September 29, 2003 JEMH van Bronswijk, TU/e 1

Health risks from waterHealth risks from water

Opportunities & Problems

September 29, 2003 JEMH van Bronswijk, TU/e 2

Water is LifeWater is Life

• Human = 65% H2O• Minimal Daily loss: 1 kg H20 / person• Maximal Hourly loss: 10 kg H2O / person• Loss to be replenished by eating & drinking• Human <60% H20: in danger zone

September 29, 2003 JEMH van Bronswijk, TU/e 3

Potable WaterPotable Water

• Perishable Commodity (< 24 Hours)• Keep cool or add Chlorine or active oxygen-derivate• Keep Running• Bio-film development on Surfaces

08-06-02 7s640-6biolag: J.E.M.H. van Bronswijk

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Healthy and Sustainable BuildingHealthy and Sustainable Building

Potable WaterPotable Water

Disease Risks:- Veteran’s Disease caused by Legionella- Infections / Intoxications of ‘Household Water’ (= 2nd quality water)

Prevention:- Keep potable water supply below 18°C at all times- Mark each ‘Household Water’ outlet individually and clearly- Stimulate distinguishable odour and taste of 1st & 2nd quality water- Make disconnecting of 2nd quality water-systems easy- Inform consumer

08-06-02 7s640-6biolag: J.E.M.H. van Bronswijk

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Healthy and Sustainable BuildingHealthy and Sustainable Building

Hot WaterHot Water Disease Risks:- Scalding - Veteran’s Disease caused by Legionella- Pontiac Fever caused by Legionella- Atopic Disease through lack off mite extermination at laundering- Humidifier Disease through antigens of micro-organisms

Prevention:- Install thermostatic mixing faucet- Replace boiler by geyser with a short hot water conduct- Install facility for washing machine with extra water heating (>60oC)- Inform consumer

September 29, 2003 JEMH van Bronswijk, TU/e 6

LegionellaLegionella Risk Risk

• Veteran’s Disease & Pontiac Fever• Lung infection (Shower, Air-Conditioning, Cooling Towers)• 18oC < Bacterial Growth < 60oC• Bacterial Survival up to 65oC• Viable Legionella present in surface & coastal waters

September 29, 2003 JEMH van Bronswijk, TU/e 7

• 950-990x cases of Pontiac Fever• 9-30x surviving Veteran-Disease

patients, but with persisting chronic symptoms

• 1-20x fatal cases

1000 1000 LegionellaLegionella-infections-infections

Source: JEMH van Bronswijk e.a. 1999. Gezond en Duurzaam Bouwen (GeDuBo). Research Reportfor the Netherlands Ministry of Housing

Legionellosis Risk ClassesLegionellosis Risk Classes

JEMH van Bronswijk, October 9, 1999

Source: CJPA Hoebe, JJM Cluitmans, JHT Wagenvoort, WJ van Leeuwen, MAJ Bilkert-Mooiman 1999. Koud leidingwater als bron van fatale nosocomiale pneumonieën door Legionella pneumophila in een revalidatiekliniek. Nederl. Tijdschr. Geneesk. 143(20):1041-1045

cfu / l water healthy young adults YOPI

(Young, Old, Pregnant, Immuno-Suppressed)

0-100* no risk no risk 101-1,000 no risk moderate risk

1,001-10,000 moderate risk high risk > 10,000 high risk very high risk

* Netherlands Hygienic limit (1999) = 50 cfu / l water

September 29, 2003 JEMH van Bronswijk, TU/e 9

LegionellosisLegionellosis

• Since the 1986 report of the Health Administration 5,000+ preventable deaths occurred in NL

• For each Legionella death 50 to 1,000 persons are diseased

• Risk in modern dwellings and in hospitals is comparable

• Preventive technology is available

September 29, 2003 JEMH van Bronswijk, TU/e 10

LegionellaLegionella extermination extermination

* Use a thermostatic mixing tap with automatic emptying, to prevent both burns and a Legionella infection!Source: Report Gezondheidsraad 1986; Pubmed 1995-1999

