literature review on safe drinking water

Literature review: Water quality and public health problems in developing countries

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Eni Muryani; Literature review: Water quality and public health problems in developing countries. AIP Conf. Proc. 23 November 2021; 2363 (1): 050020. https://doi.org/10.1063/5.0061561

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Water’s essential function as drinking water is a significant daily intake. Contamination by microorganisms (bacteria or viruses) on water sources and drinking water supplies is a common cause in developing countries like Indonesia. This paper will discuss the sources of clean water and drinking water and their problems in developing countries; water quality and its relation to public health problems in these countries; and what efforts that can be make to improve water quality. The method used is a literature review from the latest journals. Water quality is influenced by natural processes and human activities around the water source Among developed countries, public health problems caused by low water quality, such as diarrhea, dysentery, cholera, typhus, skin itching, kidney disease, hypertension, heart disease, cancer, and other diseases the nervous system. Good water quality has a role to play in decreasing the number of disease sufferers or health issues due to drinking and the mortality rate. The efforts made to improve water quality and public health are by improving WASH (water, sanitation, and hygiene) facilities and infrastructure and also WASH education.

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Drinking Water Quality and Public Health

• S.I.: Drinking Water Quality and Public Health
• Published: 04 February 2019
• Volume 11 , pages 73–79, ( 2019 )

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• Peiyue Li   ORCID: orcid.org/0000-0001-8771-3369 1 , 2 &
• Jianhua Wu 1 , 2  

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Drinking water quality is one of the greatest factors affecting human health. However, drinking water quality in many countries, especially in developing countries is not desirable and poor drinking water quality has induced many waterborne diseases. This special issue of Exposure and Health was edited to gain a better understanding of the impacts of drinking water quality on public health so that proper actions can be taken to improve the drinking water quality conditions in many countries. This editorial introduction reviewed some latest research on drinking water quality and public health, summarized briefly the main points of each contribution in this issue, and then some research fields/directions were proposed to boost further scientific research in drinking water quality and public health. The papers in this issue are interesting and cover many aspects of this research topic, and will be meaningful for the sustainable drinking water quality protection.

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Acknowledgements

Prof. Andrew Meharg, the Editor in Chief of Exposure and Health and Fritz Schmuhl, the Publishing Editor are sincerely acknowledged for their approval and support on this special issue. The publisher and the entire editorial team are strong, making the publication smooth and quick. It is one of the top editorial teams in the publishing community. We are greatly grateful to contributors whose manuscripts have been rejected and those whose manuscripts have been published in this special issue, and many reviewers are also acknowledged. Without interested authors and without voluntary reviewers, it would be impossible to publish this special issue. We are also grateful to various funding agencies and organizations who have provided financial support to our research, and they are the National Natural Science Foundation of China (41502234, 41602238, 41572236 and 41761144059), the Research Funds for Young Stars in Science and Technology of Shaanxi Province (2016KJXX-29), the Special Funds for Basic Scientific Research of Central Colleges (300102298301), the Fok Ying Tong Education Foundation (161098), the General Financial Grant from the China Postdoctoral Science Foundation (2015M580804 and 2016M590911), the Special Financial Grant from the China Postdoctoral Science Foundation (2016T090878 and 2017T100719), the Special Financial Grant from the Shaanxi Postdoctoral Science Foundation (2015BSHTDZZ09 and 2015BSHTDZZ03), and the Ten Thousand Talents Program.

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School of Environmental Science and Engineering, Chang’an University, No. 126 Yanta Road, Xi’an, 710054, Shaanxi, China

Peiyue Li & Jianhua Wu

Key Laboratory of Subsurface Hydrology and Ecological Effects in Arid Region of the Ministry of Education, Chang’an University, No. 126 Yanta Road, Xi’an, 710054, Shaanxi, China

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Li, P., Wu, J. Drinking Water Quality and Public Health. Expo Health 11 , 73–79 (2019). https://doi.org/10.1007/s12403-019-00299-8

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Received : 16 January 2019

Revised : 16 January 2019

Accepted : 21 January 2019

Published : 04 February 2019

Issue Date : 15 June 2019

DOI : https://doi.org/10.1007/s12403-019-00299-8

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Surveillance of Drinking Water Quality Worldwide: Scoping Review Protocol

Affiliations.

• 1 Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil.
• 2 Technical School of Health of Cajazeiras, Federal University of Campina Grande, Cajazeiras 58900-000, Brazil.
• 3 School of Health, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil.
• 4 René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte 30190-009, Brazil.
• 5 Public Health Departament, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil.
• PMID: 35897360
• PMCID: PMC9331759
• DOI: 10.3390/ijerph19158989

Universal access to clean and safe drinking water is essential for life maintenance since exposure to poor quality water is harmful to health. Drinking water quality is part of public health actions and, together with sanitation, a human right essential for life and a sustainable development goal. Moreover, an independent surveillance system conducted by the Ministry of Health or government agencies is needed for the safety of drinking water quality. We propose a scoping review protocol to identify and map worldwide surveillance actions and initiatives of drinking water quality implemented by government agencies or public health services. This scoping review protocol is based on the Joanna Briggs Institute manual and guided by the PRISMA-ScR. Articles, theses, dissertations, and official documents consulted in the following databases will be included: Medline/PubMed, Scopus, LILACS, Web of Science, Embase, Engineering Village, and gray literature. No date limit or language will be determined. The authors will develop a worksheet for data extraction. Quantitative (simple descriptive statistics) and qualitative data (thematic analysis) will be analyzed. The final scoping review will present the main findings, impacts, challenges, limitations, and possible research gaps related to surveillance of drinking water quality on population health.

Keywords: drinking water; government; potable water; public health surveillance; quality control.

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• Research Support, Non-U.S. Gov't
• Drinking Water*
• Review Literature as Topic
• Systematic Reviews as Topic
• Water Quality
• Drinking Water

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Water safe after Jacksonville hazmat incident at facility

05/16/2024 by Staff Report

JACKSONVILLE – City officials have confirmed that the city drinking water is safe to consume and there are no public health hazards after a hazardous material incident took place earlier this week at its water treatment plant.

The town’s fire and emergency services responded at 11 a.m. Tuesday to a call at the facility located at 177 New Frontier Way, where crews found that a private transport contractor that was delivering water treatment chemicals inadvertently discharged zinc orthophosphate into a storage tank containing sulfuric acid.

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“The chemicals were contained and at no time were any chemicals spilled,” the city said.

At the time, immediate areas were evacuated and an adequate isolation area was established for continued oversight. Air quality measurements were conducted through the night until units demobilized, according to the city.

Officials said Wednesday evening in the most recent update that “an environmental remediation company is on the scene to ensure proper cleanup and identify the need for any additional actions.”

Sulfuric acid is used to lower pH levels of incoming water and is removed in the treatment process before consumption and Zinc orthophosphate is used as a corrosion inhibitor to ensure integrity of pipes and valves. These chemicals and their levels are in compliance with Environmental Protection Agency standards, officials said.

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Wisconsin DNR Seeks Public commend on Green Bay Safe Drinking Water Loan Program Project

May 13, 2024 8:10 AM CDT

By: Lisa M. Hale

GREEN BAY, WI – (WGBW) – The Wisconsin Department of Natural Resources is looking for public comment for an environmental review of the Green Bay Safe Drinking Water Loan Program Project which includes upgrading the lead service lines in the city. 

The program determined the project won’t result in significant adverse environmental effects. Green Bay is applying for funding to improve the public drinking water system throughout the city. Comments can be submitted by May 24th to the DNR.

Press Release

Dnr seeking public comment for environmental review of green bay safe drinking water loan program project.

MADISON, Wis. – The Wisconsin Department of Natural Resources (DNR) today announced the city of Green Bay is an applicant for funding through the Safe Drinking Water Loan Program to improve its public drinking water system.

The project includes upgrading the lead service lines in the city of Green Bay.

Activities related to this project are minor actions under Chapter NR 150, Wis. Admin. Code, for which no environmental analysis is required; however, following the Safe Drinking Water Loan Program federal requirement 40 C.F.R. §35.3580, an environmental review must be conducted before funding this project.

