Water Laboratories and Waterborne Disease Outbreaks. Patrick Luedtke MD, MPH and Sanwat Chaudhuri, PhD
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1 Water Laboratories and Waterborne Disease Outbreaks Patrick Luedtke MD, MPH and Sanwat Chaudhuri, PhD
2 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
3 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?
4 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%
5 Human Dependence On Water A human can live days without food? In a hot dry environment, humans can live days without water?
6 Human Dependence On Water A human can live ~60+ days without food? In a hot dry environment, humans can live ~3 days without water?
7 If the absence of water can kill, can the presence of water kill?
8 Specific Water-related Diseases 1. Water-borne: 2. Water-contact: 3. Water-insect: 4. Water-washed: (lack of water)
9 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
10 Drinking Water Outbreaks by Agent: N = 818 Avg = 22 per year CDC Surveillance Summaries: September 23, 2011, volume 60(ss12);38-68
11 Data in this Table are compiled from CDC Morbidity and Mortality Weekly Report Surveillance Summaries for , , , and
12 Drinking Water Disease Outbreaks by Illness & Etiology: CDC Surveillance Summaries: September 23, 2011, volume 60(ss12);38-68
13 Outbreaks by Etiology, System, & Source
14 Water Outbreaks by Deficiency
15 Recreational Water Outbreaks:
16 Water Food Outbreak Links Foodborne illnesses per year: 47.8 million ---Hospitalizations: 127, 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 estimates of foodborne illness
17 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
18 Top 5 Causes of Hospitalization Salmonella = 19,336 Norovirus = 14,663 Campylobacter spp. = 8,463 T. gandii = 4,428 E. coli O157 = 2,138
19 Top 5 Causes of Death Salmonella = 378 T. gondii = 327 L. monocytogenes = 255 Norovirus = 149 Campylobacter = 76**
20 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*
21 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
22 Roles of Water Laboratorians Test water samples for waterborne pathogens Analyze & report to appropriate agencies Health officials Water systems Environmental programs Other (hospitals etc.)
23 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!
24 Barriers to Waterborne Investigations
25 Volume & Resources
26
27
28 Laboratory Incarceration
29 Emotion: "Clean" water depends on one's perspective... San Francisco Exploratorium
30 A Sip of Conflict -or- The Conflicted Sip
31 More Emotion Outhouse Springs Bottled Water Adams Outdoor Advertising, South Carolina,
32 Infrastructure Challenges
33
34 Multifactorial
35 Beijing Olympic Venue
36 Transition Crypto method review: Becky Hoffman Legionella Outbreak experience: Windy Tanner
37 Questions?
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