A literature review of waterborne outbreaks in the last decade in Türkiye

Year 2023, Volume: 40 Issue: 2, 401 - 409, 19.07.2023

Emre Akgül , Hatice Nilden Arslan , Özlem Terzi

Abstract

The present study aimed to evaluate the studies in the literature on waterborne outbreaks in the last decade. Between 2010-2020, the literature was reviewed using the words "waterborne outbreak, outbreak investigation, Türkiye and water" with PubMed, Google academic, and TR Index databases. The 14 articles suitable for the outbreak review were reached and evaluated regarding the significant results. The responsible agents were determined as Norovirus in six studies, F. Tularensis in four, Shigella spp. in two, Rotavirus in one, and polymicrobial factors in one. In these outbreaks, 51,802 people were affected. Studies were descriptive, case-control, and retrospective cohort. The most outbreaks occurred in 2014 (n=4) and 2010 (n=3). The largest outbreak was a Norovirus outbreak in the Elbistan district of Kahramanmaras, where 34,490 people were affected. In these outbreaks, 641 people received inpatient treatment, while no deaths were reported. In five of the outbreaks, the spots where the water was contaminated were detected, and it was not detected in nine. Failures in the water supply network, the lack of water tanks per the legislation, and the lack of chlorination for different reasons were determined to have caused waterborne outbreaks. Continuous water disinfection, overhauling non-compliance water tanks, timely maintenance and replacement of water networks, and strengthening communication between the institution responsible for water disinfection and health institutions can prevent waterborne outbreaks that could become a significant public health problem.

