BEACHNET==> ER visits for Diarrheal Illness Increased After Release of Undertreated Sewage

["Shannon Briggs" <briggss4@michigan.gov>]

PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1472-e1475
(doi:10.1542/peds.2007-0283) 

FOR ABSTRACT
http://pediatrics.aappublications.org/cgi/content/abstract/120/6/e1472


Pediatric Emergency Department Visits for Diarrheal Illness Increased
After Release of Undertreated Sewage

Ryan L. Redman, MD(a), Cheryl A. Nenn, MS(b), Daniel Eastwood, MS(a)
and Marc H. Gorelick, MD, MSCE(a) 

(a) Emergency Department, Medical College of Wisconsin, Milwaukee,
Wisconsin
(b) Friends of Milwaukee's Rivers, Milwaukee, Wisconsin 

CONTEXT. Contamination of local waterways may occur through release of
partially treated sewage. The Environmental Protection Agency has
recently reviewed regulatory standards for this practice. However, the
health effects of these events have not been well studied. 

OBJECTIVE. Our goal was to identify any increase in visits to a
pediatric emergency department for diarrheal illness after sewage bypass
into Lake Michigan. 

METHODS. The study was conducted as a retrospective, observational
time-series analysis in a tertiary care children's hospital emergency
department with an annual volume of 45000 visits. We collected data for
2002-2004 pertaining to the daily number of emergency department visits
for children (aged <19 years) for diarrheal illness (using specified
International Classification of Diseases, Ninth Edition codes as a
reference). Daily diarrheal illness visits were the dependent variable
in a time-series model. The primary independent variable was the
occurrence of a sewage-bypass event in the 3 to 7 preceding days.
Potential confounders included the season and daily rainfall. Separate
models were created for visits from people living in zip codes that used
Lake Michigan drinking water and those who used other water sources. 

RESULTS. Over the 3-year study period, there was a mean of 5.0 ± 3.8
(SD) daily visits for diarrheal illness from people who lived in zip
codes that used Lake Michigan drinking water and 1.2 ± 1.4 (SD) from
outside that area. There were 6 sewage-bypass events identified. After
adjusting for the season and rainfall, there was a significant increase
of 2.5 to 2.7 visits only from people who lived in zip codes that used
Lake Michigan drinking water after the 2 largest of the 6 bypass events.


CONCLUSIONS. Emergency department visits for diarrheal illness
increased significantly after 2 events of release of partially treated
sewage into area waterways. These data suggest a potentially harmful
effect of such practices. 
--------------------------------------------------------------------------------
Key Words: gastrointestinal infections environmental health

Abbreviations: EDemergency department ARIMAautoregressive integrated
moving average ICD-9 International Classification of Diseases, Ninth
Edition CHWChildren's Hospital of Wisconsin CIconfidence interval
--------------------------------------------------------------------------------
Accepted May 10, 2007.

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