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Vatnsbornar hópsýkingar á Íslandi – greining á umfangi og ástæðum

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Authors
María J. Gunnarsdóttir
Ása St. Atladóttir
Sigurður M. Garðarsson
Issue Date
2020-06

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Other Titles
Waterborne outbreaks in Iceland - analysis of scale and causes
Citation
María J. Gunnarsdóttir, Ásta St. Atladóttir, Sigurður M. Garðarsson. Vatnsbornar hópsýkingar á Íslandi: greining á umfangi og ástæðum. 2020; 106(6): 293-301.
Abstract
TILGANGUR Hreint neysluvatn er undirstaða lýðheilsu. Algengasta orsök sýkinga af völdum neysluvatns eru sýklar sem berast með saur manna eða dýra í vatnið. Markmið þessarar rannsóknar er að taka saman skráðar vatnsbornar hópsýkingar á 20 ára tímabili, 1998-2017, og greina hvað hafi valdið þeim. Jafnframt eru tekin saman tilvik þar sem neysluvatn hefur mengast þó sjaldan sé skráð hópsýking í tengslum við þau. AÐFERÐIR Gögn eru fengin úr gagnagrunnum rannsóknastofa, sóttvarnasviði Embættis landlæknis, Embætti sóttvarnarlæknis, skýrslum og viðtölum við viðkomandi heilbrigðiseftirlit og sóttvarnalækna. NIÐURSTÖÐUR Á tímabilinu 1998-2017 voru skráðar 15 vatnsbornar hópsýkingar, allar hjá minni vatnsveitum og sumar á fjölförnum ferðamannastöðum og í sumarhúsabyggðum. Sýkillinn er annaðhvort Campylobacter eða nóróveira og í einu tilfelli Cryptosporidium (launsporasýking). Um 500 manns urðu veikir í þessum hópsýkingum og þær höfðu áhrif á um 8000 manns, í lengri eða skemmri tíma. Rannsóknir hafa sýnt að einungis um 10% þeirra sem veikjast fara til læknis, og rata þannig í skrár, og því má leiða að því líkur að í það minnsta 250 manns hafi orðið veikir að meðaltali á ári hverju vegna mengaðs neysluvatns. Greining á niðurstöðum neysluvatnssýna leiddi í ljós að saurmengun greinist að meðaltali í um 50 vatnsveitum á ári hverju, sem er um 5% af skráðum vatnsveitum landsins. Helsta orsök vatnsbornu hópsýkinganna er lélegur frágangur og viðhald á vatnsbólum. ÁLYKTANIR Ýmislegt bendir til að vatnsbornar hópsýkingar séu fleiri en þær sem eru skráðar í opinberar skýrslur og þá sérstaklega hjá minni vatnsveitum. Einnig virðist heilbrigðisyfirvöldum á viðkomandi svæðum oft ekki gert viðvart þegar frávika verður vart í eftirliti. Nauðsynlegt er að bæta skráningu, upplýsingaflæði milli aðila, faraldsfræðilegar úttektir og eftirfylgni við hópsýkingar af völdum neysluvatns þannig að hægt sé að læra af reynslunni. Bæta þarf vatnsgæði hjá minni vatnsveitum og taka upp fyrirbyggjandi úttektir og hættumat á mengun.
Purpose: Clean drinking water is essential for public health. The cause of waterborne outbreaks is most often faecal contamination of water from animals or humans. The objective of this resarch was to collect available information on waterborne outbreaks in Iceland for the twenty year period, 1998-2017. Incident of faecal and pathogenic pollution in samples where also collected even though rarely followed by registered outbreak. Methods: Data are obtained from laboratory databases, the Directorate of Health, reports and interviews with the relevant surveillance authorities and epidemiologists. Results: The results show that for the period investigated fifteen waterborne outbreaks were registered, all in small water supplies, many of which served transitent population, tourists and summerhouse dwellers. About 500 illnesses were confirmed and 8000 people affected. Other research have shown that around 10% of illnesses in waterborne outbreaks are registered so it can be estimated that on average 250 people have been taken ill every year because of contaminated drinking water. Analysis of monitoring water quality data show that on average 50 water supplies, or about 5% of the Icelandic registered water supplies have contained faecal matter every year. The most frequent cause of waterborne outbreak were poor design and inadequate maintainance of water intakes. Conclusions: It is likely that waterborne outbreaks are more numerous than are registered in official reports, especially concerning small water supplies. It also seems that the local heath authorities are often not informed of incidents of non-compliance. It is important to improve registration, information exchange between parties, epidemiological surveys and follow up of outbreaks due to drinking water to gather lessons learned. Water quality at small water supplies needs to be improved with risk-based approach and risk management.
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https://www.laeknabladid.is/tolublod/2020/06/nr/7383
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