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Waterborne Diseases
Prof. Nigel J Silman
Public Health England Institute of Biosensing Technology
Porton Down University of the West of England
Salisbury, SP4 0JG Bristol, BS16 1QY
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Safe drinking-water is a basic need for
human development, health and well-
being, and because of this it is an
internationally accepted human right
(WHO, 2001).
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Some Statistics
• Diarrhoeal diseases account for over 3.6% of global burden
of disease, DALY (Disability Adjusted Life Years)
• This equates to 2 million deaths per annum (WHO), majority
in under 5 year olds
• 88% of diarrhoeal diseases worldwide are linked to unsafe
water supplies
• This does not include diseases where water has a
component in the infectious disease cycle
• e.g. Schistosomiasis (water stage in life-cycle)
• Malaria (vectors replicate in stagnant water)
• Chemical intoxication
• Recreationally related deaths due to drowning3 Waterborne Diseases | SWIG Water & Health | 31st January 2018
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Some Visual Statistics
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Some Statistics Closer to Home!
• ECDC report low numbers of waterborne disease outbreaks
(typically ‘teens)
• This is an underestimation
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CAWST (Centre for Affordable Water and Sanitation Technology)
• For example, in 2006, 17
outbreaks, 3952 patients,
181 hospitalised
• Causes: erratic and
extreme rainfall
(including low rainfall)
• Flooding (yes!) in UK,
Finland, Czech Rebublic
& Sweden
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• Classical Waterborne Diseases
• Cholera
• Typhoid Fever
• Giardia
• Cryptosporidium
• Indicators of Faecal Contamination
• E. coli
• Faecal Streptococci
• Respiratory Diseases
• Legionella pneumphila
Key Diseases of Concern
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Case Studies:
The Public Health Problem in Gaza
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• >90% of water in Gaza classified as
“unsuitable for human consumption”
• Increasing salinity in groundwater
• Contamination with pesticides, fertilisers,
sewage, heavy metals & solid waste
• HEALTH RISKS:
• Infectious disease
• High nitrate content
• Salinity
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Water Sources in Gaza
• Groundwater:
• Aquifers
• Main water source
• Artesian wells & springs
• Surface Water:
• River(s) (Jordan River)
• More saline towards Dead Sea
• Wadis
• Seasonal reservoirs
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Current Testing Regimen
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• Aquifer Testing• Two samples per annum from each well (Spring & Autumn)
• No microbiology
• Desalinated Water• Known bacteriological contamination
• Little mandated testing undertaken
• Known contamination of pipes, nozzles, storage tanks etc.
• Bottled Water• 3 random samples per annum
• 50% bottled waters had high bacterial counts
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Case Studies:
An Unusual Waterborne Disease
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47 heater-cooler units across 13 different NHS Trusts
HPC: ranged from < 100 cfu/L - 3 x 109 cfu/L (mean = 108)
Mycobacteria spp recovered from water taken from 35/47 HCUs (74%)
Legionella spp detected in water taken from 4/5 HCUs
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Case Studies:
An Unusual Waterborne Disease
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Case Studies:
An Unusual Waterborne Disease
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3T HCU (2002) – out of active service
Water microbiology
HPC: mean ~4 x 108 cfu/L (n=10)
range of common waterborne organisms
including a number of opportunistic pathogens:
Sphingomonas paucimobilis
Stenotrophomonas maltophilia
Brevundimonas vesicularis
M. chimaera was also present
(as was Legionella pneumophila!)
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Diagnostic Approaches
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State of the Art?
• Membrane Filtration
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Portable Approaches
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• Total coliforms
• Faecal coliforms
• Faecal Streptococcus spp.
• Na
• K
• Ca
• Mg
• Sulphate
• Nitrate
• Chloride
• TDS
• Heavy metals
Routine chemical & microbiological parameters:
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Rapid Diagnostics
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Centralised
Service
Point of Use
Community
Home Use
Considerations:
• Rapidity / convenience
• Positively affects management
• Straightforward use
• High PPV
• Cost Effective
• Throughput??
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Antibody / Antigen Biomarkers
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Nucleic Acid Amplification
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• Relies on absolute fidelity between
primer, probe & target
• PCR needs a thermocycler – not that
portable!
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Legionella Detection by PCR
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Summary
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