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Water Borne Diseases in the Pacific Region

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Water Borne Diseases in the Pacific Region ExamplesExamples ofof DiseasesDiseases AAssociatedssociated withwith WaterborneWaterborne TransmissionTransmission inin thethe PacificPacific IslandIsland RegionRegion Second Seminar on Water Management in Islands Coastal and Isolated Areas Noumea, New Caledonia, 26-28 May 2008 François FAO Public Health Surveillance and Communicable Disease Control Section Secretariat of the Pacific Community OutbreaksOutbreaks ofof communicablecommunicable diseasesdiseases withwith waterwater playingplaying aa potentialpotential oror majormajor rolerole inin thethe transmissiontransmission CholeraCholera TyphoidTyphoid feverfever LeptospirosisLeptospirosis MinistersMinisters ofof HealthHealth CommitmentCommitment ¾¾ YanucaYanuca (1995):(1995): ConceptConcept ofof ““healthyhealthy islandsislands”” == ecologicalecological modelmodel ofof healthhealth promotion.promotion. ““ HealthyHealthy islandsislands shouldshould bebe placesplaces where:where: z ChildrenChildren areare nurturednurtured inin bodybody andand mindmind z EnvironmentsEnvironments inviteinvite learninglearning andand leisureleisure z PeoplePeople workwork andand ageage withwith dignitydignity z EcologicalEcological balancebalance isis sourcesource ofof pridepride”” WhatWhat isis thethe PPHSN?PPHSN? ¾ PPHSNPPHSN isis aa voluntaryvoluntary networknetwork ofof countries/territoriescountries/territories andand institutions/institutions/ organisationsorganisations ¾ DedicatedDedicated toto thethe promotionpromotion ofof publicpublic healthhealth surveillancesurveillance && responseresponse ¾ CurrentCurrent focusfocus onon CDs:CDs: epidemicepidemic onesones firstfirst ¾ PPHSNPPHSN GoalGoal isis toto improveimprove publicpublic healthhealth surveillancesurveillance inin thethe PacificPacific Islands,Islands, inin aa sustainablesustainable wayway CholeraCholera VibrioVibrio choleraecholerae CHOLERA OUTBREAKS In the last 10 years, the following countries were affected by cholera . Country Year of Outbreak Comments Pohnpei, 2000 Serotype: Ogawa Federated States Cases: 3500 of Micronesia (*) of Micronesia (*) Deaths: 20 Marshall Islands 2000 Serotype: Ogawa Cases: > 300 Deaths: 6 (*) Environmental Protection Agency monitoring data between March 1999 and May 2000 showed that • Only 36 (40%) of 90 samples from community water supplies were free of faecal coliforms—a traditional indicator of faecal pollution. • Only 12 (42%) of 29 samples collected from individual household supplies were free from faecal coliforms • None of the 65 samples from Kolonia water supply contained any faecal coliforms, and over 64% of samples contained a residual of chlorine disinfectant CholeraCholera WhatWhat isis choleracholera ?? ¾ AcuteAcute painlesspainless waterywatery diarrhoeadiarrhoea (+/(+/-- vomiting)vomiting) SevereSevere casescases :: deadlydeadly dehydrationdehydration inin aa couplecouple ofof hourshours ¾ CausedCaused byby VibrioVibrio CholeraCholera serogroupserogroup 0101 oror 01390139 VibrioVibrio CholeraCholera 0101 hashas twotwo biotypes:biotypes: classicalclassical andand ElEl TorTor twotwo serotypes:serotypes: InabaInaba andand OgawaOgawa ¾ FaecalFaecal--oraloral transmissiontransmission throughthrough foodfood oror waterwater highlightshighlights placesplaces withwith hygienehygiene && sanitationsanitation problemsproblems ¾ Incubation:Incubation: aa fewfew hourshours toto 55 daysdays (aver.2(aver.2--33 days)days) ¾ HighlyHighly infectiousinfectious ~~ manymany asymptomaticasymptomatic infectionsinfections withwith ElEl TorTor ¾ TransmittedTransmitted byby humanshumans toto humanshumans CholeraCholera WhatWhat areare thethe controlcontrol measuresmeasures ?? AggressiveAggressive measuresmeasures forfor control:control: ¾ earlyearly treatmenttreatment withwith ORSORS && IVIV fluidsfluids (+(+ antibiotics)antibiotics) decentralised,decentralised, withwith activeactive casecase--searchingsearching ¾ healthhealth educationeducation disease,disease, hygienehygiene (personal,(personal, water,water, food),food), sewagesewage disposal,disposal, earlyearly treatmenttreatment ¾ ensureensure safesafe waterwater supplysupply ¾ ensureensure safesafe sewagesewage disposaldisposal CholeraCholera PotentialPotential risksrisks forfor choleracholera spreadspread inin thethe Pacific:Pacific: •• CholeraCholera endemicendemic inin manymany ofof thethe countriescountries surrounding/havingsurrounding/having linkslinks withwith thethe PacificPacific IslandsIslands •• TravelTravel ++:++: eextensivextensive airair traveltravel transporttransport ofof personalpersonal foodfood itemsitems shipsships andand fishingfishing boatsboats •• ManyMany receptivereceptive environmentsenvironments inin thethe PacificPacific Islands,Islands, withwith water,water, sanitationsanitation andand hygienehygiene problems,problems, asas wellwell asas somesome receptivereceptive culturalcultural practicespractices (e.g.