The complex association between drinking water consumption and endemic gastrointestinal illness as shown by Swedish cohort studies

Author:

Säve-Söderbergh Melle12ORCID,Toljander Jonas1ORCID,Simonsson Magnus13ORCID

Affiliation:

1. a Swedish Food Agency, 751 26 Uppsala, Sweden

2. b Institute of Environmental Medicine, Karolinska Institutet, Stockholm 171 77, Sweden

3. c European Union Reference Laboratory for Foodborne Viruses, Swedish Food Agency, Uppsala 751 26, Sweden

Abstract

ABSTRACT It is well known that municipal drinking water may be the cause of gastrointestinal illness (GII) outbreaks, but it is still unclear to what extent drinking water contributes to endemic GII. To explore this, we conducted a prospective cohort study among 6,955 adults in five municipalities in Sweden, collecting monthly GII episodes and mean daily cold drinking water consumption through SMS (Short Message Service). When the association between drinking water consumption and GII (all symptoms) and acute gastrointestinal illness (AGI, vomiting and/or three loose stools during a 24-h period) were assessed, there were indications that the association departed from linearity, following a unimodal shape. Among consumers in surface water areas, the highest risk of GII and AGI was generally seen among the average consumers, while the opposite was seen among groundwater consumers. The association however also seemed to be affected by neighbouring communities. The results of the study indicate that there is indeed an association between drinking water consumption and endemic GII, but the nature of this association is complex and likely affected by multiple factors, for example, water source type in the home and degree of exposure to drinking water from additional sources.

Publisher

IWA Publishing

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