Water Laboratories and

Waterborne Disease Outbreaks

Patrick Luedtke MD, MPH and Sanwat Chaudhuri, PhD

Objectives

• Quiz: The privilege of fresh water

• Review: The varieties of waterborne

diseases

• Discuss: The anatomy of waterborne

outbreaks

• Review: “The “Big 5” in human health

• Discussion: Crypto method & Legionella

outbreak

Today’s Quiz:

1. Percentage of Earth covered by water?

2. Percentage of Earth’s water that is “fresh?”

3. Percentage of Earth’s fresh water that is not readily available?

4. Percentage of all water on Earth that is both fresh and available?

Today’s Quiz:

1. Percentage of Earth covered by water?

70%

2. Percentage of Earth’s water that is “fresh?”

3%

3. Percentage of Earth’s fresh water that is not

readily available?

~70% - ice caps, ~30% groundwater

4. Percentage of all water on Earth that is both fresh

and available?

0.007%

http://www.globalchange.umich.edu/globalchange2/current/lectures/freshwater_supply/freshwater.html

Human Dependence On Water

A human can live ___ days without food?

In a hot dry environment, humans can live

___ days without water?

Human Dependence On Water

A human can live ~60+ days without food?

In a hot dry environment, humans can live

~3 days without water?

If the absence of water can kill, can the

presence of water kill?

Specific Water-related Diseases

1. Water-borne:

2. Water-contact:

3. Water-insect:

4. Water-washed: (lack of water)

Specific Water-related Diseases

1. Water-borne: cholera, giardia, hepatitis A

2. Water-contact: schistosomiasis, guinea worm (Dracunculus medinensis)

3. Water-insect: malaria, yellow fever

4. Water-washed: (lack of water) trachoma

Drinking Water Outbreaks by Agent:

1971 - 2008

CDC Surveillance Summaries: September 23, 2011, volume 60(ss12);38-68

N = 818

Avg = 22 per year

Data in this Table are compiled from CDC “Morbidity and Mortality Weekly Report Surveillance

Summaries” for 1991-1992, 1993-1994, 1995-1996, 1997-1998 and 1999-2000.

Drinking Water Disease Outbreaks

by Illness & Etiology: 2007-2008

CDC Surveillance Summaries: September 23, 2011, volume 60(ss12);38-68

Outbreaks by Etiology, System, &

Source

Water Outbreaks by Deficiency

Recreational Water Outbreaks:

1989-2000

Water – Food Outbreak Links

Foodborne illnesses per year: 47.8 million

---Hospitalizations: 127,839

---Deaths: 3,037

How many of these “foodborne outbreaks”

were from contaminated water used during

the production, shipping, preparation, or

consumption of the food?

Data Source: CDC---2011 estimates of foodborne illness

Top 5 Pathogens: Illnesses/yr

• Norovirus = 5,461,731

• Salmonella = 1,027,561

• C. perfringens = 965,958

• Campylobacter spp. = 845,024

• S. aureus = 241,148

Top 5 Causes of Hospitalization

• Salmonella = 19,336

• Norovirus = 14,663

• Campylobacter spp. = 8,463

• T. gandii = 4,428

• E. coli O157 = 2,138

Top 5 Causes of Death

• Salmonella = 378

• T. gondii = 327

• L. monocytogenes = 255

• Norovirus = 149

• Campylobacter = 76**

Diseases, Agents & Symptoms

Disease Microbial agent General Symptoms

Cholera Vibrio cholera Diarrhea, vomiting, can

cause death

Botulism Clostridium

botulinum

Dry mouth, double vision,

difficult breathing,

vomiting, possible

diarrhea, death.

Dysentery Shigella, Salmonella Bloody diarrhea

Cryptosporidiosis Protozoan Self-limited AGI

Giardiasis Protozoan(Giardia

lamblia)

Chronic diarrhea

Legionairres’ disease Legionella Variable*

Typhoid fever Salmonella typhi Variable*

Waterborne Dz: The Recent

Past---Predicting the Future? • Since 2004 the number of crypto outbreaks

has tripled for recreational waters (e.g.,

Utah’s crypto outbreak in swimming pools)

• Legionella among the most frequent causes

of drinking water associated outbreaks

Roles of Water Laboratorians

• Test water samples for waterborne

pathogens

• Analyze & report to appropriate agencies

– Health officials

– Water systems

– Environmental programs

– Other (hospitals etc.)

Roles of Water Laboratorians

• Labidemiologist roles: Assist in

---Outbreak investigation

---Rapid identification of dz

---Detection of source of dz

• Most importantly: Do what

the physician cannot do!

Barriers to Waterborne

Investigations

Volume & Resources

Laboratory Incarceration

Emotion: "Clean" water

depends on one's perspective ...

San Francisco Exploratorium

A Sip of Conflict -or- The Conflicted Sip

Adams Outdoor

Advertising, South

Carolina, 2002

http://www.outhousesprings.com/index.html

More

Emotion

Outhouse Springs

Bottled Water

Infrastructure Challenges

Multifactorial

Beijing Olympic Venue

Transition

• Crypto method review: Becky Hoffman

• Legionella Outbreak experience: Windy

Tanner

Questions?