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Dr. Yves Filion Dr. Kieran Moore Dr. Anna Majury Dr. Kevin Hall

Queen’s CHRP Study - Enhanced Disease Surveillance of GI Outbreaks Caused By Drinking Water Contamination. Dr. Yves Filion Dr. Kieran Moore Dr. Anna Majury Dr. Kevin Hall. Outline. State of Canadian water infrastructure Mechanisms of system contamination

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Dr. Yves Filion Dr. Kieran Moore Dr. Anna Majury Dr. Kevin Hall

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  1. Queen’s CHRP Study -Enhanced Disease Surveillance ofGI Outbreaks Caused By Drinking Water Contamination Dr. Yves Filion Dr. Kieran Moore Dr. Anna Majury Dr. Kevin Hall

  2. Outline • State of Canadian water infrastructure • Mechanisms of system contamination • Queen’s CFI study: enhanced GI detection • Queen’s CHRP study: decision support for GI outbreak response

  3. Water Infrastructure: Canadian Context Water systems in Ontario date from 50s and 60s Infrastructure debt in Canada is $60B (PEO ‘08) As of March 31/08, 1766 boil-waters (CMAJ) Canadian water systems are vulnerable…

  4. Mechanisms of System Contamination Accidental Treatment failure (North Battleford, Milwaukee) Network intrusion caused by hydraulic transients Deliberate Soil • Injection of biological agents: • Hydrants • Pump stations • Water treatment facilities Pipe Contaminated GW

  5. Transport of Biological Agents in Water Distribution Systems • Network as delivery system • Agent carried by pipe advection • Human exposure through water consumption • Large human populations susceptible to exposure Risk of Exposure Tank Intrusion Point PS

  6. Queen’s CFI Study - Enhanced Detection of Gastrointestinal Illness Pharmacy #3 • GIS-based GI detection algorithm • Multivariate detection with water quality and health data • Water quality: turbidity, chlorine residual • Health: customer complaints and OTC medication sales WQ #5 Tank WQ #4 WQ #1 WQ #2 Pharmacy #2 WQ #3 Pharmacy #1 Pumping Station

  7. Queen’s CFI Study - Enhanced Detection of Gastrointestinal Illness • Disease transmission model (DTM) to simulate outbreak data: • Turbidity, chlorine residual • Complaints, OTC sales • DTM modules: • Hydraulic (pressure / flow) • Transport (pipe advection) • Dynamic disease evolution • Health-seeking behaviour (self-medication) Courtesy of US EPA, http://www.epa.gov/nrmrl/wswrd/dw/epanet.html.

  8. Queen’s CHRP Study - Decision Support for GI Outbreak Response • Objective: combine detection with decision support capabilities to enhance inter- agency outbreak communication and coordination between water utilities and health units • Project: DSS that integrates water quality data and nontraditional health data with expert knowledge

  9. Chlorine Turbidity Telehealth Expert Knowledge • Engineer • Clinical Epidemiologist • Clinical Microbiologist • Physician DSS ED Chief Complaint (GI) OTC Medication Water Complaints Queen’s CHRP Study - DSS

  10. Thoughts and Discussion...

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