Health & Comfort Water

1. Health & ComfortWater Opportunities & Problems JEMH van Bronswijk, TU/e

2. Water is Life Human = 65% H2O Minimal Daily loss: 1 kg H20 / person Maximal Hourly loss: 10 kg H2O / person Loss to be replenished by eating & drinking Human <60% H20: in danger zone JEMH van Bronswijk, TU/e

3. Potable Water Perishable Commodity (< 24 Hours) Keep cool or add Chlorine-derivate Keep Running Bio-film development on Surfaces JEMH van Bronswijk, TU/e

4. Healthy and Sustainable BuildingPotable Water • Disease Risks: • Veteran’s Disease caused by Legionella • - Infections / Intoxications of ‘Household Water’ (= 2nd quality water) • Prevention: • Keep potable water supply below 18°C at all times • Mark each ‘Household Water’ outlet individually and clearly • Stimulate distinguishable odour and taste of 1st & 2nd quality water • Make disconnecting of 2nd quality water-systems easy • Inform consumer 7s640-6biolag: J.E.M.H. van Bronswijk

5. Healthy and Sustainable BuildingHot Water • Disease Risks: • Scalding • Veteran’s Disease caused by Legionella • Pontiac Fever caused by Legionella • Atopic Disease through lack off mite extermination at laundering • Humidifier Disease through antigens of micro-organisms • Prevention: • Install thermostatic mixing faucet • Replace boiler by geyser with a short hot water conduct • Install facility for washing machine with extra water heating (>60oC) • Inform consumer 7s640-6biolag: J.E.M.H. van Bronswijk

6. Legionella Risk Veteran’s Disease & Pontiac Fever Lung infection (Shower, Air-Conditioning, Cooling Towers) 18oC < Bacterial Growth < 60oC Bacterial Survival up to 65oC Viable Legionella present in surface & coastal waters JEMH van Bronswijk, TU/e

7. 1000 Legionella-infections • 950-990x cases of Pontiac Fever • 9-30x surviving Veteran-Disease patients, but with persisting chronic symptoms • 1-20x fatal cases Source: JEMH van Bronswijk e.a. 1999. Gezond en Duurzaam Bouwen (GeDuBo). Research Report for the Netherlands Ministry of Housing JEMH van Bronswijk, TU/e

8. Legionellosis Risk Classes Source:CJPA Hoebe, JJM Cluitmans, JHT Wagenvoort, WJ van Leeuwen, MAJ Bilkert-Mooiman 1999. Koud leidingwater als bron van fatale nosocomiale pneumonieën door Legionella pneumophila in een revalidatiekliniek. Nederl. Tijdschr. Geneesk. 143(20):1041-1045 JEMH van Bronswijk, October 9, 1999

9. Legionellosis • Since the 1986 report of the Health Administration 5,000+ preventable deaths occurred in NL • For each Legionella death 50 to 1,000 persons are diseased • Risk in modern dwellings and in hospitals is comparable • Preventive technology is available JEMH van Bronswijk, TU/e

10. Legionella extermination • At temperatures >64°C no breathing of Legionella occurs* • No growth <18°C; Legionella remains vital • 0.5 mg free chlorine / l water kills bacteria • Copper or silver-ions in the water decrease growth * Use a thermostatic mixing tap with automatic emptying, to prevent both burns and a Legionella infection! Source: Report Gezondheidsraad 1986; Pubmed 1995-1999 JEMH van Bronswijk, TU/e

11. Waste Water Bathroom, Toilet, Kitchen: Human pathogens from man & pets (SARS!) (Run-off) Rainwater: Human pathogens from birds & rodents Waste water is a breeding ground for biting insects & a domain of rodents: keep is covered JEMH van Bronswijk, TU/e

12. Outdoor Water Visual Comfort Water Management Recreation Diarrhoea (e.g. Escherichia coli, Salmonella) Weil’s Disease Temperate-region Malaria (brackish water) JEMH van Bronswijk, TU/e

13. SARS in Hong Kong Spread by air and waste water JEMH van Bronswijk, TU/e

14. SARS • Severe Acute Respiratory Syndrome • SARS Corona virus, a RNA virus • 2003: 908 deaths on 8.422 patients • Survivors: bone degradation due to medication • Economy disrupted JEMH van Bronswijk, TU/e

