubMed Ford AC, Thabane M, Collins SM, Moayyedi P, Garg AX, Clark WF, et al. Prevalence of uninvestigated dyspepsia 8 years after a large waterborne outbreak of bacterial dysentery: a cohort study. Gastroenterology. 2010;138:1727–36. quiz e12.CrossRefPubMed
17.
go back to reference Carter JD. Reactive arthritis: defined etiologies, emerging pathophysiology, and unresolved treatment. Infect Dis Clin North Am. 2006;20:827–47.CrossRefPubMed Carter JD. Reactive arthritis: defined etiologies, emerging pathophysiology, and unresolved treatment. Infect Dis Clin North Am. 2006;20:827–47.CrossRefPubMed
18.
go back to reference Rimhanen-Finne R, Hänninen ML, Vuento R, Laine J, Jokiranta S, Snellman M, et al. Contaminated water caused the first outbreak of giardiasis in Finland, 2007: a descriptive study. Scand J Infect Dis. 2010;42:613–9.CrossRefPubMed Rimhanen-Finne R, Hänninen ML, Vuento R, Laine J, Jokiranta S, Snellman M, et al. Contaminated water caused the first outbreak of giardiasis in Finland, 2007: a descriptive study. Scand J Infect Dis. 2010;42:613–9.CrossRefPubMed
Metadata
Title
A controlled survey of less typical long-term consequences after an extensive waterborne epidemic
Authors
Janne Laine
Outi Laine
Jukka Lumio
Jaakko Antonen
Salla Toikkanen
Mikko J. Virtanen
Markku Kuusi
the Pirkanmaa Waterborne Outbreak Study Group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2017
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-017-2260-9

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