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. 2003 May;111(5):742–748. doi: 10.1289/ehp.5914

Septic system density and infectious diarrhea in a defined population of children.

Mark A Borchardt 1, Po-Huang Chyou 1, Edna O DeVries 1, Edward A Belongia 1
PMCID: PMC1241485  PMID: 12727604

Abstract

One-quarter of U.S. households use a septic system for wastewater disposal. In this study we investigated whether septic system density was associated with endemic diarrheal illness in children. Cases--children 1 to < 19 years old seeking medical care for acute diarrhea--and controls resided in the Marshfield Epidemiologic Study Area, a population-based cohort in central Wisconsin. Enrollment was from February 1997 through September 1998. Study participants completed a structured interview, and septic system density was determined from county sanitary permits. Household wells were sampled for bacterial pathogens and indicators of water sanitary quality. Risk factors were assessed for cases grouped by diarrhea etiology. In multivariate analyses, viral diarrhea was associated with the number of holding tank septic systems in the 640-acre section surrounding the case residence [adjusted odds ratio (AOR), 1.08; 95% confidence interval (CI), 1.02-1.15; p = 0.008], and bacterial diarrhea was associated with the number of holding tanks per 40-acre quarter-quarter section (AOR, 1.22; 95% CI, 1.02-1.46; p = 0.026). Diarrhea of unknown etiology was independently associated with drinking from a household well contaminated with fecal enterococci (AOR, 6.18; 95% CI, 1.22-31.46; p = 0.028). Septic system densities were associated with endemic diarrheal illness in central Wisconsin. The association should be investigated in other regions, and standards for septic systems should be evaluated to ensure that the public health is protected.