The Safe Drinking Water Loan Program has determined that the project will not result in significant adverse environmental effects, and no further environmental review or analysis is needed before proceeding with funding the project.

The public is encouraged to submit comments regarding this decision and the potential environmental impacts of this project. Submit comments by May 24, 2024 to:

Wisconsin Department of Natural Resources C/O Michelle Brietzman, Community Financial Assistance, CF/2 101 S. Webster St. P.O. Box 7921 Madison, WI 53707 [email protected]

Based on the comments received, the Safe Drinking Water Loan Program may prepare an environmental analysis before proceeding with the funding process. The analysis would summarize the DNR’s consideration of the project’s impacts and reasonable alternatives.

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The Best Insulated Water Bottles of 2024

Insulated water bottles are an essential gear item for summer — that much is obvious. But they also have lots of great uses throughout the year. Check out the best insulated bottles of 2024 here.

If you’re looking to purchase a water bottle for outdoor adventures, an insulated bottle should be high on your list. Insulated bottles are designed to keep cold liquids colder longer (and hot liquids hotter) and are usually higher quality and more durable than their plastic counterparts.

Plus, having a reusable water bottle is great for the environment. For this review, we looked at water bottles that have some form of insulation (whether stainless steel construction or otherwise) and a good-sealing cap or lid. And we evaluated each on factors like insulation, shape and volume, durability, and price. All told, we’ve sourced, filled, and drained more than 40 different water bottles since 2021, and pulled together the top 15 in our line-up today.

These bottles didn’t get off easy, either. Each vessel underwent our in-house testing regimen, which saw them all examined for timed ice retention, a leak test, as well as a quasi-scientific taste test. Safe to say, these bottles have been vetted, and to choose the best of the best, we ranked each bottle on features, feedback from our testing, and price.

For more information about insulated water bottles, check out our Buyer’s Guide , Comparison Chart , and FAQ at the end of this article. Otherwise, top off your bottle and scroll through our picks for the best insulated water bottles of 2024.

Editor’s Note: Our team gave this Guide an update on May 16, 2024, with the addition of the RTIC Vacuum Insulated Bottle , our new Best Budget pick.

• Best Overall Insulated Water Bottle: Hydro Flask Wide Mouth Bottle
• Best Budget Insulated Water Bottle: RTIC Vacuum Insulated Bottle
• Most Durable Insulated Water Bottle: YETI Rambler Chug Water Bottle
• Best Water Bottle for Driving: Stanley Quencher H2.0 Flowstate Tumbler
• Best Insulated Can Cooler: YETI Rambler Colster
• Best Insulated Growler: MiiR Growler
• Best Insulated Water Bottle for Kids: Thermos Funtainer Bottle With Straw

Hydro Flask Wide Mouth Bottle

• Material Stainless steel
• Insulation type Double-wall vacuum
• BPA-free Yes
• Weight 1 lb., 2 oz. in 40 fl. oz. size
• Available volumes 20, 24, 32, 40 and 64 fl. oz.

• Long-standing cold and heat retention
• Slim profile fits into many pockets and cupholders
• Wide mouth accommodates ice cubes
• Not impervious to dents

Sometimes you don’t want to mess with the OG. Hydro Flask’s Wide Mouth ($50) won out as the best insulated bottle, with a massive following both in the GearJunkie offices, as well as with adventurers abroad. There may only be so many ways to craft an insulated bottle today, but Hydro Flask hits the nail on the head with this one.

Astute observers will note that our top spot has long been occupied by Hydro Flask’s Standard Mouth offering, but all tides change eventually, and after consistent testing side by side, we now lean on our Wide Mouth bottle more to slake our thirst on a hot summer’s day. The wide mouth also better accommodates loading ice cubes in the bottle, keeping it ice cold for longer.

No matter the model, the brand’s double-wall vacuum insulation and pro-grade stainless steel construction are designed to maintain drink temperatures for hours without altering taste — an impressive 24 hours of cold and 12 hours of heat retention.

And we found during testing that this bottle is pretty durable as well, thanks to its powder-coated exterior. We will note that even the best has a limit, and dropping the Wide Mouth bottle from a good height is liable to lead to some dings.

Our testers raved about this bottle for its great insulation and lineup of more than 12 fun colors. Also, being on the skinnier side, it fits in most cup holders and pack pockets. While it also comes in 20-, 24- and 32-ounce sizes, we like the 40-ounce best for most activities. The Hydro Flask Wide Mouth is easily the bottle we reach for the most often as we head out the door.

RTIC Vacuum Insulated Bottle

• Weight 15.0 oz. in 32 fl. oz. size
• Available volumes 32, 36, and 40 fl. oz.

• Affordable Price
• Good heat and cold retention
• Flip-up lid allows drinking without removing the whole lid
• Available in over a dozen colors
• Not as heavy-duty as some other models

RTIC is a well-respected player in the cooler and drinkware market for offering high-quality, durable products at a more reasonable price than some of the other big brands. Their Vacuum Insulated Bottle ($20 for the 32-ounce size) hits the mark for simple quality at an unbeatable price.

The RTIC Bottle shares many similarities with comparable models from Hydro Flask and YETI, like stainless steel construction, double-wall vacuum insulation, and a powder-coated protective finish. We’re also big fans of the flip-top lid that lets you drink from the bottle without removing the entire lid. In our years of hydrating at home, at the office, in the car, or out in nature, we can’t tell you how many spills we’ve had with other bottles from accidentally leaving the lid partially open. It’s still possible to leak a little out of the flip-top lid, but you won’t be drenching yourself like you would with a completely open bottle.

While the RTIC Bottle looks and performs similarly to the Hydro Flask and YETI models, it doesn’t feel quite as heavy-duty and indestructible. Having said that, we haven’t experienced any quality or durability issues in our testing. Also remember that you can buy two RTIC Bottles for the same price of one of the others, which is why it earns our pick as the best value option.

YETI Rambler Chug Water Bottle

• Weight 1 lb., 3.2 oz. in the 18 fl. oz. size
• Available volumes 18, 26, 36, 46, 64 fl. oz.

• Fits in most cup holders
• Available in a wide variety of colors, sizes, and lid types
• Standard issue Chug cap isn’t for everyone

YETI’s 26-ounce Rambler Bottle ($40) is another amazing insulated bottle. This one is tied with our top choice for its stainless steel construction and insulating performance, however, it weighs slightly more — although that also gives it points for durability.

Available in an impressive five different volumes, there’s bound to be a Rambler bottle for any sized adventure you might be planning. The bottle comes standard with YETI’s Chug Cap, which is about the only controversial feedback among testers — some loved the two-part narrow mouth cap, and some didn’t.

A final note — one of the best parts of buying from an established brand like YETI is the broad range of supplementing accessories available. We counted five different lid styles available for the Rambler , which makes it a super versatile bottle to match whatever hydration needs you might have.

Of all of the insulated bottles we’ve tested over the years, offerings like the Rambler consistently held up better than their counterparts, making this bottle one tough option for those who leave the kid gloves at home.

YETI Rambler Colster

• Weight 9.6 oz. in 12 fl. oz. size
• Available volumes 12 fl. oz., 12 fl. oz. Slim Can, 16 fl. oz. Tall Can

• Simple design with only two parts
• Truly keeps drinks chilled
• Not a one size fits all solution
• A little heavy

When the heat of the summer comes on, water isn’t the only thing we’re looking to slake our thirsts. Your favorite foam can koozie may get all the laughs, but a true insulating can cooler like the YETI Rambler Colster ($25) will keep your favorite beverage chilled for far longer. We found the Colster to be the best of the bunch, with a simple design that just plain works on a long day outside.

Made of the same double-wall stainless steel construction as the rest of YETI’s insulated offerings, the Colster retains the same high performance in a smaller package. And by utilizing a simple lock ring design, this can cooler will holster any 12-ounce can with ease, though it won’t accommodate the other can styles made today.

Luckily, YETI makes the Colster in additional 12-ounce Slim Can , and 16-ounce Tall Can versions. We did find the Colster a bit hefty for what it is but chalked it up to being necessary for adequate insulation.

