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

在美国，大约有4800万人通过私人水井供水，这些水井往往未经治疗。我们最好的 据估计，每年有130万例胃肠道疾病(GI)归因于 来自美国未经处理的私人水井的水，但在现实中，没有强有力的流行病学数据可以 用于估计可归因于这些来源的胃肠道感染病例。井水相关的胃肠道感染很可能是由 巨大的医疗费用和工作/上学天数的损失，以及对长期健康的风险增加 并发症。当考虑到弱势群体，如儿童时，这种影响被放大 5岁时，年纪大了，免疫功能受损。 我们提出了第一个随机对照试验(RCT)来估计与以下疾病相关的GI负担 私人井水。我们将测试家用处理私人井水的紫外线(UV)与 SHAM(安慰剂非活性紫外线设备)可降低5岁以下儿童胃肠道感染的发生率。目前， 是否没有先前的随机对照试验或研究寻找胃肠道感染和未经处理的水的消费之间的因果关系？ 尽管已经在地下水中发现了病原体，包括深井 含水层。 在一个跨学科咨询委员会的指导下，我们将实现以下目标： 目标1-量化与饮用未经治疗的私人水井相关的地方性儿童胃肠道感染的发生率 并将其与饮用紫外线处理过的井水的发生率进行比较。 目标1a-使用我们收集的水质数据构建定量微生物风险评估(QMRA) 评估与饮用未经处理的私人井水相关的儿童GI的风险，并比较 从风险模型到我们在目标1中计算的发生率。 目标2-识别、量化和比较消费儿童粪便中的病毒、细菌和原虫病原体 经紫外线处理或未经处理(假)的私人井水(包括无症状和有症状的病例)。 目的3-探索饮用未经处理的井水和大便样本中病原体的存在 未经处理的私人井水(仅限假手术组)。 这些数据将填补与联邦不受监管的私人水相关的零星GI的知识空白 在美国的供应。我们的结果将测试负担得起的水处理干预措施，并告知GI负担 在美国和全球管理井水的估计和政策决定。政策变化将有助于更好地 保护农村家庭，特别是散发性肠道感染风险最高的儿童。

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.