1. September 29, 2003JEMH van Bronswijk, TU/e1 Health risks from water Opportunities & Problems

2. September 29, 2003JEMH van Bronswijk, TU/e2 Water is Life Human = 65% H 2 O Minimal Daily loss: 1 kg H 2 0 / person Maximal Hourly loss: 10 kg H 2 O / person Loss to be replenished by eating & drinking Human <60% H 2 0: in danger zone

3. September 29, 2003JEMH van Bronswijk, TU/e3 Potable Water Perishable Commodity (< 24 Hours) Keep cool or add Chlorine or active oxygen-derivate Keep Running Bio-film development on Surfaces

4. 08-06-027s640-6biolag: J.E.M.H. van Bronswijk 4 Healthy and Sustainable Building Potable Water Disease Risks: - Veteran’s Disease caused by Legionella - Infections / Intoxications of ‘Household Water’ (= 2 nd quality water) Prevention: - Keep potable water supply below 18°C at all times - Mark each ‘Household Water’ outlet individually and clearly - Stimulate distinguishable odour and taste of 1 st & 2 nd quality water - Make disconnecting of 2 nd quality water-systems easy - Inform consumer

5. 08-06-027s640-6biolag: J.E.M.H. van Bronswijk 5 Healthy and Sustainable Building Hot Water Disease Risks: - Scalding - Veteran’s Disease caused by Legionella - Pontiac Fever caused by Legionella - Atopic Disease through lack off mite extermination at laundering - Humidifier Disease through antigens of micro-organisms Prevention: - Install thermostatic mixing faucet - Replace boiler by geyser with a short hot water conduct - Install facility for washing machine with extra water heating (>60 o C) - Inform consumer

6. September 29, 2003JEMH van Bronswijk, TU/e6 Legionella Risk Veteran’s Disease & Pontiac Fever Lung infection ( Shower, Air-Conditioning, Cooling Towers ) 18 o C < Bacterial Growth < 60 o C Bacterial Survival up to 65 o C Viable Legionella present in surface & coastal waters

7. September 29, 2003JEMH van Bronswijk, TU/e7 950-990x cases of Pontiac Fever 9-30x surviving Veteran-Disease patients, but with persisting chronic symptoms 1-20x fatal cases 1000 Legionella-infections Source: JEMH van Bronswijk e.a. 1999. Gezond en Duurzaam Bouwen (GeDuBo). Research Report for the Netherlands Ministry of Housing

8. Legionellosis Risk Classes JEMH van Bronswijk, October 9, 1999 Source: CJPA Hoebe, JJM Cluitmans, JHT Wagenvoort, WJ van Leeuwen, MAJ Bilkert-Mooiman 1999. Koud leidingwater als bron van fatale nosocomiale pneumonieën door Legionella pneumophila in een revalidatiekliniek. Nederl. Tijdschr. Geneesk. 143(20):1041-1045

9. September 29, 2003JEMH van Bronswijk, TU/e9 Legionellosis Since the 1986 report of the Health Administration 5,000+ preventable deaths occurred in NL For each Legionella death 50 to 1,000 persons are diseased Risk in modern dwellings and in hospitals is comparable Preventive technology is available

10. September 29, 2003JEMH van Bronswijk, TU/e10 Legionella extermination * Use a thermostatic mixing tap with automatic emptying, to prevent both burns and a Legionella infection! Source: Report Gezondheidsraad 1986; Pubmed 1995-1999 At temperatures >64°C no breathing of Legionella occurs* No growth <18°C; Legionella remains vital 0.5 mg free chlorine / l water kills bacteria Copper or silver-ions in the water decrease growth

11. September 29, 2003JEMH van Bronswijk, TU/e11 Waste Water Bathroom, Toilet, Kitchen: Human pathogens from man & pets (also SARS) (Run-off) Rainwater: Human pathogens from birds & rodents Waste water is a breeding ground for biting insects & a domain of rodents: keep is covered

12. September 29, 2003JEMH van Bronswijk, TU/e12 Outdoor Water risks & opportunities Visual Comfort Water Management Recreation Diarrhoea ( e.g. Escherichia coli, Salmonella ) Weil’s Disease Temperate-region Malaria ( brackish water ) SARS ?

13. 09-04-017s640-3biolag: J.E.M.H. van Bronswijk 13 Causes of Summer Flu Infectious Bacterial Gastro-Enteritis Source: NRH Burgess 1990. Public Health Pests. Chapman & Hall, London; E Eyskens, L Feenstra, AE Meinders, JP Vandenbroucke 1991. Codex Medicus. 9e druk. Elsevier, Amsterdam 1.Campylobacter jejuni (incubation period: 24 - 72 Hrs) Duration of illness: 1 - 4 Days; Infected food: chicken, milk, water Vectors: fly, rat, mouse, cockroach, rain water, 2 nd quality water 2.Clostridium perfringens (incubation period: 8 - 24 Hrs) Duration of illness: < 7 Days; Infected food: too slowly chilled dishes Vectors: fly, rat, mouse, cockroach, human hands 3.Salmonella (incubation period: 8-48 Hrs) Duration of illness: 5 - 7 Days; Infected food: meat dishes, water Vectors: fly, rat, mouse, cockroach, rain water, 2 nd quality water 4.Staphylococcus aureus (incubation period: < 6 Hrs) Duration of illness: < 24 Hrs; Infected food: milk products, meat dishes Vectors: fly, rat, mouse, cockroach, human hands

14. September 29, 2003JEMH van Bronswijk, TU/e14 Weil’s Disease First described by Adolf Weil (1848-1916) in Wiesbaden (Germany) Infection with Leptispira ictero-haemorrhagiae Human disease after contact with urine of infected rodents such as the Norway Rat (Rattus norvegicus); most common in Zuid- Holland Symptoms and Course: incubation period of 2- 20 days; followed by 4-9 days with severe flu- like symptoms; may develop from 6 th -12 th day of illness into meningitis, as well as damage to liver, kidneys and heart

15. September 29, 2003JEMH van Bronswijk, TU/e15 Preventing Weil’s Disease *Minimize open water in residential areas **Open city water should have steep banks Mow banks of city water 2x yearly Keep city water deep (> 3 m) Exterminate Rattus sp in residential areas Inform consumers Number of drowned children will: * decrease ** increase

16. 08-06-027s640-6biolag: J.E.M.H. van Bronswijk 16 Healthy and Sustainable Building Open Water in Cities & Towns Disease Risks: - Weil’s Disease - Papular Urticaria due to mosquitoes and biting flies - Re-introduction of temperate-region malaria (only in brackish areas) Prevention: - Fill up marshy fields and stagnant waters in living areas - Refrain from introducing water-purifying marshes in living areas - Can marshes or ponds not be avoided: install rat & mosquito extermination program - Prevent mosquitoes & black flies from entering the house (fixed insect screens in windows & doors) - Inform consumer

17. September 29, 2003JEMH van Bronswijk, TU/e17

18. September 29, 2003JEMH van Bronswijk, TU/e18 Dutch Anti-malaria Poster from the 1st half of the 20 th century Ziet gij muggen lang van poot Aarzelt niet, maar slaat ze dood Translation: Do you see mosquitoes long of legs ? Don’t wait, squeeze them to death