Children and Environmental Impacts

1. Children and Environmental Impacts Food and Water Impacts

2. Introduction • The majority of waterborne microorganisms that cause human disease come from animal and human fecal wastes. These contain a wide variety of viruses, bacteria, and protozoa that may get washed into drinking water supplies or recreational waters.

3. Most treated wastewater goes into rivers and lakes. Occasionally, heavy rains overwhelm sewer systems, causing them to overflow. This can put communities at risk from high concentrations of microbial pollutants in raw, untreated sewage. Public health advisories notify citizens when such large discharges occur.

4. The Past • 50 years ago, foodborne was primarily locally prepared foods. Fault was from inadequate refrigeration, hot holding or cooling. • In fact, less than 4% of foodborne illness are associated with clostridium perfringens, staphylococcus aureus, bacillus cereus.

5. The Present • Last 25 years we have a different story! • New emerging pathogens • Campylobacter jejuni • Escherichia Coli O157:H7 • Listeria Monocytogenes • Norovirus • Salmonella Enteritidis • Shigella • Toxoplasma gondii

6. Why the Change? • Much of the knowledge of these pathogens are inadequate but… • Spread to humans from animal reservoir • Contaminate food in early production than at the consumer level • Contamination may look, smell and taste normal • Some may survive traditional preparation techniques

7. A Greater Concern • The emerging infectious disease from foodborne have other threats than gastroenteritis: • Chronic sequelae • Miscarriages • Meningitis • Congenital malformations • Hemolytic uremic syndrome • Reactive arthritis • Guillain-Barre syndrome

8. Septic Systems • Not all human waste is treated in sewage treatment facilities. There are approximately 25 million septic tanks in the united states, receiving 175 billion gallons of wastewater. Pathogenic viruses, bacteria and other microbes in these wastes can sometimes escape and contaminate ground and surface waters.

9. Animal Wastes • Nearly 1.4 billion tons of animal manure are produced annually in the United States. These animal wastes carry concentrations of microbes as high as a billion organisms per gram of feces. Most are part of normal bodily flora, but some are potentially harmful to humans.

10. Specific Organisms Associated with Animal Feces • Infected cattle can excrete millions of E. coli O157:H7, Cryptosporidium, Giardia, and other microbes in their manure. Chicken wastes can carry the pathogenic bacteria Salmonella and Campylobacter. • In areas of intensive livestock production, manure-laden run-off is the main suspect in blooms of toxic microbes such as Pfiesteria in estuaries and coastal regions.

11. Children and EH • Currently, use of more than 70,000 chemicals is allowed in the united states. Little is known about the health effects of the majority of these chemicals on children. Exposures to environmental toxins, such as lead, are now known to cause permanent damage to a child's nervous system other toxicants are being implicated in causing adverse health effects in children.

12. Chemicals • While exposures to some environmental hazards have decreased due to regulations, children continue to be exposed to toxicants in water, air and food.(1)

13. How Can Children Get Exposed? • The main water sources of exposure: • Drinking water • Eating fish and shellfish from contaminated water • Adsorption through skin via bathing or recreational water (swimming) • Inhalation of vapor from water source(showering)

14. How Are Children Exposed? • Fetal exposure occurs through maternal exposure to environmental toxicants, as the fetus is dependent on the mother and many substances can cross the placenta. Sometimes this is from a mother's self-exposure, such as environmental tobacco smoke. However, lead in a mother's bones which may be harmless to a mother can be transferred to her fetus, causing exposure levels that are potentially harmful.

15. Children Exposed • Additionally, maternal and paternal exposures that occur before conception can affect a child. PCBs, for example, bioaccumulate in fatty fish and are stored in the body when eaten. These are passed on to fetuses, newborns and infants through the placenta and maternal breast milk.(2)

16. Sensitive Subpopulations • Subpopulations of concern: • Children • Mothers (pregnant, or nursing) • Elderly • Immune compromised

17. Other Factors of Influence • Poverty • Race • Ethnicity

18. Current Methods of Detection • The primary source of microbial contamination is believed to be human and animal fecal waste and/or improperly treated sewage. The primary mode of detection is the use of a “coliform count” which demonstrates the number and type of bacterial organisms (which are similar to pathogenic fecal organisms) from a water sample.