For those who like to sip a little slower (or have trouble remembering which can they were drinking from), the Colster is the perfect companion to your next six-pack.

MiiR Growler

• Weight 1 lb., 13 oz. in 64 fl. oz. size
• Available volumes 64 fl. oz.

• Handles carbonated beverages easily, no leaks here
• Lid and pour handle make for easy distribution
• Rubber seal can retain scents

One of the things that bedevil many insulated bottles is carbonated beverages — but not the 64-ounce MiiR Growler ($60). This insulated brewtainer keeps your favorite IPA locked down, thanks to an innovative threadless lid and locking clasp that seals in freshness and carbonation.

MiiR considered all the niceties as well, incorporating a lid that locks into place in the open position so as to not impede a good pour. The Growler holds an impressive 4 pints of liquid and keeps them chilled for a long time. We will note the rubber seal that’s used can hold onto the scent of whatever is stored last, but this can be removed and washed separately.

One of the things that sets MiiR apart from other manufacturers is the company’s ingrained global philanthropy, funded by a portion of the sales of every product. To date, MiiR has donated $3.75 million to various nonprofits, ranging from sustainable food systems to land and water protections. You can feel good knowing your Growler is doing something positive for the world.

Excellent for bringing the party with you (and keeping it chill), the MiiR Growler makes the cut for anyone looking to transport their brews and enjoy them too.

Stanley Quencher H2.0 Flowstate Tumbler

• Weight 1.4 lbs in 40 fl. oz. size
• Available volumes 14, 20, 30, 40, and 64 fl. oz.

• Car cup holder compatible even in larger sizes
• 3-position lid including reusable straw
• Large handle improves grip
• Lid is not leak-proof
• 40 fl. oz. size is quite heavy

At larger volumes, many insulated water bottles won’t fit in a car cup holder. The Stanley Quencher H2.0 Flowstate Tumbler ($45) solves this problem with a tapered bottom designed for cup holder compatibility, even in the 40-ounce size. Fill up this tumbler before your next road trip, and you’ll stay hydrated for the long haul. 

The 3-position lid features a reusable straw for sipping and a wider mouth opening for chugging. We especially liked using the straw while driving; it makes it easy to keep your eyes on the road while enjoying your beverage. It’s worth noting that the rotating mechanism on the lid does not seal, and this lid is not leakproof. If you are looking for a bottle to throw in your bag while on the go, this tumbler is not the ideal choice.

We recently brought the Stanley Quencher on a drive into the mountains for an overnight backpacking trip. Drinking water is important before big days in the mountains, and we hit the trail feeling well-hydrated. We left the tumbler half full in the car overnight, and we were pleasantly surprised to enjoy cool water after the trip, even though the car was sitting in the sun when we returned. 

While we wouldn’t recommend this for hiking or backpacking, the Stanley Quencher H2.0 Flowstate Tumbler is our new favorite road trip companion.

Thermos Funtainer Bottle With Straw

• Weight 4 oz. in 12 fl. oz. size
• Available volumes 12, 16 fl. oz.

• Perfect size for lunch boxes and backpacks
• Built-in straw is easy to manage for kids
• Can leak from air hole if not closed properly

A fun and trusty water bottle is a great way to encourage your kids to stay hydrated. The 12-ounce Thermos Funtainer ($20) from Thermos is a durable, safe, and affordable bottle designed for kids of all ages. Plus, it comes with a built-in straw.

This compact and packable bottle comes in all sorts of kid-friendly colors and patterns. Though the capacity is a fairly small 12 ounces, it’s the perfect size for small hands. This bottle fits easily into most school bags and lunch boxes.

Made from BPA-free stainless steel, this bottle is both lightweight and thoroughly durable. The click-shut lid is easy to open and quite leakproof when properly closed (which was our only complaint). When tucked away with the lid closed, the Funtainer keeps liquids cold and refreshing for a full 12 hours.

Right at home in any lunch pail, the Thermos Funtainer keeps tykes hydrated all day long.

Igloo Sport Sipper Bottle

• Weight 14.4 oz. in 20 fl. oz. size
• Available volumes 20 fl. oz.

• Budget price
• Rubberized bottle stays put
• Flattened edge on bottle improves grip and lines up straw
• Bail handle is a bit loose

Going budget doesn’t have to mean scraping the bottom of the barrel, and the Igloo Sport Sipper Bottle ($20) is proof positive of that. The brand has been getting coolers right for 75 years running, so it’s unsurprising that its foray into insulated bottles has produced a winner.

Built with a reliable stainless steel double wall construction, the Sport Sipper claims cold retention of up to 24 hours, and up to 6 hours with hot beverages — numbers that we were able to confirm in our own testing. Not too shabby for a cool $20 out of your pocket.

With a mostly round exterior profile, the Sport Sipper bottles also feature a flattened edge for your thumb along the front of the bottle. Not only does this give you some gripping power, but it also lines up the straw for quick access. Smart.

Flipping up the straw is a snap, and the rubberized bottom helps keep the important side down. The bail-style handle, while handy, was a bit floppy in our usage (and despite our best fixer efforts, no tightening of the hex screws would alleviate it). No deal breaker in our opinion, just something to keep in mind when toting the bottle around.

For less than you might spend on lunch, the Igloo Sport Sipper slides in as an affordable way to keep your beverages cool this summer.

Owala FreeSip Vacuum Water Bottle

• Weight 15.2 oz. in 32 fl. oz. size
• Available volumes 19, 22, 32, 40 fl. oz.

• Well constructed flip top lid
• FreeSip spout for sipping or gulping
• Tough powdercoating
• Handle doesn't lock out
• Not for use with hot liquids

When it comes to insulated water bottles, it’s tough to imagine anything new under the sun. But with a spout design that impressed us right out of the gate, the Owala FreeSip ($33) proves that there’s still innovation to be done.

While many other bottles have interchangeable lids that offer different means of drinking, the FreeSip spout is a bit of a hybrid, combining both a straw and open-mouth neck. You have the choice of either sipping or chugging. The whole affair is protected by a stout flip-top lid, and in testing, we came to really enjoy drinking from this bottle.

Backed up with a triple-layer vacuum construction, the Owala FreeSip has all the tech to do what insulated water bottles do best, and we had no problem keeping our water cool all day. Our only slight arose with the carry loop, which has a detent (or catch) for locking it down in the closed position, but not in the up.

Other than that small flaw, it’s perfect for drinking on the go. The FreeSip is high on our list of best water bottles on the market today.

Hydro Flask Insulated Sports Bottle

• Weight 14.1 oz. in 20 fl. oz. size

• Ergonomic grip
• Fits in bottle cage
• Cap is backward compatible with standard mouth Hydro Flask bottles
• Rigid, no-squeeze construction
• Mediocre flow rate
• Cap can whistle when sucking

A “sports bottle” might seem like an out-of-place inclusion in a roundup of Best Insulated Bottles, since on its face it’s an entirely different class. But Hydro Flask bucked that logic when it designed the insulated, double-wall stainless steel Sport Bottle ($40). It bears a striking similarity to the brand’s hallmark products, with a twist — or rather, a grip.

This 20-ounce, wide-mouth bottle has an ergonomic girdle that’s perfect for grabbing and holding while biking, running, walking, or even standing still. But that groove belies the real function of the Sport Bottle; while your instincts will tell you to squeeze the bottle, that’s not how it works.

A pop-spout sport cap, similar to a standard bike bottle, dispenses liquid with the help of a pinhole air valve. When upturned, water dribbles out mechanically. It’s not a gush, but it’s not painstakingly slow either.

It can be a little counterintuitive if you’re accustomed to squeeze bottles. And while you can suck to increase flow rate, you need to allow air to refill into the bottle to keep drinking. In other words, it’s not the fastest or most explosive bottle out there.

But it has all of Hydro Flask’s quintessential style and thermal performance, in an ergonomic, trendy design. Best of all, the Sport Bottle is compatible with any wide-mouth Hydro Flask lid, and likewise, the sport cap is backward-compatible with any previous wide-mouth bottle. So mix and match to your liking!

