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?
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
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!
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