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Water Borne Diseases

Typhoid, Acute diarrhoeal diseases,

Hepatitis A and Cholera are major
diseases. Food poisoning cases are also
reported. Scarcity of drinking water, poor
sanitation and contaminated water
sources are main risk factors of these
diseases. Out breaks of Hepatitis-A had been reported from Ernakulam, Thrissur, Malappuram, Wayanad,
Kozhikode, Kannur, Alappuzha and Kottayam. Hepatitis E
cases were also reported from some districts.
Typhoid outbreaks were reported from Wayanad,
Malappuram and Kannur districts.

Hepatitis A is a viral liver disease that can cause mild to severe illness. The disease is closely associated with poor sanitation and a lack of personal
hygiene habits. The symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal
discomfort, dark-colored urine and jaundice. Recovery from symptoms following infection may be slow and take several weeks or months. Hepatitis A
vaccine is available for use where improvements in sanitation and provision of clean water are challenging.
leptospirosis, typhoid
Hepatitis A
The report says that the number of people infected with hepatitis A in the district has increased from 145 in 2010 to 734 in 2011 and
has touched 764 till September 2012. The number of people infected with hepatitis A from Kollam district in 2011 was nearly 16 per
cent of the total figure of the State. The trend is continuing this year too.
Hepatitis A is associated with inadequate water supply, poor sanitation and poor hygiene leading to infection and inflammation of
the liver. The disease is often transmitted through contaminated water and food.
The report says that the number of typhoid cases reported to the Kollam unit of the Integrated Disease Surveillance Project (IDSP)
has increased from 28 in 2010 to 62 in 2011 and touched an alarming 113 till September this year. Typhoid is caused by bacteria
transmitted from faeces to ingestion. Contaminated water is one of the pathways for transmission of the disease. People become
infected after consuming food that has been handled by persons who are infected with the disease or by drinking water that has been
contaminated by sewage containing the bacteria. Clean water, hygiene and good sanitation prevent the spread of the disease.
The number of acute diarrhoeal disease (ADD) is also on the rise. The number of ADD cases reported to the Kollam IDSP increased
from 7,717 in 2010 to 10,821 in 2011 and has touched 8,670 till September this year. The report says that ADD is a symptom of
infection caused by a host of bacterial, viral and parasitic organisms, most of which can be spread by contaminated water.
Calling for urgent action to arrest the spread of these waterborne diseases, Dr. Rakeshs report says that in the district there is
widespread contamination of water sources mainly caused by the unscientific way of disposing sewage and other solid wastes into
water sources.
The report says that though virus and bacteria in the water can be destroyed by boiling water for five minutes, it is not happening
especially in eateries, juice stalls, ice manufacturing units and toddy shops. Many eateries are seen mixing hot water with untreated
water which is of no use.
Diarrhoea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. It is most commonly caused by gastrointestinal infections
which kill around 2.2 million people globally each year, mostly children in developing countries. The use of water in hygiene is an important
preventive measure but contaminated water is also an important cause of diarrhoea. Cholera and dysentery cause severe, sometimes life threatening
forms of diarrhoea.
The disease and how it affects people
Diarrhoea is the passage of loose or liquid stools more frequently than is normal for the individual. It is primarily a symptom of gastrointestinal
infection. Depending on the type of infection, the diarrhoea may be watery (for example in cholera) or passed with blood (in dysentery for example).
Diarrhoea due to infection may last a few days, or several weeks, as in persistent diarrhoea. Severe diarrhoea may be life threatening due to fluid loss in
watery diarrhoea, particularly in infants and young children, the malnourished and people with impaired immunity.
The impact of repeated or persistent diarrhoea on nutrition and the effect of malnutrition on susceptibility to infectious diarrhoea can be linked in a
vicious cycle amongst children, especially in developing countries.
Diarrhoea is also associated with other infections such as malaria and measles. Chemical irritation of the gut or non-infectious bowel disease can also
result in diarrhoea.
The cause
Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. It
is more common when there is a shortage of clean water for drinking, cooking and cleaning and basic hygiene is important in prevention.
Water contaminated with human faeces for example from municipal sewage, septic tanks and latrines is of special concern. Animal faeces also contain
microorganisms that can cause diarrhoea.
Diarrhoea can also spread from person to person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or
stored in unhygienic conditions. Water can contaminate food during irrigation, and fish and seafood from polluted water may also contribute to the
The infectious agents that cause diarrhoea are present or are sporadically introduced throughout the world. Diarrhoea is a rare occurrence for most
people who live in developed countries where sanitation is widely available, access to safe water is high and personal and domestic hygiene is
relatively good. World-wide around 1.1 billion people lack access to improved water sources and 2.4 billion have no basic sanitation. Diarrhoea due to
infection is widespread throughout the developing world. In Southeast Asia and Africa, diarrhoea is responsible for as much as 8.5% and 7.7% of all
deaths respectively.
Scope of the Problem
Amongst the poor and especially in developing countries, diarrhoea is a major killer. In 1998, diarrhoea was estimated to have killed 2.2 million
people, most of whom were under 5 years of age (WHO, 2000). Each year there are approximately 4 billion cases of diarrhoea worldwide.
Key measures to reduce the number of cases of diarrhoea include:
Access to safe drinking water.
Improved sanitation.
Good personal and food hygiene.
Health education about how infections spread.
Key measures to treat diarrhoea include:
Giving more fluids than usual, including oral rehydration salts solution, to prevent dehydration.
Continue feeding.
Consulting a health worker if there are signs of dehydration or other problems.

