Wells and Enteric Disease Transmission: A randomized trial of children supplied drinking water from private wells (WET-Trial)

水井和肠道疾病传播：一项针对儿童从私人水井提供饮用水的随机试验（WET-试验）

• 批准号: 10199991
• 负责人: Heather M Murphy
• 金额: $ 78.32万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10199991
• 关键词: Accounting; Adenoviruses; Advisory Committees; Age; Bacteria; Campylobacter; Canada; Child; Childhood; Communities; Consumption; Cryptosporidium; Data; Devices; Diarrheagenic E. coli; Disease; Elderly; Enteral; Enterovirus; Epidemiologic Methods; Feces; Giardia; Health; Health Care Costs; Household; Immune; Immunocompromised Host; Incidence; Intervention; Knowledge; Link; Modeling; Norovirus; Paper; Pennsylvania; Placebos; Policies; Privatization; Protozoa; Publishing; Randomized Controlled Trials; Risk; Risk Assessment; Risk Estimate; Salmonella; Schools; Shigella; Source; System; Testing; Ultraviolet Rays; United States; Viral; Virus; Vulnerable Populations; Washington; Water; Water Supply; Water consumption; Wisconsin; Work; burden of illness; cost; disease transmission; drinking water; enteric infection; enteric pathogen; epidemiologic data; gastrointestinal; ground water; high risk; microbial; pathogen; placebo group; randomized trial; rural families; stool sample; water quality; water sampling; water treatment; waterborne illness; waterborne pathogen; well water

Approximately 48 million people in the US are served by private, and frequently untreated, wells. Our best estimate is that 1.3 million cases of gastrointestinal illnesses (GI) per year are attributed to consuming water from untreated private wells in the US, but in reality, there are no robust epidemiological data that can be used to estimate cases of GI attributable to these sources. It is likely that well water-associated GI causes significant healthcare costs and lost work/school days, as well as increased risk for long term health complications. This impact is magnified when accounting for vulnerable populations such as children under the age of 5, the elderly, and the immunocompromised. We propose the first randomized controlled trial (RCT) to estimate the burden of GI associated with private well water. We will test if household treatment of private well water by ultraviolet light (UV) vs. sham (placebo inactive UV device) decreases the incidence of GI in children under 5. At present, there are no prior RCTs or studies that have sought causal links between GI and the consumption of untreated water from private wells despite the fact that pathogens have been recovered in groundwater, including deep aquifers. Under the guidance of an interdisciplinary advisory committee we will execute the following aims: Aim 1- Quantify the incidence rate of endemic childhood GI associated with consuming untreated private well water and compare that to the incidence rate of consuming well water treated by UV. Aim 1a- Construct a Quantitative Microbial Risk Assessment (QMRA) using water quality data we collect to estimate the risk of childhood GI associated with consuming untreated private well water and compare the incidence from the risk model to the incidence we calculate in Aim 1. Aim 2- Identify, quantify and compare viral, bacterial and protozoan pathogens in stool of children consuming UV treated or untreated (sham) private well water (including both asymptomatic and symptomatic cases). Aim 3- Explore the presence of pathogens in untreated well water and stool samples of children consuming untreated private well water (sham group only). These data will fill a knowledge gap on sporadic GI associated with federally-unregulated private water supplies in the US. Our results will test an affordable water treatment intervention and inform GI burden estimates and policy decisions for managing well water in the US and globally. Policy changes will help better protect rural families, especially children who are at highest risk for sporadic enteric infections.

在美国，大约有4800万人使用私人的、经常未经处理的威尔斯井。我们最好的 据估计，每年有130万例胃肠道疾病（GI）归因于消费 美国未经处理的私人威尔斯井中的水，但实际上，没有可靠的流行病学数据可以 用于估计可归因于这些来源的GI病例。很可能与井水相关的GI导致 医疗保健费用高昂，工作/上学时间减少，长期健康风险增加 并发症如果考虑到弱势群体，如儿童， 5岁，老年人和免疫功能低下者。 我们提出了第一个随机对照试验（RCT），以估计胃肠道的负担与 私人井水我们将测试家庭处理私人井水的紫外线（UV）与。 假手术（安慰剂无活性紫外线装置）降低了5岁以下儿童胃肠道的发生率。而目前 没有先前的随机对照试验或研究寻找GI和饮用未经处理的水之间的因果关系 从私人威尔斯井中提取的病原体， 含水层 在跨学科咨询委员会的指导下，我们将实现以下目标： 目标1-量化与饮用未经处理的私人水井相关的地方性儿童胃肠道发病率 并将其与饮用经紫外线处理的井水的发病率进行比较。 目标1a-利用我们收集的水质数据构建定量微生物风险评估（QMRA）， 估计与饮用未经处理的私人井水相关的儿童GI风险，并比较 从风险模型的发生率到我们在目标1中计算的发生率。 目的2-确定、量化和比较儿童粪便中的病毒、细菌和原生动物病原体， 紫外线处理或未经处理（假）私人井水（包括无症状和有症状的病例）。 目的3-探索未经处理的井水和儿童粪便样本中是否存在病原体， 未经处理的私人井水（仅假手术组）。 这些数据将填补与联邦政府不受管制的私人水有关的零星GI的知识空白 在美国的供应。我们的研究结果将测试负担得起的水处理干预措施，并告知GI负担 为美国和全球的井水管理提供评估和政策决策。政策变化将有助于更好地 保护农村家庭，特别是最易患散发性肠道感染的儿童。