Gastrointestinal upsets and new copper plumbing--is there a connection?
Knobeloch L. Schubert C. Hayes J. Clark J. Fitzgerald C. Fraundorff A.
Wisconsin Department of Health and Family Services, Madison 53703, USA.
This article summarizes two investigations that examine the health effects of prolonged exposure to copper-contaminated drinking water. The first study was initiated after elevated copper levels were detected in several homes that were either newly constructed or recently remodeled. All of these homes were served by the same municipal water supplier. The second case involved illnesses and water-quality problems that were reported by several residents of a mobile home park shortly after a new water distribution system was installed. Findings from these investigations suggest that copper-contaminated drinking water may be a fairly common cause of nausea, diarrhea, abdominal cramps, and headaches-especially among residents of new or recently-remodeled homes, and in areas where water supplies are naturally corrosive.
Hepatitis A infections in Wisconsin: trends in incidence and factors affecting surveillance, 1986-1995.
Roels TH. Christl M. Kazmierczak JJ. MacKenzie WR. Davis JP.
Wisconsin Division of Health, Madison 53703, USA.
From January 1986 through December 1995, 4,143 cases of hepatitis A virus (HAV) infection were reported in Wisconsin. The annual hepatitis A incidence remained stable from 1986 through 1988, with a mean annual rate of 4.7 cases per 100,000 (endemic HAV incidence rate). During 1989-1993, the incidence of HAV infection increased with a peak in 1992 of 19 cases per 100,000 population. A large foodborne outbreak (1992) and community wide outbreaks among African American residents (1989-1993) and Native Americans residents (1991) were associated with these high rates of HAV infection. The community wide outbreaks affected different groups: among African Americans, incidence rates were highest in young adults 15-34 years old; among Native Americans rates were highest in children 5-14 years old. Approximately 2,343 (57%) patients had no apparent risk factor (e.g., international travel, contact with person with HAV infection) for acquiring HAV infection. Factors limiting control of HAV infection in Wisconsin included poor reporting by laboratories (only 19% of all reported cases were independently reported to the Wisconsin Division of Health by a laboratory and fewer than 50% of these reports were from private laboratories), incomplete reporting by Wisconsin physicians or designees (74% of cases confirmed in Wisconsin laboratories were reported in 1995), failure to submit follow-up case report forms (14% of cases), and a prolonged interval between diagnosis and follow-up (> or = 15 days for 610 cases). Efforts should be enhanced to improve the reporting of cases of HAV infection by private laboratories, particularly through the use of automated electronic reporting.
Sporadic cases of hemorrhagic colitis associated with Escherichia coli O157:H7 in rural Wisconsin.
Cai Q. Olson J.
Department of General Internal Medicine, Marshfield Clinic, WI, USA.
The epidemiology and clinical aspects of Escherichia coli O157:H7 (E. coli O157:H7) infections in rural Wisconsin have rarely been reported. In the last six years, 66 cases of E. coli O157:H7 infection were encountered at our institution. Bloody diarrhea was the universal presentation and all cases represented apparent sporadic infection as institutional or community-wide outbreaks were not found in our study. The mean age was 31 (range 7 months to 86 years), 25% less than 10 years old and 60% were female. Most cases were seen in summer and early autumn (88%). Two patients (3%) developed hemolytic-uremic syndrome. Case-fatality rate in this study was 1.5%. Antibiotic treatment and hospitalization did not change the course and outcome of the infection. Routine screening of E. coli O157:H7 during winter time (December and January) may not be necessary in our rural area. The understanding gained from our study might foster better infection control.