Stanley IceFlow Flip Straw Water Bottle

• Weight 16 oz. in 22 fl. oz. size
• Available volumes 17, 22 fl. oz.

• One of the better straw-drinking lids
• Bottle shape fits well in your hand
• Only smaller volumes are available
• Can be difficult to clean

Borrowing from the company’s successes in the realm of thermoses , Stanley has produced a great insulated bottle with the IceFlow Flip Straw Water Bottle ($32). We don’t have too many straw-drinking lids in our review, but this bottle executed it perfectly.

The contoured bottle shape fits well in our hands, and the oversized bail on top meant we weren’t scrambling to keep a hold of it. Because it’s a straw bottle, you’re limited to only using cold liquids in it. Our biggest complaint, however, was the rubber seal is particularly deep inside the lid and not ideal for washing.

With a good pedigree, the IceFlow bottle comes from a long line of keeping hot things hot and cold things cold and is the perfect fit for walking and drinking on the go.

Hydro Flask Lightweight Wide Mouth

• Weight 12.6 oz. in 32 fl. oz. size
• Available volumes 21, 24, 32 fl. oz.

• Lightweight construction
• Same Hydro Flask build quality
• Higher price
• Temperature retention somewhat compromised by low weight

Hydro Flask’s new Lightweight Trail Series bottles have r eally won us over . If it weren’t for the price, this bottle might be in our top three.

The Lightweight Wide Mouth ($50) weighs just 11 ounces, has a perforated strap to keep weight down, and is designed to work with most backcountry water filters. Hydro Flask did some metal wizardry on this bottle, giving it tapered walls that are thicker on the bottom for durability, and thinner on top for weight savings.

Compared to the Wide Mouth Hydro Flask , we did note some diminished ability to keep drinks cold for as long, but the difference is small. When you’re counting ounces, the Lightweight Wide Mouth comes in clutch.

Klean Kanteen Insulated TKWide With Twist Cap

• Weight 1 lb., 4 oz. in 32 fl. oz. size
• Available volumes 12, 16, 20, 32, 64 fl. oz.

• Fully insulated cap increases temperature retention
• Stainless steel cap bottom means there’s a full steel interior
• Lid can be a bit hard to grasp

This Klean Kanteen bottle ($45) has a wide mouth, is vacuum-insulated, and holds 32 ounces of your drink of choice. It’s more expensive than others on this list but has everything you need: a cap and fold-down carry handle, a stainless steel interior, and insulation to keep liquids hot for 24 hours and iced for an incredible 83!

We were especially impressed with the thought put into the lid design. Using what Kleen Kanteen calls its TK Closure, the internal threads of the bottle are more like rows of bumps, meaning fewer nooks and crannies to clean. The lid is also fully vacuum insulated and sports a stainless steel bottom, meaning your water only sees steel on the inside of this bottle.

Some testers commented they didn’t like the ergonomics of the lid. We noted that it’s slightly narrower and shorter than other wide-mouths on this list. But if that’s no bother to you, the Kleen Kanteen TKWide bottle could be for you.

Purist Mover Bottle

• Material Stainless steel & glass
• Weight 12.2 oz. in 18 fl. oz. size
• Available volumes 18, 32 fl. oz.

• Glass lining eliminates any metallic taste from water
• Sleek fit and look
• Painted finish scratches easily

Purist uses a glass interior coating to combat the odors and flavors some don’t like in their stainless steel bottles. Meanwhile, the exterior sports the tried-and-true stainless steel construction for durability. The brand’s medium size, the Mover 18-ounce bottle ($50), has a convenient sipping cap.

We also liked testing the 32-ounce, wide-mouth size (same insulation and materials, just holds more), although the 18-ounce fits much better in cupholders, packs, and bags. We like the muted colors and professional aesthetic of this brand.

Unfortunately, we did find the Purist Mover Bottle to be a bit lacking when it came to scratch prevention. With no powder coat finish, scratches showed up easily in the painted finish. For the price, this was a bit disappointing. For those who place taste above all else, however, the Mover bottle makes no exceptions.

CamelBak MultiBev Water Bottle

• Weight 1 lb., 5 oz. in 16/22 fl. oz. size
• Available volumes 12/17, 16/22 fl. oz.

• Many options for sharing beverages
• Keeps drinks cold for a long time
• Heavy design
• A bit fiddly to keep track of all the parts

This is by no means a bottle you’ll want to take backpacking, but it’s a really cool design. CamelBak designed the MultiBe v ($50) for just what it sounds like — multiple beverages on the go. This bottle separates into both an insulated bottle, and a cup.

It’s great to fill up with water or coffee at the start of your day, and then have a reusable and insulated option for other drinks later. The incorporated cup is also great for sharing, and both components hold the cold and hot temps well.

Because it is so feature-rich, we did find a few things fiddly to handle, such as the Roll and Fold silicone lid, which stows in the main lid of the MultiBe v . That aside, it did give our testers a lot of flexibility in doling out beverages at the end of a hot day.

Insulated Water Bottle Comparison Chart

How We Tested Insulated Water Bottles

Long a holdout to the niceties of an insulated bottle, GearJunkie Senior Editor Nick Belcaster finally came around to the wonders of insulated water bottles after being gifted a Hydro Flask. It turns out that having ice-cold water hours after leaving the house is worth it.

When you work and play in extreme environments, the benefits of keeping hot water hot and cold water cold start to click. Contributor Katie Griffith originally sought an insulated bottle so she could sip on a liter of hot chocolate during an ice climbing trip. Now she packs her Hydro Flask every day for work as a rock climbing guide in Joshua Tree and savors each gulp of cold water in the desert heat. 

Many in the GearJunkie offices enjoy bringing an insulated bottle to work, and we tapped into this collective knowledge to assemble our list of bottles. We then put them through the wringer and pulled together the best of the best insulated bottles you see here.

We started our foray into the world of insulated water bottles in 2021 with a slate of 14 bottles, aiming to cut through the noise and distill down a huge market into a handful of the best insulated water bottles available. In order to test our slate of insulated bottles, we subjected them to common-place use, such as on hot day hikes, bike commuting, or airline travel. We paid close attention to how long each bottle held onto chilled water as well as important issues such as leaking or denting.

In 2023, we expanded our horizons when Nick looked afar for the best bottles for more special circumstances, and tested models to include the best options for insulated growlers, can coolers, and self-cleaning water bottles. 

At the end of 2023, we tweaked our choices again, pivoting some of our award winners to newly updated standard bearers, and added significantly to our Buyer’s Guide to really dig deep into subjects such as volume, materials, and styles.

In 2024, we added a few additional products to the mix, including popular models from RTIC and Stanley.

Buyer’s Guide: How to Choose an Insulated Water Bottle

It’s worth noting that this article specifically covers the best insulated water bottles. We also have a separate gear guide for the best thermoses , for when the temps dip and a hot drink is needed. You may also want to read up on the best backpacking water filters .

Style of Insulated Bottle

Insulated bottles come in many shapes and sizes. Some closely resemble other plastic sports bottles with spill-proof, screw-top lids. The best overall bottle, Hydro Flask’s Wide Mouth , falls into this category. These are often the most versatile option and may replace your Nalgene when weight isn’t a big factor. 

Beyond the standard water bottle, this list also includes tumblers, can coolers, and growlers. A tumbler more closely resembles a cup with a lid than a water bottle. The Stanley Quencher H2.0 Flowstate Tumbler is great for all-day hydration, but the lid is not spill-proof. You can’t pack it in a backpack like other water bottles. 

Other styles are even more specialized, like the MiiR Growler . This insulated container is designed specifically for storing carbonated beverages like beer or kombucha. The lid functions to seal in carbonation and freshness; you wouldn’t need this for your daily beverages. The YETI Rambler Colster is also not designed for direct drinking; this insulated can cooler slides around your bubbly water or beer to keep it chilled. 

Pick a water bottle with enough volume for all your activities. If you really love one particular insulated bottle, consider getting two sizes — one for daily use and one with more volume for longer trips or travel. (Also consider if the bottle you’ve chosen will work with a water filter or in your pack pocket if you know you’ll be taking it with you on the trail.) If you spend a lot of time driving, note that after a certain volume, fitting into most cup holders isn’t going to happen.

