Occurrence of Legionella in UK household showers

Household water systems have been proposed as a source of sporadic, community acquired Legionnaires’ disease. Showers represent a frequently used aerosol generating device in the domestic setting yet little is known about the occurrence of Legionella spp. in these systems. This study has investigated the prevalence of Legionella spp. by culture and qPCR in UK household showers. Ninety nine showers from 82 separate properties in the South of England were sampled. Clinically relevant Legionella spp. were isolated by culture in 8% of shower water samples representing 6% of households. Legionella pneumophila sg1 ST59 was isolated from two showers in one property and air sampling demonstrated its presence in the aerosol state. A further 31% of showers were positive by Legionella spp. qPCR. By multi-variable binomial regression modelling Legionella spp. qPCR positivity was associated with the age of the property (p = 0.02), the age of the shower (p = 0.01) and the frequency of use (p = 0.09). The concentration of Legionella spp. detected by qPCR was shown to decrease with increased frequency of use (p = 0.04) and more frequent showerhead cleaning (p = 0.05). There was no association between Legionella spp. qPCR positivity and the cold water supply or the showerhead material (p = 0.65 and p = 0.71, respectively). Household showers may be important reservoirs of clinically significant Legionella and should be considered in source investigations. Simple public health advice may help to mitigate the risk of Legionella exposure in the domestic shower environment.     

Use,microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12–24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12–18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5% were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19–24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10–0.39, p < 0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR = 0.50, 95% CrI 0.23–0.90, p = 0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance.     

Assessing patterns and determinants of latrine use in rural settings: A longitudinal study in Odisha,India

Introduction

Monitoring of sanitation programs is often limited to sanitation access and coverage, with little emphasis on use of the facilities despite increasing evidence of widespread non-use.

Microbial contamination of drinking water from risky tubewells situated in different hydrological regions of Bangladesh

This study, conducted in 40 selected upazilas covering four hydrological regions of Bangladesh, aimed at determining the risk of selected shallow tubewells (depth <30m) used for drinking purpose (n = 26,229). This was based on WHO’s sanitary inspection guidelines and identifying the association of sanitary inspection indicators and risk scores with microbiological contamination of shallow tubewells. The main objective of the study was to observe the seasonal and regional differences of microbial contamination and finally reaching a conclusion about safe distance between tubewells and latrines by comparing the contamination of two tubewell categories (category-1: distance ≤10 m from nearest latrine; n = 80 and category 2: distances 11–20 m from nearest latrine; n = 80) in different geographical contexts. About 62% of sampled tubewells were at medium to high risk according to WHO’s sanitary inspection guidelines, while the situation was worst in south-west region. Microbiological contamination was significantly higher in sampled category-1 tubewells compared to category-2 tubewells, while the number of contaminated tubewells and level of contamination was higher during wet season. About 21% (CI₉₅ = 12%–30%), 54% (CI₉₅ = 43%–65%) and 58% (CI₉₅ = 46%–69%) of water samples collected from category-1 tubewells were contaminated by E. coli, FC, and TC respectively during the wet season. The number of category-1 tubewells having E.coli was highest in the north-west (n = 8) and north-central (n = 4) region during wet season and dry season respectively, while the level of E.coli contamination in tubewell water (number of CFU/100 ml of sample) was significantly higher in north-central region. However, the south-west region had the highest number of FC contaminated category-1 tubewells (n = 16 & n = 17; respectively during wet and dry season) and significantly a higher level of TC and FC in sampled Category-1 tubewells than north-west, north-central and south-east region, mainly during wet season. Multivariate regression analysis could identified some sanitary inspection indicators, such as tubewell within <10 m of latrine, platform absent/broken, pollution source (i.e. household’s waste dumping point/poultry/dairy farm) within 10 m of tubewell and unimproved sanitation facility which were significantly associated with presence of microbial contaminants in tubewell water (p < 0.01). A tubewell with high risk level was associated with a higher chance of having FC and TC in tubewell water than a tubewell with a medium risk during wet season, but no such conclusion could be drawn in case of E.coli contamination. Construction of pit latrine in areas with high water table should be highly discouraged. Raised sealed pits or flush/pour flash to septic tank could be installed considering sanitary inspection criteria. Water should be treated before drinking.     

Livestock ownership and microbial contamination of drinking-water: Evidence from nationally representative household surveys in Ghana,Nepal and Bangladesh

Background

Current priorities for diarrhoeal disease prevention include use of sanitation and safe water. There have been few attempts to quantify the importance of animal faeces in drinking-water contamination, despite the presence of potentially water-borne zoonotic pathogens in animal faeces.

