Indicators of Recreational Water Contamination and Illness

描述（由申请人提供）：2002年，我们的小组应NAS/NRC的要求审查所有将水质指标与人类健康联系起来的证据。我们将这些结果作为荟萃分析发表（Wade et al. 2003）。传统指标（总大肠菌群、粪便大肠菌群和肠球菌）存在问题，因为分析时间过长（18-96小时），难以及时发出警告。微生物学技术的进步现在很明显，有理由将现有指标与更快速测量的新指标进行比较。此外，统计方法的重要进展（如使用暴露加权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之间重要的多变量关系的可能性。作为准备，我们于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。我们每小时在与游泳者地点相关的地点采集水样。我们对这一试点数据进行了分析，显示了我们检测游泳风险的能力，以及在试点中使用的一种新指标（F+噬菌体）与健康结果的强烈关联。我们提出了最新发布的EPA数据，显示在淡水站点通过快速QPCR（与我们使用的方法相同）测量的胃肠道（Gl）疾病与肠球菌之间存在很强的相关性。我们建议在4个夏天的时间里，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，包括快速方法和从每个游泳者的水样中提取的病毒试剂。我们2003年的试点研究小组完好无损（加州大学伯克利分校、SCCWRP、哈佛大学、UNO、OHSU），现在NOAA霍林斯海洋实验室也加入了进来。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.