Waterborne Infections. Create an environment to maintain ecological conditions to promote health and prevent disease Create an environment to maintain.

Waterborne InfectionsWaterborne Infections

Create an environment to Create an environment to maintain ecological conditions to maintain ecological conditions to promote health and prevent promote health and prevent diseasedisease

Public Health issue: Safe drinking Public Health issue: Safe drinking water and proper sanitationwater and proper sanitation

WaterWater

International Drinking Water Supply International Drinking Water Supply and Sanitation decade: 1981-1990and Sanitation decade: 1981-1990

34 World Health Assembly 34 World Health Assembly emphasized that safe drinking water emphasized that safe drinking water is a basic element of primary health is a basic element of primary health care – key to attainment of Health for care – key to attainment of Health for allall

Safe Drinking WaterSafe Drinking Water

Free from pathogenic agentsFree from pathogenic agents Free from harmful chemicalsFree from harmful chemicals Pleasant to tastePleasant to taste Usable for domestic purposesUsable for domestic purposes

Water requirementWater requirement

2 litres per head per day: Basic 2 litres per head per day: Basic physiological requirementphysiological requirement

PH: Adequate water supply to PH: Adequate water supply to maintain proper hygienemaintain proper hygiene

15-200 l/per capita adequate15-200 l/per capita adequate India 40 l/ capita target India 40 l/ capita target

Sources of Water SupplySources of Water Supply RainRain Surface: Surface:

Impounding reservoirsImpounding reservoirsRivers and StreamsRivers and StreamsTanks/ Ponds/ LakesTanks/ Ponds/ Lakes

Ground waterGround waterShallow wellsShallow wellsDeep wellsDeep wellsSpringsSprings

Water PollutionWater Pollution

Gases: Nitrogen, Carbon Gases: Nitrogen, Carbon dioxide, Hydrogen Sulphidedioxide, Hydrogen Sulphide

Minerals: Salts of Ca, MgMinerals: Salts of Ca, Mg Suspended impurities: Clay, Suspended impurities: Clay,

Silt, Sand, MudSilt, Sand, Mud MicroorganismsMicroorganisms

Water Pollution due to Water Pollution due to UrbanizationUrbanization

Sewage: Decomposable Sewage: Decomposable organic matter and microbesorganic matter and microbes

Industrial and trade wastesIndustrial and trade wastes Agricultural pollutantsAgricultural pollutants PhysicalPhysical

Health HazardsHealth Hazards 60% towns getting adequate water60% towns getting adequate water Low daily per capita supplyLow daily per capita supply Inefficient distributionInefficient distribution LeakageLeakage Progress in rural sector very slowProgress in rural sector very slow Few Sewage treatment plantsFew Sewage treatment plants Poor hygiene: Poorly designed/ Poor hygiene: Poorly designed/

maintained sewage systemmaintained sewage system Fertilizer: Human discardFertilizer: Human discard

Diarrhea and intestinal worm Diarrhea and intestinal worm infestation: 10% total burden infestation: 10% total burden of disease in the developing of disease in the developing world.world.

Inadequate water supply Inadequate water supply increases risk of increases risk of Schistosomiasis, guinea Schistosomiasis, guinea worm disease, skin and eye worm disease, skin and eye infections.infections.

Population with Access to Population with Access to Safe Water (%)Safe Water (%)

IndiaIndia 8585 BangladeshBangladesh 8080 IndonesiaIndonesia 6363 NepalNepal 4848 MaldivesMaldives 8888 SriLankaSriLanka 5757 ThailandThailand 7070

Population with Access to Population with Access to Adequate SanitationAdequate Sanitation

IndiaIndia 2929 BangladeshBangladesh 3030 IndonesiaIndonesia 5151 NepalNepal 2222 MaldivesMaldives 4040 SriLankaSriLanka 6666 ThailandThailand 7474

BacteriaBacteria Vibrio choleraeVibrio cholerae SalmonellaSalmonella CampylobacterCampylobacter ShigellaShigella diarrheogenic Escherichia coli.diarrheogenic Escherichia coli. Legionella pneumophilaLegionella pneumophila M. xenopi, M. abscessus, M. M. xenopi, M. abscessus, M.

