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Bottled water

Bottled water. Gordon Nichols Gastrointestinal, Emerging and Zoonotic Infections Department HPA Centre for Infections 61, Colindale Avenue, London NW9 5EQ gordon.nichols@hpa.org.uk. Bottled water. Mineral water Spring water Bottled water Water dispensers.

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Bottled water

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  1. Bottled water Gordon Nichols Gastrointestinal, Emerging and Zoonotic Infections Department HPA Centre for Infections 61, Colindale Avenue, London NW9 5EQ gordon.nichols@hpa.org.uk

  2. Bottled water • Mineral water • Spring water • Bottled water • Water dispensers

  3. Cholera in Portugal 19742467 hospitalised cases and 48 deaths

  4. Cholera cases in Lisbon 1974 Total cases in Lisbon Cases known to have consumed bottled water, visited the spa or worked at the spa within 5 days of symptoms

  5. Salmonella Bareilly, USA 2000 • Multi-state outbreak April-August. • 84 persons affected. • Associated with drinking bottled water (spring water or ‘infant’ water) or with water from a linked private well or spring. • Water treated by filtration, UV and ozonization, but E.coli and coliforms detected in some samples suggesting poor application of treatment. • MMWR 2002;51:SS1-28

  6. Campylobacter jejuni,USA 1997 • 106 soldiers became ill after a training exercise in Greece • Greek bottled water identified as the source • No further information available • MMWR 2000;49:SS4 1-21.

  7. 11 patients infected 4 hospitalised Public tap water is too salty to drink General use of bottled reverse osmosis treated municipal water Multi-use bottles Hot water and chlorine cleaning Coliforms detected in bottled water poor cleaning of returned bottles suspected MMWR 1996;45:SS1-33. Vibrio cholerae non O1, Saipan, Northern Mariana Island 1994

  8. Natural Mineral Water Microbiological analysis must include: • a demonstration of the absence of parasites and pathogenic organisms, quantitative determination of the indicators of faecal contamination, showing: • absence of Escherichia coli and other coliforms in 250 ml, • absence of faecal streptococci in 250 ml, • absence of sporulated sulphite-reducing anaerobes in 50 ml and • absence of Pseudomonas aeruginosa in 250 ml. • determination of total viable colony count per millilitre of water at 20-22 °C in 72 hours on agar-agar or agar-gelatine mixture; and at 37 °C in 24 hours on agar-agar. • It may be necessary to carry out analysis of parasites (Giardia, Cryptosporidium, parasitic helminths, amoebae) and pathogens (Salmonella spp., Shigella spp., Aeromonas hydrophila spp. and Vibrio spp.) in specified volumes of water at not less than six monthly intervals over two years. • Quantitative determination of the indicators of faecal contamination (E. coli and other coliforms) should be carried out at least every month for two years. The total viable count should be measured every month for two years and should be no higher than normally observed (i.e. there should be no evidence of occasional contamination).

  9. Natural Mineral Waters

  10. Spring, Bottled and Dispenser Waters

  11. Bacteria found in Bottled water Pseudomonas acidovorans Pseudomonas aeruginosa Pseudomonas alcaligenes Pseudomonas diminuta Pseudomonas fluorescens Pseudomonas mesophilica Pseudomonas paucimobilis Pseudomonas pseudalcaligines Pseudomonas putida Pseudomonas stutzeri Pseudomonas vesicularis Acinetobacter junii Burkholderia cepacia CDC gr.IVC-2d Commamonas sp. Flavobacterium oryzahabitans Moraxella sp. Sphaeromonas paucimobilis Staphylococcus spp. Ralstonia pikettii Stenotrophomonas maltophilia • Benito et al, 1999. Int J Food Micro • Hernandz-Duquino & Rosenberg, 1987 Can J Micro • Hunter 1993 J Appl Micro • Manaia et al, 1990 J Appl Bact

