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Center for Public Health Preparedness Grand Rounds

Center for Public Health Preparedness Grand Rounds. Assessing the Threat of Water Contamination: Waterborne Disease, Water Pollution and Water Terrorism Patricia L. Meinhardt, MD, MPH, MA

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Center for Public Health Preparedness Grand Rounds

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  1. Center for Public Health Preparedness Grand Rounds Assessing the Threat of Water Contamination: Waterborne Disease, Water Pollution and Water Terrorism Patricia L. Meinhardt, MD, MPH, MA Executive Medical Director Center for Occupational and Environmental MedicineArnot Ogden Medical Center Elmira, New York

  2. Thanks to our Sponsors: • University at Albany School of Public Health • Centers for Disease Control and Prevention • Association of Schools of Public Health

  3. Viewer Call-In Phone: 800-452-0662 Fax: 518-426-0696

  4. Evaluations Please complete and return your evaluations to the University at Albany School of Public Health Center for Public Health Preparedness. Your feedback is invaluable to this program. Thank you!

  5. Evaluations can be submitted online at:http://www.ualbanycphp.org/eval/cphpeval.cfm?ID=19 or they can be mailed to us.

  6. Center for Public Health Preparedness For more information please contact us or log on to our website. 518-486-7921 www.ualbanycphp.org

  7. Patricia L. Meinhardt, MD, MPH, MA www.WaterHealthConnection.org

  8. How real is the terrorist threat to US water supplies?

  9. Contamination of water reserves by either chemical compounds, infectious pathogens, or radiologic agents… • May affect the health of millions of Americans. • May lead to significant morbidity and mortality especially in vulnerable populations at increasedrisk of disease.

  10. Partnership TriadProtecting Drinking Water and Public Health Drinking Water Professionals PatientsWater Consumers MedicalCommunity Public HealthCommunity

  11. Local public health departments play a critical role in water protection and security since they… • May be the first to recognize intentional water contamination • Will need to notify water utilities promptly • Will provide critical initial data to state and federal public health agencies

  12. Causes of Waterborne Disease in US • DRINKING WATER CONTAMINATION • RECREATIONAL WATER POLLUTION • "SPECIAL USES" WATER CONTAMINATION • INTENTIONAL WATER CONTAMINATION OR WATER TERRORISM

  13. DRINKING WATER CONTAMINATION Microbial contamination of drinking water • animal or human sewage pathogens • inadequately treated source water • resistant pathogens to treatment technologies

  14. Chemical contamination of drinking water • agricultural run-off • leakage from underground storage tanks • industrial discharges and chemical spills • erosion of natural deposits - arsenic, lead, etc.

  15. RECREATIONAL WATER POLLUTION • According to recent EPA report, as many as 40% of US beaches, rivers, estuaries and lakes may be polluted with microbial or chemical contaminant. • Recreational water outbreaks have been reported in swimming and wading pools, lakes and ponds, rivers and canals, decorative fountains, hot tubs and springs. • During 1999-2000 reporting period, 59 recreational waterborne outbreaks were reported with 2093 illnesses and four deaths in the U.S.

  16. Waterborne Outbreaks by WATER SOURCE DRINKING WATER Well 68.4% Spring 5.3% Irrigation system 7.9% Surface water 18.4% Modified from: MMWR, Surveillance for Waterborne Disease Outbreaks United States, 1999-2000

  17. Waterborne Outbreaks by ETIOLOGIC AGENT DRINKING WATER Unidentified 43.6% Bacterial 23.1% Chemical 5.1% Viral 10.3% Parasitic 17.9%

  18. DRINKING WATER Untreated Groundwater 43.6% Waterborne Outbreaks by DEFICIENCY Treatment deficiency 23.1% Untreated Surface water 2.6% Miscellaneous 15.4% Distribution system 15.4%

  19. Intentional Water Contamination • Water may represent a potential target for terrorist activity with contamination of US water supplies as part of an effort to damage our national infrastructure.

  20. Possible scenarios include: community-wide waterborne disease outbreaks or a cluster of water-related cases from either biological, chemical or radiological terrorist agents.

