Association between heavy precipitation events and waterborne outbreaks in four Nordic countries, 1992-2012

Bernardo Guzman Herrador, Birgitte Freiesleben De Blasio, Anneli Carlander, Steen Ethelberg, Hans Olav Hygen, Markku Kuusi, Vidar Lund, Margareta Löfdahl, Emily MacDonald, Jaime Martinez-Urtaza, Gordon Nichols, Caroline Schönning, Bertrand Sudre, Linda Trönnberg, Line Vold, Jan C. Semenza, Karin Nygård

Research output: Contribution to journalReview articlepeer-review

18 Citations (SciVal)


We conducted a matched case-control study to examine the association between heavy precipitation events and waterborne outbreaks (WBOs) by linking epidemiological registries and meteorological data between 1992 and 2012 in four Nordic countries. Heavy precipitation events were defined by above average (exceedance) daily rainfall during the preceding weeks using local references. We performed conditional logistic regression using the four previous years as the controls. Among WBOs with known onset date (n=89), exceedance rainfall on two or more days was associated with occurrence of outbreak, OR=3.06 (95% CI 1.38-6.78), compared to zero exceedance days. Stratified analyses revealed a significant association with single household water supplies, ground water as source and for outbreaks occurring during spring and summer. These findings were reproduced in analyses including all WBOs with known outbreak month (n=186). The vulnerability of single households to WBOs associated with heavy precipitation events should be communicated to homeowners and implemented into future policy planning to reduce the risk of waterborne illness.

Original languageEnglish
Pages (from-to)1019-1027
Number of pages9
JournalJournal of Water and Health
Issue number6
Publication statusPublished - 1 Dec 2016


  • Extreme precipitation
  • Heavy precipitation
  • Infection
  • Outbreak
  • Waterborne

ASJC Scopus subject areas

  • Water Science and Technology
  • Waste Management and Disposal
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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