Water-related disease surveillance and response Roger Aertgeerts Program manager WHO Regional Office...

Water-related disease surveillance and response

Roger Aertgeerts

Program manager

WHO Regional Office for Europe

Protocol Implementation Workshop Minsk 4-5 April 2011


5 April 2011 Page 2

Targets are team work

• Manage resources• Provide water and

sanitation• Survey diligently• Detect outbreaks• Implement contingency

plans• Live and learn, and pass

it on…



5 April 2011 Page 3

Agenda

• Water use– Target setting

• Access to water and sanitation– Target setting for water services

• Water-related diseases– Target setting for surveillance systems



5 April 2011 Page 4

23%

10%

19%

12%

0%

5%

10%

15%

20%

25%

BLR MDA RUS UKR

Water withdrawal for domestic use (%)



5 April 2011 Page 5

278

540 523

764

0

100

200

300

400

500

600

700

800

BLR MDA RUS UKR

Water withdrawal for domestic use (m3/c)



5 April 2011 Page 6

Target setting

• Effective demand management can be an important contribution to climate change adaptation. Possible targets include– Reduction of unaccounted-for-water– Reduction of leaks– Introduction of metering systems



5 April 2011 Page 7

Agenda






5 April 2011 Page 8

94

6

94

6

76

24

76

24

89

11

89

11

0

10

20

30

40

50

60

70

80

90

100

Access No access Access No access Access No access

Urban Rural Total

Access to improved sanitation %

1990

2008



5 April 2011 Page 9

142,744133,797

9,1729,070

47,620

14,735

44,253

13,640

190,658

23,614

178,048

22,651

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000


Urban Rural Total

Access to improved sanitation (1,000 pop)

19902008



5 April 2011 Page 10

Target setting in sanitation

• Legal, institutional and administrative set-up• Issues of reliable information• Issues of infrastructure• Issues of economic capacity




Examples of target setting

• Finland– Universal centralized sewerage and

wastewater treatment• Czech Republic

– Compliance with EU 91/271/EEC – Construction of wastewater treatment

facilities in small settlements with less than 2,000 inhabitants, where sewerage exists




98

2

98

2

82

18

91

9

94

6

96

4

0

10

20

30

40

50

60

70

80

90

100


Urban Rural Total

Access to safe water (%)

19902008




149,364

2,551

140,063

2,743

54,420

10,934

52,875

5,018

200,784

13,485

192,938

7,761

0

50,000

100,000

150,000

200,000

250,000


Urban Rural Total

Access to safe water (1,000 pop)

1990

2008




Target setting in access to safe water

• Legal, institutional and administrative setup• Issues of reliable information• Issues of quality• Issues of economic capacity• Awareness-raising, education and training




Examples of targets to safe water

• Hungary– Nation-wide survey on population without access to

drinking water, and exploration of feasible solutions– Development of social subsidies

• Portugal– Affordability: 2% of family income as limit

• Czech Republic– Facilitation of connection of residences in suburbs

and small villages to public supply




Agenda







“Water-related disease” means

Any significant adverse effects on human health such as death, disability, illness and disorders, caused directly or indirectly by the condition, or changes in the quantity or quality, of any waters;




Classes of water-related diseases

• Classic water-related diseases– Cholera– Typhus– Typhus

• Emerging water-related diseases– Cryptosporidiosis– Campylobacteriosis– Giardiasis– Legionellosis




Classic: Typhus - Viral hepatitis A

Viral hepatitis A

0

20

40

60

80

100

120

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Inci

denc

e ra

te (/

100.

000)

BLR

MDA

RUS

UKR

• Significant differences in incidence rate• Inconsistent reporting• Mostly decreasing trend

Typhus

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Year

Inci

denc

e ra

te (1

,000

)

BLR

MDARUS

UKR




Emerging: Cryptosporidiosis Legionellosis

• Very uneven reporting system• Repeated cases of outbreaks

Legionellosis

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Inci

denc

e ra

te (/

100,

000)

BLR

MDARUS

UKR

Cryptosporidiosis

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Inci

denc

e ra

te (/

100,

000)

BLR

MDA

RUS

UKR




Obligations under Art 6 par 2 (b)

Parties shall establish and publish national and/or local targets for the standards and levels of performance that need to be achieved to realize

The reduction of the scale of outbreaks and incidents of water-related disease;




Aspects in target setting

• Legal and administrative set-up• Availability and reliability of information on the

water quality• Issues of water-related disease surveillance• Economic sustainability




Obligations under Art 8

• Comprehensive national and/or local surveillance and early-warning systems established that– Identify outbreaks or incidents of wrd– Provide prompt and clear notification– Recommend preventive and remedial

action– Plan response to outbreaks




Target setting: focus and structure

• Priority diseases – is the activity a real priority for the country?

• Structure – is the structure of the national system effective and efficient?




Target setting: processes and capacity

• Detection (identifying cases and outbreaks)• Registration• Confirmation (epi and lab confirmation)• Reporting (early warning and routine)• Analysis and interpretation




Targets: response capacity

• Response– Control / response– Outbreak investigation– Programme adjustment– Changes in policy and planning

• Feedback• Evaluation and monitoring




Surveillance targets: support functions

• Setting standards• Training• Supervision• Communication systems• Human resources• Material resources• Financial resources




Assessing, mapping and communication

• Laboratories– Availability, functionality and level of

sophistication– Accreditation– Electronic data management and reporting

• Health mapping– National capacity or at least database

preparation




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