Hepatitis, a broad term for inflammation of the liver, has a number of infectious and non-infectious causes. Two of the viruses that cause hepatitis
(hepatitis A and E) can be transmitted through water and food; hygiene is therefore important in their control.
The disease and how it affects people
Among the infectious causes, hepatitis A and hepatitis E are associated with inadequate water supplies and poor sanitation and hygiene, leading to
infection and inflammation of the liver. The illness starts with an abrupt onset of fever, body weakness, loss of appetite, nausea and abdominal
discomfort, followed by jaundice within a few days. The disease may range from mild (lasting 1-2 weeks) to severe disabling disease (lasting several
months). In areas highly endemic for hepatitis A, most infections occur during early childhood. The majority of cases may not show any symptoms;
fatal cases due to fulminant acute hepatitis are rare. Nearly all patients recover completely with no long-term effects.
The cause
Hepatitis A and E viruses, while unrelated to one another, are both transmitted via the faecal-oral route, most often through contaminated water and
from person to person. Hepatitis A could also be transmitted via food contaminated by infected food-handlers, uncooked foods, or foods handled after
cooking. Hepatitis A has also caused outbreaks transmitted through injecting or non-injecting drug use.
Both hepatitis A and E are found worldwide. Hepatitis A is particularly frequent in countries with poor sanitary and hygienic conditions (in Africa,
Asia, and Central and South America). Countries with economies in transition and some regions of industrialized countries where sanitary conditions
are sub-standard are also highly affected, southern and eastern Europe and some parts of the Middle East. Outbreaks of hepatitis E have occurred
in Algeria, Bangladesh, China, Ethiopia, Indonesia, Iran, Libya, Mexico, Myanmar, Nepal, Pakistan, Somalia, and the Central Asian republics of the
Scope of the Problem
The mortality rate is low (0.2% of icteric cases) and the disease ultimately resolves. Occasionally, extensive necrosis of the liver occurs during the first
6-8 weeks of illness. In such cases, high fever, marked abdominal pain, vomiting, jaundice, and hepatic encephalopathy (with coma and seizures) are
the signs of fulminant hepatitis, leading to death in 70-90% of the patients. In these cases mortality is highly correlated with increasing age, and
survival is uncommon over 50 years of age. Among patients with chronic hepatitis B or C or underlying liver disease, who are superinfected with
hepatitis A virus, the mortality rate increases considerably.
Improved economic and sanitary conditions may lead to a higher disease incidence in older age groups, with higher reported rates of clinically evident
hepatitis A. In countries with very low hepatitis A infection rates, the disease may occur among specific risk groups such as travellers. Hepatitis E is
mainly found in young to middle-aged adults. Women in the third trimester of pregnancy are especially susceptible to acute fulminant hepatitis arising
from hepatitis E infection.
As there are no specific antiviral drugs against hepatitis A and E, prevention of these viral diseases remains the most important weapon for their
control, such as:
Providing education on good sanitation and personal hygiene, especially hand-washing
Adequate and clean water supplies and proper waste disposal
Vaccination against hepatitis A for persons at risk, e.g. travellers visiting areas where the disease is common.