Most bottles we tested are available in volumes from around 12 to 64 ounces. A 12 or 16-ounce bottle is ideal for morning coffee or tea, while you’ll likely want a 24- or 32-ounce bottle to stay hydrated. For all-day, outdoor activities, bringing at least two liters of water is typically recommended, which would translate to about 64 ounces of capacity. We find that two 32-ounce bottles fit easier in a backpack than one 64-ounce vessel. 

Make sure the bottle you choose lists how long it keeps water (or other liquids) cold. The standard is 24 hours, but we’ve noticed in many of these bottles the contents will stay colder for longer . You’ll want to know how good the insulation is, especially if you live in a hotter climate.

What are the interior and exterior materials? Most insulated bottles use some form of stainless steel double-wall insulation, but not all, like the triple-wall build of the Owala FreeSip . Also, look at the exterior material: Is there a powder coating? Does it reduce condensation? Is there a rubber grip or protective design on the base?

Once you find a bottle you think will work for you, pick out a fun color while you’re at it! Colors are mainly just a preference but can also help identify your bottle in a crowd.

Temperature Retention

One of the most important aspects of an insulated bottle, temperature retention is how well it keeps the hot things hot and the cold things cold. The majority of insulated bottles will use some type of vacuum insulation to achieve this. 

Heat energy needs mass to travel through, so by removing the air in between the two layers of the bottle, the liquid inside is able to retain its temperature for longer. We’ve found that most bottles are able to keep hot liquids hot for around 12 hours and cold liquids cold for about 24.

An insulated water bottle is basically a thermos with different design features. Most thermoses are also built with vacuum insulation, but they typically come with a lid designed for pouring hot liquid and a cap that doubles as a small cup for sipping tea or coffee. 

Lids on thermoses can also be more effective at keeping liquids hot or cold. The lids on insulated water bottles focus on hydration, with straws like the Stanley Quencher H2.0 Flowstate Tumbler or open tops like the Hydro Flask Wide Mouth . 

Don’t get us wrong; the insulated bottles we tested are still great at temperature retention. We filled the Stanley Quencher halfway with half-inch ice cubes and no water. After 24 hours in a 65-70 degree room, we found some water, but most of the ice cubes had shrunk only 50%.

Metal bottles can sometimes impart a metallic taste to water, often after being left for a long period of time. Bottles like the Purist Mover implement a silicon dioxide coating on the interior of the bottom to create a glass-like barrier. This can greatly reduce the metal taste that is imparted to water.

Keeping insulated bottles clean is also important to limit any off-tastes. Pay attention to how easy the bottle might be to clean. Look at the threads on the lid as well as how easy it is to remove any gaskets for cleaning. Many bottles are marked as dishwasher safe on the top rack but not all.

A quick tip for cleaning your insulated bottle: Mix two to three tablespoons of baking soda and warm water and shake inside your bottle. Let sit for a few hours and then rinse out with water.

Lids & Handles

A bad lid can ruin an insulated bottle. Manufacturers understand consumers have many uses for their bottles and produce a number of different lids to fit them. The most basic will be a simple screw cap, but there are also lids that incorporate straws, flip closures, and even magnets.

Lids will also have a good bit to do with the mouth style of the bottle. Narrow-mouth bottles can make sipping directly from the bottle nice and easy but will limit your ability to put ice into the bottle. Wide-mouth bottles can accept things like water filters with ease, but without a steady hand, they can lead to some spillage.

Some lids are designed to be leak-proof when closed, and some are not. YETI’s 26-ounce Rambler Bottle , for example, features a secure lid that doesn’t allow spillage when screwed on correctly. The Stanley Quencher is not leak-proof and doesn’t claim to be; what it sacrifices in spillage it makes up for in ease of sipping with the reusable straw. The rotating cover helps reduce leaking but doesn’t prevent it. 

Our tester performed a leak test on the Quencher by adding food coloring to water inside the bottle, screwing it shut, turning it on its side, and timing both types of covers for ten seconds. The Quencher was nearly full during the test. With the rotating cover closed, a small blue puddle formed on a paper towel within a short time. With the straw still in place, a big puddle spilled over a paper towel almost immediately. 

At their most basic, insulated bottles are sleek cylinders, which aren’t the most stable. Having a lid that you can clip a carabiner to can ensure it won’t make an escape. Others will sport a layer of silicone to improve grip or a contoured shape that fits your hand. We found the Stanley IceFlow Flip Straw Water Bottle to be one of the nicest to handle.

Lastly, think hard about your budget. These bottles are an investment but totally worth it, especially if (like us) you spend lots of time outside. And before buying, always check to see if your favorite bottle is on sale.

You can find insulated bottles that won’t break the bank in the $15-25 range like the RTIC Vacuum Insulated Bottle and the Igloo Sport Sipper. Some of our favorites lie in the $30-50 range, including the Hydro Flask Wide Mouth or the YETI Rambler Vacuum Bottle. Though a little spendier, both of these come in larger volumes and feature a coating that improves durability. 

The most specialized bottles come with the highest price tag, including the MiiR Growler, Hydro Flask Lightweight Wide Mouth , and Purist Mover Bottle . All sports technologies that go above and beyond daily hydration needs like holding in carbonation, adding a taste-free liner, or being made from uber-thin materials to cut down weight.

On this list, we have selected the Hydro Flask Wide Mouth 40-ounce bottle as the best overall insulated water bottle. This option provides a useful blend of quality insulation and heavy-duty construction. We also like that it fits easily in most cup holders.

Still, the best-insulated water bottle is the one that meets your needs. If you are looking for a bottle with smaller volume, you may want to go with the 26-ounce YETI Rambler or 32-ounce Owala FreeSip .

All of the bottles on this list will do a great job at keeping your hot liquids hot and your cold liquids cold for impressively long periods. That said, the YETI Rambler Chug Water Bottle performs exceptionally well when filled with hot contents. It’s a lightweight bottle that keeps liquids piping hot and is thoroughly leakproof.

It is important to regularly clean reusable water bottles to prevent the growth of bacteria. Many insulated water bottles are dishwasher safe, and others can be easily cleaned with dish soap and hot water.

On this list, many of the bottles are made from easy-to-clean materials such as stainless steel and linings such as glass or copper. After cleaning, it is a good idea to take the cap off of your bottle and let it fully air dry.

Generally, it is safe to fill insulated water bottles with contents other than water. For coffee and tea, an insulated water bottle can allow you to enjoy a hot drink all through the morning.

However, it is especially important that you clean your bottle thoroughly after filling it with anything other than water. Because of the different shapes of insulated bottles, some are easier to clean than others.

For food like hot soup or oatmeal, you’re going to be better off with a food-specific thermos. These are similar to insulated water bottles, but their short and stout shape makes them easier to use and clean. A good thermos can keep hot food at a safe temperature for hours — an excellent counterpart to an insulated bottle!

Yes, many insulated water bottles are dishwasher-safe. Always double-check the manufacturer’s directions before washing your bottle. If your bottle is not dishwasher-safe, it can be cleaned with hot water, a little dish soap, and a thorough rinsing.

Always check to see what the manufacturer suggests. Many insulated water bottles can be washed in the dishwasher, which is an effective way to thoroughly remove any bacteria that may be present.

If washing by hand, scrub the inside and outside of the bottle with hot water and dish soap. Be sure to fully clean out the threads on both the cap and bottle. After cleaning, let all parts fully air dry.

Thanks to hardy stainless steel or ceramic construction, a good insulated water bottle should last many years — or potentially decades for the careful owner. We’ve all seen those old green Stanley bottles that are three decades old and still going strong.

The biggest threat to insulated water bottles is puncturing. If the double or triple-walled insulation of your bottle is punctured, it will lose its ability to insulate. To prevent this, avoid dropping your bottle onto jagged or hard surfaces. Plastic insulated water bottles are less prone to dents and punctures, but they are generally not as rugged overall.

If an insulated bottle becomes punctured, it will lose its vacuum and be replaced by air molecules. Since there is now matter in between the inner and outer bottles, heat transfer occurs much quicker.

