| Waterborne diseases | |
|---|---|
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| Waterborne diseases can be spread via groundwater which is contaminated with fecal pathogens from pit latrines. | |
| Specialty | Infectious disease |
Waterborne diseases are diseases caused bypathogenicmicro-organisms that are transmitted bywater.[1] Thesediseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water.[2] They are a pressing issue in rural areas amongstdeveloping countries all over the world. Whilediarrhea and vomiting are the most commonly reported symptoms of waterborne illness, other symptoms can include nausea, stomach cramps, fever, and skin, ear, respiratory, or eye problems.[3] Lack of cleanwater supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Therefore, reliable access to cleandrinking water andsanitation is the main method to prevent waterborne diseases.[4]
Microorganisms causing diseases that characteristically are waterborne prominently includeprotozoa andbacteria, many of which areintestinal parasites, or invade the tissues orcirculatory system through walls of the digestive tract. Various other waterborne diseases are caused byviruses.
Yet other important classes of waterborne diseases are caused bymetazoan parasites. Typical examples include certainNematoda, that is to say "roundworms". As an example of waterborne Nematode infections, one important waterborne nematode disease isDracunculiasis. It is acquired by swallowing water in which certaincopepoda occur that act as vectors for the Nematoda. Anyone swallowing a copepod that happens to be infected with Nematodelarvae in thegenusDracunculus, becomes liable to infection. The larvae causeguinea worm disease.[5]
Another class of waterbornemetazoan pathogens are certain members of theSchistosomatidae, a family of bloodflukes. They usually infect people that make skin contact with the water.[5]Blood flukes are pathogens that causeSchistosomiasis of various forms, more or less seriously affecting hundreds of millions of people worldwide.[6]
The term waterborne disease is reserved largely for infections that predominantly are transmitted through contact with or consumption of microbiallypolluted water. Many infections may be transmitted by microbes or parasites that accidentally, possibly as a result of exceptional circumstances, have entered the water. However, the fact that there might be an occasional infection need not mean that it is useful to categorize the resulting disease as "waterborne". Nor is it common practice to refer to diseases such asmalaria as "waterborne" just becausemosquitoes have aquatic phases in their life cycles, or because treating the water they inhabit happens to be an effective strategy in control of the mosquitoes that are thevectors.[citation needed]
A related term is "water-related disease" which is defined as "any significant or widespread adverse effects on human health, such as death, disability, illness or disorders, caused directly or indirectly by the condition, or changes in the quantity or quality of any water".[7]: 47 Water-related diseases are grouped according to their transmission mechanism: water borne, water hygiene, water based, water related.[7]: 47 The main transmission mode for waterborne diseases isingestion of contaminated water.[citation needed]
Lack of cleanwater supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Thefecal–oral route is a disease transmission pathway for waterborne diseases.[8]Poverty also increases the risk of communities to be affected by waterborne diseases. For example, the economic level of a community impacts their ability to have access to clean water.[9] Less developed countries might be more at risk for potential outbreaks of waterborne diseases but more developed regions also are at risk to waterborne disease outbreaks.[10]
The lack of education in impoverished regions is a key component to the issue of waterborne disease. The more a society is educated on an issue, the more they can take action and solve the problem domestically rather than relying on foreign counties for aid. Many countries in theMiddle East,South East Asia, andSub-Saharan Africa are prone to these issues because they lack advanced education.[11] For example,Morocco has a very insufficient labor supply for the production of food and other work forces that it could very well be maximizing. In response, theUnited States and Morocco along with many other agencies worked together to initiate H2OMaghreb. This program works to educated the people of Morocco on clean water and sanitization through simulations of water treatment. Not only do the virtual reality technologies recreate rare emergency circumstances to practice dealing with, but they also provide jobs for a poorer country to help the economy too.[11]
