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Boudou M, Cleary E, ÓhAiseadha C, Garvey P, McKeown P, O'Dwyer J, Hynds P. Spatiotemporal epidemiology of cryptosporidiosis in the Republic of Ireland, 2008-2017: development of a space-time "cluster recurrence" index. BMC Infect Dis 2021; 21:880. [PMID: 34454462 PMCID: PMC8401175 DOI: 10.1186/s12879-021-06598-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ireland frequently reports the highest annual Crude Incidence Rates (CIRs) of cryptosporidiosis in the EU, with national CIRs up to ten times the EU average. Accordingly, the current study sought to examine the spatiotemporal trends associated with this potentially severe protozoan infection. Methods Overall, 4509 cases of infection from January 2008 to December 2017 were geo-referenced to a Census Small Area (SA), with an ensemble of geo-statistical approaches including seasonal decomposition, Local Moran’s I, and space–time scanning used to elucidate spatiotemporal patterns of infection. Results One or more confirmed cases were notified in 3413 of 18,641 Census SAs (18.3%), with highest case numbers occurring in the 0–5-year range (n = 2672, 59.3%). Sporadic cases were more likely male (OR 1.4) and rural (OR 2.4), with outbreak-related cases more likely female (OR 1.4) and urban (OR 1.5). Altogether, 55 space–time clusters (≥ 10 confirmed cases) of sporadic infection were detected, with three “high recurrence” regions identified; no large urban conurbations were present within recurrent clusters. Conclusions Spatiotemporal analysis represents an important indicator of infection patterns, enabling targeted epidemiological intervention and surveillance. Presented results may also be used to further understand the sources, pathways, receptors, and thus mechanisms of cryptosporidiosis in Ireland. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06598-3.
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Affiliation(s)
- M Boudou
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland.
| | - E Cleary
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland
| | - C ÓhAiseadha
- Department of Public Health, Health Service Executive (HSE), Dr. Steevens' Hospital, Dublin 8, Republic of Ireland
| | - P Garvey
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - P McKeown
- Health Protection Surveillance Centre, 25 Middle Gardiner Street, Dublin 1, Republic of Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Sciences, Environmental Research Institute (ERI), University College Cork, Cork, Republic of Ireland.,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland
| | - Paul Hynds
- Environmental Sustainability and Health Institute (ESHI), Technological University Dublin, Greenway Hub, Grangegorman, Dublin 7, D07 H6K8, Republic of Ireland. .,Irish Centre for Research in Applied Geosciences (iCRAG), University College Dublin, Dublin 4, Republic of Ireland.
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Socio-economic factors associated with the incidence of Shiga-toxin producing Escherichia coli (STEC) enteritis and cryptosporidiosis in the Republic of Ireland, 2008–2017. Epidemiol Infect 2021. [PMCID: PMC8365853 DOI: 10.1017/s0950268821001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Republic of Ireland (ROI) currently reports the highest incidence rates of Shiga-toxin producing Escherichia coli (STEC) enteritis and cryptosporidiosis in Europe, with the spatial distribution of both infections exhibiting a clear urban/rural divide. To date, no investigation of the role of socio-demographic profile on the incidence of either infection in the ROI has been undertaken. The current study employed bivariate analyses and Random Forest classification to identify associations between individual components of a national deprivation index and spatially aggregated cases of STEC enteritis and cryptosporidiosis. Classification accuracies ranged from 78.2% (STEC, urban) to 90.6% (cryptosporidiosis, rural). STEC incidence was (negatively) associated with a mean number of persons per room and percentage of local authority housing in both urban and rural areas, addition to lower levels of education in rural areas, while lower unemployment rates were associated with both infections, irrespective of settlement type. Lower levels of third-level education were associated with cryptosporidiosis in rural areas only. This study highlights settlement-specific disparities with respect to education, unemployment and household composition, associated with the incidence of enteric infection. Study findings may be employed for improved risk communication and surveillance to safeguard public health across socio-demographic profiles.