  21. WMD Agents with Potential for Dispersal in Water Bacterial Pathogens Melioidosis PlagueSalmonella Shigellosis Tularemia Anthrax Brucellosis Cholera C. perfringens Glanders

  22. Parasitic Pathogens Cryptosporidiosis Viral pathogens Hepatitis A Smallpox Viral Encephalitides Viral Hemorrhagic fevers Rickettsial Pathogens Psittacosis Q Fever Typhus

  23. Bacterial Biotoxins Clostridium botulinum toxins Clostridium perfringens toxins Staphylococcus enterotoxin B Mycotoxins Aflatoxin T-2 mycotoxin Anatoxin A Microcystins

  24. Bacterial Biotoxins • Clostridium botulinum toxins • Clostridium perfringens toxins • Staphylococcus enterotoxin B • Mycotoxins • Aflatoxin • T-2 mycotoxin • Anatoxin A • Microcystins

  25. Plant and Algae-Derived Biotoxins • Ricin • Marine Biotoxins • Saxitoxin • Tetrodotoxin

  26. Skin Blistering Agents • Lewisite • Nitrogen Mustards • Incapacitating Agents • CNS Depressants (BZ) • CNS Stimulants (LSD) • Nerve Agents • G agents (Tabun, Sarin, Soman) V agents (VX) • Blood Agents • Cyanide Compounds • Arsine Compounds

  27. Industrial and Agricultural Compounds Pesticides Dioxins, furans, PCBs Explosive nitro compounds and oxidizers • Ammonium nitrate combined with fuel oil

  28. Flammable industrial gases, liquids, and solids • cyanides • Nitriles • Corrosive industrial acids and bases • nitric acid • sulfuric acid

  29. Internal Contamination from Water Exposure • Internal exposure due to ingestion of contaminated food and water • Internal contamination through skin or wound absorption or deposition from contact with contaminated material including water

  30. Diagnostic Challenges to Recognizing Water Terrorism • Many WMD agents display a significantly different clinical picture when the route of exposure is ingestion. • Many of the signs and symptoms of water-related disease are non-specific and mimic more common medical disorders.

  31. Obtaining accurate exposure histories from patients who may have been exposed to waterborne agents can be difficult and challenging. • The majority of WMD agents that may be used during intentional contamination of water supplies are not unique to water.

  32. Possible Points of Contamination of U.S. Water From Acts of Terrorism • Upstream of a community water supply system • Community water treatment plant • Post-treatment water distribution system

  33. Building water tanks, cisterns, individual storage tanks • Bottled water production, food processing, commercial water • Contamination of recreational waters (swimming pools, etc.)

  34. Epidemiologic Indicators of Possible Water Terrorism • “Impossible epidemiology” with waterborne diseases diagnosed in a community not previously encountered • Localized disease epidemics in a specific neighborhood possibly indicating contamination of post-treatment water

  35. Waterborne disease at a single location (school, hospital, nursing home) with rare pathogen • Waterborne disease presenting in a community during an unusual time of the year or found in a community where the normal vector of transmission is absent

  36. Critical Role of Public Health Departments PUBLIC HEALTH PRACTITIONERS must embrace the fact that … Local health departments play a critical role in protecting water supplies and must promptly notify water utilities of any possible penetration of water protection and water treatment procedures.

  37. PUBLIC HEALTH PRACTITIONERS must embrace the fact that … WORKING WITH NEW PARTNERS IS IMPERATIVE! These new partnerships need to include local water utilities and water quality specialists.

  38. Recognizing Waterborne Disease and the Health Effects of Water Pollution Physician On-Line Reference Guide(WaterHealthConnection.org) Created to assist the medical and PUBLIC HEALTH community recognize and manage waterborne disease and the health effects of water contamination from either natural OR intentional contamination of water.

  39. Recognizing Waterborne Disease and the Health Effects of Water Pollution A Physician On-Line Reference Guide(WaterHealthConnection.org) • New Section – Physician Preparedness for Acts of Water Terrorism • Peer-review by leading terrorism experts from public health, medical academia and military medicine

  40. Conclusions The new public health challenges facing all of us today include protecting water resources from both natural and intentional contamination. Collaboration and partnership between the drinking water community and the public health and medical community is the key to any successful effort to ensure our nation’s safe drinking water and protect our community’s public health. Funding provided by EPA grant # 83053501 © 2000 - 2003 Patricia L. Meinhardt, MD, MPH, MA and Arnot Ogden Medical Center. All Rights Reserved.

  41. University at Albany School of Public Health Center for Public Health Preparedness For more information please contact us or log on to our website. 518-486-7921 www.ualbanycphp.org

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