Microbial quality of drinking water from microfiltered water dispensers

A comparison was made between the microbial quality of drinking water obtained from Microfiltered Water Dispensers (MWDs) and that of municipal tap water. A total of 233 water samples were analyzed. Escherichia coli (EC), enterococci (ENT), total coliforms (TC), Staphylococcus aureus, Pseudomonas aeruginosa and heterotrophic plate count (HPC) at 22 °C and 37 °C were enumerated. In addition, information was collected about the principal structural and functional characteristics of each MWD in order to study the various factors that might influence the microbial quality of the water.EC and ENT were not detected in any of the samples. TC were never detected in the tap water but were found in 5 samples taken from 5 different MWDs. S. aureus was found in a single sample of microfiltered water. P. aeruginosa was found more frequently and at higher concentrations in the samples collected from MWDs. The mean HPCs at 22 °C and 37 °C were significantly higher in microfiltered water samples compared to those of the tap water.In conclusion, the use of MWDs may increase the number of bacteria originally present in tap water. It is therefore important to monitor the quality of the dispensed water over time, especially if it is destined for vulnerable users.     

Water quality at points-of-use in the Galapagos Islands

Piped drinking water is often considered a gold standard for protecting public health but research is needed to explicitly evaluate the effect of centralized treatment systems on water quality in developing world settings. This study examined the effect of a new drinking water treatment plant (DWTP) on microbial drinking water quality at the point-of-use on San Cristobal Island, Galapagos using fecal indicator bacteria total coliforms and Escherichia coli. Samples were collected during six collection periods before and after operation of the DWTP began from the freshwater sources (n = 4), the finished water (n = 6), and 50 sites throughout the distribution system (n = 287). This study found that there was a significant decrease in contamination by total coliforms (two orders of magnitude) and E. coli (one order of magnitude) after DWTP operation began (p < 0.001). However, during at least one post-construction collection cycle, total coliforms and E. coli were still found at 66% and 28% of points-of-use (n = 50), respectively. During the final collection period, conventional methods were augmented with human-specific Bacteroides assays – validated herein – with the goal of elucidating possible microbial contamination sources.Results show that E. coli contamination was not predictive of contamination by human wastes and suggests that observed indicator bacteria contamination may have environmental origins. Together these findings highlight the necessity of a holistic approach to drinking water infrastructure improvements in order to deliver high quality water through to the point-of-use.     

Microbiological quality of water in a city with persistent and recurrent waterborne diseases under tropical sub-rural conditions: The case of Kikwit City,Democratic Republic of the Congo

The availability of safe drinking water in sub-Saharan countries remains a major challenge because poor sanitation has been the cause of various outbreaks of waterborne disease due to the poor microbiological quality of water used for domestic purposes. The faecal indicator bacteria (FIB) used in the present study included Escherichia coli (E. coli) and Enterococcus (ENT). FIB and aerobic mesophilic bacteria (AMB) were quantified during July 2015 (dry season) and November 2015 (rainy season) in order to assess the quality of drinking water from wells (n = 3; P1–P3), and two rivers, the River Lukemi (RLK, n = 3) and River Luini (RLN, n = 2) in the city of Kikwit, which is located in the province of Kwilu in the Democratic Republic of the Congo. Kikwit is well known for its outbreaks of persistent and recurrent waterborne diseases including Entamoeba, Shigella, typhoid fever, cholera, and Ebola Viral Hemorrhagic Fever. Consequently, E. coli, ENT, and AMB were quantified in water samples according to the standard international methods for water quality determination using the membrane filtration method. The FIB characterization was performed for human-specific Bacteroides by PCR using specific primers. The results obtained revealed high FIB concentrations in river samples collected during both seasons. For example, E. coli respectively reached 4.3 × 10⁴ and 9.2 × 10⁴ CFU 100 mL^?1 in the dry season and the wet season. ENT reached 5.3 × 10³ CFU 100 mL^?1 during the dry season and 9.8 × 10³ CFU 100 mL^?1 in the wet season. The pollution was significantly worse in the wet season compared to the dry season. Surprisingly, no faecal contamination was observed in well water samples collected in the dry season while E. coli and ENT were detected in all wells in the wet season with values of 6, 7, and 11 CFU mL^?1 for E. coli in wells P1–P3, respectively and 3, 5, 9 CFU mL^?1for ENT in the same wells. Interestingly, the PCR assays for human-specific Bacteroides HF183/HF134 indicated that 97–100% captured in all analyses of isolated FIB were of human origin. The results indicate that contamination of E. coli, ENT, and AMB in the studied water resources increases during the wet season. This study improves understanding of the microbiological pollution of rivers and wells under tropical conditions and will guide future municipal/local government decisions on improving water quality in this region which is characterised by persistent and recurrent waterborne diseases. Although the epidemiology can be geographically localised, the effects of cross border transmission can be global. Therefore, the research results presented in this article form recommendations to municipalities/local authorities and the approach and procedures can be carried out in a similar environment.     