  12. Growth of bacteria in bottled water • PCA diluted ¼ and 1/10 • Few qualitative or quantitative differences between counts at purchase and after 6 months at room temperature • Benito et al, 1999. Int J Food Micro • Hernandz-Duquino & Rosenberg, 1987 Can J Micro • Hunter 1993 J Appl Micro • Manaia et al, 1990 J Appl Bact

  13. Survival of Escherichia coli O157 in natural mineral water (NMW), Sterile mineral water (SMW) and sterile distilled deionised water (SDW) (Kerr et al, 1999 J Appl Micro)

  14. Effect of Escherichia coli O157 added to natural mineral water (NMW) on the autochthnonous flora(Kerr et al, 1999 J Appl Micro)

  15. Growth kinetics of Pseudomonas aeruginosa in bottled waterTamagnini & Gonzalez 1997 • Counts of Ps aeruginosa increased to between 103 and 106/ml within 6 days of bottling • Doubling time 26 hours with accompanying flora • Doubling time of 3.6 hours in sterile water

  16. Protozoa • Naegleria gruberi • Acanthamoeba astronyxis • Valkampfia valkampfi • Bodomorpha minima • Cryptosporidium spp. • Giardia spp.

  17. Algae • Blue-green • Agmenellum • Anabena • Cylindrospermum Green • Actinastrum • Ankistrodesmus • Staurastrum • Eudorina • Oocystis • Scenedesmus • Tetraedron • Diatoms • Bacillaria • Cyclotella • Melosira • Synedra

  18. Microcystis aeruginosa

  19. Viruses • A group in Switzerland has reported the detection of Norwalk-like viruses (NLVs) in mineral waters (Beuret et al. 2000 and Beuret et al. 2002) • The first described the detection of NLV in 21 x 1.5 litre samples of 69 mineral waters from 11 out of 29 different brands • The second reported detecting NLV in 53 out of 159 samples tested from 3 brands and contamination was confirmed by testing further samples from positive batches. Waters were either imported into Switzerland or bottled there • One-litre and 0.1-litre volumes of water were tested. All positives occurred in the one-litre volumes. • It is likely that non-viable virus sequences were detected

  20. Campylobacter spp. • Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia. • Outbreaks tend to be small • Outbreaks associated with private water supplies • Seasonal changes in incidence • Continuing increase in cases • Epidemiology remains unclear • Case case association between Campylobacter and bottled water (Evans et al, 2003)

  21. Outbreaks linked to private water supplies 1970-2004* 32 outbreaks • Campylobacter (13) • Cryptosporidium (3) • Cryptosporidium and Campylobacter (2) • Campylobacter & E. coli O157 (1) • Giardia (1) • E.coli O157 (3) • Norovirus (1) • Streptobacillus (1) • Salmonella paratyphi B (1) • Not known (6) *Said B, Wright F, Nichols GL, Reacher M, Rutter M. Outbreaks of infectious disease associated with private drinking water supplies in England and Wales 1970-2000. Epidemiol Infect. 2003 Jun;130(3):469-79.*Yip, H. Risk Assessment of Private Water supplies. PhD Thesis 2007

  22. Water use in the home • Greater use of end point treatment devices • Dissatisfaction with chlorine residual and hardness • Increased water storage in the kitchen • Increased consumption of bottled water • Increased risk of cross contamination in the kitchen

  23. Public and private water supply telephone survey – Overview • Interview success rate 46% (317 / 687) • Water supplies • 61 Private supply (19%) • 254 Mains supply (80%) • 2 Both private and mains (1%) • Key finding • Private water supply users are happier with their drinking water than mains water users (Private = 95%, Mains = 76%) • Reasons why people like their water: • TASTE • Reasons why people don’t like their water: TASTE & “CHEMICAL” (especially Chlorine) • People on mains supplies drink more bottled water (31%) than people on private supplies (16%).

  24. Conclusions • Bottled water is a safe product • Main risk is from faecal contamination of the source • Escherichia coli and enterococci are the important indicators • Risk assessment linked to monitoring is a safe means of control

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