Waterborne Infections

Create an environment to
maintain ecological conditions to
promote health and prevent
disease

Public Health issue: Safe drinking

water and proper sanitation

Water

International Drinking Water Supply

and Sanitation decade: 1981-1990
34 World Health Assembly
emphasized that safe drinking water
is a basic element of primary health
care key to attainment of Health for
all

Safe Drinking Water

Free from pathogenic agents

Free from harmful chemicals
Pleasant to taste
Usable for domestic purposes

Water requirement

2 litres per head per day: Basic

physiological requirement
PH: Adequate water supply to
maintain proper hygiene
15-200 l/per capita adequate
India 40 l/ capita target

Sources of Water Supply

Rain
Surface:
Impounding reservoirs
Rivers and Streams
Tanks/ Ponds/ Lakes
Ground water
Shallow wells
Deep wells
Springs

Water Pollution
Gases: Nitrogen, Carbon
dioxide, Hydrogen Sulphide
Minerals: Salts of Ca, Mg
Suspended impurities: Clay,
Silt, Sand, Mud
Microorganisms

Water Pollution due to

Urbanization
Sewage: Decomposable
organic matter and microbes
Industrial and trade wastes
Agricultural pollutants
Physical

Health Hazards

60% towns getting adequate water

Low daily per capita supply
Inefficient distribution
Leakage
Progress in rural sector very slow
Few Sewage treatment plants
Poor hygiene: Poorly designed/
maintained sewage system
Fertilizer: Human discard

Diarrhea and intestinal worm

infestation: 10% total burden
of disease in the developing
world.
Inadequate water supply
increases risk of
Schistosomiasis, guinea
worm disease, skin and eye
infections.

Population with Access to

Safe Water (%)

India
Bangladesh
Indonesia
Nepal
Maldives
SriLanka
Thailand

85
80
63
48
88
57
70

Population with Access to

Adequate Sanitation

India
Bangladesh
Indonesia
Nepal
Maldives
SriLanka
Thailand

29
30
51
22
40
66
74

AETIOLOGICAL AGENTS

Bacteria
Vibrio cholerae
Salmonella
Campylobacter
Shigella
diarrheogenic Escherichia coli.
Legionella pneumophila
M. xenopi, M. abscessus, M.
fortuitum, and M. chelonae
Leptospira

Viruses
Hepatitis A and E
Polio virus
Rotavirus, Adenovirus, Norwalk
agent

Helminthic
Roundworm
Whipworm
Hydatid Disease
Protozoal
Giardia lamblia
Entamoeba histolytica
Acanthamoeba,
Hartmannella
Naegleria fowleri
Cyclospora
Isospora
Cryptosporidium
Microsporidia

Bacterial infections

Presenting symptoms:
Diarrhea:

Cholera
Dysentery: Shigellosis
Flu like illness (Pontiac fever)
Pneumonia (Legionnaires disease)
Bacteremia (Typhoid)
Septicemia (Leptospira)

Cholera
7 Pandemics: Last in 1961
Vibrio cholerae O1, non O1,
O139
Transmission via water
contaminated with faeces
Rice Water Stools
Dehydration, electrolyte
imbalance

Typhoid

Systemic infection
Salmonella Typhi
Can be sporadic, epidemic,
endemic
Endemic in India
Man is the only reservoir
Peaks in July-September
Transmisison Feco-oral. Directly
or indirectly by ingestion of
contaminated wtare/ milk/food
Continuous fever- 3-4 weeks

Viral Infections

Gastroenteritis
Polio
Hepatitis

Parasitic Infections
Gastrointestinal disturbances
Encephalitis

Poliomyelitis

Acute viral infection

Infection of alimentary canal.
CNS affected in 1%; paralysis,
death
Feco-oral transmisison. Survives
long in cold environment.
Occurs mostly in rainy season
Environmental sources:
Contaminated Water, milk, food
Droplet in fection in acute phase

Viral Hepatitis

Hepatitis A
Picornavirus
Fever, chills, generalized
malaise, vomiting, jaundice
Mode of transmisison: feco-oral
Hepatitis E: First major epidemic
in Delhi in 1955

Amoebiasis

Entamoeba histolytica
dysentry
Infective form: cyst

Diarrhea
Feco-oral

Giardiasis

Giardia lamblia
Abdominal discomfortdiarrhea
Feco-oral transmission
Infective form-Cyst

Diagnosis

Signs and symptoms

Laboratory diagnosis

Sample collection
Transport
Microscopy
Culture
Serological assays
Molecular diagnosis