The disease and how it affects people
Leptospirosis is a bacterial disease that affects both humans and animals. The early stages of the disease may include high fever, severe headache,
muscle pain, chills, redness in the eyes, abdominal pain, jaundice, haemorrhages in skin and mucous membranes (including pulmonary bleeding),
vomiting, diarrhoea and a rash.
The cause
Pathogenic Leptospira spp. cause leptospirosis. Human infection occurs through direct contact with the urine of infected animals or by contact with a
urine-contaminated environment, such as surface water, soil and plants. The causative organisms have been found in a variety of both wild and
domestic animals, including rodents, insectivores, dogs, cattle, pigs and horses. Leptospires can gain entry through cuts and abrasions in the skin and
through mucous membranes of the eyes, nose and mouth. Human-to-human transmission occurs only rarely.
Leptospirosis occurs worldwide, in both rural and urban areas and in temperate and tropical climates. It is an occupational hazard for people who work
outdoors or with animals, such as rice and sugar-cane field workers, farmers, sewer workers, veterinarians, dairy workers and military personnel. It is
also a recreational hazard to those who swim or wade in contaminated waters. In endemic areas the number of leptospirosis cases may peak during the
rainy season and even may reach epidemic proportions in case of flooding.
Scope of the Problem
The number of human cases worldwide is not well-documented. It probably ranges from 0.1 to 1 per 100 000 per year in temperate climates to 10 or
more per 100 000 per year in the humid tropics. During outbreaks and in high-risk groups, 100 or more per 100 000 may be infected. For several
reasons leptospirosis is overlooked and consequently underreported in many areas of the world. In the wake of hurricane Mitch in 1995, an outbreak of
leptospirosis with pulmonary haemorrhages was reported in Nicaragua. In 1998, there was an outbreak in the continental United States. 1998 also saw
an outbreak in Peru and Ecuador following heavy flooding. A post-cyclone outbreak was reported in Orissa, India in 1999.
The disease is often difficult to diagnose clinically; laboratory support is indispensable. Treatment with appropriate antibiotics should be initiated as
early as possible. Untreated cases can progress to a more severe and potentially fatal stage. Preventive measures must be based on a knowledge of the
groups at particular risk of infection and the relevant local epidemiological factors. For intervention one may:
aim at control at the level of the infection source (e.g. rodent control, animal vaccination);
interrupt the transmission route (e.g. wearing protective clothing, refrain from contact with infected animals and from swimming in contaminated
water, provide clean drinking-water); or
prevent infection or disease in the human host (e.g. vaccination, antibiotic prophylaxis, information to doctors, veterinarians, risk groups and the
general population).

Typhoid and paratyphoid enteric fevers
Typhoid and paratyphoid fevers are infections caused by bacteria which are transmitted from faeces to ingestion. Clean water, hygiene and good
sanitation prevent the spread of typhoid and paratyphoid. Contaminated water is one of the pathways of transmission of the disease.
The disease and how it affects people
Typhoid fever is a bacterial infection of the intestinal tract and bloodstream. Symptoms can be mild or severe and include sustained fever as high as
39-40 C, malaise, anorexia, headache, constipation or diarrhoea, rose-coloured spots on the chest area and enlarged spleen and liver. Most people
show symptoms 1-3 weeks after exposure. Paratyphoid fever has similar symptoms to typhoid fever but is generally a milder disease.
The cause
Typhoid and paratyphoid fevers are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively. Typhoid and paratyphoid germs are
passed in the faeces and urine of infected people. People become infected after eating food or drinking beverages that have been handled by a person
who is infected or by drinking water that has been contaminated by sewage containing the bacteria. Once the bacteria enter the persons body they
multiply and spread from the intestines, into the bloodstream.
Even after recovery from typhoid or paratyphoid, a small number of individuals (called carriers) continue to carry the bacteria. These people can be a
source of infection for others. The transmission of typhoid and paratyphoid in less-industrialized countries may be due to contaminated food or water.
In some countries, shellfish taken from sewage-contaminated beds is an important route of infection. Where water quality is high, and chlorinated water
piped into the house is widely available, transmission is more likely to occur via food contaminated by carriers handling food.
Typhoid and paratyphoid fevers are common in less-industrialized countries, principally owing to the problem of unsafe drinking-water, inadequate
sewage disposal and flooding.
Scope of the Problem
The annual incidence of typhoid is estimated to be about 17 million cases worldwide.
Public health interventions to prevent typhoid and paratyphoid include:
health education about personal hygiene, especially regarding hand-washing after toilet use and before food preparation; provision of a safe water
proper sanitation systems;
excluding disease carriers from food handling.
Control measures to combat typhoid include health education and antibiotic treatment. A vaccine is available, although it is not routinely recommended
except for those who will have prolonged exposure to potentially contaminated food and water in high-risk areas. The vaccine does not provide full
protection from infection.

