Surveillance of waterborne diseases

Implementation of the Protocol on Water and Health

Mihály Kádár

National Institute of Environmental Health, Budapest

ISEE, Balatonfödvár, 4-6 September, 2003

Main objectives of the Protocol • To promote prevention, control and reduction of water-

related diseases throughout the WHO/Euro region by:– Ensuring adequate drinking water supplies and sanitation;– Effective systems for surveillance and monitoring of water

supply and services;– Giving special consideration to vulnerable groups of

population;– Providing the public with information and raise public

awareness;– Enhancing international cooperation in pursuing the above

objectives;– Reviewing and assessment of progress.

Footsteps of work under the Protocol

– 1st Meeting of the Signatories to the Protocol Budapest, November, 2002;– 1st Meeting of the Working Group of Water and Health, Budapest, May,

2001;– 2nd Meeting of the Working Group of Water and Health, Budapest,

October, 2002;

– Small WG Meeting on the Evidence Base and Develoment of a Reporting Scheme for WRD;

– Experts Worskhop on Goals and Strategies for WRD Surveillance;– Workshop on Health Risks in Aquifer Recharge– Workshop on Rapid Environmental Health Risk Assessment

– 2nd Meeting of the Signatories to the Protocol, Geneve, July, 2003.

Draft Guidelines of the Surveillance for Water Related Diseases (1)

Framework: HEALTHTARGETS

Risk Managemen

t

PUBLIC HEALTH STATUS

Assessment ofRisk

Draft Guidelines of the Surveillance for Water Related Diseases (2)

General overview:– Reactive system: monitoirng and management of WRD– Proactive systems: monitoring and management of water quality– Multi-level institutional outline and legal-political background

Water-borne infectious diseases:– priority groups of pathogens/events in Europe and symptom-based definitions– Managing information: sources and reporting– Outbreak investigation

Water-borne diseases caused by chemical substances:– Origin/ways of contamination– Monitoring strategies for chemicals and their health effects

Draft Guidelines of the Surveillance for Water Related Diseases (3)

Proactive surveillance-monitoring:– HACCP principle as an operational basis– Most important groups of the Critical Control

Points of a water supply system:• Source and catchment• Chain of treatment• Distribution system components and environment• Domestic plumbing system and points of use

WatSan_P1: Waste water treatment coverage

Year

Percent of population withsecondary sewage treatment

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

1996 1997 1998 1999 2000 2001

WatSan_S1:Exceedance of recreational water

limit values for microbiological parameters

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

1999 2000 2001

Year

Percent of exceedances

WatSan_S2: Exceedance of WHO drinking water guidelines for microbiological parameters

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

1997 1998 1999 2000 2001

Percent of exceedances

Year

WatSan_S3: Exceedance of WHO drinking water guidelines for chemical parameters

27,0%

28,0%

29,0%

30,0%

31,0%

1997 1998 1999 2000 2001

Year

Percent of exceedances

WatSan_E1 Outbreaks of waterborne diseases

Year

Number of outbreaks by Number of cases byTotal

Drinking water

Recreational water

Drinking water

Recreational water

population

1996 0 1   25 10.432.233

1997 0 0     10.349.956

1998 0 0     10.317.458

1999 2 0 210   10.267.150

2000 0 1   36 10.239.790

2001 1 0 68   10.203.079

WatSan_E2  Diarrhoea morbidity in children

0,0500,0

1000,01500,02000,02500,03000,03500,04000,04500,0

1996 1997 1998 1999 2000 2001

Year

Case/100.000

THANK YOU FOR YOUR ATTENTION!