Indicators of Recreational Water Contamination and Illness

描述（由申请人提供）：2002年，NAS/NRC要求我们小组审查将水质指标与人类健康联系起来的所有证据。我们将这些结果作为荟萃分析发表（Wade et al. 2003）。传统的指标（总大肠菌群，粪大肠菌群和肠球菌）是有问题的，因为长时间的分析时间（18-96小时）使及时预警变得困难。微生物学技术的进步现已十分明显，有理由将现有指标与更迅速测量的新指标进行比较。此外，统计方法的重要进展（例如使用暴露加权的逆概率估计多变量剂量反应函数）尚未用于调查这些指标与健康和预测的重要多变量关系的可能性。作为准备，我们在2003年在圣地亚哥的6个海滩进行了一项研究。我们招募了12,458名海滩使用者，记录了详细的游泳历史，并收集了14天的疾病数据。我们每小时在游泳者所在地收集水样。我们目前的试验数据分析表明，我们有能力检测游泳的风险，并与试点中使用的1种新指标（F+大肠杆菌噬菌体）的健康结果有很强的关联。我们提出了新发布的EPA数据，显示在淡水站点中通过快速QPCR（我们使用的相同方法）测量的胃肠道（GI）疾病和肠球菌之间的强相关性。我们建议，在4个夏天，在Doheny海滩（加州污染最严重的公共海滩之一）招募至少17，600名海滩用户，使用相同的设计，并扩大我们的指标测试，包括快速方法和空间上与每个游泳者相关的水样中的病毒因子。我们2003年的试点研究团队是完整的（加州大学伯克利分校，SCCWRP，哈佛，UNO，OHSU），现在已经加入了NOAA霍林斯海洋实验室。有关关闭海滩的决定具有巨大的经济影响。如果成功，我们将量化健康与传统指标以及病毒指标的新型快速方法之间的关系。

DESCRIPTION (provided by applicant): In 2002, our group was asked by NAS/NRC to review all evidence linking water quality indicators to human health. We published these results as a meta-analysis (Wade et al. 2003). Traditional indicators (total coliform, fecal coliform, and Enterococcus) are problematic because prolonged analysis times (18-96 hours) make timely warnings difficult. Advances in microbiologic techniques are now pronounced and justify a comparison of current indicators with more rapidly measured new indicators. Additionally, important advances in statistical methods (such as the estimation of multivariate dose-response functions using inverse-probability of exposure weighting) have not been used to investigate the possibility of important multivariate relationships of these indicators to health and prediction. As preparation, we conducted a study at 6 San Diego beaches in 2003. We enrolled 12,458 beach users, recorded detailed swimming histories and collected illness data for 14 days. We collected hourly water samples at sites linked to the swimmer locations. We present analyses of this pilot data showing our ability to detect risk from swimming and a strong association with health outcomes of 1 novel indicator (F+ coliphage) used in the pilot. We present newly released EPA data showing a strong correlation between gastrointestinal (Gl) illness and Enterococcus measured by rapid QPCR (same method we use) in a freshwater site. We propose, over 4 summers, to enroll at least 17,600 beach users at Doheny Beach (one of California's most contaminated public beaches) using the same design and expanding our indicator testing to include rapid methods and viral agents from water samples spatially linked to each swimmer. Our 2003 pilot study research team is entirely intact (UC Berkeley, SCCWRP, Harvard, UNO, OHSU) and now has been joined by the NOAA Hollings Marine Lab. Decisions about beach closures have enormous economic implications. If successful, we will quantify the relationship between health and novel rapid methods for traditional indicators as well as viral indicators.