An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland.

An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49.5-56.4] in the contaminated area, 15.6% (95% CI 13.1-18.5) in the uncontaminated area and 6.5% (95% CI 4.8-8.8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.

Survival of Campylobacter jejuni in potable water biofilms: a comparative study with different detection methods.

Campylobacteria are important foodborne pathogens. C. jejuni bacteria have caused several drinking water-related epidemics in Finland. Normally, C. jejuni is not able to multiply in drinking water or in biofilms although it may survive in biofilms. The survival of C. jejuni in biofilms was studied using the Propella biofilm reactor. The number of bacteria was analysed with traditional culture methods and with fluorescence in situ hybridisation (FISH). By culture methods C. jejuni was detectable for only 1 d after spiking whereas bacteria were found from biofilms for at least 1 week after spiking and from outlet water of the reactor for 3 weeks when using FISH. These results suggested that C. jejuni may survive in biofilms and culture methods probably seriously underestimate the real number in water and in biofilms.

An outbreak of gastroenteritis from a non-chlorinated community water supply.

STUDY OBJECTIVE: To determine the source and the extent of a community wide outbreak of gastroenteritis. DESIGN: A matched case-control study with postal questionnaires. Subtyping of campylobacter strains by pulsed field gel electrophoresis (PFGE). SETTING: A rural municipality with a population of 8600 in southern Finland, August 2000. Two thirds of the population receive non-chlorinated ground water from the municipal water supply. PARTICIPANTS: Cases were randomly selected among residents of the municipality who contacted the municipal health centre because of gastroenteritis and had illness onset between 31 July and 20 August 2000. Community controls were identified from the population registry and matched according to sex, year of birth, and postal code. MAIN RESULTS: Four hundred and sixty three persons contacted the municipal health centre because of gastroenteritis. Campylobacter jejuni was isolated from stool samples of 24 persons. One hundred and thirty seven cases and 388 controls were enrolled in the case-control study. In multivariate analysis, drinking unboiled water from the municipal supply was significantly associated with illness (odds ratio 11.1, 95% confidence interval 1.4 to 90.2). C jejuni was isolated from one tap water sample. The water isolate and all but one of the patient isolates were indistinguishable by PFGE. CONCLUSIONS: Combining epidemiological investigation with molecular subtyping methods provided strong evidence that water was the source of the outbreak. Non-chlorinated small ground water systems may be susceptible to waterborne outbreaks and constitute a risk to rural populations.

Gas chromatographic-mass spectrometric detection of 2- and 3-hydroxy fatty acids as methyl esters from soil, sediment and biofilm.

Hydroxy fatty acids (OH-FAs) can be used in the characterization of microbial communities, especially Gram-negative bacteria. We prepared methyl esters of 2- and 3-OH-FAs from the lipid extraction residue of soil, sediment, and biofilm samples without further purification or derivatization of hydroxyl groups. OH-FA methyl esters were analyzed using a gas chromatograph equipped with a mass selective detector (GC-MS). The ions followed in MS were m/z 103 for 3-OH-FAs and m/z 90 and M-59 for 2-OH-FAs. The rapid determination of 3- and 2-OH-FAs concomitantly with phospholipid fatty acids provided more detailed information on the microbial communities present in soil, sediment, and drinking water biofilm.

Microbially available organic carbon, phosphorus, and microbial growth in ozonated drinking water.

Ozonation is a disinfection technique commonly used in the treatment of drinking water. It destroys harmful microbes, but it also degrades organic matter in water, increasing the bioavailability of organic matter. Recently, it was found that not only organic carbon but also phosphorus can limit the microbial growth in drinking water, which contains high amount of organic matter. We used a bioassay to analyze whether ozone could also increase the microbially available phosphorus (MAP) in drinking water, and whether MAP in ozone-treated water was associated with the growth of heterotrophic microbes. We found that both assimilable organic carbon and MAP concentrations were increased by ozone treatment. In ozonated water, microbial growth was mainly limited by phosphorus, and even minor changes in MAP concentration dramatically increased the growth potential of heterotrophic microbes. In this study, ozonation increased the MAP by 0.08-0.73 microgram P/l, resulting in an increase of 80,000-730,000 CFU/ml in water samples. In contrast to MAP, the content of assimilable organic carbon (AOCpotential) did not correlate with microbial growth. The results show that in water treatment not only AOCpotential but also MAP should be considered as an important factor that can limit microbial growth in drinking water.