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Selected References

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  1. Barwick R. S., Levy D. A., Craun G. F., Beach M. J., Calderon R. L. Surveillance for waterborne-disease outbreaks--United States, 1997-1998. MMWR CDC Surveill Summ. 2000 May 26;49(4):1–21. [PubMed] [Google Scholar]
  2. Beller M., Ellis A., Lee S. H., Drebot M. A., Jenkerson S. A., Funk E., Sobsey M. D., Simmons O. D., 3rd, Monroe S. S., Ando T. Outbreak of viral gastroenteritis due to a contaminated well. International consequences. JAMA. 1997 Aug 20;278(7):563–568. [PubMed] [Google Scholar]
  3. Bruzzi P., Green S. B., Byar D. P., Brinton L. A., Schairer C. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol. 1985 Nov;122(5):904–914. doi: 10.1093/oxfordjournals.aje.a114174. [DOI] [PubMed] [Google Scholar]
  4. DeStefano F., Eaker E. D., Broste S. K., Nordstrom D. L., Peissig P. L., Vierkant R. A., Konitzer K. A., Gruber R. L., Layde P. M. Epidemiologic research in an integrated regional medical care system: the Marshfield Epidemiologic Study Area. J Clin Epidemiol. 1996 Jun;49(6):643–652. doi: 10.1016/0895-4356(96)00008-x. [DOI] [PubMed] [Google Scholar]
  5. Dowd S. E., Pillai S. D., Wang S., Corapcioglu M. Y. Delineating the specific influence of virus isoelectric point and size on virus adsorption and transport through sandy soils. Appl Environ Microbiol. 1998 Feb;64(2):405–410. doi: 10.1128/aem.64.2.405-410.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fankhauser R. L., Noel J. S., Monroe S. S., Ando T., Glass R. I. Molecular epidemiology of "Norwalk-like viruses" in outbreaks of gastroenteritis in the United States. J Infect Dis. 1998 Dec;178(6):1571–1578. doi: 10.1086/314525. [DOI] [PubMed] [Google Scholar]
  7. Fleisher J. M., Jones F., Kay D., Stanwell-Smith R., Wyer M., Morano R. Water and non-water-related risk factors for gastroenteritis among bathers exposed to sewage-contaminated marine waters. Int J Epidemiol. 1993 Aug;22(4):698–708. doi: 10.1093/ije/22.4.698. [DOI] [PubMed] [Google Scholar]
  8. Glass R. I., Lew J. F., Gangarosa R. E., LeBaron C. W., Ho M. S. Estimates of morbidity and mortality rates for diarrheal diseases in American children. J Pediatr. 1991 Apr;118(4 Pt 2):S27–S33. doi: 10.1016/s0022-3476(05)81422-2. [DOI] [PubMed] [Google Scholar]
  9. Herwaldt B. L., Craun G. F., Stokes S. L., Juranek D. D. Waterborne-disease outbreaks, 1989-1990. MMWR CDC Surveill Summ. 1991 Dec;40(3):1–21. [PubMed] [Google Scholar]
  10. Korhonen L. K., Martikainen P. J. Comparison of some enrichment broths and growth media for the isolation of thermophilic campylobacters from surface water samples. J Appl Bacteriol. 1990 Jun;68(6):593–599. doi: 10.1111/j.1365-2672.1990.tb05225.x. [DOI] [PubMed] [Google Scholar]
  11. Kramer M. H., Herwaldt B. L., Craun G. F., Calderon R. L., Juranek D. D. Surveillance for waterborne-disease outbreaks--United States, 1993-1994. MMWR CDC Surveill Summ. 1996 Apr 12;45(1):1–33. [PubMed] [Google Scholar]
  12. Lawson H. W., Braun M. M., Glass R. I., Stine S. E., Monroe S. S., Atrash H. K., Lee L. E., Englender S. J. Waterborne outbreak of Norwalk virus gastroenteritis at a southwest US resort: role of geological formations in contamination of well water. Lancet. 1991 May 18;337(8751):1200–1204. doi: 10.1016/0140-6736(91)92868-3. [DOI] [PubMed] [Google Scholar]
  13. Levy D. A., Bens M. S., Craun G. F., Calderon R. L., Herwaldt B. L. Surveillance for waterborne-disease outbreaks--United States, 1995-1996. MMWR CDC Surveill Summ. 1998 Dec 11;47(5):1–34. [PubMed] [Google Scholar]
  14. McAnulty J. M., Rubin G. L., Carvan C. T., Huntley E. J., Grohmann G., Hunter R. An outbreak of Norwalk-like gastroenteritis associated with contaminated drinking water at a caravan park. Aust J Public Health. 1993 Mar;17(1):36–41. doi: 10.1111/j.1753-6405.1993.tb00102.x. [DOI] [PubMed] [Google Scholar]
  15. Moe C. L., Sobsey M. D., Samsa G. P., Mesolo V. Bacterial indicators of risk of diarrhoeal disease from drinking-water in the Philippines. Bull World Health Organ. 1991;69(3):305–317. [PMC free article] [PubMed] [Google Scholar]
  16. Moore A. C., Herwaldt B. L., Craun G. F., Calderon R. L., Highsmith A. K., Juranek D. D. Surveillance for waterborne disease outbreaks--United States, 1991-1992. MMWR CDC Surveill Summ. 1993 Nov 19;42(5):1–22. [PubMed] [Google Scholar]
  17. Payment P., Richardson L., Siemiatycki J., Dewar R., Edwardes M., Franco E. A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards. Am J Public Health. 1991 Jun;81(6):703–708. doi: 10.2105/ajph.81.6.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Russell K. J., Laramore G. E., Griffin T. W., Parker R. G., Davis L. W., Krall J. W. Fast neutron radiotherapy for the treatment of carcinoma of the urinary bladder. A review of clinical trials. Am J Clin Oncol. 1989 Aug;12(4):301–306. doi: 10.1097/00000421-198908000-00005. [DOI] [PubMed] [Google Scholar]
  19. Schiemann D. A. Development of a two-step enrichment procedure for recovery of Yersinia enterocolitica from food. Appl Environ Microbiol. 1982 Jan;43(1):14–27. doi: 10.1128/aem.43.1.14-27.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Taylor J. W., Gary G. W., Jr, Greenberg H. B. Norwalk-related viral gastroenteritis due to contaminated drinking water. Am J Epidemiol. 1981 Oct;114(4):584–592. doi: 10.1093/oxfordjournals.aje.a113224. [DOI] [PubMed] [Google Scholar]
  21. Vaughn J. M., Landry E. F., Thomas M. Z. Entrainment of viruses from septic tank leach fields through a shallow, sandy soil aquifer. Appl Environ Microbiol. 1983 May;45(5):1474–1480. doi: 10.1128/aem.45.5.1474-1480.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Woessner W. W., Ball P. N., DeBorde D. C., Troy T. L. Viral transport in a sand and gravel aquifer under field pumping conditions. Ground Water. 2001 Nov-Dec;39(6):886–894. doi: 10.1111/j.1745-6584.2001.tb02476.x. [DOI] [PubMed] [Google Scholar]

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