Heavy weather events, water quality and gastroenteritis in Norway.

Climate change will lead to more extreme weather events in Europe. In Norway, little is known about how this will affect drinking water quality and population's health due to waterborne diseases. The aim of our work was to generate new knowledge on the effect of extreme weather conditions and climate change on drinking water and waterborne disease. In this respect we studied the relationship between temperature, precipitation and runoff events, raw and treated water quality, and gastroenteritis consultations in Norway in 2006-2014 to anticipate the risk with changing climate conditions. The main findings are positive associations between extreme weather events and raw water quality, but only few with treated drinking water. Increase in maximum temperature was associated with an increase in risk of disease among all ages and 15-64 years olds for the whole year. Heavy rain and high runoff were associated with a decrease in risk of gastroenteritis for different age groups and time periods throughout the year. No evidence was found that increase in precipitation and runoff trigger increased gastroenteritis outbreaks. Large waterworks in Norway currently seem to manage extreme weather events in preventing waterborne disease. However, with more extreme weather in the future, this may change. Therefore, modelling future climate scenarios is necessary to assess the need for improved water treatment capacity in a future climate.

Detection of Legionella by cultivation and quantitative real-time polymerase chain reaction in biological waste water treatment plants in Norway.

Cases of Legionnaires' disease associated with biological treatment plants (BTPs) have been reported in six countries between 1997 and 2010. However, knowledge about the occurrence of Legionella in BTPs is scarce. Hence, we undertook a qualitative and quantitative screening for Legionella in BTPs treating waste water from municipalities and industries in Norway, to assess the transmission potential of Legionella from these installations. Thirty-three plants from different industries were sampled four times within 1 year. By cultivation, 21 (16%) of 130 analyses were positive for Legionella species and 12 (9%) of 130 analyses were positive for Legionella pneumophila. By quantitative real-time polymerase chain reaction (PCR), 433 (99%) of 437 analyses were positive for Legionella species and 218 (46%) of 470 analyses were positive for L. pneumophila. This survey indicates that PCR could be the preferable method for detection of Legionella in samples from BTPs. Sequence types of L. pneumophila associated with outbreaks in Norway were not identified from the BTPs. We showed that a waste water treatment plant with an aeration basin can produce high concentrations of Legionella. Therefore, these plants should be considered as a possible source of community-acquired Legionella infections.