{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:31:22Z","timestamp":1768822282343,"version":"3.49.0"},"reference-count":15,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,12,1]]},"abstract":"<jats:p>CONTEXT. Contamination of local waterways may occur through release of partially treated sewage. The Environmental Protection Agency has recently reviewed regulatory standards for this practice. However, the health effects of these events have not been well studied.<\/jats:p>\n               <jats:p>OBJECTIVE. Our goal was to identify any increase in visits to a pediatric emergency department for diarrheal illness after sewage bypass into Lake Michigan.<\/jats:p>\n               <jats:p>METHODS. The study was conducted as a retrospective, observational time-series analysis in a tertiary care children's hospital emergency department with an annual volume of \u223c45000 visits. We collected data for 2002\u20132004 pertaining to the daily number of emergency department visits for children (aged &amp;lt;19 years) for diarrheal illness (using specified International Classification of Diseases, Ninth Edition codes as a reference). Daily diarrheal illness visits were the dependent variable in a time-series model. The primary independent variable was the occurrence of a sewage-bypass event in the 3 to 7 preceding days. Potential confounders included the season and daily rainfall. Separate models were created for visits from people living in zip codes that used Lake Michigan drinking water and those who used other water sources.<\/jats:p>\n               <jats:p>RESULTS. Over the 3-year study period, there was a mean of 5.0 \u00b1 3.8 (SD) daily visits for diarrheal illness from people who lived in zip codes that used Lake Michigan drinking water and 1.2 \u00b1 1.4 (SD) from outside that area. There were 6 sewage-bypass events identified. After adjusting for the season and rainfall, there was a significant increase of 2.5 to 2.7 visits only from people who lived in zip codes that used Lake Michigan drinking water after the 2 largest of the 6 bypass events.<\/jats:p>\n               <jats:p>CONCLUSIONS. Emergency department visits for diarrheal illness increased significantly after 2 events of release of partially treated sewage into area waterways. These data suggest a potentially harmful effect of such practices.<\/jats:p>","DOI":"10.1542\/peds.2007-0283","type":"journal-article","created":{"date-parts":[[2007,11,30]],"date-time":"2007-11-30T17:33:39Z","timestamp":1196444019000},"page":"e1472-e1475","source":"Crossref","is-referenced-by-count":15,"title":["Pediatric Emergency Department Visits for Diarrheal Illness Increased After Release of Undertreated Sewage"],"prefix":"10.1542","volume":"120","author":[{"given":"Ryan L.","family":"Redman","sequence":"first","affiliation":[{"name":"Emergency Department, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl A.","family":"Nenn","sequence":"additional","affiliation":[{"name":"Friends of Milwaukee's Rivers, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Emergency Department, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc H.","family":"Gorelick","sequence":"additional","affiliation":[{"name":"Emergency Department, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2007,12,1]]},"reference":[{"key":"2021120901583244400_R1","unstructured":"Blackburn BG, Craun GF, Yoder JS, et al. Surveillance for waterborne-disease outbreaks associated with drinking water: United States, 2001\u20132002. MMWR Surveill Summ.\u20082004;53:23\u201345"},{"key":"2021120901583244400_R2","unstructured":"US Environmental Protection Agency, Office of Water. Report to Congress: impacts and control of CSOs and SSOs. Available at: http:\/\/cfpub.epa.gov\/npdes\/cso\/cpolicy_report2004.cfm. Accessed May 26, 2006"},{"key":"2021120901583244400_R3","doi-asserted-by":"crossref","unstructured":"Payment P, Richardson L, Siemiatycki J, Dewar R, Edwardes M, Franco E. A randomized trial to evaluate the risk of gastrointestinal disease due to consumption of drinking water meeting current microbiological standards. Am J Public Health.\u20081991;81:703\u2013708","DOI":"10.2105\/AJPH.81.6.703"},{"key":"2021120901583244400_R4","unstructured":"National Academy of Sciences. From Monsoons to Microbes: Understanding the Ocean's Role in Human Health. Washington, DC: National Academies Press; 2000"},{"key":"2021120901583244400_R5","unstructured":"US Environmental Protection Agency, Office of Enforcement and Compliance Assurance. Enforcement alert. Available at: www.epa.gov\/Compliance\/resources\/newsletters\/civil\/enfalert\/bypass.pdf. Accessed May 26, 2006"},{"key":"2021120901583244400_R6","unstructured":"68 Federal Register63042\u201363052 (2003)"},{"key":"2021120901583244400_R7","doi-asserted-by":"crossref","unstructured":"Castor ML, Beach MJ. Reducing illness transmission from disinfected recreational water venues: swimming, diarrhea and the emergence of a new public health concern. Pediatr Infect Dis J.\u20082004;23:866\u2013870","DOI":"10.1097\/01.inf.0000138081.84891.30"},{"key":"2021120901583244400_R8","doi-asserted-by":"crossref","unstructured":"MacKenzie WR, Schell WL, Blair KA, et al. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission [published correction appears in Ann Intern Med. 1996;158]. Clin Infect Dis.\u20081995;21:57\u201362","DOI":"10.1093\/clinids\/21.1.57"},{"key":"2021120901583244400_R9","doi-asserted-by":"crossref","unstructured":"Goldstein ST, Juranek DD, Ravenholt O, et al. Cryptosporidiosis: an outbreak associated with drinking water despite state-of-the-art water treatment [published correction appears in Ann Intern Med. 1996;125:158]. Ann Intern Med.\u20081996;124:459\u2013468","DOI":"10.7326\/0003-4819-124-5-199603010-00001"},{"key":"2021120901583244400_R10","doi-asserted-by":"crossref","unstructured":"Kuusi M, Klemets P, Miettinen I, et al. An outbreak of gastroenteritis from a non-chlorinated community water supply. J Epidemiol Community Health.\u20082004;58:273\u2013277","DOI":"10.1136\/jech.2003.009928"},{"key":"2021120901583244400_R11","unstructured":"Box G, Jenkins G. Time Series Analysis: Forecasting and Control. San Francisco, CA: Holden-Day; 1976"},{"key":"2021120901583244400_R12","doi-asserted-by":"crossref","unstructured":"Schwartz J, Levin R, Hodge K. Drinking water turbidity and pediatric hospital use for gastrointestinal illness in Philadelphia. Epidemiology.\u20081997;8:615\u2013620","DOI":"10.1097\/00001648-199711000-00005"},{"key":"2021120901583244400_R13","doi-asserted-by":"crossref","unstructured":"Ljung G, Box G. On a measure of lack of fit in time series models. Biometrika.\u20081978;65:297\u2013303","DOI":"10.1093\/biomet\/65.2.297"},{"key":"2021120901583244400_R14","unstructured":"Dorfman M. Swimming in Sewage. New York, NY: Natural Resources Defense Council; 2004. Available at: www.nrdc.org\/water\/pollution\/sewage\/sewage.pdf. Accessed April 17, 2007"},{"key":"2021120901583244400_R15","doi-asserted-by":"crossref","unstructured":"Messner M, Shaw S, Regli S, Rotert K, Blank V, Soller J. An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application. J Water Health.\u20082006;4(suppl 2):201\u2013240","DOI":"10.2166\/wh.2006.024"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/e1472\/1175007\/zpe012070e1472.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/e1472\/1175007\/zpe012070e1472.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T08:35:13Z","timestamp":1639038913000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/120\/6\/e1472\/70540\/Pediatric-Emergency-Department-Visits-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,12,1]]},"references-count":15,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2007,12,1]]},"published-print":{"date-parts":[[2007,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-0283","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,12,1]]}}}