• At temperatures >64°C no breathing of Legionella occurs*

• No growth <18°C; Legionella remains vital• 0.5 mg free chlorine / l water kills bacteria• Copper or silver-ions in the water

decrease growth

September 29, 2003 JEMH van Bronswijk, TU/e 11

Waste WaterWaste Water• Bathroom, Toilet, Kitchen: Human pathogens from man & pets (also SARS)• (Run-off) Rainwater: Human pathogens from birds & rodents• Waste water is a breeding ground for biting insects & a domain of rodents: keep is covered

September 29, 2003 JEMH van Bronswijk, TU/e 12

Outdoor WaterOutdoor Waterrisks & opportunitiesrisks & opportunities

• Visual Comfort• Water Management• Recreation• Diarrhoea (e.g. Escherichia coli, Salmonella)• Weil’s Disease• Temperate-region Malaria (brackish water)•SARS ?

09-04-01 7s640-3biolag: J.E.M.H. van Bronswijk

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Causes of Summer FluCauses of Summer FluInfectious Bacterial Gastro-EnteritisInfectious Bacterial Gastro-Enteritis

Source: NRH Burgess 1990. Public Health Pests. Chapman & Hall, London; E Eyskens, L Feenstra,AE Meinders, JP Vandenbroucke 1991. Codex Medicus. 9e druk. Elsevier, Amsterdam

1. Campylobacter jejuni (incubation period: 24 - 72 Hrs) Duration of illness: 1 - 4 Days; Infected food: chicken, milk, waterVectors: fly, rat, mouse, cockroach, rain water, 2nd quality water

2. Clostridium perfringens (incubation period: 8 - 24 Hrs) Duration of illness: < 7 Days; Infected food: too slowly chilled dishesVectors: fly, rat, mouse, cockroach, human hands

3. Salmonella (incubation period: 8-48 Hrs)Duration of illness: 5 - 7 Days; Infected food: meat dishes, waterVectors: fly, rat, mouse, cockroach, rain water, 2nd quality water

4. Staphylococcus aureus (incubation period: < 6 Hrs)Duration of illness: < 24 Hrs; Infected food: milk products, meat dishesVectors: fly, rat, mouse, cockroach, human hands

September 29, 2003 JEMH van Bronswijk, TU/e 14

Weil’s DiseaseWeil’s Disease• First described by Adolf Weil (1848-1916) in

Wiesbaden (Germany)• Infection with Leptispira ictero-haemorrhagiae• Human disease after contact with urine of

infected rodents such as the Norway Rat (Rattus norvegicus); most common in Zuid-Holland

• Symptoms and Course: incubation period of 2-20 days; followed by 4-9 days with severe flu-like symptoms; may develop from 6th-12th day of illness into meningitis, as well as damage to liver, kidneys and heart

September 29, 2003 JEMH van Bronswijk, TU/e 15

Preventing Weil’s DiseasePreventing Weil’s Disease• *Minimize open water in residential areas• **Open city water should have steep banks• Mow banks of city water 2x yearly• Keep city water deep (> 3 m)• Exterminate Rattus sp in residential areas• Inform consumers

Number of drowned children will:* decrease** increase

08-06-02 7s640-6biolag: J.E.M.H. van Bronswijk

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Healthy and Sustainable BuildingHealthy and Sustainable Building

Open Water in Cities & TownsOpen Water in Cities & Towns

Disease Risks:- Weil’s Disease- Papular Urticaria due to mosquitoes and biting flies- Re-introduction of temperate-region malaria (only in brackish areas)

Prevention:- Fill up marshy fields and stagnant waters in living areas- Refrain from introducing water-purifying marshes in living areas- Can marshes or ponds not be avoided: install rat & mosquito extermination program- Prevent mosquitoes & black flies from entering the house (fixed insect screens in windows & doors)- Inform consumer

September 29, 2003 JEMH van Bronswijk, TU/e 17

September 29, 2003 JEMH van Bronswijk, TU/e 18

Dutch Anti-malaria Poster Dutch Anti-malaria Poster from the 1st half of the 20from the 1st half of the 20thth century century

Ziet gij muggen lang van pootAarzelt niet, maar slaat ze dood

Translation:Do you see mosquitoes long of legs ?

Don’t wait, squeeze them to death