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Jagai JS, DeFlorio-Barker S, Lin CJ, Hilborn ED, Wade TJ. Sanitary Sewer Overflows and Emergency Room Visits for Gastrointestinal Illness: Analysis of Massachusetts Data, 2006-2007. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:117007. [PMID: 29187322 PMCID: PMC5947952 DOI: 10.1289/ehp2048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sanitary sewer overflows (SSOs) occur when untreated sewage is discharged into water sources before reaching the treatment facility, potentially contaminating the water source with gastrointestinal pathogens. OBJECTIVES The objective of this paper is to assess associations between SSO events and rates of gastrointestinal (GI) illness in Massachusetts. METHODS A case-crossover study design was used to investigate association between SSO events and emergency room (ER) visits with a primary diagnosis of gastrointestinal (GI) illness in Massachusetts for 2006-2007. ER visits for GI were considered exposed if an SSO event occurred in the county of residence within three hazard periods, 0-4 d, 5-9 d, or 10-14 d, before the visit. A time-stratified bidirectional design was used to select control days for each ER visit on the same day of the week during the same month. Fixed effect logistic regression models were used to estimate the risk of ER visits following the SSO event. RESULTS During the study period, there were 270 SSO events for northeastern Massachusetts and 66,460 ER admissions with GI illness listed as the primary diagnostic code. The overall odds ratio (OR) for ER visits for GI illness was 1.09 [95% confidence interval (CI): 1.03, 1.16] in the 10-14 d period following an SSO event, with positive ORs for all age groups and for three of the four counties. The 0-4 d and 5-9 d periods following an SSO event were not associated with ER visits for GI illness overall, and associations by county or age were inconsistent. CONCLUSIONS We demonstrated an association between SSO events and ER visits for GI illness using a case-crossover study design. In light of the aging water infrastructure in the United States and the expected increase in heavy rainfall events, our findings suggest a potential health impact associated with sewage overflows. https://doi.org/10.1289/EHP2048.
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Affiliation(s)
- Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Stephanie DeFlorio-Barker
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Cynthia J Lin
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Elizabeth D Hilborn
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Timothy J Wade
- National Health and Environmental Effects Research Laboratory, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
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Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003-2007. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:873-9. [PMID: 25855939 PMCID: PMC4559956 DOI: 10.1289/ehp.1408971] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/06/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change. OBJECTIVES The aim of this study was to assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed in the presence of CSOs. METHODS For the study period 2003-2007, time series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: a) CSOs impacting drinking water sources, b) CSOs impacting recreational waters, c) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥ 90th and ≥ 95th percentile) and extreme (≥ 99th percentile) precipitation events, controlling for temperature and long-term time trends. RESULTS The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall. CONCLUSIONS The rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for GI illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation. CITATION Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015. Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: an analysis of Massachusetts data, 2003-2007. Environ Health Perspect 123:873-879; http://dx.doi.org/10.1289/ehp.1408971.
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Affiliation(s)
- Jyotsna S Jagai
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois, USA
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Mor SM, DeMaria Jr. A, Naumova EN. Hospitalization records as a tool for evaluating performance of food- and water-borne disease surveillance systems: a Massachusetts case study. PLoS One 2014; 9:e93744. [PMID: 24740304 PMCID: PMC3989214 DOI: 10.1371/journal.pone.0093744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/06/2014] [Indexed: 11/26/2022] Open
Abstract
We outline a framework for evaluating food- and water-borne surveillance systems using hospitalization records, and demonstrate the approach using data on salmonellosis, campylobacteriosis and giardiasis in persons aged ≥65 years in Massachusetts. For each infection, and for each reporting jurisdiction, we generated smoothed standardized morbidity ratios (SMR) and surveillance to hospitalization ratios (SHR) by comparing observed surveillance counts with expected values or the number of hospitalized cases, respectively. We examined the spatial distribution of SHR and related this to the mean for the entire state. Through this approach municipalities that deviated from the typical experience were identified and suspected of under-reporting. Regression analysis revealed that SHR was a significant predictor of SMR, after adjusting for population age-structure. This confirms that the spatial “signal” depicted by surveillance is in part influenced by inconsistent testing and reporting practices since municipalities that reported fewer cases relative to the number of hospitalizations had a lower relative risk (as estimated by SMR). Periodic assessment of SHR has potential in assessing the performance of surveillance systems.
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Affiliation(s)
- Siobhan M. Mor
- Farm Animal and Veterinary Public Health, Faculty of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity/School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Bureau of Infectious Diseases, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, United States of America
- * E-mail: (SMM); (ENN)
| | - Alfred DeMaria Jr.
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Elena N. Naumova
- Bureau of Infectious Diseases, Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, United States of America
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, Massachusetts, United States of America
- * E-mail: (SMM); (ENN)
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Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12403-013-0095-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jagai JS, Griffiths JK, Kirshen PK, Webb P, Naumova EN. Seasonal patterns of gastrointestinal illness and streamflow along the Ohio River. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1771-90. [PMID: 22754472 PMCID: PMC3386587 DOI: 10.3390/ijerph9051771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 04/12/2012] [Accepted: 04/20/2012] [Indexed: 11/16/2022]
Abstract
Waterborne gastrointestinal (GI) illnesses demonstrate seasonal increases associated with water quality and meteorological characteristics. However, few studies have been conducted on the association of hydrological parameters, such as streamflow, and seasonality of GI illnesses. Streamflow is correlated with biological contamination and can be used as proxy for drinking water contamination. We compare seasonal patterns of GI illnesses in the elderly (65 years and older) along the Ohio River for a 14-year period (1991-2004) to seasonal patterns of streamflow. Focusing on six counties in close proximity to the river, we compiled weekly time series of hospitalizations for GI illnesses and streamflow data. Seasonal patterns were explored using Poisson annual harmonic regression with and without adjustment for streamflow. GI illnesses demonstrated significant seasonal patterns with peak timing preceding peak timing of streamflow for all six counties. Seasonal patterns of illness remain consistent after adjusting for streamflow. This study found that the time of peak GI illness precedes the peak of streamflow, suggesting either an indirect relationship or a more direct path whereby pathogens enter water supplies prior to the peak in streamflow. Such findings call for interdisciplinary research to better understand associations among streamflow, pathogen loading, and rates of gastrointestinal illnesses.