19. Detection • Current regulations for both recreational and drinking waters are based on this coliform count, as well as other measures of pathogenic and non pathogenic organisms.

20. Microbial Exposure • Although the primary illness resulting from microbial contamination is gastroenteritis, there are also specific severe illnesses (such as cholera) as well as other illnesses (such as life-threatening skin infection from Vibrio vulnificus).

21. Types of Microbial Contaminants • Salmonella species1 • Cryptospiridium1 • Escherichia coli (E. Coli)1,5 • Staphococcus aureus2 • Clostridium perfringens2 • Giardia Vibrio cholera3 • Enterococcus hepatitis A4 • Vibrio vulnificans1 • Enterovirus Norovirus (Norwalk)4 • Listeria1,5 • Toxoplasmosis3,5 Source bad bug book: http://www.cfsan.fda.gov/~mow/intro.html 1) Bacterium 2) Enterotoxin 3) Protozoan 4) Virus 5) Pregnancy Complications

22. Other Contaminants • Heavy metals and pesticides: • MethylMercury (organic) • Mercury • PCBs • Chlordane • Dioxins • DDT • Arsenic

23. Methods of Protecting the Public • Fish advisories: • Generally, local governments protect people from possible risks of eating contaminated fish by monitoring their waters and issuing fish advisories when contaminant levels are unsafe. While most of the nation's waters contain fish that are safe to eat, a consumption advisory may recommend that people limit or avoid eating certain species of fish caught from certain lakes, rivers or coastal waters.

24. Fish Advisory • In some cases, advisories apply to specific water types (such as lakes), or they may include recommendations for specific groups (like pregnant women or children). Advisories apply to locally-caught fish or wildlife as well as fish purchased in stores and restaurants.

25. Swimming Advisories • Purpose: notify the public when and which waters in the state that are not suitable for recreational uses.

26. Boiled water Advisories • Issued when contamination is suspected or when there is a potential for microbial contamination of the public water supply to occur

27. When is a boiled Advisory Issued? • Flooding • Water Line Break • Loss of System Pressure • Failure to detect 0.2 mg/L chlorine residual

28. Consumer Advisory • Issued when conditions within a public water system indicate there is the possibility of adverse health effects if the water is consumed. • This advisory will inform affected persons of all actions which should be taken to protect their health.

29. When are they issued? • When chemical contaminations is detected • Publicized threats (chemical/biological) • Violations • Boiling water is ineffective in these cases

30. Fish Advisories • http://water.nr.state.ky.us/dow/dwfish.htm • Major concerns with fish advisories are methylmercury and PCB’s. • Fish advisory: it is a collaboration among DEP, fish and wildlife and public health advising the public on safe amount of fish consumption based on risk level. This advisory is to protect the general public and special populations such as elderly, nursing mothers, children and pregnant women.

31. Requirement From 401 KAR 8:020 • Water service must immediately notify local health department of advisories and notices • Water service must have protocols, acceptable to LHD, for after hours notification • Water service must develop protocols with LDH describing how and when LDH will notified of advisory or notice.

32. Best Prevention Methods • Bacteria multiply rapidly between 40 °F and 140 °F. To keep food out of this “danger zone,” keep cold food cold and hot food hot. • Store food in the refrigerator (40 °F or below) or freezer (0 °F or below). • Cook food to 160 °F (145 °F for roasts, steaks and chops of beef, veal, and lamb). • Maintain hot cooked food at 140 °F or above. • When reheating cooked food, reheat to 165 °F.

33. Controls • Hand washing • Cross contamination • Proper temperature and storage • Proper cooking temperature

34. What about what I drink? • Know your water source: http://www.epa.gov/safewater/dwinfo/ky.htm (local water source and profile) • Weak Immune system: http://www.epa.gov/safewater/crypto.html • When in doubt stay out!!

35. References • 1)Children’s Environmental Health Network. “An Introduction to Children’s Environmental Health.” http://www.cehn.org/cehn/WhatisPEH.html • 2) Children’s Environmental Health Network. “Preventing Child Exposures to Environmental Hazards: Research and Policy Issues” http://www.cehn.org/cehn/symposium.html#How