ADONA and perfluoroalkylated substances in plasma samples of German blood donors living in South Germany

Perfluorinated compounds are fully fluorinated anthropogenic substances that have been used in various products, applications, and industrial processes. Due to their persistence and toxic effects, some of them are restricted, and therefore replacement products have been developed.The aim of the study was to quantify the body burden of different perfluorinated substances in two adult populations living close to or about 80 km apart from a former perfluorooctanoate (PFOA) production plant who are exposed via drinking water, and in a control population. In this plant, the replacement emulsifier 3H-perfluoro-3-[(3-methoxy-propoxy)propanoic acid] (ADONA) has been used in the production of fluoropolymers since 2008.We quantified 7 perfluorinated compounds and ADONA in a total of 396 plasma samples collected at different time points. With regard to samples collected in 2015 or 2016, the highest 95th percentile levels were 13.5 μg/l for perfluorooctane sulfonate (PFOS), 3.0 μg/l for perfluorononanoate (PFNA), and 1.5 μg/l for perfluorohexane sulfonate (PFHxS). For PFOA, the highest 95th percentile was found at the site close to the facility (85.5 μg/l), while in the control region the value was 2.4 μg/l. Overall, the concentration of PFOA and PFOS declined over time in all study regions. ADONA was detected only in few samples slightly above the limit of quantification (0.2 μg/l).While health risks related to ADONA are unlikely under the present exposure situation, the exposure to PFOA via tap water should be reduced markedly, especially for the population living close to the plant.     

Chronic PM2.5 exposure and risk of infant bronchiolitis and otitis media clinical encounters

Chronic particulate matter less than 2.5 μm in diameter (PM_2.5) exposure can leave infants more susceptible to illness. Our objective is to estimate associations of the chronic PM_2.5 exposure with infant bronchiolitis and otitis media (OM) clinical encounters. We obtained all first time bronchiolitis (n = 18,029) and OM (n = 40,042) clinical encounters among children less than 12 and 36 months of age, respectively, diagnosed from 2001 to 2009 and two controls per case matched on birthdate and gestational age from the Pregnancy to Early Life Longitudinal data linkage system in Massachusetts. We applied conditional logistic regression to estimate odds ratios (OR) and confidence intervals (CI) per 2-μg/m³ increase in lifetime average satellite based PM_2.5 exposure_. Effect modification was assessed by age, gestational age, frequency of clinical encounter, and income. We examined associations between residential distance to roadways, traffic density, and infant bronchiolitis and OM risk. PM_2.5 was not associated with infant bronchiolitis (OR = 1.02, 95% CI = 1.00, 1.04) and inversely associated with OM (OR = 0.97, 95% CI = 0.95, 0.99). There was no evidence of effect modification. Compared to infants living near low traffic density, infants residing in high traffic density had elevated risk of bronchiolitis (OR = 1.23, 95% CI = 1.14, 1.31) but not OM (OR = 0.98, 95% CI = 0.93, 1.02) clinical encounter. We did not find strong evidence to support an association between early-life long-term PM_2.5 exposure and infant bronchiolitis or OM. Bronchiolitis risk was increased among infants living near high traffic density.     

Blood cadmium concentrations in Korean adolescents: From the Korea National Health and Nutrition Examination Survey 2010–2013

Objective

To assess blood cadmium levels in Korean adolescents with respect to demographic and lifestyle factors.

Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities

Objective

We assessed prevalence of suicidal ideation and plans among illicit drug users and their association with contextual factors, by gender.

Measurement of volatile organic compounds in bottled and tap waters by purge and trap GC–MS: Are drinking water types different?