Political turmoil and war stimulate the transmission of waterborne disease in addition to lack of education. Countries in theEastern Mediterranean Region deal with this issue especially.[12] The world bank has classifiedYemen, along with several other countries in the Eastern Mediterranean Region as "fragile and conflict-affected countries."Syria andLebanon[13] had not seen any out breaks ofcholera in about three decades, yet they did in 2022. War destroys necessary infrastructure for clean water and sanitization structures: a recipe for disease to spread. Two years ago the world health organization changed the status of cholera to a Grade 3 global public health emergency. Between the years 2016 and 2022 Yemen saw 2.5 million cases of cholera.[14] These outbreaks are closely tied to the conflicts in the region. War also destroys the necessary medical facilities and hospitals to take care of patients who have contracted the waterborne diseases. In the Eastern Mediterranean Region, countries are no longer grappling with apandemic, but rather anendemic.[12]
Other war torn regions such asGaza must manage complex water systems which present more danger to the quality of water and chance of waterborne disease being present. Gaza gets the majority of their water from underground but also some fromIsrael; they also have several desalination plants across the region.[15] Workers are constantly working to fix water pipeline systems that have been destroyed byartillery from the war but are sometimes killed in the process.[15] For a comparison of a safe country's clean water consumption to a war torn country's water consumption, Americans use about 300 liters per day while in Gaza a person would use about 80 liters per day. With every part of the water system in Gaza suffering harm in some shape or form by 2024, waterborne disease cases shortly thereafter exploded with 600,000 cases ofacute diarrhea and even a 10 month old withpolio.[15]
Climate change influences the growth and survival ofbacteria and other pathogens in food and water systems.[16][17][18] It affects waterborne diseases by influencing water temperature,water quality,sanitation, andmicrobial ecology.[19]: 1107 [20]: 12
Warmer waters, increasedflooding,precipitation andhumidity promote the growth and spread of bacteria such asVibrio cholerae, which causescholera, and other pathogens responsible forgastroenteritis, wound infections anddiarrheal diseases.[19]: 1107 [20]: 12 [21] Higher water temperatures can also increase the yield of bacteria from drinking water delivery systems and during periods of warmer temperatures water consumption rates are also typically higher. Together these increase the probability of pathogen ingestion and infection.[22]
Heavy rainfall and flooding caused by climate change can also affect pathogen transmission via impacts on sanitation and/or drinking water treatment infrastructure, contaminating drinking water sources or food products. Floods can overwhelm water systems, causingbackflows that lead to contamination ofgroundwater and other drinking water sources.[21]
| Disease and transmission[3][23] | Microbial agent | Sources of agent in water supply | General symptoms |
|---|---|---|---|
| Acanthamoeba keratitis (cleaning of contact lenses with contaminated water) | Acanthamoeba spp. (A. castellanii andA. polyphaga) | widely distributed free-living amoebae found in many types of aquatic environments, including surface water, tap water, swimming pools, and contact lens solutions | Eye pain, eye redness, blurred vision, sensitivity to light, sensation of something in the eye, and excessive tearing |
| Amoebiasis (hand-to-mouth) | Protozoan (Entamoeba histolytica) (Cyst-like appearance) | Sewage,non-treated drinking water,flies in water supply, saliva transfer(if the other person has the disease) | Abdominal discomfort,fatigue, weight loss,diarrhea,bloating,fever |
| Cryptosporidiosis (oral) | Protozoan (Cryptosporidium parvum) | Collects on water filters and membranes that cannot bedisinfected,animal manure, seasonalrunoff of water. | Flu-like symptoms, watery diarrhea, loss of appetite, substantial loss of weight,bloating, increased gas,nausea |
| Cyclosporiasis | Protozoan parasite (Cyclospora cayetanensis) | Sewage,non-treated drinking water | cramps, nausea,vomiting, muscle aches, fever, and fatigue |
| Giardiasis (fecal-oral) (hand-to-mouth) | Protozoan (Giardia lamblia) Most common intestinal parasite | Untreated water, poor disinfection, pipe breaks, leaks,groundwater contamination,campgrounds where humans and wildlife use same source of water.Beavers andmuskrats createponds that act asreservoirs for Giardia. | Diarrhea, abdominal discomfort,bloating, andflatulence |
| Microsporidiosis | Protozoan phylum (Microsporidia), but closely related tofungi | Encephalitozoon intestinalis has been detected ingroundwater, the origin of drinking water[24] | Diarrhea andwasting inimmunocompromised individuals. |
| Naegleriasis (primary amebic meningoencephalitis [PAM]) (nasal) | Protozoan (Naegleria fowleri) (Cyst-like appearance) | Watersports,non-chlorinated water | Headache, vomiting, confusion, loss of balance, light sensitivity,hallucinations,fatigue, weight loss,fever, and coma |
| Disease and transmission[25][26] | Microbial agent | Sources of agent in water supply | General symptoms |
|---|---|---|---|
| Botulism | Clostridium botulinum | Bacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract through consumption of contaminateddrinking water or (more commonly) food | Dry mouth,blurred and/ordouble vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech,vomiting and sometimesdiarrhea. Death is usually caused byrespiratory failure. |
| Campylobacteriosis | Most commonly caused byCampylobacter jejuni | Drinking water contaminated withfeces | Producesdysentery-like symptoms along with ahigh fever. Usually lasts 2–10 days. |
| Cholera | Spread by the bacteriumVibrio cholerae | Drinking water contaminated with the bacterium | In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea,nausea,cramps,nosebleed, rapidpulse, vomiting, andhypovolemic shock (in severe cases), at which point death can occur in 12–18 hours. |
| E. coli Infection | Certain strains ofEscherichia coli (commonlyE. coli) | Water contaminated with the bacteria | Mostly diarrhea. Can cause death inimmunocompromised individuals, the very young, and the elderly due todehydration from prolonged illness. |
| M. marinum infection | Mycobacterium marinum | Naturally occurs in water, most cases from exposure inswimming pools or more frequentlyaquariums; rare infection since it mostly infectsimmunocompromised individuals | Symptoms includelesions typically located on the elbows, knees, and feet (fromswimming pools) or lesions on the hands (aquariums). Lesions may be painless or painful. |
| Dysentery | Caused by a number of species in the generaShigella andSalmonella with the most common beingShigella dysenteriae | Water contaminated with the bacterium | Frequent passage offeces withblood and/ormucus and in some cases vomiting of blood. |
| Legionellosis (two distinct forms: Legionnaires' disease and Pontiac fever) | Caused by bacteria belonging to genusLegionella (90% of cases caused byLegionella pneumophila) | Legionella is a very common organism that reproduces to high numbers in warm water;[27] but only causes severe disease when aerosolized.[28] | Pontiac fever produces milder symptoms resembling acuteinfluenza withoutpneumonia. Legionnaires' disease has severe symptoms such asfever,chills, pneumonia (with cough that sometimes producessputum),ataxia,anorexia, muscle aches,malaise and occasionally diarrhea and vomiting |
| Leptospirosis | Caused by bacterium of genusLeptospira | Water contaminated by the animal urine carrying the bacteria | Begins withflu-like symptoms then resolves. The second phase then occurs involvingmeningitis,liver damage (causesjaundice), andkidney failure |
| Otitis Externa (swimmer's ear) | Caused by a number ofbacterial andfungal species. | Swimming in water contaminated by the responsible pathogens | Ear canal swells, causing pain and tenderness to the touch |
| Salmonellosis | Caused by many bacteria of genusSalmonella | Drinking water contaminated with the bacteria. More common as afood borne illness. | Symptoms includediarrhea,fever, vomiting, and abdominal cramps |
| Typhoid fever | Salmonella typhi | Ingestion of water contaminated withfeces of an infected person | Characterized by sustained fever up to 40 °C (104 °F), profusesweating; diarrhea, muscle aches, fatigue, and constipation may occur. Symptoms progress todelirium, and thespleen andliver enlarge if untreated. In this case, it can last up to four weeks and cause death. Some people with typhoid fever develop a rash called "rose spots", small red spots on the abdomen and chest. |
| Vibrio Illness | Vibrio vulnificus,Vibrio alginolyticus, andVibrio parahaemolyticus | Can enterwounds from contaminated water. Also acquired by drinking contaminated water or eating undercookedoysters. | Symptoms include abdominal tenderness, agitation, bloody stools, chills, confusion, difficulty paying attention (attention deficit), delirium, fluctuating mood, hallucination, nosebleeds, severe fatigue, slow, sluggish, lethargic feeling, weakness. |
| Disease and transmission[24][29][3][30][31] | Viral agent | Sources of agent in water supply | General symptoms |
