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Recreational Water and Prevention of Waterborne Disease Transmission

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Recreational Water and Prevention of Waterborne Disease Transmission The Domestic Public Health Impact of Climate Change: U.S. Perspective on Waterborne Disease Transmission 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 POLLUTION Climate change: disease Respiratory allergies, poison ALLERGIES ivy • Temperature rise Malaria, dengue, VECTOR-BORNE DISEASES 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, hygiene-related disease Anxiety, post-traumatic MENTAL HEALTH 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 50 40 30 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 50 40 30 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 Human Services • "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“.
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