http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6006a1.htm?s_cid=mm6006a1_e&source=govdelivery
Community Health Impact of Extended Loss of Water Service — Alabama, January 2010
MMWR WeeklyFebruary 18, 2011 / 60(06);161-166
Access to clean water is fundamental to good health (1). During January 2010, approximately 18,000 residents of two predominantly rural counties in Alabama lost access to municipal water for up to 12 days after below-freezing temperatures led to breaks in water mains and residential water pipes and caused widespread systemic mechanical failures. To assess potential health impacts, use of alternative water sources, and effectiveness of the emergency response, the Alabama Department of Public Health (ADPH) invited CDC to assist in an investigation that included a survey of 470 households representing 1,283 residents and a qualitative investigation (i.e., focus group discussions and interviews with key informants). This report summarizes the results of that investigation, which found a significantly higher prevalence of acute gastrointestinal illness (AGI) among residents of households that lost both water service and water pressure (adjusted odds ratio [AOR] = 2.6), that lost water service for ≥7 days (AOR = 2.4), and that lost water pressure for ≥7 days (AOR = 3.5). Significant dose-response relationships were observed between increased duration of lost water service or pressure and AGI. The survey and qualitative investigation revealed that households, communities, water utilities, and institutions were not adequately prepared for water emergencies in areas of communication and notification, planning for alternative water sources, and interagency coordination. Health effects from loss of water supply or water pressure might be mitigated by public health involvement in fostering household, community, and interagency preparedness, and developing communication strategies that will reach the majority of citizens in a timely manner.
Community A and community B are located in two contiguous, predominantly rural counties in southwestern Alabama, served primarily by three interconnected public water utilities. Because freezing conditions are rare in this area, few building code regulations require burial or insulation of residential water pipes. During January 4–11, 2010, overnight low temperatures ranged from 12°F to 22°F (-11°C to -6°C), causing many utility water mains and residential water pipes to break. The resulting systemic water loss and related mechanical failures forced water utilities to cut off service to most households in the two communities (Figure). Local ADPH offices did not learn about the water shortages until January 10 in community A, when a resident complained about restaurants operating without water, and January 11 in community B, when an ADPH nurse found a school operating without water. Subsequently, ADPH issued boil water advisories for both communities. Three agencies were involved in supplying emergency water to the affected communities: the Alabama Emergency Management Agency provided five truckloads of bottled water to community A and one truckload to community B; the National Guard delivered nonpotable water to community A; and ADPH deployed water filtration/UV disinfection units to both communities……
Results
610 (68%) that were eligible for inclusion.
“…..Of those, a respondent in 470 (77%) households completed the survey, providing data on 1,283 persons. Median age of the 1,283 was 36 years (range: 0–94 years), and 54% were female; 55% were black, and 44% were white. Demographic characteristics of respondents were similar to census data for both counties.
Among households with no loss of water service or pressure, AGI was reported for 13 (4.3%) residents during January 4–31. AGI was associated with combined loss of water service and pressure (67 residents [12.4%], AOR = 2.6), loss of service ≥7 days (46 [13.2%], AOR = 2.4), and loss of pressure ≥7 days (23 [15.6%], AOR = 3.5) and 3–6 days (30 [12.7%], AOR = 2.8). Dose-response relationships were evident for the duration of both loss of service and loss of pressure (p for trend = 0.03 and 0.002, respectively) (Table).
The prevalence of ARI among unaffected households was 13.9%. Although individual AORs were not statistically significant, reporting of ARI increased with increasing duration of loss of pressure (1–2 days, 12.8%; 3–6 days, 20.5%; ≥7 days, 22.8%; p-value for trend = 0.04). Loss of water service was not associated with ARI. A total of 25 persons (1.6%) reported skin complaints, and 15 (1.0%) reported eye complaints; these outcomes were not significantly associated with loss of service or pressure.
Of the 470 surveyed households, 108 (23%) reported water pipe breaks as a result of the January freeze. A total of 210 (45%) of the 470 households had any water stored for emergencies, and <10% had stored >5 gallons. Among households in community A and community B, which were under a boil water advisory, residents in 90% of the households had heard about the advisory. However, <50% heard about it at the beginning of the water emergency, and 30% reported drinking unboiled tap water. In community B, residents in 40% of the households said they heard about the boil water advisory from family, friends, or neighbors, and not from official sources. In both community A and community B, residents preferred to hear emergency information via telephone (73.4% and 59.1%, respectively), television (37.4% and 42.4%), or radio (42.4% and 24.2%), compared with informal sources such as friends and neighbors (15.1% and 9.1%) (preferences were not mutually exclusive)……
Editorial Note
In this investigation, the prevalence of AGI in households unaffected by the January 2010 water emergency (4.3%) was similar to the national 1-month background prevalence (5.1%) of acute diarrheal illness identified in FoodNet population surveys (2), whereas the prevalence of AGI in the most affected households was significantly higher (12.4%–15.6%). Of 780 drinking water–associated outbreaks reported in the United States during 1971–2006, 10% were associated with water distribution system deficiencies (3). Although a limited number of epidemiologic studies have investigated the association between low water pressure and illness, some have identified increased AGI in populations experiencing low water pressure (4–6). Even without loss of water service, brief periods of low pressure lasting only seconds (pressure transients) can draw contaminants into the distribution system through numerous cracks and leaks in water pipes (7) or back-siphonage from household plumbing systems that lack adequate backflow prevention devices. The findings from this investigation suggest that additional studies are needed to assess the prevalence of waterborne disease attributable to water distribution systems……..
References
- World Health Organization. Guidelines for drinking-water quality. 3rd ed. Geneva, Switzerland: World Health Organization; 2008. Available at http://www.who.int/water_sanitation_health/dwq/fulltext.pdf . Accessed February 14, 2011.
- Jones TF, McMillian MB, Scallan E, et al. A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003. Epidemiol Infect 2007;135:293–301.
- Craun GF, Brunkard JM, Yoder JS, et al. Causes of outbreaks associated with drinking water in the United States from 1971 to 2006. Clin Microbiol Rev 2010;23:507–28.
- Hunter PR, Chalmers RM, Hughes S, Syed Q. Self-reported diarrhea in a control group: a strong association with reporting of low-pressure events in tap water. Clin Infect Dis 2005;40:e32–4.
- Nygard K, Wahl E, Krogh T, et al. Breaks and maintenance work in the water distribution systems and gastrointestinal illness: a cohort study. Int J Epidemiol 2007;36:873–80.
- Payment P, Siemiatycki J, Richardson L, Renaud G, Franco E, Prevost M. A prospective epidemiological study of gastrointestinal health effects due to the consumption of drinking water. Int J Environ Health Res 1997;7:5–31.
- LeChevallier MW, Gullick RW, Karim MR, Friedman M, Funk JE. The potential for health risks from intrusion of contaminants into the distribution system from pressure transients. J Water Health 2003;1:3–14.
- Hennessy TW, Ritter T, Holman RC, et al. The relationship between in-home water service and the risk of respiratory tract, skin, and gastrointestinal tract infections among rural Alaska natives. Am J Public Health 2008;98:2072–8.
- Kirmeyer G, Richards W, Smith C. An assessment of water distribution systems and associated research needs. Denver, CO: American Water Works Association Research Foundation; 1994.
- American Water Works Association. Dawn of the replacement era: reinvesting in drinking water infrastructure. Denver, CO: American Water Works Association; 2001. Available at http://www.win-water.org/reports/infrastructure.pdf . Accessed February 14, 2011.