To test if your bottle still has its vacuum sealing: Carefully fill the bottle with boiling water and wait five minutes. Then feel for any hot spots, which would indicate loss of insulation.

The Best Thermoses of 2024

If you want your favorite liquids to stay hot all day, check out our roundup of the best thermoses of 2024. Get ready to warm up with a hot drink.

The Best Backpacking Water Filters of 2024

We tested the best backpacking water filters and purifiers for your next trip into the great outdoors.

Mary Murphy is the Managing Editor of GearJunkie. She has been writing about hiking, running, climbing, camping, skiing, and more for eight years, and has been on staff at GearJunkie since 2019. Prior to that, Mary wrote for 5280 Magazine in Denver while working as an outdoor instructor teaching climbing, kayaking, paddleboarding, and mountain biking. Based in Denver, Colorado, Murphy is an avid hiker, runner, backpacker, skier, yogi, and pack-paddleboarder.

Katie is a freelance writer and gear tester with GearJunkie. She has been writing about climbing, mountaineering, and backpacking for five years. In addition to freelance writing, she teaches clinics and runs women’s climbing events as a guide and instructor for She Moves Mountains. Based in Joshua Tree, CA, and Index, WA, Katie loves climbing splitter cracks in the mountains, riding her bicycle, and cooking yummy food for her friends.

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• J Environ Public Health
• v.2018; 2018

Estimating Typhoid Fever Risk Associated with Lack of Access to Safe Water: A Systematic Literature Review

Vijayalaxmi v. mogasale.

1 Epidemiology Unit, International Vaccine Institute, Seoul, Republic of Korea

Enusa Ramani

2 Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea

Vittal Mogasale

Ju yeon park.

3 Biostatistics and Data Management Department, International Vaccine Institute, Seoul, Republic of Korea

Thomas F. Wierzba

4 Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea

5 PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC, USA

Associated Data

All data related to the research is available in the manuscript.

Unsafe water is a well-known risk for typhoid fever, but a pooled estimate of the population-level risk of typhoid fever resulting from exposure to unsafe water has not been quantified. An accurate estimation of the risk from unsafe water will be useful in demarcating high-risk populations, modeling typhoid disease burden, and targeting prevention and control activities.

We conducted a systematic literature review and meta-analysis of observational studies that measured the risk of typhoid fever associated with drinking unimproved water as per WHO-UNICEF's definition or drinking microbiologically unsafe water. The mean value for the pooled odds ratio from case-control studies was calculated using a random effects model. In addition to unimproved water and unsafe water, we also listed categories of other risk factors from the selected studies.

The search of published studies from January 1, 1990, to December 31, 2013 in PubMed, Embase, and World Health Organization databases provided 779 publications, of which 12 case-control studies presented the odds of having typhoid fever for those exposed to unimproved or unsafe versus improved drinking water sources. The odds of typhoid fever among those exposed to unimproved or unsafe water ranged from 1.06 to 9.26 with case weighted mean of 2.44 (95% CI: 1.65–3.59). Besides water-related risk, the studies also identified other risk factors related to socioeconomic aspects, type of food consumption, knowledge and awareness about typhoid fever, and hygiene practices.

Conclusions

In this meta-analysis, we have quantified the pooled risk of typhoid fever among people exposed to unimproved or unsafe water which is almost two and a half times more than people who were not exposed to unimproved or unsafe water. However, caution should be exercised in applying the findings from this study in modeling typhoid fever disease burden at country, regional, and global levels as improved water does not always equate to safe water.

1. Introduction

Typhoid fever is a systemic bacterial illness of public health importance. The disease is transmitted person to person due to fecal contamination of food and water [ 1 ]. The causative agent, Salmonella enterica serovar Typhi ( S. Typhi), is exclusive to humans who are the natural host and reservoirs [ 2 ]. Humans can become chronic carriers and food handling practices among carriers can result in food contamination and S . Typhi transmission [ 2 ]. However, use of sewage contaminated water for irrigation and domestic use is considered critical in maintaining typhoid endemicity in developing countries as demonstrated in Santiago, Chile [ 2 ]. Since the major routes of transmission of typhoid fever are through drinking water or eating food contaminated with Salmonella typhi , the World Health Organization (WHO) recommends provision of safe water as one of the preventive measures for typhoid fever [ 2 ].

Defining and monitoring quality and ensuring water safety in low- and middle-income countries (LMICs) are challenging. The WHO defines microbiologically safe water based on the amount of Escherichia coli which should be 0 CFU/100 ml [ 3 ] suggesting there should not be any fecal contamination. Continuous monitoring of the microbiologically safe water requires periodic laboratory testing of water sources which is difficult in resource poor settings of LMICs. To simplify the process WHO-UNICEF Joint Monitoring Programme (JMP) has defined alternative indicators, “improved water” and “unimproved water” sources [ 4 ], which deemed to represent safe water and unsafe water, respectively ( Table 1 ).

Improved and unimproved drinking water sources based on WHO/UNICEF Joint Monitoring Programme for water supply and sanitation [ 4 ].

∗ Please refer to WHO/UNICEF Joint Monitoring Programme for water supply and sanitation [ 4 ] for details. Note that any microbiologically contaminated water source was considered unsafe water in the analysis.

People who drink safe water are likely to have lower risk of typhoid fever compared to people drink unsafe water which is one of the several risk factors for typhoid fever. However, typhoid fever global disease burden estimates often extrapolate the incidence rates obtained from high-risk populations to rest of the populations [ 5 , 6 ] which is likely to be an overestimation. Hence, it is necessary to correct the incidence rates while extrapolating the data collected from populations drinking unsafe water to population drinking safe water. But, there is no database that provides information on drinking safe water or unsafe water that can be used in global disease burden estimation. Alternately, there is global database available on access to improved water to populations [ 7 ] which can be used as a proxy for safe water consumption. Therefore, it is necessary to link the risk of unsafe water to unimproved water. Although a systematic review presented earlier has showed that the microbiological safety of improved water is inconsistent [ 8 ] but provides a measure of sanitary protection and it is the only dataset that can be applied at the global level for water-related risk correction.

While many studies have explored the risk of typhoid fever from unsafe water, there has not been a systematic review that presented pooled estimate of the quantitative risk. We conducted a systematic literature review to quantify the probability of symptomatic S . typhi infection among residents who consumed unimproved or unsafe water compared to residents who did not consume unimproved or unsafe water. The primary purpose of this review was to derive a quantitative value on excess risk of typhoid fever due to the consummation of unimproved or unsafe water which can be used as a correction factor in global disease burden estimates [ 6 ].

2. Materials and Methods

A systematic literature review was conducted independently by each of two researchers. Each researcher first identified studies on risk factors for typhoid fever and then selected from those publications, papers presenting water-related risks. The search results from two researchers were compared and any differences between them were resolved based on discussion and agreement. If unresolved, a third independent researcher made the final decision. All selected papers were reviewed by a third researcher before data extraction to confirm its adherence to inclusion and exclusion criteria.

To identify studies, in addition to searching primary databases, PubMed and Embase, searches were also made in WHO and Pan American Health Organization (PAHO) databases. The search was limited to studies published in English language, from January 1, 1990, to December 31, 2013. The detailed inclusion and exclusion criteria are provided in Table 2 . The search terms used were (“typhoid” OR “typhoid fever” OR “ Salmonella Typhi” OR “ S. Typhi” OR “ Salmonella infection” OR “enteric fever”) AND (“risk factors” OR “predictive factors” OR “associated factors” OR “attributed factors” OR “exposure factors” OR “related factors” OR “predisposing factors”). Search results are documented in a PRISMA diagram [ 31 ].

Selection criteria for systematic literature review.

