Technical and policy guidance for setting up, implementing and assessing surveillance systems of water-related disease. Minsk 5-6 April 2011 Enzo Funari. Italian Higher Institute of Health.
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Minsk 5-6 April 2011
Enzo Funari. ItalianHigherInstituteofHealth
2. HEALTH RISKS FROM MICROBIAL PATHOGENS
3. HEALTH RISKS FROM CHEMICALS
4 HEALTH RISKS IN THE WATER SYSTEM
5. ESSENTIAL EPIDEMIOLOGY
6. ESSENTIAL SURVEILLANCE.
7. DATA MANAGEMENT AND ANALYSIS USING GEOGRAPHICAL INFORMATION SYSTEM
The publication is available at http://www.unece.org/env/documents/2010/wat/MP_WH/wh/ece_mp_wh_2010_L3_E.pdf
157 pages, 18 tables, 22 figures
II. Water safety plans
III. Legal obligations with regard to disease surveillance
IV. Surveillance system for water-related diseases
V. How to set up an essential surveillance system for water-related diseases (OMT)
VI. How a water-related disease surveillance system should work in practice
VII. How to evaluate a surveillance system for water-related diseases
VIII. National examples
I. The problem (Introduction)
Figure 1‑2 SDR diarrhoeal disease and assessing surveillance systems of water-related disease
below 5 y of age (Source: WHO Health for All)
While mortality data are surely the most striking, morbidity figures show that water-related diseases continues to be a serious problem in the European region, are hampering sustainable development and imposing prohibitive economic costs.
Surveying the health status of communities
Controlling and reducing the burden of WRDs has two main tools
Promoting adequate preventive measures in order to ensure safe access to water (adequate quality and quantity)
Examples where the system failed included an outbreak of giardiasis in Hordaland (Bergen) in 2004 – 2005 where the surveillance system proved to be “late” in detecting outbreaks.
Raw waters should be protected against pollution in the catchment area
Surface and shallow waters must always be treated before being used as a source of drinking-water;
the higher the level of contamination of raw water, the greater the efficiency of the water treatment process required;
Figure 8‑1 Sources of failures in the WSP approach giardiasis in Hordaland (Bergen) in 2004 – 2005 where the surveillance system proved to be “late” in detecting outbreaks.WHO WSPs
Drinking-water: subject to surveillance for the main risk factors (special attention to microbial quality)
Adequate education and training for the personnel
Surveillance systems implemented in several countries in the EURO Region but often do not include specific surveillance for WRDs.
Specific WRDs surveillance systems would provide relevant added value, as they can:
Mapping of pollution hazards and identifying risks;
promote intervention measures to control and prevent WRDs;
target resources towards areas with priority needs;
assess the effectiveness of the implemented water and sanitation interventions in reducing diseases.
In countries with limited resources:
High incidence of typhoid fever→ need for targeted vaccine campaigns;
epidemic and endemic giardiasis and cryptosporidiosis → need for water filtration (chlorination is not very effective against these pathogens)
need of household water treatment of water in high-risk areas;
outbreaks in adequately treated piped water supplies ( intrusion problems in the water distribution system) → need to keep water pressure stable or accept additional measures like booster chlorination
high prevalence of helminth infections → need for improvements in sanitation and increased water availability for general hygiene;
High incidence of blue-baby syndrome → need to control and reduce nitrate concentrations in drinking water.
Local diseases (diseases that are not present throughout the country concerned but may potentially have a severe local impact) : methemoglobinaemia, arsenicosis, viral infections (particularly those attributable to Norovirus) and parasitic diseases.
OMT composition: representatives of waterworks and sanitation system, water department of the regional environmental agency, expert in hygiene and environmental medicine.
The publication is available at http://www.unece.org/env/documents/2010/wat/MP_WH/wh/ece_mp_wh_2010_L2_E.pdf
22 pages, 2 figures