The Domestic Impact of Climate Change: U.S. Perspective on Waterborne

Michael J. Beach, Ph. D. Centers for Disease Control and Prevention Potential U.S. Health Effects of Climate Change

Heat stress, cardiovascular HEAT  failure SEVERE WEATHER  Injuries, fatalities Asthma, cardiovascular AIR  Climate change: disease Respiratory allergies, poison ALLERGIES  ivy • Temperature rise Malaria, dengue, VECTOR-BORNE  encephalitis, hantavirus, Rift • Sea level rise Valley fever • Hydrologic Cryptosporidiosis, Naegleria, WATER-BORNE DISEASES  Campylobacteriosis, extremes vibriosis leptospirosis Malnutrition, diarrhea, algal WATER AND FOOD SUPPLY  blooms, -related disease Anxiety, post-traumatic  stress, despair, depression Forced migration, civil Adapted from J. Patz ENVIRONMENTAL REFUGEES  conflict Potential Climate Change-related Events Impacting Waterborne Disease

• Environmental change/disturbance • Extreme weather events • Flood: CSO, SSOs • Drought: soil/geologic changes • Re-use of water and wastewater • Urbanization • Increased cooling system usage • Exploitation of man-made habitats • Legionella, Mycobacterium Potential Climate Change-related Events Impacting Waterborne Disease

• Increasing water temperatures and/or nutrients • Enhanced growth of pathogens • Naegleria, Vibrio, Pseudomonas, HAB • HAB-Related Illness Surveillance System (HABISS) • Environmental data, animal and human illness • All recreational water indicators Increasing recreational activities • Swimming pools, ambient waters How Can Changes in Waterborne Disease Transmission Be Monitored? Waterborne-Disease Surveillance: Real World

• Not all water-related pathogens and chemicals are nationally notifiable • Most water-related pathogens and chemicals have multiple modes of transmission • Most individual cases are not investigated so mode of transmission is unknown • Reported cases represent only a small portion of the burden of disease • Water quality databases have no connection to health effects data 60

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40

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20 Are There Surrogates for Number of WBDOS_ 10

0 Waterborne Disease Case 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001* 2004 Year Reporting?

• Outbreaks can serve as indicators for trends in waterborne disease transmission in the U.S. and can connect health effects with water quality data National Waterborne Disease and Outbreak Surveillance System

• Collaborative surveillance system • CDC, EPA, CSTE since 1971

• State/local DOH’s have 10 responsibility for detecting, investigating, reporting WBDOs Waterborne Disease and Outbreak Surveillance System: Usefulness • Disease control • Identify contaminated water sources • Knowledge of disease causation • Identify etiologic agents (old and new) • Trend identification • Etiologic agents, water sources, deficiencies • Guidance and evaluation • Evaluate the adequacy of current technologies for providing safe water • Establish research priorities • Assess effectiveness of water regulations/codes Drinking Water-Associated Outbreaks, United States, 1971-2004

60 Public, surface water Private, groundwater

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20 Number of WBDOS_

10

0 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001* 2004 Year N=803, MMWR (2006) 55(SS12):31-65 •Beginning in 2003, mixed agents of more than 1 etiologic agent type were included in the surveillance system. However, the first observation is a previously unreported outbreak in 2002. •† Beginning in 2001, Legionnaires’ disease was added to the surveillance system, and Legionella species were classified separately in this figure. Opportunities for Improvement: Needed ASTHO Assistance

• Support CSTE in making WBDO’s nationally notifiable in your state • Support deployment of National Outbreak Reporting System (NORS) from CDC • Expanded version of Foodborne Outbreak Reporting System (eFORS) • Put an emphasis on improved detection, investigation, and reporting of WBDOs • Training • Improved risk factor data collection Acknowledgements

DPD • Michael Beach • Sharon Roy • Jonathan Yoder • Michele Hlavsa

EPA • Rebecca Calderon • Gunther Craun Newly Required Disclaimer From the Department of Health and

• "The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy“