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Journal of Water and Health Vol 04 No Suppl 2 pp 71–88 © IWA Publishing 2006 doi:10.2166/wh.2006.018

A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States

John M. Colford, Sharon Roy, Michael J. Beach, Allen Hightower, Susan E. Shaw and Timothy J. Wade

Division of Epidemiology, School of Public Health, University of California, Berkeley, 140 Warren Hall, MC 7360, Berkeley, CA 94720, USA jcolford@berkeley.edu
Water and Environment Activity, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop F22, Atlanta GA 30341-3724, USA
Statistics and Data Management Branch, Centers for Disease Control and Prevention, Kenya Field Station, Unit 64112, APO AE 09831-4112, USA
Office of Ground Water and Drinking Water, United States Environmental Protection Agency, 1200 Pennsylvania Ave, N.W., MC 4607, Washington DC 20460, USA
Human Studies Division, United States Environmental Protection Agency, MD 58C, Research Triangle Park, NC 27711, USA


The incidence of acute gastrointestinal illness (AGI) attributable to public drinking water systems in the United States cannot be directly measured but must be estimated based on epidemiologic studies and other information. The randomized trial is one study design used to evaluate risks attributable to drinking water. In this paper, we review all published randomized trials of drinking water interventions in industrialized countries conducted among general immunocompetent populations. We then present an approach to estimating the incidence (number of cases) of AGI attributable annually to drinking water. To develop a national estimate, we integrate trial results with the estimated incidence of AGI using necessary assumptions about the estimated number of residents consuming different sources of drinking water and the relative quality of the water sources under different scenarios. Using this approach we estimate there to be 4.26–11.69 million cases of AGI annually attributable to public drinking water systems in the United States. We believe this preliminary estimate should be updated as new data become available.

Keywords: drinking; epidemiologic studies; gastrointestinal diseases; intervention studies; randomized controlled trials; water

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