Surveillance of waterborne diseases

1. Surveillance of waterborne diseases Implementation of the Protocol on Water and Health Mihály Kádár National Institute of Environmental Health, Budapest ISEE, Balatonfödvár, 4-6 September, 2003

2. Main objectives of the Protocol • To promote prevention, control and reduction of water-related diseases throughout the WHO/Euro region by: • Ensuring adequate drinking water supplies and sanitation; • Effective systems for surveillance and monitoring of water supply and services; • Giving special consideration to vulnerable groups of population; • Providing the public with information and raise public awareness; • Enhancing international cooperation in pursuing the above objectives; • Reviewing and assessment of progress.

3. Footsteps of work under the Protocol • 1st Meeting of the Signatories to the Protocol Budapest, November, 2002; • 1st Meeting of the Working Group of Water and Health, Budapest, May, 2001; • 2nd Meeting of the Working Group of Water and Health, Budapest, October, 2002; • Small WG Meeting on the Evidence Base and Develoment of a Reporting Scheme for WRD; • Experts Worskhop on Goals and Strategies for WRD Surveillance; • Workshop on Health Risks in Aquifer Recharge • Workshop on Rapid Environmental Health Risk Assessment • 2nd Meeting of the Signatories to the Protocol, Geneve, July, 2003.

4. Draft Guidelines of the Surveillance for Water Related Diseases (1) Framework: HEALTH TARGETS Risk Management Assessment of Risk PUBLIC HEALTH STATUS

5. Draft Guidelines of the Surveillance for Water Related Diseases (2) General overview: • Reactive system: monitoirng and management of WRD • Proactive systems: monitoring and management of water quality • Multi-level institutional outline and legal-political background Water-borne infectious diseases: • priority groups of pathogens/events in Europe and symptom-based definitions • Managing information: sources and reporting • Outbreak investigation Water-borne diseases caused by chemical substances: • Origin/ways of contamination • Monitoring strategies for chemicals and their health effects

6. Draft Guidelines of the Surveillance for Water Related Diseases (3) Proactive surveillance-monitoring: • HACCP principle as an operational basis • Most important groups of the Critical Control Points of a water supply system: • Source and catchment • Chain of treatment • Distribution system components and environment • Domestic plumbing system and points of use

7. WatSan_P1: Waste water treatment coverage Percent of population with secondary sewage treatment Year

8. WatSan_S1:Exceedance of recreational water limit values for microbiological parameters Percent of exceedances Year

9. WatSan_S2: Exceedance of WHO drinking water guidelines for microbiological parameters Percent of exceedances Year

10. WatSan_S3: Exceedance of WHO drinking water guidelines for chemical parameters Percent of exceedances Year

11. WatSan_E1 Outbreaks of waterborne diseases

12. WatSan_E2Diarrhoea morbidity in children Case/100.000 Year

13. THANK YOU FOR YOUR ATTENTION!