fortuitumfortuitum, and , and M. chelonaeM. chelonae LeptospiraLeptospira

VirusesViruses Hepatitis A and EHepatitis A and E Polio virusPolio virus Rotavirus, Adenovirus, Norwalk Rotavirus, Adenovirus, Norwalk

agent agent

AETIOLOGICAL AGENTS

HelminthicHelminthic RoundwormRoundworm WhipwormWhipworm Hydatid DiseaseHydatid Disease

ProtozoalProtozoal Giardia lambliaGiardia lamblia Entamoeba histolyticaEntamoeba histolytica AcanthamoebaAcanthamoeba,, HartmannellaHartmannella Naegleria fowleriNaegleria fowleri CyclosporaCyclospora IsosporaIsospora CryptosporidiumCryptosporidium MicrosporidiaMicrosporidia

Bacterial infectionsBacterial infections Presenting symptomsPresenting symptoms: :

Diarrhea: CholeraDiarrhea: Cholera Dysentery: ShigellosisDysentery: Shigellosis Flu like illness (Pontiac fever)Flu like illness (Pontiac fever) Pneumonia (Legionnaire’s disease)Pneumonia (Legionnaire’s disease) Bacteremia (Typhoid)Bacteremia (Typhoid) Septicemia (Leptospira)Septicemia (Leptospira)

CholeraCholera

7 Pandemics: Last in 19617 Pandemics: Last in 1961 Vibrio choleraeVibrio cholerae O1, non O1, O1, non O1,

O139O139 Transmission via water Transmission via water

contaminated with faecescontaminated with faeces Rice Water StoolsRice Water Stools Dehydration, electrolyte Dehydration, electrolyte

imbalanceimbalance

TyphoidTyphoid Systemic infectionSystemic infection Salmonella Salmonella TyphiTyphi Can be sporadic, epidemic, endemicCan be sporadic, epidemic, endemic Endemic in IndiaEndemic in India Man is the only reservoirMan is the only reservoir Peaks in July-SeptemberPeaks in July-September Transmisison Feco-oral. Directly or indirectly Transmisison Feco-oral. Directly or indirectly

by ingestion of contaminated wtare/ by ingestion of contaminated wtare/ milk/foodmilk/food

Continuous fever- 3-4 weeksContinuous fever- 3-4 weeks Involvement of Lymphoid tissueInvolvement of Lymphoid tissue

Viral InfectionsViral Infections

GastroenteritisGastroenteritis PolioPolio HepatitisHepatitis

Parasitic InfectionsParasitic InfectionsGastrointestinal disturbancesGastrointestinal disturbancesEncephalitisEncephalitis

PoliomyelitisPoliomyelitis Acute viral infectionAcute viral infection Infection of alimentary canal.Infection of alimentary canal. CNS affected in 1%; paralysis, deathCNS affected in 1%; paralysis, death Feco-oral transmisison. Survives long in Feco-oral transmisison. Survives long in

cold environment.cold environment. Occurs mostly in rainy seasonOccurs mostly in rainy season Environmental sources: Contaminated Environmental sources: Contaminated

Water, milk, foodWater, milk, food Droplet in fection in acute phase of Droplet in fection in acute phase of

diseasedisease

Viral HepatitisViral Hepatitis

Hepatitis AHepatitis A PicornavirusPicornavirus Fever, chills, generalized Fever, chills, generalized

malaise, vomiting, jaundicemalaise, vomiting, jaundice Mode of transmisison: feco-oralMode of transmisison: feco-oral Hepatitis E: First major epidemic Hepatitis E: First major epidemic

in Delhi in 1955in Delhi in 1955

AmoebiasisAmoebiasis

Entamoeba histolytica Entamoeba histolytica Diarrhea – Diarrhea – dysentrydysentry

Infective form: cyst Infective form: cyst Feco-oral Feco-oral transmissiontransmission

GiardiasisGiardiasis

Giardia lamblia Giardia lamblia Abdominal discomfort- Abdominal discomfort- diarrheadiarrhea

Feco-oral transmission Infective form-CystFeco-oral transmission Infective form-Cyst

DiagnosisDiagnosis Signs and symptomsSigns and symptoms Laboratory diagnosisLaboratory diagnosis

Sample collectionSample collection Transport Transport MicroscopyMicroscopy CultureCulture Serological assaysSerological assays Molecular diagnosisMolecular diagnosis