1. Global infectious diseases: infections transmitted through water and food IID 233

2. Course goals Review impact of major infectious diseases associated with water Review impact of major infectious diseases associated with food Consider impact of environment, climate, water and food processing/handling/treatment on individual and public health Focus on disease epidemiology, transmission, presentation and natural history, pathogenesis, diagnosis, treatment and prevention.

3. Water-related diseases Water (and food) ingested -> Diarrhea Viral, Bacterial, Parasitic diarrhea, acute chronic/repetitive: effect on Nutrition, development, vaccine “take” Examples: Rotavirus, norovirus, enteroviruses, bacterial secretory diarrhea, bacterial dysenteric diarrhea Diarrhea kills 1.8 million/year

4. Water (and food) ingested -> Systemic infections Examples: hepatitis A & E, polio, enteric fever, parasites (dracunculosis) Estimated deaths >200,000/year

5. Water exposure: skin Leptospirosis: breaks through skin Schistosomiasis: infection goes directly through skin Deaths >200,000/year

6. Water related: breeding sites for vectors Malaria Japanese encephalitis Dengue River blindness: Onchocerciasis Deaths >1 million/year

7. Water ABSENCE Trachoma Contamination www.bbc WWW.orbis

8. Water: non-infectious: Arsenic Fluorosis Lead Pesticides Others www.es.ucl.ac.uk

9. Access to water supply WHO In 2010, 780 million billion people lacked access to improved water sources; 10% world’s population. Over half of the world’s population has access to improved water through household connections or yard tap. Of the 780 million without improved water sources, nearly two thirds live in Asia. In sub-Saharan Africa, 42% of the population is still without improved water.

10. Access to sanitation WHO 2.6 billion people lacked access to improved sanitation, which represented 42% of the world’s population. Over half of those without improved sanitation – nearly 1.5 billion people – live in China and India. In sub-Saharan Africa sanitation coverage is a mere 36%. Only 31% of the rural inhabitants in developing countries have access to improved sanitation, as opposed 73% of urban dwellers. www.one.org

11. Emergencies and disasters WHO Almost two billion people were affected by natural disasters in the last decade of the 20th century, 86% of them by floods and droughts. Flooding increases the ever-present health threat from contamination of drinking-water systems from inadequate sanitation, with industrial waste and by refuse dumps. Droughts cause the most ill-health and death because they often trigger and exacerbate malnutrition and famine, and deny access to adequate water supplies. Disaster management requires a continuous chain of activities that includes prevention, preparedness, emergency response, relief and recovery. www.cbc.ca www.countdown.org

12. Food processing Shiga toxin expressing E. coli (STEC) and cattle Campylobacter and salmonella and fowl Antibiotic use LA Times www.stuff.co.nz

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