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Affiliation(s)
- Jyotsna S. Jagai
- U.S. Environmental Protection Agency, Research Triangle Park, NC 27711, USA
- Author to whom correspondence should be addressed; ; Tel.: +1-919-966-6209; Fax: +1-919-966-7584
| | - Jeffrey K. Griffiths
- Tufts University School of Medicine, Boston, MA 02111, USA; (J.K.G.); (E.N.N.)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA;
- Tufts University School of Engineering, Medford, MA 02155, USA
| | - Paul K. Kirshen
- Institute for the Study of Earth, Oceans, and Space, University of New Hampshire, Durham, NH 03824, USA;
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA;
| | - Elena N. Naumova
- Tufts University School of Medicine, Boston, MA 02111, USA; (J.K.G.); (E.N.N.)
- Tufts University School of Engineering, Medford, MA 02155, USA
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Lobdell DT, Jagai JS, Rappazzo K, Messer LC. Data sources for an environmental quality index: availability, quality, and utility. Am J Public Health 2011; 101 Suppl 1:S277-85. [PMID: 21836111 PMCID: PMC3222503 DOI: 10.2105/ajph.2011.300184] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES An environmental quality index (EQI) for all counties in the United States is under development to explore the relationship between environmental insults and human health. The EQI is potentially useful for investigators researching health disparities to account for other concurrent environmental conditions. This article focused on the identification and assessment of data sources used in developing the EQI. Data source strengths, limitations, and utility were addressed. METHODS Five domains were identified that contribute to environmental quality: air, water, land, built, and sociodemographic environments. An inventory of possible data sources was created. Data sources were evaluated for appropriate spatial and temporal coverage and data quality. RESULTS The overall data inventory identified multiple data sources for each domain. From the inventory (187 sources, 617 records), the air, water, land, built environment, and sociodemographic domains retained 2, 9, 7, 4, and 2 data sources for inclusion in the EQI, respectively. However, differences in data quality, geographic coverage, and data availability existed between the domains. CONCLUSIONS The data sources identified for use in the EQI may be useful to researchers, advocates, and communities to explore specific environmental quality questions.
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Affiliation(s)
- Danelle T Lobdell
- Office of Research and Development, US Environmental Protection Agency Research Triangle Park, NC 27711, USA.
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González-Moreno O, Domingo L, Teixidor J, Gracenea M. Prevalence and associated factors of intestinal parasitisation: a cross-sectional study among outpatients with gastrointestinal symptoms in Catalonia, Spain. Parasitol Res 2010; 108:87-93. [PMID: 20862495 DOI: 10.1007/s00436-010-2044-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
Abstract
The aim of this study was to report the prevalence of intestinal parasites in stool specimens from outpatients in Catalonia (Spain), and to evaluate the association of age, seasonality, and gender on general parasitisation and by the most frequent detected species. A total of 13,913 samples from 8,313 patients (1-3 specimens per patient) reporting digestive disorders were examined between 1999 and 2005 as a part of medical examinations. Samples were fixed with MIF solution and microscopically examined as wet mounts. Permanent stain was obtained by the modified Ziehl-Neelsen technique for intestinal coccidia. Nineteen species of intestinal parasites were identified. Blastocystis hominis (585 patients) was the predominant species, followed by Giardia duodenalis (321), Dientamoeba fragilis (131), Entamoeba coli (60) and Cryptosporidium sp. (59). Prevalence of helminths was low, being Enterobius vermicularis as the most frequently reported helminth (49 patients). The overall parasitisation was 1,136/8,313 (13.7%); prevalence in adults was 19.8% with a maximum in spring (14.8%). In the adjusted models, age was the main factor associated with infection: adults, with B. hominis and Entamoeba coli (odds ratio (OR) = 6.0 and OR = 8.5, respectively) and children, with Cryptosporidium and Giardia (OR = 2.0 and OR = 3.3, respectively). However, seasonality cannot be considered related with infection. The total prevalence was low, taking into account that all the subjects examined presented gastrointestinal symptoms and that species traditionally considered as non-pathogenic were included in the study.
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Affiliation(s)
- Olga González-Moreno
- Laboratory of Parasitology, Faculty of Pharmacy, University of Barcelona, Av Joan XXIII, s/n, 08028 Barcelona, Spain.
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