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Journal of Water and Health Vol 07 No 1 pp 1–8 © IWA Publishing 2009 doi:10.2166/wh.2009.143

Rainfall and outbreaks of drinking water related disease and in England and Wales

Gordon Nichols, Chris Lane, Nima Asgari, Neville Q. Verlander and Andre Charlett

Environmental and Enteric Diseases Department, Health Protection Agency Centre for Infections, 61, Colindale Avenue, London, NW9 5EQ, UK
*Also at: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK Tel.: +44(0)208 327 6036 Fax: +44(0)208 327 6036 E-mail: gordon.nichols@hpa.org.uk
Consultant in Communicable Disease Control, North East and Central London Health Protection Unit, 68 Leadenhall Street, London, EC3A 3DH, UK
Statistics Department, Health Protection Agency Centre for Infections, 61, Colindale Avenue, London, NW9 5EQ, UK


A case-crossover study compared rainfall in the 4 weeks before drinking water related outbreaks with that in the five previous control years. This included public and private drinking water related outbreaks in England and Wales from 1910 to 1999. Of 111 outbreaks, 89 met inclusion criteria and the implicated pathogens included Giardia, Cryptosporidium, E. coli, S. Typhi, S. Paratyphi, Campylobacter and Streptobacillus moniliformis. Weather data was derived from the British Atmospheric Data Centre There was a significant association between excess cumulative rainfall in the previous 7 days and outbreaks (p=0.001). There was an excess of rainfall below 20 mm for the three weeks previous to this in outbreak compared to control weeks (p=0.002). Cumulative rainfall exceedances were associated with outbreak years. This study provides evidence that both low rainfall and heavy rain precede many drinking water outbreaks and assessing the health impacts of climate change should examine both.

Keywords: climate change; drinking; outbreaks; rainfall; waterborne; water safety plans

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