Low pressure and intermittent service are associated with reported symptoms of gastrointestinal illness in small water

supplies

JJ Wedgworth, MS, PhD CandidateUniversity of Alabama

Department of Biological Sciences

Our TeamJoe Brown PhD PE, London School of Tropical

Medicine and Hygiene, Principal InvestigatorPauline Johnson PhD, UA CCEE, Principle

InvestigatorJulie Olson PhD, UA Biological Sciences (co-PI)Christine Stauber PhD, GSU Environmental

Health (co-PI)Mark Elliott PhD, UA CCEEJJ Wedgworth, PhD candidate, UA Biological

SciencesPhillip Grammer MS, PhD student, UA CCEERick Forehand MS, UA CCEE alumnusDaniel Bunei MS, UA CCEE alumnus

OutlineBackground and

context: Alabama’s Black Belt

Pilot data and hypothesis generation

GoalsMethods overviewPreliminary data Next steps

Alabama’s Black BeltCommon Demographic and

Socio-economic CharacteristicsHigh PovertyHigh UnemploymentDecreasing PopulationHigh Percentage of Minorities

Common ThemesDecaying infrastructurePoor access to basic services

and health careHigh percentage of vulnerable

people (the young, elderly and infirm)

2010 Black Belt in ComparisonCounty 1 County 2 County 3 Alabama US

Population 15,421 13,478 11,482 4,802,740 311,591,917

Population Change

-2.2% -2.1% -1.6% 0.5% 0.9%

Population Density/mi2

24.5 15.4 13.1 94.4 87.4

Living in Poverty

24.6% 34.8% 38.5% 17.1% 13.8%

Median Income

$29,299 $25,338 $23,491 $42,081 $51,914

Public Water 81.5% 91.4% 61.7% 89% 86%

On-site Septic

60.3% 55.4% 53.7% 43.6% 24.1%

“non-perc” soils

77% 74% 83% NA NA

PWS Violations Alabama 1997-2012Type of systems Populatio

n servedViolations: HAA

Violations: TTHMs

Violations: coliform

Total violations

Total violations per 100,000 people

Large (10,001-100,000) 4,136,225 15

28 100 143 3

Top third per capita income 3,248,710 11

15 51 77 2

Middle third per capita income 664,795 4

5 21 30 5

Lower third per-capita income 222,720 0

8 28 36 16

Medium (3,301-10,000) 1,027,417 38

69 160 267 26

Top third per capita income 408,615 10 25 50 85 21 Middle third per capita income 384,255 23

23 58 104 27

Lower third per-capita income 234,547 5

21 52 78 33

Small (501-3,300) 362,352 65 128 273 466 129 Top third per capita income 124,756 13 25 70 108 87 Middle third per capita income 139,053 34

74 107 215 155

Lower third per-capita income 98,543 18

29 96 143 145

Very Small (<500) 11,168 11 13 42 66 591 Top third per capita income 2,547 6

1 9 16 628

Middle third per capita income 3,928 4

9 10 23 586

Lower third per-capita income 4,693 1

3 23 27 575

Total 5,537,162 129 238 575 942

17

> 8x

197x

L Talebi

> 40x

Small Rural System Challenges1. More than 94 percent of the nation’s 156,000 public water systems serve fewer than 3,300 persons (EPA 2009). This results in wide service areas with disperse populations. 2. Small-scale, decentralized, or rural systems may be particularly susceptible to problems as infrastructure ages (ADPH 2009). Aging infrastructure leads to an increase in operation and maintenance challenges.3. All of these issues combined make it increasingly more difficult for systems to meet the regulatory requirements.

– Water Quality and Wastewater survey in 3 Counties:• 14 water systems, 900 households, 18

months

1. Assess public health impacts associated with small, rural water supply system performance and water quality.

2. Conduct microbial risk assessments to identify sources of microbial contamination. Propose risk reduction strategies for rural systems.

3. Identify possible transmission pathways for waterborne pathogens.

4. Identify low-cost, practicable, sustainable risk mitigation strategies to protect public health.

EPA-STAR

Household level Health Data surveysPOU Water Quality

Flamed/Un-flamed samples

System level Water distribution:

System attributes, upgrades, O&M

OSS Wastewater system evaluation

Data Collection

Field and Lab Quality Testing

Parameters

Physical Turbidity, Pressure

Chemical Free &

Total Cl, pH

Dead End Ultrafiltrati

on for Identificatio

n of Pathogens

System Performan

ce Data

Microbial source

tracking

Not in the Job Description

Household Level Water Sampling

A total of 900 households were visited and samples were taken from faucets (grab samples) and from outdoor taps (flamed samples)

16.7% of all flamed samples were + for total coliforms

12.2 % of all grab samples were + for total coliforms

< 1% of either type of samples were positive for E. coli

FIB contamination was not associated with any reported symptom of gastrointestinal illness (diarrhea, vomiting, nausea or abdominal cramping)

Low Pressure, Intermittent Service and GI Symptoms

Reports of low water pressure were associated with any symptoms of GI illness, reported watery diarrhea and vomiting.

Reported intermittent service was also associated with reported symptoms of GI illness, watery diarrhea and vomiting.

Measured vs Reported Water Pressure0

50

100

150

Pre

ssure

1 (

psi

)

Very Strong Strong Moderate Weak Very Weak

SummaryRelatively high percentage of samples

positive for TC, lower than expected number of E. coli positives.

Significant health associations emerging with some water quality measures including reported low pressure and intermittent service.

No association with reported sanitation conditions.

Data collection and analysis are ongoing System-level samples are of central importance

to study questionsAt-risk areas emerging when merging

household and system data

Next StepsSystem Level Samples

10 sample points for each system chosen based on location within the system and areas of vulnerability

100 liter sample taken at each sample point4 time pointsSample analyzed for:

pH, turbidity, pressure, free and total chlorine Total coliform, E. coli, and Enterococci by IDEXX Coliphage by Single Agar Layer-EPA 1602 Heteroptrophic Plate Count Cryptosporidium, Giardia, norovirus, adenovirus,

and potentially others

AcknowledgmentsAll Project Staff and

StudentsCDCEmory UniversityUniversity of AlabamaGeorgia State UniversityLSTMHLocal Water System

OperatorsCommunity PartnerHousehold participants

FundingDepartment of

Biological SciencesCenter for Community

Based Partnerships (CCBP)

EPA STAR

***DISCLAIMER: Although the research described in the article has been funded wholly or in part by the United States Environmental Protection Agency through grant R834866 to the University of Alabama and Georgia State University, it has not been subject to the Agency’s required peer and policy review and therefore does not necessarily reflect the views of the Agency and no official endorsement should be inferred.

QUESTIONS?