A gradient of acute gastroenteritis was characterized, to assess risk of long-term health sequelae after drinking bacterial-contaminated water

Amit X. Garg, John Marshall, Marina Salvadori, Heather R. Thiessen-Philbrook, Jennifer Macnab, Rita S. Suri, R. Brian Haynes, Janet Pope, William Clark, Steve Collins, John Howard, Jeff Mahon, Douglas Matsell, Louise Moist, Joel Ray, Patricia Rosas-Arellano

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: A municipal water system became contaminated with Escherichia coli O157:H7 and Campylobacter spp. Beginning 2 years after an outbreak, all residents from the region were invited to participate in a cohort study assessing the risk of long-term sequelae. We aimed to develop a method to grade the accuracy and severity of self-reported acute symptoms. Study Design and Setting: We corroborated participant survey responses with health records at the time of the outbreak. Of the 4,135 participants, 1,388 were asymptomatic during the outbreak, 1,752 had symptoms of acute self-limited gastroenteritis that could neither be confirmed nor refuted by prior health records, and 995 had symptoms that necessitated medical attention (and thus were confirmed by prior health records). Results: The gradient related to the severity of acute symptoms. Compared to those with unconfirmed gastroenteritis, participants with confirmed gastroenteritis were more likely to describe fever, bloody diarrhea, and prolonged diarrhea (all P < .03). The gradient also correlated with long-term plausible outcomes, including chronic gastrointestinal symptoms, chronic symptoms of arthritis or depression, and the avoidance of municipal water ingestion after the outbreak (P for trend consistently < .03). Conversely, for the outcome of chronic tinnitus, an association was neither expected nor observed (P for trend = .26). Conclusion: We successfully characterized a gradient to be used in future primary analyses assessing the risk of long-term health sequelae after an outbreak.

Original languageEnglish (US)
Pages (from-to)421-428
Number of pages8
JournalJournal of Clinical Epidemiology
Volume59
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Keywords

  • Bias
  • Campylobacter
  • Cohort study
  • Environmental exposure
  • Escherichia coli O157
  • Gastroenteritis
  • Health survey
  • Risk factors

ASJC Scopus subject areas

  • Epidemiology

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