Keywords

bibliometric study, waterborne outbreak, Türkiye

References

• 1. Hacımustafaoğlu M, Onurmen O. Definition of an Outbreak (Epidemic) in İnfectious Diseases Practice. J Pediatr Inf. 2018;12(4):172-3.
• 2. Arpacioglu S, Baltali Z, Unubol B. Burnout, fear of Covid, depression, occupational satisfaction levels and related factors in healthcare professionals in the COVID-19 pandemic. Cukurova Medical Journal. 2021; 46(1):88-100.
• 3. Nwabor OF, Nnamonu E, Martins P, Ani O. Water and waterborne diseases: a review. Int J Trop Dis Health. 2016;12(4):1-14.
• 4. World Health Organization. [Internet]. [cited 13.08.2021]. Available from: https://www.who.int/news/item/13-04-2017-radical-increase-in-water-and-sanitation-investment-required-to-meet-development-targets
• 5. Ercumen A, Gruber JS, Colford Jr JM. Water distribution system deficiencies and gastrointestinal illness: a systematic review and meta-analysis. Environmental health perspectives. 2014;122 (7):651-60.
• 6. Park J, Kim JS, Kim S, Shin E, Oh K-H, Kim Y, et al. A waterborne outbreak of multiple diarrhoeagenic Escherichia coli infections associated with drinking water at a school camp. International Journal of Infectious Diseases. 2018;66:45-50.
• 7. World Health Organization. Water, sanitation, hygiene and health: a primer for health professionals. No. WHO/CED/PHE/WSH/19.149. World Health Organization, 2019.
• 8. Benedict KM, Reses H, Vigar M, Roth DM, Roberts VA, Mattioli M, et al. Surveillance for waterborne disease outbreaks associated with drinking water—United States, 2013–2014. MMWR Morbidity and mortality weekly report. 2017;66(44):1216.
• 9. Edition F. Guidelines for drinking-water quality. WHO chronicle. 2011;38(4):104-8.
• 10. Bernadeta Dadonaite, Hannah Ritchie and Max Roser (2018) - "Diarrheal diseases". Published online at OurWorldInData.org. [cited 12.08.2021]. Available from: https://ourworldindata.org/diarrheal-diseases#burden-of-diarrheal-diseases
• 11. Centers for Disease Control and Prevention. Global Water, Sanitation, & Hygiene (WASH) [cited 12.08.2021]. Available from: https://www.cdc.gov/healthywater/global/diarrhea-burden.html
• 12. Sahan S, Yilmaz S, Topal S, Özarslan F, Yenice AÇ, Göktaş DC, et al. The Investigation of Acute Gastroenteritis Cases, Elbistan District, Kahramanmaras Province, August 2016. The Turkish Bulletin of Hygiene and Experimental Biology. 2017;74(EK-1):13-20.
• 13. Ozudoğru B, Kazik Y, Kizilaslan M, Temel F. A Shigella sonnei gastroenteritis outbreak in Bayburt province, Türkiye, October 2014. The Turkish Bulletin of Hygiene and Experimental Biology. 2018;75(4):409-20.
• 14. Topal S, Celik H, Yilmaz Ş, Özoğlu E, Karaoğlanoğlu O, Temel F, et al. Outbreak of Shigella sonnei infection in Terme City, Türkiye, September 2012. The Turkish Bulletin of Hygiene and Experimental Biology. 2019;76(2):141-8.
• 15. Erdoğan H, Arslan H. Evaluation of a Legionella outbreak emerged in a recently opening hotel. Mikrobiyoloji Bulteni. 2013;47(2):240-9.
• 16. Republic of Türkiye. Legal Gazette. Regulation on Waters for Human Consumption. [cited 20.08.2021]. Available from: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=7510&MevzuatTur=7&MevzuatTertip=5
• 17. Republic of Türkiye. Legal Gazette. Disinfection Technical Communique [cited 25.08.2021]. Available from: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=21096&MevzuatTur=9&MevzuatTertip=5
• 18. Barlas G, Tozan E, Altuğ Y, et al. An investigation of an outbreak of gastroenteritis in the Tavsanli District of Kutahya Province, July 2014, a Case-Control Study. Turk J Public Health. 2016;14(2):81-94.
• 19. Özgüler ZÖ, Temel F, Duman P, et al. Epidemiological approach, control measures and challenges of a norovirusassociated waterborne outbreak in Unye district in August 2017. The Turkish Bulletin of Hygiene and Experimental Biology. 2019;76(4):441-452.
• 20. Çan G, Yavuzyılmaz A, Çınarka H, et al. Norovirus Outbreak Investigation in Surmene District of Trabzon Province July 2010. TAF Preventive Medicine Bulletin. 2011;10(5): 501-510
• 21. Duman P, Demirbilek Y, Çelik F, Şenol M, Özçelik R, Koçkar M, et al. A gastroenteritis outbreak caused by contaminated tap water, Akharim town, Afyonkarahisar Province, Türkiye, May 2014. The Turkish Bulletin of Hygiene and Experimental Biology. 2016;73(3):221-32.
• 22. Sozen H, Gönen İ, Beydilli H. An outbreak of norovirus gastroenteritis in a county in Türkiye. Journal of Microbiology and Infectious Diseases. 2014;4(01):26-9.
• 23. Tozan E, Duman P, Elbasan HD, Aktepe Ö, Sezen F, Temel F, et al. A gastroenteritis outbreak investigation, NIGDE city center, March 2014. Turk J Public Health. 2016;14(1):1-12.
• 24. Sezen F, Aval E, Ağkurt T, Yilmaz Ş, Temel F, Güleşen R, et al. A large multi-pathogen gastroenteritis outbreak caused by drinking contaminated water from antique neighbourhood fountains, Erzurum city, Türkiye, December 2012. Epidemiology & Infection. 2015;143(4):704-10.
• 25. Ali B, Aktuna G, Özgülcü Ş, Sezgin B, Temel F, Çelebi B. Afyonkarahisar ili Dinar ilçesinde 2015 yılı Ocak ayında görülen tularemi vakaları. The Turkish Bulletin of Hygiene and Experimental Biology. 2016;73(3):233-44.
• 26. Bozkurt I, Kiliç S. Tularemia is Spreading from North to South Side of Türkiye: A Small Outbreak in Kahramanmaras, Türkiye. Mikrobiyol Bul. 2014;48(3):413-9.
• 27. Dikici N, Ural O, Sümer Ş, et al. Tularemia in Konya region, Turkey. Mikrobiyol Bul. 2012;46(2):225-235.
• 28. Aktas D, Celebi B, Isik ME, et al. Oropharyngeal tularemia outbreak associated with drinking contaminated tap water, Turkey, July–September 2013. Emerging infectious diseases. 2015;21(12):2194.
• 29. Ozgun Ş, Yıldırım E, Solmaz A, Kireçci M, Hüdayioğlu MR. An Investigation of an Acute Pesticide Intoxication Outbreak; the Vali Saim ÇOTUR RBPES, Kahramanmaraş, May 2008. TAF Preventive Medicine Bulletin. 2009;8(3).
• 30. Hrudey S, Payment P, Huck P, Gillham R, Hrudey E. A fatal waterborne disease epidemic in Walkerton, Ontario: comparison with other waterborne outbreaks in the developed world. Water Science and Technology. 2003;47(3):7-14.
• 31. Kaynar P, Yilmaz M, Semizoğlu Ö, Eriş Zİ, Dursun FK, Cesaretli Y, et al. Su örneklerinde norovirüs varlığının cross-flow mikrofiltrasyon ve RT-PCR ile belirlenmesi. Türk Hijyen ve Deneysel Biyoloji Dergisi. 2017;74(EK-1):1-6.
• 32. Guzman Herrador B, de Blasio BF, Carlander A, Ethelberg S, Hygen HO, Kuusi M, et al. Association between heavy precipitation events and waterborne outbreaks in four Nordic countries, 1992–2012. Journal of Water and Health. 2016;14(6):1019-27. doi: 10.2166/wh.2016.071.
• 33. Ada D, Bozkurt E, Tanrıkulu S, Akdağ M. The effect of centralisation in local areas of potable water services on microbiological pollution and case rate of acute gastroenteritis infection in water control for potable water: Tekirdağ example. The Turkish Bulletin of Hygiene and Experimental Biology. 2017;74(1):1-12.
• 34. Ay G, Boztaş NG, Paşa N, Şahin B, Çalışkan T, editors. Microbiological Evaluation of Drinking and Potable Water of Edirne Province in 2013. Public Health Congress; 2014.
• 35. Bulut YE, Evcil Ü, Adikti S, Kökel M. Determination of Level of Knowledge and Awareness Among Village Headmen in Bitlis Province Regarding Chlorination. The Turkish Bulletin of Hygiene and Experimental Biology. 2017;74(EK-1):95-100.
• 36. Kolayli CC, Topbaş M, Üçüncü ŞY, Gamze Ç. Domestic water tank usage of people in a rural area: A study in Trabzon. The Turkish Bulletin of Hygiene and Experimental Biology. 2019;77(2):195-206.