Water.org. Water and Public Health Pathogens and waterborne disease 2 million deaths annually due to...
Transcript of Water.org. Water and Public Health Pathogens and waterborne disease 2 million deaths annually due to...
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• Water.org
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Water and Public Health
• Pathogens and waterborne disease• 2 million deaths annually due to
unsafe water, sanitation and hygiene• 4% of the global disease burden could
be prevented by improving water supply, sanitation, and hygiene
– WHO 2013
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http://www.smashinglists.com/10-leading-causes-of-mortality-worldwide/
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Prüss-Üstün et al., 2008
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Prüss-Üstün et al., 2008
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Burden of Diarrheal Diease
• Diarrheal burden– 90% of deaths are in children <5– 80% of deaths in children <2
• 1 in 200 children die from diarrhea worldwide
• 88% of diarrheal disease due to unsafe water, inadequate sanitation and hygiene– Significant improvement in morbidity and mortality can be
achieved thru sanitation and minimal water treatment– 95% of diarrheal deaths in children <5 could be prevented
with sanitation upgrades and provision of safe water supply
WHO 2004; Green et al. 2009
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Fecal-Oral Transmission
Enteric OriginBacteriaVirusesHelminthsProtozoa
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Some Water Related Diseases
CampylobacteriosisSalmonellosis
ShigellosisLeptospirosisTyphoid fever
CholeraRotavirusNorovirusHepatitis A
AscarisRingworm
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‘F-Diagram’Enteric Disease Transmission
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Barriers to Transmission
Improved Sanitation
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2.5 billion people still lacked access to improved sanitation facilities in 2011 (WHO, 2013)
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Green et al. 2009
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Barriers to Transmission
Improved Hygiene / Access
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768 million people still relied on unimproved drinking water sources in 2011 (WHO, 2013)
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Disinfection (~1905)
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Efforts in Sanitation and Hygiene may need to be increased to ameliorate higher risk of enteric disease with
climate change
IPCC 2007. Working Group II
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Water.org• More than 3.4 million people die each year from water, sanitation,
and hygiene-related causes. • Lack of access to clean water and sanitation kills children at a rate
equivalent of a jumbo jet crashing every four hours.• Of the 60 million people added to the world's towns and cities every
year, most move to informal settlements (i.e. slums) with no sanitation facilities.9
• 780 million people lack access to an improved water source; approximately one in nine people.14
• "[The water and sanitation] crisis claims more lives through disease than any war claims through guns." 11
• An American taking a five-minute shower uses more water than the average person in a developing country slum uses for an entire day.11
• Over 2.5X more people lack water than live in the United States.3
• More people have a mobile phone than a toilet.5
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Cholera
Sanitation, Hygiene, Environment, Climate
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Cholera
• Derived from Greek word referring to rain rushing from a gutter– Causes profuse watery diarrhea
• Known since Hippocrates• First epidemic described in 1563 in India• 7 seven known pandemics
– 7th began in 1961
icddr,b
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1858 - London
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Historical Perspective • Cholera linked to water
source– John Snow– London 1854 cholera
outbreak– 500 fatal cases, 10 days– Linked to Broad St. pump
• First link to water
• Causative agent identified– Robert Koch– 1883 isolated bacterium – Vibrio cholerae (comma)
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http://www.sewerhistory.org/images/bm/bms9/1899_bms902.gif
Sanitation Improvements and Cholera, 1800s
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• 2011, 58 countries from all continents reported cases (589,854 - vastly underestimates true burden)
• Case burden has shifted to the Americas (Haiti, Dominican Republic)
• Globally, cholera incidence has increased since 2004
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Vibrio cholerae• Infection via
– Water– Shellfish (crabs and bivalves)– Person-to-person
• Only Vibrio that can grow in fresh waters (optimal growth at low salinities)– Vibrio are most commonly cultured bacterial genus from
marine waters• Since 1978, known to occur in warm estuarine waters
world-wide• Disease of sanitation AND the environment
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Seventh Cholera Pandemic
2010
Environment and climate
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Vibrio cholerae
• >200 serotypes– O1 in pandemics (El Tor &
Classical)– O139 new toxigenic strain
• Cholera toxin (CTX)– Phage encoded– Acts in intestines to produce
profuse diarrhea
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Cholera Transmission Dynamics
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Vibrio & V. cholerae are strongly temperature associated.
Very rapid doubling times as temperatures rise.
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Vibrio cholerae in the EnvironmentUp to 104 cells/copepod
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PROBLEM
Prevention of Cholera Transmission
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Prevention of Cholera Transmission
0.2 – 0.8 µm
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Prevention of Cholera Transmission
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Prevention of Cholera Transmission
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Colwell et al. 2003
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