Risk-Based Approach To Evaluate the Public Health Benefit of Additional Wastewater Treatment

Soller, Jeffrey A.; Olivieri, Adam W.; Crook, James; Cooper, Robert C.; Tchobanoglous, George; Parkin, Rebecca; Spear, Robert C.; Eisenberg, Joseph N. S.

doi:10.1021/es025774p

Cited by 43 publications

(33 citation statements)

References 45 publications

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“…When more complete case data become available, the data may reduce the uncertainty not only in the timing of the exposure but also in the values of the remaining parameters and the estimate of averted cases. In the past, we have explored such calibrations with Monte Carlo methods (11,(33)(34)(35).…”

Section: Limitationsmentioning

confidence: 99%

Strategies to Reduce Person-to-Person Transmission during WidespreadEscherichia coliO157:H7 Outbreak

Seto

Soller²,

Colford

2007

Emerg. Infect. Dis.

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RESEARCHDuring the Escherichia coli O157:H7 outbreak in 2006 in the United States, the primary strategy to prevent illness was to advise consumers not to eat spinach. No widespread warnings were issued about preventing person-to-person (secondary) transmission. A disease transmission model, fi tted to the current data, was used to investigate likely reductions in illnesses that could result from interventions to prevent secondary transmission. The model indicates that exposure to contaminated spinach occurred early in the outbreak and that secondary transmission was similar to that in previous E. coli outbreaks (≈12%). The model also suggests that even a modestly effective strategy to interrupt secondary transmission (prevention of only 2%-3% of secondary illnesses) could result in a reduction of ≈5%-11% of symptomatic cases. This analysis supports the use of widespread public health messages during outbreaks of E. coli O157:H7 with specifi c advice on how to interrupt secondary transmission.W idespread distribution of contaminated spinach was implicated in an Escherichia coli O157:H7 (E. coli O157) outbreak in the United States in 2006. As of September 24, 2006, a total of 173 cases had been reported in 25 states; 88% of cases were reported over an 18-day period from August 19 through September 5, 2006 (1). The outbreak strain was particularly virulent, resulting in 1 death, 53% of patients being hospitalized, and a 16% rate of hemolytic uremic syndrome. At the time of our analysis, the potential extent of the outbreak was unknown because new cases were still being reported. The Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration advised consumers not to eat spinach as the primary strategy for protecting against foodborne transmission of E. coli O157 (2). No warnings, however, were issued regarding the prevention of person-to-person (secondary) transmission.According to recent studies on the extent of secondary transmission for E. coli O157 and other pathogens, the initially reported foodborne illnesses in the outbreak may have represented only a small fraction of a larger outbreak that included asymptomatic infections and secondary infections among household members of infected persons and other close contacts. Specifi cally, the E. coli O157 literature indicates that a large proportion (72%) of infections are asymptomatic (3), exposure to low doses can result in infection (4), and reported secondary transmission rates are on the order of 4%-16% (5). Further, outbreaks of shigellosis (6), cryptosporidiosis (7), and giardiasis (8,9) indicate that other highly infectious enteric pathogens can spread from person to person after being introduced into a community through water, food, or other sources (9). Recent adenovirus outbreak data indicate that persons with asymptomatic infection who are shedding virus can be a primary cause of continual transmission of infection (10). And in a prolonged giardiasis outbreak that occurred in late 2003 in a Boston, Massachusetts, suburb, 30 ...

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Section: Limitationsmentioning

confidence: 99%

Strategies to Reduce Person-to-Person Transmission during WidespreadEscherichia coliO157:H7 Outbreak

Seto

Soller²,

Colford

2007

Emerg. Infect. Dis.

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“…Also, original site-specific valuation studies are likely to be financially and technically beyond the reach of local agencies in the short term, and a sufficient number of relevant studies of acceptable quality are available for transfer. We follow transfer methods used in past studies that relate to various components of our total problem (18,19). Figure 1 illustrates the overall schema in which the transfer estimates will be applied.…”

Section: Transfer Policy Analysismentioning

confidence: 99%

Economic and Health Risk Trade-Offs of Swim Closures at a Lake Michigan Beach

Rabinovici

Bernknopf

Wein

et al. 2004

Environ. Sci. Technol.

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This paper presents a framework for analyzing the economic, health, and recreation implications of swim closures related to high fecal indicator bacteria (FIB) levels. The framework utilizes benefit transfer policy analysis to provide a practical procedure for estimating the effectiveness of recreational water quality policies. Evaluation criteria include the rates of intended and unintended management outcomes, whether the chosen protocols generate closures with positive net economic benefits to swimmers, and the number of predicted illnesses the policy is able to prevent. We demonstrate the framework through a case study of a Lake Michigan freshwater beach using existing water quality and visitor data from 1998 to 2001. We find that a typical closure causes a net economic loss among would-be swimmers totaling $1274-37 030/ day, depending on the value assumptions used. Unnecessary closures, caused by high indicator variability and a 24-h time delay between when samples are taken and the management decision can be made, occurred on 14 (12%) out of 118 monitored summer days. Days with high FIB levels when the swim area is open are also common but do relatively little economic harm in comparison. Also, even if the closure policy could be implemented daily and perfectly without error, only about 42% of predicted illnesses would be avoided. These conclusions were sensitive to the relative values and risk preferences that swimmers have for recreation access and avoiding health effects, suggesting a need for further study of the impacts of recreational water quality policies on individuals.

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“…Of all the illnesses considered in the literature, GI is most commonly associated with exposure to polluted water (10)(11)(12)(21)(22)(23)(24)(25)(26). To estimate the risk of GI from swimming in contaminated marine waters in southern CA, we utilized two dose-response models (11,12) (Table 1) developed in epidemiology studies conducted elsewhere (in marine waters of the East U.S. coast and United Kingdom) (18,27). A local dose-response model for GI would be preferable, but does not exist.…”

Section: Methodsmentioning

confidence: 99%

Regional Public Health Cost Estimates of Contaminated Coastal Waters: A Case Study of Gastroenteritis at Southern California Beaches

Given

Pendleton

Boehm

2006

Environ. Sci. Technol.

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We present estimates of annual public health impacts, both illnesses and cost of illness, attributable to excess gastrointestinal illnesses caused by swimming in contaminated coastal waters at beaches in southern California. Beachspecific enterococci densities are used as inputs to two epidemiological dose-response models to predict the risk of gastrointestinal illness at 28 beaches spanning 160 km of coastline in Los Angeles and Orange Counties. We use attendance data along with the health cost of gastrointestinal illness to estimate the number of illnesses among swimmers and their likely economic impact. We estimate that between 627,800 and 1,479,200 excess gastrointestinal illnesses occur at beaches in Los Angeles and Orange Counties each year. Using a conservative health cost of gastroenteritis, this corresponds to an annual economic loss of $21 or $51 million depending upon the underlying epidemiological model used (in year 2000 dollars). Results demonstrate that improving coastal water quality could result in a reduction of gastrointestinal illnesses locally and a concurrent savings in expenditures on related health care costs.

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Risk-Based Approach To Evaluate the Public Health Benefit of Additional Wastewater Treatment

Cited by 43 publications

References 45 publications

Strategies to Reduce Person-to-Person Transmission during WidespreadEscherichia coliO157:H7 Outbreak

Strategies to Reduce Person-to-Person Transmission during WidespreadEscherichia coliO157:H7 Outbreak

Economic and Health Risk Trade-Offs of Swim Closures at a Lake Michigan Beach

Regional Public Health Cost Estimates of Contaminated Coastal Waters: A Case Study of Gastroenteritis at Southern California Beaches

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