Waterborne InfectionsWaterborne Infections
Create an environment to Create an environment to maintain ecological conditions to maintain ecological conditions to promote health and prevent promote health and prevent diseasedisease
Public Health issue: Safe drinking Public Health issue: Safe drinking water and proper sanitationwater and proper sanitation
WaterWater
International Drinking Water Supply International Drinking Water Supply and Sanitation decade: 1981-1990and Sanitation decade: 1981-1990
34 World Health Assembly 34 World Health Assembly emphasized that safe drinking water emphasized that safe drinking water is a basic element of primary health is a basic element of primary health care – key to attainment of Health for care – key to attainment of Health for allall
Safe Drinking WaterSafe Drinking Water
Free from pathogenic agentsFree from pathogenic agents Free from harmful chemicalsFree from harmful chemicals Pleasant to tastePleasant to taste Usable for domestic purposesUsable for domestic purposes
Water requirementWater requirement
2 litres per head per day: Basic 2 litres per head per day: Basic physiological requirementphysiological requirement
PH: Adequate water supply to PH: Adequate water supply to maintain proper hygienemaintain proper hygiene
15-200 l/per capita adequate15-200 l/per capita adequate India 40 l/ capita target India 40 l/ capita target
Sources of Water SupplySources of Water Supply RainRain Surface: Surface:
Impounding reservoirsImpounding reservoirsRivers and StreamsRivers and StreamsTanks/ Ponds/ LakesTanks/ Ponds/ Lakes
Ground waterGround waterShallow wellsShallow wellsDeep wellsDeep wellsSpringsSprings
Water PollutionWater Pollution
Gases: Nitrogen, Carbon Gases: Nitrogen, Carbon dioxide, Hydrogen Sulphidedioxide, Hydrogen Sulphide
Minerals: Salts of Ca, MgMinerals: Salts of Ca, Mg Suspended impurities: Clay, Suspended impurities: Clay,
Silt, Sand, MudSilt, Sand, Mud MicroorganismsMicroorganisms
Water Pollution due to Water Pollution due to UrbanizationUrbanization
Sewage: Decomposable Sewage: Decomposable organic matter and microbesorganic matter and microbes
Industrial and trade wastesIndustrial and trade wastes Agricultural pollutantsAgricultural pollutants PhysicalPhysical
Health HazardsHealth Hazards 60% towns getting adequate water60% towns getting adequate water Low daily per capita supplyLow daily per capita supply Inefficient distributionInefficient distribution LeakageLeakage Progress in rural sector very slowProgress in rural sector very slow Few Sewage treatment plantsFew Sewage treatment plants Poor hygiene: Poorly designed/ Poor hygiene: Poorly designed/
maintained sewage systemmaintained sewage system Fertilizer: Human discardFertilizer: Human discard
Diarrhea and intestinal worm Diarrhea and intestinal worm infestation: 10% total burden infestation: 10% total burden of disease in the developing of disease in the developing world.world.
Inadequate water supply Inadequate water supply increases risk of increases risk of Schistosomiasis, guinea Schistosomiasis, guinea worm disease, skin and eye worm disease, skin and eye infections.infections.
Population with Access to Population with Access to Safe Water (%)Safe Water (%)
IndiaIndia 8585 BangladeshBangladesh 8080 IndonesiaIndonesia 6363 NepalNepal 4848 MaldivesMaldives 8888 SriLankaSriLanka 5757 ThailandThailand 7070
Population with Access to Population with Access to Adequate SanitationAdequate Sanitation
IndiaIndia 2929 BangladeshBangladesh 3030 IndonesiaIndonesia 5151 NepalNepal 2222 MaldivesMaldives 4040 SriLankaSriLanka 6666 ThailandThailand 7474
BacteriaBacteria Vibrio choleraeVibrio cholerae SalmonellaSalmonella CampylobacterCampylobacter ShigellaShigella diarrheogenic Escherichia coli.diarrheogenic Escherichia coli. Legionella pneumophilaLegionella pneumophila M. xenopi, M. abscessus, M. M. xenopi, M. abscessus, M.