15.  Biological: SARS Coronavirus from WHO WEBSITE ← Technical: WHO symposium JEMH van Bronswijk, TU/e

16. Electronmicroscopic picture of the Coronavirus of SARS shown as little balls inside FRhK-4 cells. Enlargement to the right. SOURCE: Department of Microbiology, The University of Hong Kong and the Government Virus Unit, Department of Health, Hong Kong; taken from the website of the WHO JEMH van Bronswijk, TU/e

17. SARS events • Transmission: skin contact, inhaling • Virus: Remains viable for months in cool circumstances • Present in waste water • Spread inside buildings JEMH van Bronswijk, TU/e

18. Metropole Hotel, Hong Kong SARS only at the 9th floor (red room numbers); coridor infested in front the elevator and door number 911 Air speed in feet / min; index patient occupied red room JEMH van Bronswijk, TU/e

19. Amoy Gardens, Hong Kong (1) Index patient occupied flat 1607 for 2 nights; red figures are infested floors Virus transport trough ventilation system: start of epidemic JEMH van Bronswijk, TU/e

20. Amoy Gardens, Hong Kong (2) Waste water aerosol and gass in the bathroom [toilet rinsed with sea water] Virus transport through waste water system: spread of the epidemic p.s. also spread through rats and cockroches! JEMH van Bronswijk, TU/e

21. Causes of Summer FluInfectious Bacterial Gastro-Enteritis • Campylobacter jejuni(incubation period: 24 - 72 Hrs) Duration of illness: 1 - 4 Days; Infected food: chicken, milk, water • Vectors: fly, rat, mouse, cockroach, rain water, 2nd quality water • 2. Clostridium perfringens(incubation period: 8 - 24 Hrs) Duration of illness: < 7 Days; Infected food: too slowly chilled dishes • Vectors: fly, rat, mouse, cockroach, human hands • 3. Salmonella(incubation period: 8-48 Hrs) • Duration of illness: 5 - 7 Days; Infected food: meat dishes, water • Vectors: fly, rat, mouse, cockroach, rain water, 2nd quality water • 4. Staphylococcus aureus(incubation period: < 6 Hrs) • Duration of illness: < 24 Hrs; Infected food: milk products, meat dishes • Vectors: fly, rat, mouse, cockroach, human hands Source: NRH Burgess 1990. Public Health Pests. Chapman & Hall, London; E Eyskens, L Feenstra, AE Meinders, JP Vandenbroucke 1991. Codex Medicus. 9e druk. Elsevier, Amsterdam 7s640-3biolag: J.E.M.H. van Bronswijk

22. Weil’s Disease • First described by Adolf Weil (1848-1916) in Wiesbaden (Germany) • Infection with Leptispira ictero-haemorrhagiae • Human disease after contact with urine of infected rodents such as the Norway Rat (Rattus norvegicus); most common in Zuid-Holland • Symptoms and Course: incubation period of 2-20 days; followed by 4-9 days with severe flu-like symptoms; may develop from 6th-12th day of illness into meningitis, as well as damage to liver, kidneys and heart JEMH van Bronswijk, TU/e

23. Preventing Weil’s Disease • *Minimize open water in residential areas • **Open city water should have steep banks • Mow banks of city water 2x yearly • Keep city water deep (> 3 m) • Exterminate Rattus sp in residential areas • Inform consumers Number of drowned children will: * decrease ** increase JEMH van Bronswijk, TU/e

24. Healthy and Sustainable BuildingOpen Water in Cities & Towns • Disease Risks: • Weil’s Disease • Papular Urticaria due to mosquitoes and biting flies • Re-introduction of temperate-region malaria (only in brackish areas) • Prevention: • Fill up marshy fields and stagnant waters in living areas • Refrain from introducing water-purifying marshes in living areas • Can marshes or ponds not be avoided: install rat & mosquito extermination program • Prevent mosquitoes & black flies from entering the house (fixed insect screens in windows & doors) • Inform consumer 7s640-6biolag: J.E.M.H. van Bronswijk

25. JEMH van Bronswijk, TU/e

26. Dutch Anti-malaria Poster from the 1st half of the 20th century Ziet gij muggen lang van poot Aarzelt niet, maar slaat ze dood Translation: Do you see mosquitoes long of legs ? Don’t wait, squeeze them to death JEMH van Bronswijk, TU/e