Waterborne Diseases. Prof. Nigel J Silman. University of the West of England
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1 Waterborne Diseases Prof. Nigel J Silman Public Health England Porton Down Salisbury, SP4 0JG Institute of Biosensing Technology University of the West of England Bristol, BS16 1QY
2 Safe drinking-water is a basic need for human development, health and wellbeing, and because of this it is an internationally accepted human right (WHO, 2001). 2 Waterborne Diseases SWIG Water & Health 31 st January 2018
3 Some Statistics Diarrhoeal diseases account for over 3.6% of global burden of disease, DALY (Disability Adjusted Life Years) This equates to 2 million deaths per annum (WHO), majority in under 5 year olds 88% of diarrhoeal diseases worldwide are linked to unsafe water supplies This does not include diseases where water has a component in the infectious disease cycle e.g. Schistosomiasis (water stage in life-cycle) Malaria (vectors replicate in stagnant water) Chemical intoxication Recreationally related deaths due to drowning 3 Waterborne Diseases SWIG Water & Health 31 st January 2018
4 Some Visual Statistics 4 Waterborne Diseases SWIG Water & Health 31 st January 2018
5 Some Statistics Closer to Home! ECDC report low numbers of waterborne disease outbreaks (typically teens) This is an underestimation For example, in 2006, 17 outbreaks, 3952 patients, 181 hospitalised Causes: erratic and extreme rainfall (including low rainfall) Flooding (yes!) in UK, Finland, Czech Rebublic & Sweden CAWST (Centre for Affordable Water and Sanitation Technology) 5 Waterborne Diseases SWIG Water & Health 31 st January 2018
6 Key Diseases of Concern Classical Waterborne Diseases Cholera Typhoid Fever Giardia Cryptosporidium Indicators of Faecal Contamination E. coli Faecal Streptococci Respiratory Diseases Legionella pneumphila 6 Waterborne Diseases SWIG Water & Health 31 st January 2018
7 Case Studies: The Public Health Problem in Gaza >90% of water in Gaza classified as unsuitable for human consumption Increasing salinity in groundwater Contamination with pesticides, fertilisers, sewage, heavy metals & solid waste HEALTH RISKS: Infectious disease High nitrate content Salinity 7 Waterborne Diseases SWIG Water & Health 31 st January 2018
8 Water Sources in Gaza Groundwater: Aquifers Main water source Artesian wells & springs Surface Water: River(s) (Jordan River) More saline towards Dead Sea Wadis Seasonal reservoirs 8 Waterborne Diseases SWIG Water & Health 31 st January 2018
9 Current Testing Regimen Aquifer Testing Two samples per annum from each well (Spring & Autumn) No microbiology Desalinated Water Known bacteriological contamination Little mandated testing undertaken Known contamination of pipes, nozzles, storage tanks etc. Bottled Water 3 random samples per annum 50% bottled waters had high bacterial counts 9 Waterborne Diseases SWIG Water & Health 31 st January 2018
10 Case Studies: An Unusual Waterborne Disease 47 heater-cooler units across 13 different NHS Trusts HPC: ranged from < 100 cfu/l - 3 x 10 9 cfu/l (mean = 10 8 ) Mycobacteria spp recovered from water taken from 35/47 HCUs (74%) Legionella spp detected in water taken from 4/5 HCUs 10 Waterborne Diseases SWIG Water & Health 31 st January 2018
11 Case Studies: An Unusual Waterborne Disease 11 Waterborne Diseases SWIG Water & Health 31 st January 2018
12 Case Studies: An Unusual Waterborne Disease 3T HCU (2002) out of active service Water microbiology HPC: mean ~4 x 10 8 cfu/l (n=10) range of common waterborne organisms including a number of opportunistic pathogens: Sphingomonas paucimobilis Stenotrophomonas maltophilia Brevundimonas vesicularis M. chimaera was also present (as was Legionella pneumophila!) 12 Waterborne Diseases SWIG Water & Health 31 st January 2018
13 Diagnostic Approaches 13 Waterborne Diseases SWIG Water & Health 31 st January 2018
14 State of the Art? Membrane Filtration 14 Waterborne Diseases SWIG Water & Health 31 st January 2018
15 Portable Approaches Routine chemical & microbiological parameters: Total coliforms Faecal coliforms Faecal Streptococcus spp. Na K Ca Mg Sulphate Nitrate Chloride TDS Heavy metals 15 Waterborne Diseases SWIG Water & Health 31 st January 2018
16 Rapid Diagnostics Centralised Service Point of Use Community Home Use Considerations: Rapidity / convenience Positively affects management Straightforward use High PPV Cost Effective Throughput?? 16 Waterborne Diseases SWIG Water & Health 31 st January 2018
17 Antibody / Antigen Biomarkers 17 Waterborne Diseases SWIG Water & Health 31 st January 2018
18 Nucleic Acid Amplification Relies on absolute fidelity between primer, probe & target PCR needs a thermocycler not that portable! 18 Waterborne Diseases SWIG Water & Health 31 st January 2018
19 19 Waterborne Diseases SWIG Water & Health 31 st January 2018
20 Legionella Detection by PCR 20 Waterborne Diseases SWIG Water & Health 31 st January 2018
21 21 Waterborne Diseases SWIG Water & Health 31 st January 2018
22 Summary 22 Waterborne Diseases SWIG Water & Health 31 st January 2018
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