fortuitumfortuitum, and , and M. chelonaeM. chelonae LeptospiraLeptospira
VirusesViruses Hepatitis A and EHepatitis A and E Polio virusPolio virus Rotavirus, Adenovirus, Norwalk Rotavirus, Adenovirus, Norwalk
agent agent
AETIOLOGICAL AGENTS
HelminthicHelminthic RoundwormRoundworm WhipwormWhipworm Hydatid DiseaseHydatid Disease
ProtozoalProtozoal Giardia lambliaGiardia lamblia Entamoeba histolyticaEntamoeba histolytica AcanthamoebaAcanthamoeba,, HartmannellaHartmannella Naegleria fowleriNaegleria fowleri CyclosporaCyclospora IsosporaIsospora CryptosporidiumCryptosporidium MicrosporidiaMicrosporidia
Bacterial infectionsBacterial infections Presenting symptomsPresenting symptoms: :
Diarrhea: CholeraDiarrhea: Cholera Dysentery: ShigellosisDysentery: Shigellosis Flu like illness (Pontiac fever)Flu like illness (Pontiac fever) Pneumonia (Legionnaire’s disease)Pneumonia (Legionnaire’s disease) Bacteremia (Typhoid)Bacteremia (Typhoid) Septicemia (Leptospira)Septicemia (Leptospira)
CholeraCholera
7 Pandemics: Last in 19617 Pandemics: Last in 1961 Vibrio choleraeVibrio cholerae O1, non O1, O1, non O1,
O139O139 Transmission via water Transmission via water
contaminated with faecescontaminated with faeces Rice Water StoolsRice Water Stools Dehydration, electrolyte Dehydration, electrolyte
imbalanceimbalance
TyphoidTyphoid Systemic infectionSystemic infection Salmonella Salmonella TyphiTyphi Can be sporadic, epidemic, endemicCan be sporadic, epidemic, endemic Endemic in IndiaEndemic in India Man is the only reservoirMan is the only reservoir Peaks in July-SeptemberPeaks in July-September Transmisison Feco-oral. Directly or indirectly Transmisison Feco-oral. Directly or indirectly
by ingestion of contaminated wtare/ by ingestion of contaminated wtare/ milk/foodmilk/food
Continuous fever- 3-4 weeksContinuous fever- 3-4 weeks Involvement of Lymphoid tissueInvolvement of Lymphoid tissue
Viral InfectionsViral Infections
GastroenteritisGastroenteritis PolioPolio HepatitisHepatitis
Parasitic InfectionsParasitic InfectionsGastrointestinal disturbancesGastrointestinal disturbancesEncephalitisEncephalitis
PoliomyelitisPoliomyelitis Acute viral infectionAcute viral infection Infection of alimentary canal.Infection of alimentary canal. CNS affected in 1%; paralysis, deathCNS affected in 1%; paralysis, death Feco-oral transmisison. Survives long in Feco-oral transmisison. Survives long in
cold environment.cold environment. Occurs mostly in rainy seasonOccurs mostly in rainy season Environmental sources: Contaminated Environmental sources: Contaminated
Water, milk, foodWater, milk, food Droplet in fection in acute phase of Droplet in fection in acute phase of
diseasedisease
Viral HepatitisViral Hepatitis
Hepatitis AHepatitis A PicornavirusPicornavirus Fever, chills, generalized Fever, chills, generalized
malaise, vomiting, jaundicemalaise, vomiting, jaundice Mode of transmisison: feco-oralMode of transmisison: feco-oral Hepatitis E: First major epidemic Hepatitis E: First major epidemic
in Delhi in 1955in Delhi in 1955
AmoebiasisAmoebiasis
Entamoeba histolytica Entamoeba histolytica Diarrhea – Diarrhea – dysentrydysentry
Infective form: cyst Infective form: cyst Feco-oral Feco-oral transmissiontransmission
GiardiasisGiardiasis
Giardia lamblia Giardia lamblia Abdominal discomfort- Abdominal discomfort- diarrheadiarrhea
Feco-oral transmission Infective form-CystFeco-oral transmission Infective form-Cyst
DiagnosisDiagnosis Signs and symptomsSigns and symptoms Laboratory diagnosisLaboratory diagnosis
Sample collectionSample collection Transport Transport MicroscopyMicroscopy CultureCulture Serological assaysSerological assays Molecular diagnosisMolecular diagnosis