|---|---|---|---|
| Hepatitis A | Hepatitis A virus (HAV) | Can manifest itself in water (and food) | Symptoms are onlyacute (nochronic stage to the virus) and includeFatigue, fever,malaise, abdominal pain, nausea, diarrhea, weight loss, itching,jaundice, anddepression. |
| Hepatitis E (fecal-oral) | Hepatitis E virus (HEV) | Enters water through thefeces of infected individuals | Symptoms of acutehepatitis (liver disease), includingfever,fatigue, loss of appetite,nausea, vomiting, abdominal pain,jaundice, dark urine, clay-colored stool, and joint pain |
| Acute gastrointestinal illness [AGI] (fecal-oral; spread by food, water, person-to-person, and fomites) | Norovirus | Enters water through thefeces of infected individuals | Diarrhea, vomiting,nausea, stomach pain |
| Poliomyelitis (Polio) | Poliovirus | Enters water through thefeces of infected individuals | 90–95% of patients show no symptoms, 4–8% have minor symptoms (comparatively) withdelirium,headache,fever, and occasionalseizures, andspastic paralysis, 1% have symptoms of non-paralyticaseptic meningitis. The rest have serious symptoms resulting inparalysis or death |
| Polyomavirus infection | Two ofPolyomavirus:JC virus andBK virus | Very widespread, can manifest itself in water, ~80% of the population hasantibodies to Polyomavirus | BK virus produces a mildrespiratory infection and can infect thekidneys ofimmunosuppressedtransplant patients. JC virus infects therespiratory system, kidneys or can causeprogressive multifocal leukoencephalopathy in thebrain (which is fatal). |
| Disease and transmission[32] | Microbial agent | Sources of agent in water supply | General symptoms |
|---|---|---|---|
| Desmodesmus infection | desmodesmus armatus | Naturally occurs in water. Can enter open wounds. | Similar to fungal infection. |
| Disease and transmission[5][3] | Agent | Sources of agent in water supply | General symptoms |
|---|---|---|---|
| Dracunculiasis [Guinea worm disease] (ingestion of contaminated water) | Dracunculus medinensis | Female worm emerges from host skin and releases larvae in water. | Slightfever, itchyrash,nausea,vomiting,diarrhea, dizziness, followed by formation of painful blister (typically on lower body parts) |
Reliable access to clean,uncontaminateddrinking water and propersanitation are the main methods to prevent waterborne diseases. Vaccination is another methord to prevent the body from geting water-born diseases[4] The aim is to break thefecal–oral route of disease transmission.[4]
Solar energy has been become a clean and efficient means by which water can now bedistilled anddesalinated. This method is environmentally safe because it does not produce mass amounts of carbon dioxide that could damage the planet. In fact, the carbon dioxide emissions are virtually zero from using solar energy to distill or desalinate water.[33]
Desalination is the process by which salt is removed from water making it potable. Because water is ascarce resource, meaning that there is a finite amount of it for all of humanity to share, research into sustainability methods for increasing the amount ofpotable water is important.[34] With an abundance of salt water on Earth, the solar desalination method is innovative and presents potential. It works by usingsolar panels that capture solar energy from the sun which it then uses to remove the salt from the water through a process called reverseosmosis. The solar energy is converted into electricity via the solar panels. This electricity is then used to push the water at high pressures through filters that block the salt from passing through but do allow the water to pass.[35] This method of desalination is also beneficial to society because it can be used in remote locations. It does not require a connection to a large pipeline system traditionally used that also produce large amounts of carbon dioxide. Specifically, this method is most productive were there is ready access to salt water, an abundance of sunshine, and a lack of fresh drinkable water.[35]
Other policies and precautions can be taken too in order to prevent the spread of disease through contaminated water. For example, appropriate amounts of chlorine can be added to the potable water pipes to remove viruses. Typical household precautions including the use of disinfection wipes and sanitization sprays also are important to use around areas where clean water consumption is very important such as in bathrooms and kitchens.[36]