Volatile organic compounds (VOCs) including major trihalomethanes (THMs) in bottled and tap waters from Central Missouri were quantified and compared with drinking water guidelines. Tap (n = 34), spring (3 brands, n = 25), purified (8 brands, n = 58), distilled (3 brands, n = 12) and flavored waters (5 brands, n = 34) along with Missouri River water (n = 30), were analyzed by purge and trap gas chromatograph–mass spectrometry (GC–MS) using USEPA method 524.2. The mean recoveries of the internal and surrogates standards were fluorobenzene: 100%, benzene d5-, chloro: 100% and 1,4-dichlorobenzene d4: 96%. Approximately 97% of all drinking water types were found to be safe for human consumption. However, two tap water samples recorded bromodichloromethane concentrations above the 60 μg/L World Health Organization (WHO) limit. Moreover, six tap water samples exceeded both the 80 μg/L USEPA Stage I limit and the 100 μg/L European Community (EC) maximum contaminant concentration (MAC) for total THMs (TTHMs) in drinking water. TTHMs in the water types ranged from 0–322 μg/L (tap), 0.1–0.3 μg/L (spring), 0–7.6 μg/L (purified), 0.1–18.1 μg/L (distilled), and 0–5.7 μg/L (flavored). Kruskal–Wallis Chi square approximation showed significant differences (P < 0.001) in the levels of THMs found in the water types. Principal components (PC1 and PC2) with 97% total variance suggested similarities in most drinking waters except for Boonville and Columbia tap waters. Dendrogram plots of TTHMs and Σ VOCs revealed two principal clusters with Columbia and Boonville tap waters in a different cluster and also distant from other water types.     

Salt content of some fast foods in Casablanca,Morocco: Pilot study

Introduction

High salt intake is associated with high blood pressure. This pilot study aimed to measure the salt content of some fast foods in Casablanca, Morocco.

Physicochemical parameters affecting the perception of borehole water quality in Ghana

Rural Ghanaian communities continue using microbiologically contaminated surface water sources due in part to undesirable organoleptic characteristics of groundwater from boreholes. Our objective was to identify thresholds of physical and chemical parameters associated with consumer complaints related to groundwater. Water samples from 94 boreholes in the dry season and 68 boreholes in the rainy season were analyzed for 18 parameters. Interviews of consumers were conducted at each borehole regarding five commonly expressed water quality problems (salty taste, presence of particles, unfavorable scent, oily sheen formation on the water surface, and staining of starchy foods during cooking). Threshold levels of water quality parameters predictive of complaints were determined using the Youden index maximizing the sum of sensitivity and specificity. The probability of complaints at various parameter concentrations was estimated using logistic regression. Exceedances of WHO guidelines were detected for pH, turbidity, chloride, iron, and manganese. Concentrations of total dissolved solids (TDS) above 172 mg/L were associated with salty taste complaints. Although the WHO guideline is 1000 mg/L, even at half the guideline, the likelihood of salty taste complaint was 75%. Iron concentrations above 0.11, 0.14 and 0.43 mg/L (WHO guideline value 0.3 mg/L) were associated with complaints of unfavorable scent, oily sheen, and food staining, respectively. Iron and TDS concentrations exhibited strong spatial clustering associated with specific geological formations. Improved groundwater sources in rural African communities that technically meet WHO water quality guidelines may be underutilized in preference of unimproved sources for drinking and domestic uses, compromising human health and sustainability of improved water infrastructure.     

Inequalities in cervical cancer screening utilisation and results: A comparison between Italian natives and immigrants from disadvantaged countries

Cervical cancer screening underutilisation is documented among immigrants from poor countries and it is associated to an augmented risk for severe lesions. In a cohort of 1,410,364 Italian women and 200,491 immigrants from poor countries differences in screening participation and results were investigated. Participation rate was lower for immigrants than for Italians: 43.98% versus 48.59% (chi(1): p < 0.001). This gap increased with age (ptrend < 0.0001). Some socio-demographic factors negatively influenced immigrants' participation. Illiteracy (OR = 0.75) versus secondary school, being single (OR = 0.71) versus attached, first screens (OR = 0.67) versus subsequent ones. Although the interaction between educational and professional levels showed that graduated immigrant women conducting an intellectual job have a higher inclination towards screening than their Italian peers (OR = 1.43 vs OR = 1.04). The Standardised Detection Ratio (SDR) suggested a frequency of severe lesions nearly double among immigrants in first screens (SDR = 1.94; 95% CI: 1.82–2.08) and even higher (SDR = 2.53; 95% CI: 2.35–2.73) for Central/Eastern Europeans. Multi-component interventions involving both patients and providers offer the greatest potential to increase cervical cancer screening uptake within foreign-born populations. So immigrant-specific interventions are needed for some immigrant groups, like Central/Eastern Europeans who are at higher risk of cervical lesions and, together with Asians and Africans, showed a poor attitude towards cancer prevention.     

Impacto del dolor crónico discapacitante: resultados de un estudio poblacional transversal con entrevista cara a cara

Objective

To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services.

Antimicrobial resistance in community-acquired urinary tract infections in Paris in 2015

Background

Urinary tract infection (UTI) is one of the most frequent community-acquired infection. Escherichia coli resistance has been on the rise since 2000s.