Date of Award

2007

Degree Type

Thesis

Degree Name

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Dr. Jeff Mahon

Second Advisor

Dr. Amit Garg

Third Advisor

Dr. William Clark

Abstract

In May 2000, the Walkerton Ontario municipal water supply was contaminated with Escherichia coli O157:H7 and Campylobacter, causing widespread gastroenteritis and hemolytic uremic syndrome (HUS). Previous studies indicate HUS may be complicated by insulin deficiency. We performed a retrospective cohort study with prospective follow-up to examine whether individuals who developed gastroenteritis without overt HUS during the outbreak are at increased risk of diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. From 2002-2005, 3259 residents of Walkerton and surrounding areas who were >10 years old with no known history of diabetes or impaired fasting glucose completed annual questionnaires and fasting plasma glucose and oral glucose tolerance tests. Participants were categorized regarding presence of gastroenteritis during the outbreak using data from multiple sources. After a mean follow-up of 4.5+1.0 years, there were no significant differences between groups in age- and sex-standardized rates of the primary composite outcome (asymptomatic: 11.0% [95% CI 8.8-13.2%]; possible gastroenteritis: 11.6% [95% CI 9.0-14.4%]; confirmed gastroenteritis: 10.9% [95% CI 9.4-12.5%]; (trend p=0.944). Gastroenteritis without HUS does not result in an increased risk of abnormal glucose homeostasis up to 5 years after the initial infection.

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