To quantify the risk, we selected one risk factor from each case-control study that best represented either improved or unimproved water based on the definition provided by WHO/UNICEF-JMP ( Table 1 ). If a water source in a study was identified as “improved,” but was reported to be “microbiologically contaminated,” we considered the water source as “unsafe.” We extracted the odds ratio of typhoid fever among those who got exposed to unimproved water or unsafe water compared to those who did not get exposed. A meta-analysis was conducted to pool the odds ratio of methodologically similar studies using a Metafor Statistical Packages for R, version 1.9-8 [ 32 , 33 ]. According to the heterogeneity test such as Q statistics and I 2 [ 33 ], the mean value for pooled odds ratio from case-control studies were calculated from a meta-analysis using random effects model with restricted maximum-likelihood estimator [ 33 ]. Cohort study findings were descriptively presented as they could not be combined with case-control study meta-analysis. We also descriptively summarized other risk factors that showed a statistically significant probability of symptomatic S . typhi infection from the selected studies for the better understanding of overall risk factors.

3. Results and Discussion

Our review yielded a total of 779 publications from the search databases ( Figure 1 ). A total of 87 duplicates were removed, and 612 were excluded on title and abstract search because they lacked data on typhoid fever related risk factors. Full texts were accessed for remaining 80 papers. Of them, 58 were excluded as they either (a) did not contain water-related risk factors or (b) could not be classified into improved or unimproved water categories based on WHO-UNICEF-JMP definition or (c) descriptive cross- sectional studies that did not present odd ratio. There were no randomized control trials. Four cohort studies were presented descriptively [ 27 – 30 ] as the risk could not be merged and summarized with majority case-control studies. Finally, we could include only case-control studies in the estimation of pooled odds ratio. Sensitivity analysis was conducted for the decision of study exclusion. At the beginning of the analysis, one study was automatically excluded due to zero-count cell [ 34 ] and another one was omitted by sensitivity analysis as an outlier [ 9 ]. Four studies had presented odds ratio for improved water which could not be combined with odds ratio for unimproved water because inverse odds of improved water are technically not the same as unimproved water [ 23 – 26 ]. We cannot assume that people unexposed to improved water are exposed to unimproved water. The pooled odds ratio presented below include 12 case-control studies from reported typhoid endemic regions and presented water-related risk factors.

PRISMA diagram representing search results of typhoid fever risk factors.

3.1. Case-Control Studies

Of the 12 selected studies, five were from South Asia [ 12 , 13 , 19 – 21 ], four were from Southeast Asia [ 15 – 17 , 22 ], two were from Central Asia [ 11 , 18 ], and one was from South-Central Europe [ 14 ]. The studies included were mostly conducted in urban settings (75.00%) and only three were outbreak investigations (25.00%, Table 3 ). There were 915 typhoid fever cases and 1,609 nontyphoid fever controls. The exposure to unimproved water was higher among cases (62.95%; n = 576/915) compared to controls (46.30%; n = 745/1609) ( Figure 2 ). Half of the cases-controls studies having improved water source were microbiologically contaminated and were considered unsafe water ( Table 3 ). The odds of typhoid fever among those who were exposed to unimproved water or unsafe water were ranged from 1.06 to 9.26 with case weighted mean of 2.44 (95% CI: 1.65 – 3.59) ( Figure 3 ).

Exposure to unimproved water among typhoid fever cases and controls in selected studies.

Forest plot showing odds ratio for typhoid fever for exposure and nonexposure to unimproved water.

Characteristics of case-control and cohort studies included in the systematic literature review.

NA – Not provided.

Besides water-related risk, the studies also listed other risk factors related to socioeconomic aspects, living condition, food consumption, knowledge and awareness about typhoid fever, and hygiene practices ( Table 4 ).

Other significant risk factors for typhoid fever identified in reviewed papers.

∧ Frozen mamey pulp imported from Guatemala used in fruit shake

∧∧ Cig Kofte is a traditional raw food made from raw meat rolled in a ball form

∗ MOR – Matched odds ratio

∗∗ OR – Odds ratio

# RR – Relative risk ratio.

3.2. Cohort Studies

Four cohort studies presented relative risk of typhoid fever attributable to exposure to unimproved water sources compared to improved water sources [ 27 – 30 ]. The risk of contracting typhoid fever in groups exposed to drinking from a government water supply tank in Rajasthan was 11.10 (95% CI: 3.70 – 33.00) times greater than those in the nonexposed group [ 27 ]. Those who drank from combined sources of government tank, hand pump, and personal tube well were 3.75 (95% CI: 1.02 – 13.80) times more likely at risk of typhoid than those not exposed to the three combined sources indicating contamination of these sources. On a floating island restaurant in France, those who drank piped water onboard from untreated River Seine source had no excess risk of typhoid fever compared to those unexposed to those sources (RR = 1.40 95% CI: 0.60 – 3.00) [ 28 ]. This study concluded that consumption of rice and chicken washed in tap water resulted in outbreak and found fecal contamination in the tap water which was untreated. In urban Karachi, univariate analysis showed that individuals who consumed tap or bottled water had same risk (RR = 0.70; 95% CI: 0.44 – 1.11) of getting typhoid fever compared to those who did not use tap or bottled water [ 30 ]. However, using regression model, after adjusting for all covariates, the study found that overall risk of typhoid fever is lower among households using a safe drinking water source (RR = 0.63; 95% CI: 0.41–0.99). In Eastern Kolkata, the study found that a significantly lower proportion of households use tap water (RR = 0.07; p value = <0.001) in typhoid fever high-risk areas compared to typhoid fever low-risk areas [ 29 ].

3.3. Case-Control Studies Excluded from Meta-Analysis

The four excluded case-control studies that presented odds of exposure to improved water among typhoid fever cases compared to controls [ 23 – 26 ] when combined together did not show any significant association with water source (OR = 0.70; 95% CI: 0.46 – 1.05) ( Figure 4 ). The risk factors selected from these four studies included utilization of municipal drinking water (OR = 0.75; 95% CI: 0.31 – 1.84) in Diyarbakir, Turkey [ 23 ], utilization of piped water (OR = 1.00; 95% CI: 0.37 – 2.72) in Ujung Pandang, Indonesia [ 24 ], drinking piped water (OR = 0.52; 95% CI: 0.23 – 1.16) in Jakarta, Indonesia [ 25 ], and utilization of tap water (OR = 0.69; 95% CI: 0.34 – 1.40) in Karachi, Pakistan [ 26 ].

Forest plot showing odds ratio for typhoid fever for exposure and nonexposure to improved water.

Two case-control studies excluded from our investigations at the time of sensitivity analysis were from Thailand [ 34 ] and Malaysia [ 9 ]. In Thailand study, drinking unboiled spring water had 37.80 (95% CI: 1.93 – 739.89) odds of typhoid fever compared to those who drank from either piped water, rain water, commercially bottled water, or water from wells. However, all typhoid fever cases were exposed to unboiled spring water. In Malaysian study, the accidental ingestion of water during swimming or bathing in a river had 32.78 (6.16 – 174.54) odds of getting typhoid fever compared to exposure from food items. In Figure 5 we have presented forest plot for odds ratio without excluding this study to show how its inclusion would have changed the results. Table 5 presents PRISMA checklist.

Forest plot showing odds ratio for typhoid fever for exposure and nonexposure to unimproved water after including one outlier study [ 9 ].

PRISMA 2009 checklist.

From [ 31 ].

3.4. Discussion

The systematic review of literature yielded 12 case-control studies from 12 sites conducted in 10 different countries and presenting variables for water-related risk that could be categorized as unimproved water or unsafe water and associated with typhoid fever. This review demonstrates that unimproved water and unsafe water are associated with quantifiable odds of having typhoid fever. The result summary has been used in estimation of typhoid fever disease burden in LMICs [ 6 ] which demarcates high-risk population who would benefit maximum from typhoid interventions such as improving water and sanitation or vaccination. Other significant risk factors associated with the occurrence of typhoid fever were related to food consumption, socioeconomic status, hygiene and sanitary practices, living condition, and water storage and handling. These factors should be quantified in future analyses and should be included in future typhoid disease burden estimates. We have not accounted for environmental factors such as rain fall and temperatures, and anthropological measures such as age in this review which should be the other considerations in future disease burden studies.