Cholera outbreaks can occur sporadically in any part of the world where water supplies, sanitation, food safety and hygiene practices are inadequate.
Overcrowded communities with poor sanitation and unsafe drinking-water supplies are most frequently affected.
The disease and how it affects people
Cholera is an acute infection of the intestine, which begins suddenly with painless watery diarrhoea, nausea and vomiting. Most people who become
infected have very mild diarrhoea or symptom-free infection. Malnourished people in particular experience more severe symptoms. Severe cholera
cases present with profuse diarrhoea and vomiting. Severe, untreated cholera can lead to rapid dehydration and death. If untreated, 50% of people with
severe cholera will die, but prompt and adequate treatment reduces this to less than 1% of cases.
The cause
Cholera is caused by the bacterium Vibrio cholerae. People become infected after eating food or drinking water that has been contaminated by the
faeces of infected persons. Raw or undercooked seafood may be a source of infection in areas where cholera is prevalent and sanitation is poor.
Vegetables and fruit that have been washed with water contaminated by sewage may also transmit the infection if V. cholerae is present.
Cholera cases and deaths were officially reported to WHO, in the year 2000, from 27 countries in Africa, 9 countries in Latin America, 13 countries in
Asia, 2 countries in Europe, and 4 countries in Oceania.
Scope of the Problem
Control of cholera is a major problem in several Asian countries as well as in Africa. In the year 2000, some 140,000 cases resulting in approximately
5000 deaths were officially notified to WHO. Africa accounted for 87% of these cases. After almost a century of no reported cases of the disease,
cholera reached Latin America in 1991; however, the number of cases reported has been steadily declining since 1995.
To prevent the spread of cholera, the following four interventions are essential:
Provision of adequate safe drinking-water
Proper personal hygiene
Proper food hygiene
Hygienic disposal of human excreta.
Treatment of cholera consists mainly in replacement of lost fluids and salts. The use of oral rehydration salts (ORS) is the quickest and most efficient
way of doing this. Most people recover in 3 to 6 days. If the infected person becomes severely dehydrated, intravenous fluids can be given. Antibiotics
are not necessary to successfully treat a cholera patient.

Jaundice is a yellow discoloration of the skin, mucous membranes, and the whites of the eyes caused by increased amounts of bilirubin in
the blood. Jaundice is a sign of an underlying disease process.
Bilirubin is a by-product of the daily natural breakdown and destruction of red blood cells in the body. The hemoglobin molecule that is
released into the blood by this process is split, with the heme portion undergoing a chemical conversion to bilirubin. Normally, the liver
metabolizes and excretes the bilirubin in the form of bile. However, if there is a disruption in this normal metabolism and/or production of
bilirubin, jaundice may result
Jaundice Causes
Jaundice may be caused by several different disease processes. It is helpful to understand the different causes of jaundice by identifying the
problems that disrupt the normal bilirubin metabolism and/or excretion.
Pre-hepatic (before bile is made in the liver)
Jaundice in these cases is caused by rapid increase in the breakdown and destruction of the red blood cells (hemolysis), overwhelming the
liver's ability to adequately remove the increased levels of bilirubin from the blood.
Jaundice Symptoms
Patient CommentsShare Your Story
Jaundice is a sign of an underlying disease process. .
Common signs and symptoms seen in individuals with jaundice include:
yellow discoloration of the skin, mucous membranes, and the whites of the eyes,
light-colored stools,
dark-colored urine, and
itching of the skin.
The underlying disease process may result in additional signs and symptoms. These may include:
nausea and vomiting,
abdominal pain,
loss of appetite,
swelling of the legs and abdomen, and
newborn jaundice.
In newborns, as the bilirubin level rises, jaundice will typically progress from the head to the trunk, and then to the hands and feet. Additional
signs and symptoms that may be seen in the newborn include:
poor feeding,
changes in muscle tone,
high-pitched crying, and