Re: BEACHNET==> ER visits for Diarrheal Illness Increased After Release of Undertreated Sewage

[mclellan@uwm.edu]

Hi everyone,
Just to give some comment on this study, since I am somewhat familiar with it,
and am currently working with these authors on a larger effort.  I think the
study tackles a very important issue that, to date, we could only speculate on,
e.g. are there measurable adverse health outcomes during sewage overflows?  I
think the authors do a good job in recognizing that this is a very preliminary
study, and limited by the number of cases and sewage overflow events that
occurred (there are approximately 0-3 per year in this study area).  A larger
sampling may or may not show the same effect.  Also, drinking water might not
be the only route of exposure during sewage overflows.  Many small tributaries
are receiving waters for CSO?s, and beaches could also be impacted.  It would
be interesting to include recreational exposures along with drinking water.

In addition to sewage overflows, during storm events alone we have detected
human viruses, suggesting unrecognized sanitary sewage inputs (e.g. illicit
cross connections to the stormwater system, or deteriorating infrastructure). 
I would not be surprised if there are subsequent adverse health effects
(perhaps at a lesser level) from storm events in general.  I think it?s
important to conduct such studies, even if they are limited, so we have a
better foundation for decision-making. Until we know more, preemptive warning
during sewage overflows seems like a logical measure for protection of public
health.


Sandra McLellan
Associate Scientist
Great Lakes WATER Institute
University of Wisconsin-Milwaukee
600 E. Greenfield Ave.
Milwaukee, WI 53204



Quoting Shannon Briggs <briggss4@michigan.gov>:

> PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1472-e1475
> (doi:10.1542/peds.2007-0283)
>
> FOR ABSTRACT
> http://pediatrics.aappublications.org/cgi/content/abstract/120/6/e1472
>
>
> Pediatric Emergency Department Visits for Diarrheal Illness Increased
> After Release of Undertreated Sewage
>
> Ryan L. Redman, MD(a), Cheryl A. Nenn, MS(b), Daniel Eastwood, MS(a)
> and Marc H. Gorelick, MD, MSCE(a)
>
> (a) Emergency Department, Medical College of Wisconsin, Milwaukee,
> Wisconsin
> (b) Friends of Milwaukee's Rivers, Milwaukee, Wisconsin
>
> CONTEXT. Contamination of local waterways may occur through release of
> partially treated sewage. The Environmental Protection Agency has
> recently reviewed regulatory standards for this practice. However, the
> health effects of these events have not been well studied.
>
> OBJECTIVE. Our goal was to identify any increase in visits to a
> pediatric emergency department for diarrheal illness after sewage bypass
> into Lake Michigan.
>
> METHODS. The study was conducted as a retrospective, observational
> time-series analysis in a tertiary care children's hospital emergency
> department with an annual volume of 45000 visits. We collected data for
> 2002-2004 pertaining to the daily number of emergency department visits
> for children (aged <19 years) for diarrheal illness (using specified
> International Classification of Diseases, Ninth Edition codes as a
> reference). Daily diarrheal illness visits were the dependent variable
> in a time-series model. The primary independent variable was the
> occurrence of a sewage-bypass event in the 3 to 7 preceding days.
> Potential confounders included the season and daily rainfall. Separate
> models were created for visits from people living in zip codes that used
> Lake Michigan drinking water and those who used other water sources.
>
> RESULTS. Over the 3-year study period, there was a mean of 5.0 ± 3.8
> (SD) daily visits for diarrheal illness from people who lived in zip
> codes that used Lake Michigan drinking water and 1.2 ± 1.4 (SD) from
> outside that area. There were 6 sewage-bypass events identified. After
> adjusting for the season and rainfall, there was a significant increase
> of 2.5 to 2.7 visits only from people who lived in zip codes that used
> Lake Michigan drinking water after the 2 largest of the 6 bypass events.
>
>
> CONCLUSIONS. Emergency department visits for diarrheal illness
> increased significantly after 2 events of release of partially treated
> sewage into area waterways. These data suggest a potentially harmful
> effect of such practices.
>
--------------------------------------------------------------------------------
> Key Words: gastrointestinal infections environmental health
>
> Abbreviations: EDemergency department ARIMAautoregressive integrated
> moving average ICD-9 International Classification of Diseases, Ninth
> Edition CHWChildren's Hospital of Wisconsin CIconfidence interval
>
--------------------------------------------------------------------------------
> Accepted May 10, 2007.
>
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