Waterborne Infections

Create an environment to maintain ecological conditions to promote health and prevent disease Create an environment to maintain ecological conditions to promote health and prevent disease Public Health issue: Safe drinking water and proper sanitation Public Health issue: Safe drinking water and proper sanitation

Water International Drinking Water Supply and Sanitation decade: International Drinking Water Supply and Sanitation decade: World Health Assembly emphasized that safe drinking water is a basic element of primary health care – key to attainment of Health for all 34 World Health Assembly emphasized that safe drinking water is a basic element of primary health care – key to attainment of Health for all

Safe Drinking Water Free from pathogenic agents Free from pathogenic agents Free from harmful chemicals Free from harmful chemicals Pleasant to taste Pleasant to taste Usable for domestic purposes Usable for domestic purposes

Water requirement 2 litres per head per day: Basic physiological requirement 2 litres per head per day: Basic physiological requirement PH: Adequate water supply to maintain proper hygiene PH: Adequate water supply to maintain proper hygiene l/per capita adequate l/per capita adequate India 40 l/ capita target India 40 l/ capita target

Sources of Water Supply Rain Rain Surface: Surface: Impounding reservoirs Impounding reservoirs Rivers and Streams Rivers and Streams Tanks/ Ponds/ Lakes Tanks/ Ponds/ Lakes Ground water Ground water Shallow wells Shallow wells Deep wells Deep wells Springs Springs

Water Pollution Gases: Nitrogen, Carbon dioxide, Hydrogen Sulphide Gases: Nitrogen, Carbon dioxide, Hydrogen Sulphide Minerals: Salts of Ca, Mg Minerals: Salts of Ca, Mg Suspended impurities: Clay, Silt, Sand, Mud Suspended impurities: Clay, Silt, Sand, Mud Microorganisms Microorganisms

Water Pollution due to Urbanization Sewage: Decomposable organic matter and microbes Sewage: Decomposable organic matter and microbes Industrial and trade wastes Industrial and trade wastes Agricultural pollutants Agricultural pollutants Physical Physical

Health Hazards 60% towns getting adequate water 60% towns getting adequate water Low daily per capita supply Low daily per capita supply Inefficient distribution Inefficient distribution Leakage Leakage Progress in rural sector very slow Progress in rural sector very slow Few Sewage treatment plants Few Sewage treatment plants Poor hygiene: Poorly designed/ maintained sewage system Poor hygiene: Poorly designed/ maintained sewage system Fertilizer: Human discard Fertilizer: Human discard

Diarrhea and intestinal worm infestation: 10% total burden of disease in the developing world. Diarrhea and intestinal worm infestation: 10% total burden of disease in the developing world. Inadequate water supply increases risk of Schistosomiasis, guinea worm disease, skin and eye infections. Inadequate water supply increases risk of Schistosomiasis, guinea worm disease, skin and eye infections.

Population with Access to Safe Water (%) India85 India85 Bangladesh80 Bangladesh80 Indonesia63 Indonesia63 Nepal48 Nepal48 Maldives88 Maldives88 SriLanka57 SriLanka57 Thailand70 Thailand70

Population with Access to Adequate Sanitation India29 India29 Bangladesh30 Bangladesh30 Indonesia51 Indonesia51 Nepal22 Nepal22 Maldives40 Maldives40 SriLanka66 SriLanka66 Thailand74 Thailand74

Bacteria Bacteria Vibrio cholerae Vibrio cholerae Salmonella Salmonella Campylobacter Campylobacter Shigella Shigella diarrheogenic Escherichia coli. diarrheogenic Escherichia coli. Legionella pneumophila Legionella pneumophila M. xenopi, M. abscessus, M. fortuitum, and M. chelonae M. xenopi, M. abscessus, M. fortuitum, and M. chelonae Leptospira Leptospira Viruses Viruses Hepatitis A and E Hepatitis A and E Polio virus Polio virus Rotavirus, Adenovirus, Norwalk agent Rotavirus, Adenovirus, Norwalk agent AETIOLOGICAL AGENTS

Helminthic Helminthic Roundworm Roundworm Whipworm Whipworm Hydatid Disease Hydatid Disease Protozoal Protozoal Giardia lamblia Giardia lamblia Entamoeba histolytica Entamoeba histolytica Acanthamoeba, Acanthamoeba, Hartmannella Hartmannella Naegleria fowleri Naegleria fowleri Cyclospora Cyclospora Isospora Isospora Cryptosporidium Cryptosporidium Microsporidia Microsporidia

Bacterial infections Presenting symptoms: Presenting symptoms: Diarrhea: Cholera Diarrhea: Cholera Dysentery: Shigellosis Dysentery: 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)

Cholera 7 Pandemics: Last in Pandemics: Last in 1961 Vibrio cholerae O1, non O1, O139 Vibrio cholerae O1, non O1, O139 Transmission via water contaminated with faeces Transmission via water contaminated with faeces Rice Water Stools Rice Water Stools Dehydration, electrolyte imbalance Dehydration, electrolyte imbalance

Typhoid Systemic infection Systemic infection Salmonella Typhi Salmonella Typhi Can be sporadic, epidemic, endemic Can be sporadic, epidemic, endemic Endemic in India Endemic in India Man is the only reservoir Man is the only reservoir Peaks in July-September Peaks in July-September Transmisison Feco-oral. Directly or indirectly by ingestion of contaminated wtare/ milk/food Transmisison Feco-oral. Directly or indirectly by ingestion of contaminated wtare/ milk/food Continuous fever- 3-4 weeks Continuous fever- 3-4 weeks Involvement of Lymphoid tissue Involvement of Lymphoid tissue

Viral Infections Gastroenteritis Gastroenteritis Polio Polio Hepatitis Hepatitis Parasitic Infections Parasitic Infections Gastrointestinal disturbances Encephalitis

Poliomyelitis Acute viral infection Acute viral infection Infection of alimentary canal. Infection of alimentary canal. CNS affected in 1%; paralysis, death CNS affected in 1%; paralysis, death Feco-oral transmisison. Survives long in cold environment. Feco-oral transmisison. Survives long in cold environment. Occurs mostly in rainy season Occurs mostly in rainy season Environmental sources: Contaminated Water, milk, food Environmental sources: Contaminated Water, milk, food Droplet in fection in acute phase of disease Droplet in fection in acute phase of disease

Viral Hepatitis Hepatitis A Hepatitis A Picornavirus Picornavirus Fever, chills, generalized malaise, vomiting, jaundice Fever, chills, generalized malaise, vomiting, jaundice Mode of transmisison: feco-oral Mode of transmisison: feco-oral Hepatitis E: First major epidemic in Delhi in 1955 Hepatitis E: First major epidemic in Delhi in 1955

Amoebiasis Entamoeba histolytica Diarrhea – dysentry Entamoeba histolytica Diarrhea – dysentry Infective form: cyst Feco-oral transmission Infective form: cyst Feco-oral transmission

Giardiasis Giardia lamblia Abdominal discomfort- diarrhea Giardia lamblia Abdominal discomfort- diarrhea Feco-oral transmission Infective form-Cyst Feco-oral transmission Infective form-Cyst

Diagnosis Signs and symptoms Signs and symptoms Laboratory diagnosis Laboratory diagnosis Sample collection Sample collection Transport Transport Microscopy Microscopy Culture Culture Serological assays Serological assays Molecular diagnosis Molecular diagnosis