(e.g. feasts,feasts, funerals,funerals, kava)kava) TyphoidTyphoid feverfever SalmonellaSalmonella typhityphi TYPHOID FEVER OUTBREAKS:1999-2008 Country Year of Outbreak Comments PNG 1999-2008 Endemoepidemic 10/1000 cases per year includes many small outbreaks It is among the 10 top causes of death in PNG Outbreaks in a school & 2004 prison Nauru 1999 (March) 50 cases Tonga 1999 (April) 14 cases Samoa 2000 (July) 122 cases 1 death Vanuatu 2000 (Dec) Small outbreak: 26 cases Tuvalu 2001 (May) ~ 22 cases 6 hospitalised. Fiji 2005-on-going ~100-200 cases per year since 2005 Now endemoepidemic, especially in Vanua Levu TyphoidTyphoid FeverFever What is typhoid fever? ¾ infectious disease caused by bacteria (Salmonella Typhi). ¾ very serious disease that leads to death in 10% to 20% of untreated patients. If patients are treated promptly with the right antibiotics, less than 1% die. How do people get typhoid fever? ¾ By eating food or drinking water contaminated by stool or urine from other infected persons. ¾ Only humans can carry the bacteria; animals do not play a role. ¾ People can become chronic carriers: these people shed the bacteria but are not ill themselves. TyphoidTyphoid FeverFever How can typhoid fever be prevented? ¾ Good personal hygiene, use of safe water, and good sanitation: ¾ People must always wash their hands with soap and water after each toilet visit and before each meal. ¾ Food should be prepared hygienically: wash hands before handling food, eat food while it’s still hot, cover food to protect from flies, and don’t use unsafe water. Known Salmonella Typhi carriers should not be allowed to prepare food for others. ¾ People should be very careful to keep feces and urine away from water and food. Never use a river as a toilet! Instead, people should only use latrines or toilets. ¾ Unsafe water (e.g. from rivers, creeks, or unsafe wells) should be boiled or treated with chlorine before drinking. Rainwater and ground water can be safe, provided it is collected correctly. ¾ Mothers should breastfeed their babies and not use powdered baby formula. LeptospirosisLeptospirosis LeptospiraLeptospira LEPTOSPIROSIS CASES & OUTBREAKS: 1995-2008 Country Year of Outbreak Comments Vanuatu 1997 Small OB- 8 confirmed cases New Caledonia Sporadic cases all over the year with annual seasonal outbreaks in February- March-April, and a geographical concentration in Bourail commune. 1995 92 notified cases 1996 139 notified cases, with 6 deaths 1997 207 notified cases, with 3 deaths 1998 132 notified cases, with 3 deaths 1999 200 notified cases, with 19 deaths 2000 82 notified cases, with 1 death 2001 129 notified cases, no death 2002 50 notified cases, with 2 deaths 2003 13 notified cases, with 1 death 2004 13 notified cases, no death 2005 40 notified cases, with 1 death 2006 65 notified cases, with 2 deaths 2007 53 notified cases, with 1 death 2008 (until May) 105 notified cases, with 3 deaths LEPTOSPIROSIS CASES & OUTBREAKS: 1995-2008 (ctd) Country Year of Outbreak Comments Fiji 1998-99-2000 Large outbreak with 141 cases, 42 deaths 2003 Endemoepidemic: small outbreaks with 2006 (April) deaths, often linked to flooding 2007 FSM-Kosrae 2000 (April-May) Small OB , 10 cases Palau 2000 (April) 3 confirmed cases CNMI 2000-2001 Outbreak, with 10 cases confirmed. Guam 2002 21 cases through recreational sport Wallis & Futuna 2004 – on-going Endemoepidemic in Futuna (around 20- 60 cases per year) 2008 (until March) 33 cases Distribution of Animal Leptospirosis [SPC Animal Health & Production Service: www.spc.int/rahs] LeptospirosisLeptospirosis WhatWhat isis LeptospirosisLeptospirosis ?? ¾ Most widespread zoonosis ¾ Long survival in fresh water, soil and mud. ¾ Longer survival of leptospires in warm & wet environment Predominant and rather seasonal in tropical settings, e.g. SE Asia, Pacific Islands (“endemo-epidemic” profile) ¾ Seasonal: summer and fall in temperate climates rainy season under warm climate flooding LeptospirosisLeptospirosis How do people get leptospirosis fever? ¾ General susceptibility in humans, though significantly less frequent in children and more in some professional groups ¾ Primarily transmitted by direct contact with the urine (& kidney & bladder) of infected animals (prefers alkaline urine). ¾ Mode of entry: 9 Mainly: abrasions/cuts in skin & mucosa, and conjunctiva 9 Others possibilities: water-borne; inhalation of water/aerosols; animal bites; direct inter-human transmission ¾ Main source of infection 9 Direct: reservoirs (maintenance hosts) 9 Indirect: surface water, mud, soil (from reservoir) Cattle, pigs, cows, … Leptospires Domestic RODENTS Animals Environment (water, mud) Humans Wild Fauna Toads
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