RANDOMIZED TRIAL OF TAPWATER TREATMENT IN THE ELDERLY

描述(改编自申请人的摘要)：有激烈的辩论 美国关于水传播传染病可能在多大程度上 通过符合联邦法规的饮用水传播给人类 病原体清除标准。关于这种情况的辩论中有一个重要的问题 在地方性环境中的传播集中在对特定 亚群(如老年人、幼儿和免疫功能低下者 个人)可能会增加初次感染和严重感染的风险 后遗症。研究表明，老年人在很大程度上 由水传播的病原体感染的风险，并且它们发展得更严重 疾病。这项建议的主要目标是评估 家庭处理自来水以减少胃肠道疾病 非制度化的老年人。这一目标将会实现 通过使用随机、控制和双盲干预 在居住在加利福尼亚州索诺马的老年人中进行试验，他们已经 美国国立卫生研究院资助的纵向队列的参与者(《老龄化的流行病学》 和身体机能“，2 R01 AG09389-06)。总共540户(810户 在这项为期五年的研究中，每个人将参加为期12个月的学习。 将使用交叉设计，其中一半的家庭将随机 选择接受处理(密封水处理装置，由 紫外线灯和1微米滤光片)，为期六个月，并将改用 为他们参与研究的剩余六个月提供安慰剂设备。这个 其他家庭最初将接受为期六个月的安慰剂治疗，最后 治疗设备。将从以下地点收集和分析粪便样本 在研究期间报告胃肠道疾病并进行测试的个人 针对广泛的细菌、病毒和原生动物病原体 加州卫生服务部。水质将会是 系统监测，以记录供水保持在 遵守适用的标准。这项研究将提供以下内容 对老年人的估计：1)老年人患高血压的归因风险 饮用自来水引起的胃肠道疾病 偶尔被人类排泄物污染的地表水水源(a 在美国广泛发生)，但接受治疗以满足联邦 标准和2)特定细菌、病毒和 老年胃肠道疾病患者粪便标本中原虫检测结果分析 生病了。提交此提案的团队目前正在进行工作，并获得了资金 由疾病控制和预防中心和美国环境局 保护机构，以改善随机、盲水中的受试者失明 在所有年龄段的个体中进行干预试验。

DESCRIPTION (Adapted from the Applicant's Abstract): There is heated debate in the United States about the extent to which waterborne infectious diseases may be transmitted to human beings through drinking water that meets federal standards for pathogen removal. One important issue in the debate about such transmission in endemic settings centers on concern that specific subpopulations (such as the elderly, young children, and immunocompromised individuals) may be at increased risk for both initial infection and serious sequelae. Studies have suggested that elderly individuals are at significant risk of infection from waterborne pathogens, and that they develop more severe disease. The principal objective of this proposal is to evaluate the ability of in-home treatment of tapwater to reduce gastrointestinal illness in non-institutionalized elderly individuals. This objective will be achieved through the use of a randomized, controlled, and double-blinded intervention trial among elderly persons living in Sonoma, California, who are already participants in an NIH-funded longitudinal cohort ("The Epidemiology of Aging and Physical Function", 2 R01 AG09389-06). A total of 540 households (810 individuals) are to be enrolled for 12 months each during this five-year study. A cross-over design will be used in which half the households will be randomly selected to receive treatment (a sealed water treatment device consisting of an ultraviolet lamp and a 1 micron filter) for six months and will be switched to a placebo device for the remaining six months of their study participation. The other households will initially receive the placebo for six months and end with the treatment device. Stool specimens will be collected and analyzed from individuals who report gastrointestinal illnesses during the study and tested for a broad range of bacterial, viral, and protozoal pathogens by the California Department of Health Services. The water quality will be systematically monitored to document that the water supply remained in compliance with applicable standards. This research will provide the following estimates among elderly individuals: 1) the attributable risk of gastrointestinal illness from the consumption of tap water derived from a surface water source that is occasionally contaminated with human waste (a widespread occurrence in the United States) but is treated to meet federal standards and 2) the rate of detection of specific bacterial, viral, and protozoal agents in stool specimens of elderly persons with gastrointestinal illness. The team submitting this proposal is currently conducting work, funded by the Centers for Disease Control and Prevention and the US Environmental Protection Agency, to improve subject blinding in randomized, blinded water intervention trials in individuals of all ages.