1. Public Health Aspects of Sewage Disposal A stroll down the fecal-oral pathway Tom Duszynski, Director of Field Epidemiology

4. Why do we care?

5. Public Health Impact: U.S. 1900 – Infectious disease mortality: 797/100,000 – 30.4% of all deaths occurred in children <5 yrs 1980: infectious disease mortality 36/100,000 1997: 1.4% of all deaths occurred in children <5yrs 5

6. Epidemiology Triad 6 Host AgentEnvironment

7. If you don’t learn from history… King Minos of Crete Evidence has turned up of a positive flushing water closet used back around 1700 B.C. Hippocrates, the "Father of Medicine" who lived around 350 B.C., recommended boiling water to filter out impurities Decline & Fall: Though the Roman Empire would last until the 6th century A.D., its fall was preceded by centuries of gradual decay, conflict and unrest. Ironically, some historians suggest that the Roman plumberi (plumbers) may have played a significant role in the downfall due to their extensive use of lead.

8. …you are doomed to repeat it 1766, Germany, Johann Peter Frank created a police medicine system that included school health, injury prevention, maternal and child health, and public water and sewage treatment. Napoleon lost thousands of his men to typhus in his march to Moscow and return in 1812-1813 In the 19th century cholera became the world's first truly global disease. By 1827 cholera had become the most feared disease of the century.

10. Cholera John Snow was an English physician and anesthesiologist Investigated a cholera outbreak that occurred during the mid-19th century in Broad Street, Golden Square, London Linked the cholera epidemic to contaminated water supplies Used a spot map of cases and tabulation of fatal attacks and deaths

11. Spot Map

12. Bacteria and Sewage discoveries The eminent Dr. John Snow demonstrated how cases of cholera that broke out in a district of central London could all be traced to a single source of contaminated drinking water. The actual discovery of the comma-shaped bacillus of cholera was made by the German Dr. Robert Koch in 1876.

13. Fun Facts about Bacteria Bacteria help our bodies with digestion and produce needed vitamins. Bacteria also help us by destroying harmful organisms within our bodies. There are more bacterial cells in your body than there are human cells. Most bacteria reproduce using a process called "binary fission." To do this, a single bacterium will grow to twice its normal size and then split into two "daughter" cells. The two new cells are exact copies of the original bacterium. Bacteria are used to make cheese, milk, sourdough bread and yogurt.

14. Fun Facts about Bacteria 99% of all bacteria are helpful. Dead or weakened bacteria and viruses are used for making helpful vaccines. Scientists estimate that bacteria produce nearly half the oxygen found in the atmosphere. Helpful bacteria are used to purify water at sewage treatment plants and to break down oil after oil spills. (Like the enzymes in Dawn) One healthy bacterium, given the proper environment, could reproduce into a colony of more than 2 million in just seven hours. There are more microbes on your body than there are humans on the entire planet. An area of skin as small as 6.5 square cm (1 square inch) may be home to more than half a million

15. Viral Diseases: Antibiotics do not work against the virus. Once you have a virus, you either fight it or die. Viruses are parasites. They are neither alive, nor dead. They cannot reproduce by themselves; they must force other cells to make progeny. The virus is made up of DNA or RNA surrounded by a protein coat. It takes over cells so that it can reproduce itself. The cell usually dies after reproduction. RNA viruses are not stable and therefore, they mutate often (FLU viruses ). Ebola is an RNA virus; this is why it can mutate so quickly. DNA viruses are more stable and therefore, they mutate less often (Hep B, HPV, Smallpox).

17. Viruses

18. Diseases associated with direct contact with sewage Campylobacteriosis Cryptosporidiosis Escherichia coli Diarrhea/ HUS Gastroenteritis Giardiasis Hepatitis A Hepatitis E Leptospirosis Poliomyelitis Salmonellosis Shigellosis Paratyphoid Fever Typhoid Fever Yersiniosis

19. Diseases with indirect transmission Encephalitis Methemoglobinemia (blue-baby syndrome)

20. Public Health Successes Vaccination Antibiotic development Sanitation improvements Chlorination of water supplies Food safety Smoking restrictions Ban on the sale of pet turtles 20

21. Public Health Successes Redesign of produce misters Automobile Safety (Air bags, Seat belts) Decreases in Lead poisonings Decreases in Asbestos exposures

22. Public Health Remember that public health is the practice of “population medicine” Part of a larger system – Our response and actions feed that larger system We can make an enormous difference – Prevention of disease is cheaper and easier than treatment

23. Questions Tom Duszynski Director of Field Epidemiology 317-233-7009 tduszyns@isdh.in.gov