Viruses in Non-Disinfected Drinking Water from Municipal Wells and Community Incidence of Acute Gastrointestinal Illness

Groundwater supplies for drinking water are frequently contaminated with low-levels of human enteric virus genomes, yet evidence for waterborne disease transmission is lacking.  AGI incidence was estimated from health diaries completed weekly by households within each study community during four, 12-week periods. Water samples were collected monthly from five to eight households per community. Viruses were measured by qPCR and infectivity assessed by cell culture. AGI incidence was related to virus measures using Poisson regression with random effects.

Communities and time periods with the highest virus measures had correspondingly high AGI incidence. This association was particularly strong for norovirus genogroup I (NoV-GI) and between adult AGI and enteroviruses when echovirus serotypes predominated. At mean concentrations of 1 and 0.8 genomic copies/L of NoV-GI and enteroviruses, respectively, the AGI incidence rate ratios (i.e., relative risk) increased by 30%. Adenoviruses were common, but tap water concentrations were low and not positively associated with AGI. The estimated fraction of AGI attributable to tap waterborne viruses was between 6% and 22%, depending on virus exposure-AGI incidence model selected, and could have been as high as 63% among children < five years old during the period when NoV-GI was abundant in drinking water.

Conclusions: The majority of groundwater-source public water systems in the USA produce water without disinfection. Our findings suggest that populations served by such systems may be exposed to waterborne viruses and consequent health risks.