RANDOMIZED TRIAL OF TAPWATER TREATMENT IN THE ELDERLY

描述（改编自申请人的摘要）： 美国关于水传播的传染病可能在多大程度上 通过符合联邦标准的饮用水传染给人类 病原体清除的标准。关于这类问题的辩论中的一个重要问题是， 在地方性环境中的传播集中在关注特定的 亚群（如老年人、幼儿和免疫功能低下者） 个体）可能会增加初始感染和严重感染的风险。 后遗症研究表明，老年人在 水传播病原体感染的风险，并且他们发展得更严重 疾病本提案的主要目的是评估 自来水的家庭处理，以减少胃肠道疾病， 非机构化的老年人。这一目标将得以实现 通过使用随机、对照和双盲干预 在居住在加州索诺马的老年人中进行的试验， 参与NIH资助的纵向队列研究（“老龄化流行病学 和生理功能”，2 R 01 AG 09389 -06）。共540户（810 在这项为期五年的研究中，每个人将被招募12个月。 将采用交叉设计，其中一半的家庭将被随机 选择接受治疗（密封的水处理装置， 紫外线灯和1微米的过滤器）六个月，并将切换到 在研究参与的剩余6个月内使用安慰剂器械。的 其他家庭最初将接受为期六个月的安慰剂， 治疗设备。粪便标本将收集并分析， 在研究期间报告胃肠道疾病并接受检测的个体 对于广泛的细菌，病毒和原生动物病原体， 加州卫生服务部。水质将 系统地监测，以记录供水仍然在 符合适用标准。这项研究将提供以下内容 估计老年人：1）归因于风险 胃肠道疾病的消费自来水来自一个 偶尔被人类排泄物污染的地表水源（a 在美国广泛发生），但被视为符合联邦 标准和2）特定细菌，病毒和 老年人胃肠道疾病粪便标本中的原虫 病提交这一提案的小组目前正在开展工作， 由美国疾病控制和预防中心和美国环境 保护机构，以改善受试者在随机化、设盲水中的盲态 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.