According to theWorld Health Organization, waterborne diseases account for an estimated 3.6% of the totalDALY(disability- adjusted life year) global burden of disease, and cause about 1.5 million human deaths annually. The World Health Organization estimates that 58% of that burden, or 842,000 deaths per year, is attributable to a lack of safe drinking water supply, sanitation and hygiene (summarized asWASH).[4]
TheWaterborne Disease and Outbreak Surveillance System (WBDOSS) is the principal database used to identify the causative agents, deficiencies, water systems, and sources associated with waterborne disease and outbreaks in the United States.[37] Since 1971, theCenters for Disease Control and Prevention (CDC), theCouncil of State and Territorial Epidemiologists (CSTE), and theUS Environmental Protection Agency (EPA) have maintained this surveillance system for collecting and reporting data on "waterborne disease and outbreaks associated with recreational water, drinking water, environmental, and undetermined exposures to water."[37][38] "Data from WBDOSS have supported EPA efforts to develop drinking water regulations and have provided guidance for CDC's recreational water activities."[37][38]
WBDOSS relies on complete and accurate data from public health departments in individual states, territories, and other U.S. jurisdictions regarding waterborne disease and outbreak activity.[37] In 2009, reporting to the WBDOSS transitioned from a paper form to the electronicNational Outbreak Reporting System (NORS).[37] Annual or biennial surveillance reports of the data collected by the WBDOSS have been published in CDC reports from 1971 to 1984; since 1985, surveillance data have been published in theMorbidity and Mortality Weekly Report (MMWR).[37]
WBDOSS and the public health community work together to look into the causes of contaminated water leading to waterborne disease outbreaks and maintaining those outbreaks.[37] They do so by having the public health community investigating the outbreaks and WBDOSS receiving the reports.[37]
Waterborne diseases can have a significant impact on the economy. People who are infected by a waterborne disease are usually confronted with related healthcare costs. This is especially the case in developing countries. On average, a family spends about 10% of the monthly households income per person infected.[39]
Socioeconomic impact refers to the effects that waterborne disease has on society such as the quality of life, medical care, the economy, and education sustainable.[40]Sustainable Development Goal 6, access to clean water and sanitization for all by the year 2030, is at the roots of many of the othersustainable development goals pertaining to society and the economy.[41] Agricultural industries in particular are most severely effected and the increasing stress comes from the booming city populations taking away water from farming. The need for clean water and sanitation is vital because without clean water there is no sustainable food source. Clean water is necessary to produce healthy crops for people to consume. If the water used for crop irrigation is contaminated, the produce could bring a ravaging disease to the people who consume it.
About one third of all of the cities in the world rely on the necessary freshwater that the agriculture industry needs. There is this constant tension on the freshwater supply because as populations in urban areas boom they demand more and more water. This demand for freshwater is estimated to increase 80% in the next 25 years which adds towater stress because farming uses about 72% of the fresh water that the cities need.[42] An example of industries doing their part to help reach Sustainable Development Goal 6 would is the Adopt-a-River Project inNairobi,Kenya. TheUnited Nations Environment Program worked with several other clubs on the project which consists of traps being established along theAthi River to capture large solid waste. Recycling stations will also be constructed and industries that dump theireffluent into water sources will also join the effort. This is a step to remove extra waste from water reducing chances of contamination of water that would eventually be used for irrigation of crops.[42]
Waterborne diseases were once wrongly explained by themiasma theory, the theory that bad air causes the spread of diseases.[43][44] However, people started to find a correlation betweenwater quality and waterborne diseases, which led to differentwater purification methods, such assand filtering andchlorinating their drinking water. Founders ofmicroscopy,Antonie van Leeuwenhoek andRobert Hooke, used the newly inventedmicroscope to observe for the first time small material particles that were suspended in the water, laying the groundwork for the future understanding of waterborne pathogens and waterborne diseases.[45]
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