The Domestic Public Health Impact of Climate Change: U.S. Perspective on Waterborne Disease Transmission

Transcription

1 The Domestic Public Health Impact of Climate Change: U.S. Perspective on Waterborne Disease Transmission Michael J. Beach, Ph. D. Centers for Disease Control and Prevention

2 Potential U.S. Health Effects of Climate Change HEAT Heat stress, cardiovascular failure SEVERE WEATHER Injuries, fatalities Climate change: AIR POLLUTION ALLERGIES Asthma, cardiovascular disease Respiratory allergies, poison ivy Temperature rise Sea level rise VECTOR-BORNE DISEASES Malaria, dengue, encephalitis, hantavirus, Rift Valley fever Hydrologic extremes WATER-BORNE DISEASES Cryptosporidiosis, Naegleria, Campylobacteriosis, vibriosis leptospirosis WATER AND FOOD SUPPLY Malnutrition, diarrhea, algal blooms, hygiene-related disease MENTAL HEALTH Anxiety, post-traumatic stress, despair, depression Adapted from J. Patz ENVIRONMENTAL REFUGEES Forced migration, civil conflict

3 Potential Climate Change-related Events Impacting Waterborne Disease Environmental change/disturbance Extreme weather events Flood: CSO, SSOs Drought: soil/geologic changes Re-use of water and wastewater Urbanization Increased cooling system usage Exploitation of man-made habitats Legionella, Mycobacterium

4 Potential Climate Change-related Events Impacting Waterborne Disease Increasing water temperatures and/or nutrients Enhanced growth of pathogens Naegleria, Vibrio, Pseudomonas, HAB HAB-Related Illness Surveillance System (HABISS) Environmental data, animal and human illness All recreational water indicators Increasing recreational activities Swimming pools, ambient waters

5 How Can Changes in Waterborne Disease Transmission Be Monitored?

6 Waterborne-Disease Surveillance: Real World Not all water-related pathogens and chemicals are nationally notifiable Most water-related pathogens and chemicals have multiple modes of transmission Most individual cases are not investigated so mode of transmission is unknown Reported cases represent only a small portion of the burden of disease Water quality databases have no connection to health effects data

7 60 Are There Surrogates for Waterborne Disease Case Reporting? Number of WBDOS_ * 2004 Year Outbreaks can serve as indicators for trends in waterborne disease transmission in the U.S. and can connect health effects with water quality data

8 National Waterborne Disease and Outbreak Surveillance System Collaborative surveillance system CDC, EPA, CSTE since 1971 State/local DOH s have 1 0 responsibility for detecting, investigating, reporting WBDOs

9 Waterborne Disease and Outbreak Surveillance System: Usefulness Disease control Identify contaminated water sources Knowledge of disease causation Identify etiologic agents (old and new) Trend identification Etiologic agents, water sources, deficiencies Guidance and evaluation Evaluate the adequacy of current technologies for providing safe water Establish research priorities Assess effectiveness of water regulations/codes

10 Drinking Water-Associated Outbreaks, United States, Public, surface water Private, groundwater Number of WBDOS_ * 2004 N=803, MMWR (2006) 55(SS12):31-65 Year Beginning in 2003, mixed agents of more than 1 etiologic agent type were included in the surveillance system. However, the first observation is a previously unreported outbreak in Beginning in 2001, Legionnaires disease was added to the surveillance system, and Legionella species were classified separately in this figure.

11 Opportunities for Improvement: Needed ASTHO Assistance Support CSTE in making WBDO s nationally notifiable in your state Support deployment of National Outbreak Reporting System (NORS) from CDC Expanded version of Foodborne Outbreak Reporting System (efors) Put an emphasis on improved detection, investigation, and reporting of WBDOs Training Improved risk factor data collection

12 Acknowledgements DPD Michael Beach Sharon Roy Jonathan Yoder Michele Hlavsa EPA Rebecca Calderon Gunther Craun

13 Newly Required Disclaimer From the Department of Health and Human Services "The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy