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TITLE from VIEW and SLIDE MASTER | November 4, 20131 |
Water and Wells: The Health connection:
“Wells to reduce waterborne diseases andThe role of Information transfer in disease prevention”
Water and Wells: The Health connection:
“Wells to reduce waterborne diseases andThe role of Information transfer in disease prevention”
Aileen M Marty MD, FACPProfessor, Infectious Diseases,
Department of Medicine, HWCOM [email protected]
TITLE from VIEW and SLIDE MASTER | November 4, 20132 | 2010 Team SA
Introduction: Water = Life
What is in the water?
Water and Health
Wells and Water: Altering evolutionary pressure
Information transfer and disease prevention
Summary
Outline
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TITLE from VIEW and SLIDE MASTER | November 4, 20133 | 2010 Team SA
Water is essential for all living things on this Earth, Water is filled with living things, and
all living things are filled with water
Introduction
Unclean water and lack of water are major health hazards* ~1.1 billion people have no sanitation facilities at all and practice
open defecation (WHO/UNICEF 2012)
* ~ 783 million people do not have access to improved drinking water sources (WHO/UNICEF 2012).
TITLE from VIEW and SLIDE MASTER | November 4, 20134 |
Water In War-torn area Middle EastWater In War-torn area Middle East
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TITLE from VIEW and SLIDE MASTER | November 4, 20135 | 2010 Team SA
Toxins, metals, salts
Living things
Radiation
Man-Made Garbage (e.g. plastics, oil spills, BW/CW agents, etc.)
What is in the water?
Microbes, Plants, and Animals (from Sponges to Vertebrates):
& their products (excreta, toxins, gases, etc.)
Viruses, bacteria, fungi, protozoa, and helminths
Seafood, including Contaminated seafood
Predatory and toxic sea life
Growing and developing vectors of disease
TITLE from VIEW and SLIDE MASTER | November 4, 20136 | 2010 Team SA
Type of Disease Description
Waterborne• Diseases transmitted by swallowing contaminated drinkingwater. Examples: cholera, typhoid
fever, cryptosporidiosis, botulism, toxins in water (e.g. Arsenic), cryptosporidiosis
Water‐carried
• Diseases acquired by accidental drinking, inhaling, or exposure to, contaminated recreational
water. Examples: cryptosporidiosis, giardiasis, Pseudomonas dermatitis, Free‐living amoeba,
Vibrio vulnificus in seawater
Water‐unwashed
• Diseases transmitted as a result of poor sanitation from inadequate quantities or quality of
water for washing hands, utensils, meats, vegetables, etc. Examples: shigellosis, hepatitis A,
hepatitis E, cyclosporiasis
Water‐based• Diseases by pathogens with an obligatory life‐cycle phase in creature that lives in water.
Examples: Diphyllobothrium infection, schistosomiasis, dracunculiasis, fascioliasis, anisakiasis
Water‐life carried• Diseases by pathogens that infect sea‐life, but are not obligatory life‐cycle phase‐based
pathogens. Examples Enteric viruses in shellfish, Hepatitis A or Vibrio vulnificus in Oysters
Water‐droplet inhaled or sully wound/mucosa
• Disease by pathogens carried in water vapor and inhaled or contaminatewound or via mucosa
Example: Legionellosis, meliodosis, Buruli ulcer
Water‐vectored• Diseases transmitted by arthropods that breed or bite in or near water Examples: yellow fever,
dengue, malaria, onchocerciasis, African trypanosomiasis, Loiasis
Water‐infected
• Diseases transmitted by preharvest pathogen contamination of edible portions of plants with
impure water, via their root systems (and to less degree via leaves). Example Escherichia coli
O157:H7, Salmonella, and Listeria monocytogenes,
Toxic Water Creatures• Disease from consuming sea‐life that produces or has ingested toxins (Biomagnification)
Examples: Puffer fish, Mercury in Fish, Ciguatera in Fish
Dangerous Marine life• Sea creatures may attack / defend themselves Examples: Sharks, electric eels, sting rays,
jellyfish
Water‐accident• Trauma/injury related to water‐related activities/accidents, or Examples: boating injuries,
drowning, bang‐stick accident, Spearfishing accident, etc.
Water quantities • Too much or scarcity of water. Examples: drowning, flooding, dehydration, overhydrating, etc.
Water and Health: Risks
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TITLE from VIEW and SLIDE MASTER | November 4, 20137 | 2010 Team SA
It’s not all diarrhea…It’s not all diarrhea…
TITLE from VIEW and SLIDE MASTER | November 4, 20138 | 2010 Team SA
Legionella species Common in outdoor reservoirs e.g. lakes or streams
Colonize and amplify in artificial water reservoirs e.g. potable water systems, cooling towers
Inhalation of water droplets with Legionella species Legionnaires’ disease Infections increase with wet humid weather
80% of Legionnaires’ disease outbreaks are associated with potable water systems in buildings
Water in buildings originates in outdoor reservoirs, as temperatures rise, more grow in pipes
~ 18,000 cases of Legionaries disease in USA/year
• 20% fatal if community acquired, 40% fatal if hospital acquired
Legionella spp. and Climate Change
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TITLE from VIEW and SLIDE MASTER | November 4, 20139 |
Transmission EM of Hartmannella vermiformis (A and B) and Human alveolar epithelial cells (C and D)Both are infected with L. pneumophila [at 4 h (A and C) and 12 h (B and D) post-infection]
Abu Kwaik Y et al. Appl. Environ. Microbiol. 1998;64:3127-3133
Legionella spp. can multiply intracellularly within protozoa
TITLE from VIEW and SLIDE MASTER | November 4, 201310 |
Oysters: Pearls and Perils
• Many studies report detection of pathogens from shellfish harvested in areas considered unpolluted
• Hepatitis• Norovirus• Adenovirus• Vibrio species• Salmonella enterica serotype Typhi
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TITLE from VIEW and SLIDE MASTER | November 4, 201311 |
Capillaria philippinensis – care for a little sushi?
TITLE from VIEW and SLIDE MASTER | November 4, 201312 |
Helicobacter PyloriHelicobacter Pylori
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TITLE from VIEW and SLIDE MASTER | November 4, 201313 |
Acute gastritis
Chronic gastritis
Atrophic gastritis
Hemorrhagic gastritis
Peptic ulcers
Acne rosacea?
Intestinal metaplastic atrophic gastritis
Reactive lymphoid hyperplasia
Mucosa-associated lymphoid tissue [MALT] lymphoma
Neoplasms?
Inflammatory and Neoplastic Lesions of Helicobacter pylori
Posselt et al. Cell Communication and Signaling 2013 11:77 doi:10.1186/1478-811X-11-77
TITLE from VIEW and SLIDE MASTER | November 4, 201314 |
Cryptosporidium (to Contrast With Cyclosporidium
Cryptosporidium (to Contrast With Cyclosporidium
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TITLE from VIEW and SLIDE MASTER | November 4, 201315 |
CyrptosporidiumCyrptosporidium
TITLE from VIEW and SLIDE MASTER | November 4, 201316 | 2010 Team SA
Routes for Fecal Contamination to Enter Humans
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TITLE from VIEW and SLIDE MASTER | November 4, 201317 |
In a Town in Hispanola With No Latrine
In a Town in Hispanola With No Latrine
TITLE from VIEW and SLIDE MASTER | November 4, 201318 | 2010 Team SA
Direct and Indirect Effects of Water issues on Growth and Development Direct and Indirect Effects of Water issues on Growth and Development
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TITLE from VIEW and SLIDE MASTER | November 4, 201319 | 2010 Team SA
Pathogen Infectious Dose 50
(# of Organisms)Shigella 10 to 102
EHEC Unknown (likely low)Campylobacter jejuni 102 to 106
Salmonella 105
Non-EHEC 108
Vibrio cholerae 108
Giardia lamblia 10 to 102 cystsEntamoeba histolytica 10 to 102 cystsCryptosporidium parvum 1 to 103 oocysts
ID50 for Representative Enteric Pathogens
TITLE from VIEW and SLIDE MASTER | November 4, 201320 |
THE INTESTINAL BARRIER
THE INTESTINAL BARRIER
Physical barrier:– Separates intestinal lumen from lamina
propria
– Biologically active• Changes daily and over years
– Has mucous coat: composed of mucins
– Motility
Three barriers Three barriers in 1:1. Physical barrier
• Non-immune barrier molecules
• Mechanical barrier
2. Innate immune barrier 3. Adaptive immune barrier.
3 FOR THE PRICE OF ONE!
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TITLE from VIEW and SLIDE MASTER | November 4, 201321 |
Surface and Mucosal Immunity to PathogensSurface and Mucosal Immunity to Pathogens
• Surfaces that confront outside side world • Skin
– Unique attributes Keratinized surface
Unique cells
Constantly exposed to microbes
• Mucosal areas– Components
GI
GU
Respiratory
Other: Eye, lactating breast, Ear
– Unique Attributes Unique cells
Constantly exposed to
» Secretory IgA
» Other secreted Ig
» Microbes (good & bad)
TITLE from VIEW and SLIDE MASTER | November 4, 201322 |
Serious Diseases
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TITLE from VIEW and SLIDE MASTER | November 4, 201323 | 2010 Team SA
Interrelated aspects of Infectious Disease
Properties of the organism (innate/acquired)
Properties of host (innate/acquired)
Physical factors: properties of the environment/micro-environment, season of year, dose received
“All Creatures Great and Small”
The three variables determine if an exposure/infection leads to clinical disease
TITLE from VIEW and SLIDE MASTER | November 4, 201324 | 2010 Team SA
Evolutionary Conflicts of Interest: – Needs of Host versus Needs of Pathogen
Pathogens evolve so that they can maximize their chance of growth and transmission
– Need Host for transmission decrease virulence
– Need water w/o host for transmission increase virulence
Natural selection is powerless to favor long-term stability if the variants that win in the short term destabilize the system
Wells and Water; Altering evolutionary pressure
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TITLE from VIEW and SLIDE MASTER | November 4, 201325 | 2010 Team SA
If contaminated water easily reaches the next victim, then the more virulent organism has an advantage
Waterborne Organism Waterborne Organism
TITLE from VIEW and SLIDE MASTER | November 4, 201326 | 2010 Team SA
Mortality and Waterborne nature of transmission of bacterial diarrheal diseases
Mortality and Waterborne nature of transmission of bacterial diarrheal diseases
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TITLE from VIEW and SLIDE MASTER | November 4, 201327 | 2010 Team SA
From Peru to neighboring nations, each with different levels of water sanitation/ safety
Vibrio cholerae
Vibrio cholerae
TITLE from VIEW and SLIDE MASTER | November 4, 201328 | 2010 Team SA Good Water Management System Decrease virulence
Virulence of Vibrio cholerae in Chile Virulence of Vibrio cholerae in Chile
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TITLE from VIEW and SLIDE MASTER | November 4, 201329 | 2010 Team SA Medium Water Management System No change in virulence
Virulence of Vibrio cholerae in PeruVirulence of Vibrio cholerae in Peru
TITLE from VIEW and SLIDE MASTER | November 4, 201330 | 2010 Team SA Poor Water Management System Increase in virulence
Virulence of Vibrio cholerae in EcuadorVirulence of Vibrio cholerae in Ecuador
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TITLE from VIEW and SLIDE MASTER | November 4, 201331 | 2010 Team SA
Changes in Virulence Alter Risk of Development of Antibiotic Resistance
TITLE from VIEW and SLIDE MASTER | November 4, 201332 | 2010 Team SA
Changes in Virulence alter risk of Antibiotic Resistance
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TITLE from VIEW and SLIDE MASTER | November 4, 201333 | 2010 Team SA
Sensitivity of Vibrio cholerae to Tetracycline1991-1993
TITLE from VIEW and SLIDE MASTER | November 4, 201334 | 2010 Team SA
Sensitivity of Vibrio cholerae to Tetracycline1997-1999
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TITLE from VIEW and SLIDE MASTER | November 4, 201335 | 2010 Team SA
Mosquito Problem Malaria ProblemAlabama 1940’s after creation of Wilson Dam
TITLE from VIEW and SLIDE MASTER | November 4, 201336 | 2010 Team SA
Plasmodium infection in Alabama pre and post use Mosquito proofing homes, offices, hospitals
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TITLE from VIEW and SLIDE MASTER | November 4, 201337 | 2010 Team SA
Information Transfer and Water Health IssuesInformation Transfer and Water Health Issues
TITLE from VIEW and SLIDE MASTER | November 4, 201338 | 2010 Team SA
More people have access to safe drinking water & sanitation but population growth eclipses these accomplishments 1/6 (1.1 billion) of world population lacks access to improved water supply, 2/5 (2.4 billion) have no improved
sanitation. Most of these people live in Asia and Africa. Rural services lag far behind urban services
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TITLE from VIEW and SLIDE MASTER | November 4, 201339 | 2010 Team SA
Information transfer and disease prevention
Information transfer and disease prevention
World Water Day - 22 March (every year since 1992)
UN-Water Activity Information System (UNW-AIS)
GEF IW:LEARN (International Waters Learning Exchange & Recourse Network)
Stakeholder Dialogues / Communications / Agreements
TITLE from VIEW and SLIDE MASTER | November 4, 201340 | 2010 Team SA
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TITLE from VIEW and SLIDE MASTER | November 4, 201341 | 2010 Team SA
Information transfer and disease prevention
Information transfer and disease prevention
UN-Water: – Members: 31 United Nations Organizations are members
• responsible for major funds and programs, specialized agencies, regional commissions, United Nations conventions and other entities within the UN system.
– Special Partners: 5 partners with Special Status
– Partners, General: 23 non-UN partner organizations
TITLE from VIEW and SLIDE MASTER | November 4, 201342 | 2010 Team SA
Thickness of line represents quantity of common activities between members & partners
UN-WaterUN-Water
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TITLE from VIEW and SLIDE MASTER | November 4, 201343 |
TITLE from VIEW and SLIDE MASTER | November 4, 201344 | 2010 Team SA
Type of Disease Description
Waterborne• Diseases transmitted by swallowing contaminated drinkingwater. Examples: cholera, typhoid
fever, cryptosporidiosis, botulism, toxins in water (e.g. Arsenic), cryptosporidiosis
Water‐carried
• Diseases acquired by accidental drinking, inhaling, or exposure to, contaminated recreational
water. Examples: cryptosporidiosis, giardiasis, Pseudomonas dermatitis, Free‐living amoeba,
Vibrio vulnificus in seawater
Water‐unwashed
• Diseases transmitted as a result of poor sanitation from inadequate quantities or quality of
water for washing hands, utensils, meats, vegetables, etc. Examples: shigellosis, hepatitis A,
hepatitis E, cyclosporiasis
Water‐based• Diseases by pathogens with an obligatory life‐cycle phase in creature that lives in water.
Examples: Diphyllobothrium infection, schistosomiasis, dracunculiasis, fascioliasis, anisakiasis
Water‐life carried• Diseases by pathogens that infect sea‐life, but are not obligatory life‐cycle phase‐based
pathogens. Examples Enteric viruses in shellfish, Hepatitis A or Vibrio vulnificus in Oysters
Water‐droplet inhaled or sully wound/mucosa
• Disease by pathogens carried in water vapor and inhaled or contaminatewound or via mucosa
Example: Legionellosis, meliodosis, Buruli ulcer
Water‐vectored• Diseases transmitted by arthropods that breed or bite in or near water Examples: yellow fever,
dengue, malaria, onchocerciasis, African trypanosomiasis, Loiasis
Water‐infected
• Diseases transmitted by preharvest pathogen contamination of edible portions of plants with
impure water, via their root systems (and to less degree via leaves). Example Escherichia coli
O157:H7, Salmonella, and Listeria monocytogenes,
Toxic Water Creatures• Disease from consuming sea‐life that produces or has ingested toxins (Biomagnification)
Examples: Puffer fish, Mercury in Fish, Ciguatera in Fish
Dangerous Marine life• Sea creatures may attack / defend themselves Examples: Sharks, electric eels, sting rays,
jellyfish
Water‐accident• Trauma/injury related to water‐related activities/accidents, or Examples: boating injuries,
drowning, bang‐stick accident, Spearfishing accident, etc.
Water quantities • Too much or scarcity of water. Examples: drowning, flooding, dehydration, overhydrating, etc.
Water and Health: Risks
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TITLE from VIEW and SLIDE MASTER | November 4, 201345 | 2010 Team SA
Water and Health: PreventionType of Disease Interception
Waterborne• Provide clean drinking water
Water‐carried• Inform about contaminated water areas, who is and who is not at risk from certain organisms
in water, clean and monitor swimming pools
Water‐unwashed • Provide clean water for sanitation of persons, animals, foods, and things
Water‐based• Interrupt the life cycle (e.g. do not allow contaminated persons to place their body
parts/fluids in water source for other host species)
Water‐life carried• Clean up natural reservoirs, avoid polluting waters
Water‐droplet inhaled• Clean up natural reservoirs, assure clean water in air‐condition units, air‐filters
Water‐vectored• Control of vectors (mosquito nets, biologic control)
Water‐infected• Assure clean water for crops
Toxic Water Creatures• Inform and Avoid seafood known to contain toxins, have food prepared by expert Fugu chef
Dangerous Marine life• Inform and Avoid areas with aggregates of dangerous animals, use shark‐repellant,
Water‐accident• Inform and Follow Standard precautions as per sport/activity,
Water quantities
• Inform and Evaluate Risks; engineering solutions to provide sufficient water and structures to
prevent flooding, building codes, desalinization, water‐rights issues/political negotiations
TITLE from VIEW and SLIDE MASTER | November 4, 201346 | 2010 Team SA
Water Health is a multifaceted problemthat requires a multifaceted approach involving diverse specialists
Beware of potential unintended consequences
Harness Evolutionary Pressures
Health Promotion for Water Safety Requires Knowledge transfer to
– Policy makers
– Health care workers
– Engineers, Scientists, Architects, Developers
– The public
SummarySummary
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TITLE from VIEW and SLIDE MASTER | November 4, 201347 | 2010 Team SA
Questions? Questions? Questions? Questions? Questions? Questions?