Mutagenicity and amount of chloroform after chlorination of bank filtered lake water.

Chlorinated drinking waters produced from humus-rich waters often have a high content of halogenated organic by-products which increases the mutagenicity of drinking water. With in vitro chlorination experiments we studied the formation of chloroform (CHCl3) and mutagenicity of artificially recharged ground water samples. The water samples where obtained from an artificial ground water plant which infiltrates humus-rich lake water through an esker island. The chlorination experiments showed that bank filtration reduced strongly the formation of chloroform and mutagenicity of chlorinated water. Reduction in the amount of chloroform and mutagenicity in chlorinated waters was strongly associated with the decrease in the total content of organic carbon and with the decrease in molecular weight of organic matter during bank filtration.

Disinfection by-products in Finnish drinking waters.

Disinfection by-products (DBPs) were measured in plant effluents of 35 Finnish waterworks, which utilized different treatment processes and raw water sources. DBPs were measured also from the distribution systems of three waterworks. Di- and trichloroacetic acids, and chloroform were the major DBPs found in treated water samples. The concentration of six haloacetic acids (HAA6) exceeded the concentrations of trihalomethanes (THMs). Chlorinated drinking waters (DWs) originating from surface waters contained the highest concentration of HAA6 and THMs: 108 and 26 microg/l, respectively. The lowest concentrations of DBPs were measured from ozonated and/or activated carbon filtrated and chloraminated DWs. Higher concentrations of HAA6, THMs, and adsorbable organic halogens were measured in summer compared to winter. The levels of chlorinated acetic acids, chloroform, and bromodichloromethane correlated positively with mutagenicity. Past mutagenicity levels of DWs were examined. A major reduction in the use of prechlorination, increased use of chloramine disinfection, and better removal of organic carbon were the most important reasons for the 69% decrease in mutagenicity from 1985 to 1994.

Molecular size distribution of natural organic matter in raw and drinking waters.

The purpose of this study was to compare the molecular size distribution (MSD) of natural organic matter (NOM) in raw waters (RW) and drinking waters (DW), and to find out the differences between MSD after different water treatment processes. The MSD of NOM of 34 RW and DW of Finnish waterworks were determined with high-performance size-exclusion chromatography (HPSEC). Six distinct fractions were generally separated from water samples with the TSK G3000SW column, using sodium acetate at pH 7 as an eluent. Large and intermediate humic fractions were the most dominant fractions in surface waters (lakes and rivers), while in artificially recharged groundwaters and natural groundwaters intermediate and small fractions predominated. Water treatment processes removed the two largest fractions almost completely shifting the MSD towards smaller molecular size in DW. Granular activated carbon (GAC) filtration, ozonation, and their combination reduced all humic fractions compared to the conventional treatment. Humic fractions correlated with total organic carbon (TOC) content and chemical oxygen demand, this being especially true in RW. The results demonstrate that the HPSEC method can be applied for a qualitative and also for rough estimate quantitative analyzes of NOM directly from RW and DW samples without sample pretreatment.

Waterborne epidemics in Finland in 1998-1999.

Fourteen waterborne epidemics occurred in Finland during 1998-1999. About 7,300 illness cases were registered in these outbreaks. All except one of the waterborne epidemics were associated with undisinfected groundwaters. An equal number of waterborne epidemics occurred in public and private water systems, but most cases of illness occurred in public water systems. The three largest epidemics comprised 6,700 illness cases. Insufficient purification treatment unable to remove Norwalk-like viruses caused the only waterborne epidemic in a surface water plant. The main reasons for groundwater outbreaks were floods and surface runoffs which contaminated water. Norwalk-like viruses caused eight and Campylobacter three of the outbreaks. In two cases the epidemic ceased by the exhaustion of susceptible persons in the exposed community but in most cases it was terminated by changing the water source, boiling the drinking water, and starting chlorination.

A large outbreak of campylobacteriosis associated with a municipal water supply in Finland.

In August 1998, an outbreak of campylobacteriosis occurred in one municipality in northern Finland. A 10% random sample of residents (population 15 000) was selected through the National Population Registry for a survey conducted by using postal questionnaires. Cases were defined as residents of the municipality with onset of acute gastroenteritis from 1 to 20 August 1998. Of 1167 respondents (response rate 78%), 218 (18.7%) met the case definition. Drinking non-chlorinated municipal tap water was strongly associated with illness (OR 34.4). The estimated total number of ill persons was 2700. Campylobacter jejuni was isolated from stool samples of 45 (61%) out of 74 patients tested. All five isolates tested had indistinguishable PFGE patterns. Water samples were negative for campylobacter and coliforms. Epidemiological and environmental evidence suggested mains repair as the source of contamination. Non-chlorinated ground-water systems may be susceptible to contamination and can cause large outbreaks.