The importance contaminated water as a major risk factor for typhoid fever is undisputable. During high-endemic period of typhoid fever in Santiago, Chile, the sewage contamination of food chain was demonstrated as the most important factor contributing to typhoid fever transmission, more than the typhoid carrier state in the family members [ 2 ]. The past epidemiological studies have demonstrated the importance of waterborne transmission, showing that only small inocula is sufficient for waterborne typhoid transmission, while foodborne transmission requires large inocula [ 2 ]. The key role of water and sanitation in typhoid fever transmission is further validated by a correlation between installment of water and sanitation system and decline in typhoid fever cases in industrialized countries. The progressive introduction of water filtration system in later 19th century was correlated with decline in typhoid fever mortality in United States of America (USA) [ 35 ]. A more decisive correlation was demonstrated in Philadelphia, USA, where water filtration system was serially introduced in six different districts between 1902 and 1909 [ 36 ]. When the condition of water supply and cause specific death rates for various diseases were examined, only typhoid fever deaths were found declining significantly following the introduction of water filtration system.

Although poor water and sanitation system is not the only risk for typhoid transmission, its undisputable importance makes it a key risk factor in defining high-risk groups. Demarcating the typhoid fever risk groups is especially important in effectively targeting control measures such as vaccination programs. The WHO has recommended targeted vaccination of high-risk population with existing typhoid polysaccharide vaccine [ 1 ]. The significance of defining high-risk groups has increased with impending availability of typhoid conjugate vaccine [ 37 ], which may necessitate revisiting of WHO policies on vaccination strategies based on well-delineated target population. Most surveillance studies were conducted in known typhoid high-risk populations, which cannot be simply extrapolated to general population because their risk of typhoid fever is lower [ 6 , 10 ]. One of the several risk corrections that can be made in applying the typhoid fever incidence from high-risk population to general population is correct for water-related risk. However, there is no data available at global level of safe water drinking, but there is a database available on improved water and unimproved water [ 7 ]. Whereas improved water is representative of safe water and unimproved water is representative of unsafe water, the only available database can be applied at the global level for water-related correction in disease burden estimate. Computing the excess risk associated with the consumption of unsafe water or unimproved water will help in understanding the additional typhoid risk in certain populations and helps in measuring risk-differential typhoid fever incidence in different communities [ 6 ]. Such characterization of disease burden that can be linked to access to improved water can help in developing risk-based vaccination strategies and forecasting vaccine demand [ 38 ], identifying high-risk populations within countries and targeting vaccination to specific population, estimate its impact, calculate cost-effectiveness, and compare the efficiency of targeted vaccination versus vaccination of whole population.

3.5. Limitations

Our study has many limitations. First, we used a basic definition of improved water to represent safe water because this variable is officially reported by WHO-UNICEF-JMP and a global data base is available that can be applied to LMICs in computing risk-differential typhoid fever disease burden. However, improved water does not always equate to safe water in many LMICs [ 8 , 39 ] and in this paper half of the case-control studies reported microbiological contamination of improved water sources. Although microbiologically unsafe water sources were combined with unimproved water sources to estimate the excess risk of typhoid fever associated with unsafe water, the results may not be generalizable to country levels as this study represented only small number of countries. Similarly, caution should be applied in generalizing the finding to unimproved water as we included both unimproved and unsafe water in one category. Second, evidence from randomized control trials is valued the highest followed by longitudinal prospective cohort studies and case-control studies based on hierarchy of strength of evidence. We had to exclude four prospective cohort studies from meta-analysis approach because it was not possible to integrate the findings from those studies into the analysis. However, these cohort studies have suggested unimproved water as an important risk factor for typhoid fever. Third, it is worth noting that we used only one variable from each case-control study that best matched “unimproved water” to keep the analysis simple. It was challenging to categorize some water sources as improved or unimproved as they did not fit into any category and we had to choose one from the remaining variables. Selection of any other variables may have presented different values or may have resulted in ambiguous findings. Fourth, some of the water sources matched the definition of improved water but a statement from investigators revealed a case of clear contamination of improved water due to reasons such as proximity to sewage pipes and breakage in water supply systems made it necessary to reconsider the improved water as unsafe. This actually deviated from the definition of unimproved water but represented unsafe water which was critical measure for risk differentials. We had club these two categories in our analysis. Fifth, the typhoid fever risk from unsafe water is represented only by 12 studies in our systematic review. Number of studies is too small to generalize and mostly represent Asia. Caution is necessary in the application of results to global disease burden estimation. Sixth, we could have missed some vital papers on water-related risk factors for typhoid fever published in other languages besides English because of search criteria. Also, our search did not include unpublished literature such as conference abstracts, doctoral thesis, or meeting presentations. This may have resulted in publication bias. Lastly, we have used only those papers containing water-related risk factors in our review and, hence, many other significant typhoid fever risk factors outside selected papers may not have been captured in this review. We could have missed some important other risk factors not presented in these studies.

3.6. Conclusions

In conclusion, based on literature review we demonstrated that the exposure to unimproved water or unsafe water is significantly associated with typhoid fever. Our findings suggest that the population without access to safe water may be considered as one indicator to delineate high-risk population for typhoid related interventions. The high-risk population decided based on lack of access to safe water can be targeted for typhoid vaccination in addition to ongoing effort to improve water and sanitation infrastructure. Future research should focus on demarcating and quantifying other factors associated with typhoid fever in addition to water-related one, so that more comprehensive risk-association mapping based on geographical information system could be developed and used for targeting typhoid interventions.

Acknowledgments

The authors thank Dr. Jin Kyung Park for statistical support. This work was supported by the Vi-based Vaccines for Asia (VIVA) Initiative, which is funded by the Bill and Melinda Gates Foundation (Grant no. 417.01). International Vaccine Institute received core funding from the Governments of Korea and Sweden.

Abbreviations

Data availability, ethical approval.

Research involved analysis of secondary data available in public domain. No human subjects are involved in this study. No ethical approval was sought.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors' Contributions

Vittal Mogasale has conceptualized the study, advised on developing search terms, served as the third reviewer in conducting the search, guided the analysis, interpreted the results, and rewrote the final manuscript. Vijayalaxmi V. Mogasale has served as first reviewer in conducting the search, developed search terms, extracted data, conducted the analysis, and wrote the first draft of manuscript. Enusa Ramani has served as second reviewer in conducting the search, assisted in data extraction and analysis, and reviewed and put together the final manuscript. Ju Yeon Park estimated weighted mean sensitivity using random effects model and drew forest plots. Thomas F. Wierzba provided overall technical advice for conceptualization and data analysis and reviewed and edited the manuscript. All authors have approved the final manuscript.

This work was supported the Vi-based Vaccines for Asia (VIVA) Initiative, which is funded by the Bill and Melinda Gates Foundation (Grant no. 417.01). International Vaccine Institute receives core funding by the Governments of Korea and Sweden.

Dept. of Natural Resources: Seeking public comment for environmental review of Green Bay Safe Drinking Water Loan Program project

• May 10, 2024

Home » Press Releases » Dept. of Natural Resources: Seeking public comment for environmental review of Green Bay Safe Drinking Water Loan Program project

MADISON, Wis.  – The Wisconsin Department of Natural Resources (DNR) today announced the city of Green Bay is an applicant for funding through the Safe Drinking Water Loan Program to improve its public drinking water system.

The project includes upgrading the lead service lines in the city of Green Bay.

Activities related to this project are minor actions under Chapter NR 150, Wis. Admin. Code, for which no environmental analysis is required; however, following the Safe Drinking Water Loan Program federal requirement 40 C.F.R. §35.3580, an environmental review must be conducted before funding this project.

The Safe Drinking Water Loan Program has determined that the project will not result in significant adverse environmental effects, and no further environmental review or analysis is needed before proceeding with funding the project.

The public is encouraged to submit comments regarding this decision and the potential environmental impacts of this project. Submit comments by May 24, 2024 to:

Wisconsin Department of Natural Resources C/O Michelle Brietzman, Community Financial Assistance, CF/2 101 S. Webster St. P.O. Box 7921 Madison, WI 53707 [email protected]

Based on the comments received, the Safe Drinking Water Loan Program may prepare an environmental analysis before proceeding with the funding process. The analysis would summarize the DNR’s consideration of the project’s impacts and reasonable alternatives.

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