Editing IPCC:AR6/WGII/Chapter-14 (section)

==== 14.5.6.5 Water-Borne Disease ====

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Heavy precipitation events are associated with contaminated drinking water and water-borne disease in North America ( ''high confidence'' ). Acute gastrointestinal illnesses increase with many hydro-climatological variables, including precipitation, streamflow and snowmelt ( [[#Harper--2011|Harper et al., 2011]] ; [[#Wade--2014|Wade et al., 2014]] ; [[#Galway--2015|Galway et al., 2015]] ). Extreme precipitation is associated with ''Campylobacter'' and ''Salmonella'' infections in the USA, particularly in counties characterised by farms and private well water ( [[#Soneja--2016|Soneja et al., 2016]] ). In Canada, human ''Giardia'' infections are associated with increased temperature, precipitation, pathogen presence in livestock manure, and river water level and flow ( [[#Brunn--2019|Brunn et al., 2019]] ). Land-use patterns and aquifer-types are associated with water-borne disease, and ecological zones with higher water-borne rates are projected to expand in range in Canada by 2080 ( [[#Brubacher--2020|Brubacher et al., 2020]] ).

In North America, stormwater and water treatment infrastructure play important roles in reducing water-borne disease risk during precipitation events ( ''high confidence'' ). In the USA, heavy precipitation events are associated with higher rates of childhood gastrointestinal illness in municipalities with untreated drinking water, but not in municipalities with treated drinking water ( [[#Uejio--2014|Uejio et al., 2014]] ). In Mexico, disparities in access to treated water are a key determinant of morbidity in children under age 5 years ( [[#Jiménez-Moleón--2011|Jiménez-Moleón and Gómez-Albores, 2011]] ; [[#Romero-Lankao--2014|Romero-Lankao et al., 2014]] a). In remote communities in Alaska and Northern Canada, challenges in water service provision and maintenance can increase risk of water-borne disease during high-impact weather events ( [[#Harper--2011|Harper et al., 2011]] ; [[#Bressler--2018|Bressler and Hennessy, 2018]] ; [[#Harper--2020|Harper et al., 2020]] ). In older sections of many North American cities, sewage treatment plant capacity is exceeded by overflow of combined sanitary and storm sewer systems during heavy precipitation events, resulting in bypass of untreated and microbiologically contaminated wastewater discharge into drinking water sources ( [[#Jagai--2017|Jagai et al., 2017]] ; [[#Olds--2018|Olds et al., 2018]] ; [[#Staley--2018|Staley et al., 2018]] ). These sewer overflow events are associated with increased gastrointestinal illness across age groups ( [[#Jagai--2017|Jagai et al., 2017]] ).

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