Phosphorus and bacterial growth in drinking water.

The availability of organic carbon is considered the key factor to regulate microbial regrowth in drinking water network. However, boreal regions (northern Europe, Russia, and North America) contain a large amount of organic carbon in forests and peatlands. Therefore, natural waters (lakes, rivers, and groundwater) in the northern hemisphere generally have a high content of organic carbon. We found that microbial growth in drinking water in Finland is highly regulated not only by organic carbon but also by the availability of phosphorus. Microbial growth increased up to a phosphate concentration of 10 micrograms of PO4-P liter-1. Inorganic elements other than phosphorus did not affect microbial growth in drinking water. This observation offers novel possibilities to restrict microbial growth in water distribution systems by developing technologies to remove phosphorus efficiently from drinking water.

Changes in water microbial quality during bank filtration of lake water.

We studied, during a 2-year period, how the microbial stability of water changed when humus-rich lake water was filtered through the ground at a bank filtration water plant. The changes in microbial quality were followed as microbial numbers and growth activity. The filtration decreased microbial counts and growth ([3H]thymidine technique) in water up to 90%. The reduction in bacterial counts and growth depended on the filtration distance. The reduction was greatest between the lake and the first sampling point. Microbial numbers and growth declined steadily after infiltration with increased filtration distance. Viable counts of heterotrophic bacteria decreased faster than total bacterial counts along filtration. The microbial numbers and bacterial production in water followed seasonal changes in water temperature. Simultaneously with the microbial numbers, the concentrations of total organic carbon and assimilable organic carbon decreased during bank filtration. These results showed that microbial stability of humus-rich water was increased by filtration to a level generally found in natural groundwaters.

Growth of Legionella and other heterotrophic bacteria in a circulating cooling water system exposed to ultraviolet irradiation.

The effect of ultraviolet irradiation on the growth and occurrence of legionella and other heterotrophic bacteria in a circulating cooling water system was studied. Water of the reservoir was circulated once in 28 h through a side-stream open channel u.v. radiator consisting of two lamps. Viable counts of legionellas and heterotrophic bacteria in water immediately after the u.v. treatment were 0-12 and 0.7-1.2% of those in the reservoir, respectively. U.v. irradiation increased the concentration of easily assimilable organic carbon. In the u.v. irradiated water samples incubated in the laboratory the viable counts of heterotrophic bacteria reached the counts in reservoir water within 5 d. The increase in viable counts was mainly due to reactivation of bacterial cells damaged by u.v. light, not because of bacterial multiplication. Despite u.v. irradiation the bacterial numbers in the reservoir water, including legionellas, did not decrease during the experimental period of 33 d. The main growth of bacteria in the reservoir occurred in biofilm and sediment, which were never exposed to u.v. irradiation.

Detection and typing of Campylobacter jejuni and Campylobacter coli and analysis of indicator organisms in three waterborne outbreaks in Finland.

Waterborne outbreaks associated with contamination of drinking water by Campylobacter jejuni are rather common in the Nordic countries Sweden, Norway, and Finland, where in sparsely populated districts groundwater is commonly used without disinfection. Campylobacters, Escherichia coli, or other coliforms have rarely been detected in potential sources. We studied three waterborne outbreaks in Finland caused by C. jejuni and used sample volumes of 4,000 to 20,000 ml for analysis of campylobacters and sample volumes of 1 to 5,000 ml for analysis of coliforms and E. coli, depending on the sampling site. Multiple samples obtained from possible sources (water distribution systems and environmental water sources) and the use of large sample volumes (several liters) increased the chance of detecting the pathogen C. jejuni in water. Filtration of a large volume (1,000 to 2,000 ml) also increased the rate of detection of coliforms and E. coli. To confirm the association between drinking water contamination and illness, a combination of Penner serotyping and pulsed-field gel electrophoresis (digestion with SmaI and KpnI) was found to be useful. This combination reliably verified similarity or dissimilarity of C. jejuni isolates from patient samples, from drinking water, and from other environmental sources, thus confirming the likely reservoir of an outbreak.