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Water Services National Training Group and National Federation of Group Water Schemes. 7 th Annual Rural Water Services Conference 18 th September 2008. Safety & Security of Water Supplies - A Public Health Issue. Dr. Heidi Pelly, Consultant, Public Health Medicine,

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water services national training group and national federation of group water schemes

Water Services National Training Group and National Federation of Group Water Schemes

7th Annual Rural Water Services Conference

18th September 2008

safety security of water supplies a public health issue

Safety & Security of Water Supplies- A Public Health Issue

Dr. Heidi Pelly,

Consultant, Public Health Medicine,

Health Services Executive

terminology
Terminology

A pathogen is a microorganism capable of causing disease in a host

Waterborne pathogens excreted in faeces of humans/animals, transmitted via ingestion

Water-based pathogens occur naturally in water, usually not transmitted person to person (e.g. Legionella spp.)

importance of waterborne pathogens
Importance of Waterborne Pathogens

Increased sensitive subpopulations

Recognition of important additional health effects, including chronic sequelae

Natural evolution of microbes with increased virulence

Development of molecular techniques leading to improvements in detection of outbreaks and their sources.

agents of waterborne or water based disease
Agents of Waterborne or Water-based Disease
  • Waterborne outbreaks generally caused by failed/absent treatment processes
  • Greatest infectivity, small dose cause infection, longer environmental survival. Removal by filtration inefficient, more resistant to disinfection.
  • Single cell organism, thick wall highly resistant to disinfection
  • Bacteria:

Shigella spp.

Toxigenic E. coli

Campylobacter spp

  • Viruses:

Norovirus

Rotavius

Hepatitis A

  • Protozoa:

Cryptosporidium spp

Giardia

Toxoplasma Gondi

landmark water incidents
Landmark Water Incidents
  • National
    • - Naas 1992
    • - Nenagh 1996
    • - Mullingar 2002
    • - Galway 2007
  • International
    • Soho 1854 – Cholera outbreak ( John Snow)
    • Hamburg 1892 – Cholera epidemic
    • Swinden 1989 – Cryptosporidium
    • Milwaukee 1993 – Cryptosporidium
    • Walkerton – E. coli
current situation
Current Situation

944 Public water supplies

777 Public group water schemes (GWS)

706 Private GWS

100,000 – 200,000 Private wells

85% surface water

Increasing demand

water services act 2007
Water Services Act 2007

‘protection of human health’

‘protection of public health’

‘public authority’ includes Health Service Executive

‘water services authority’ replaces ‘sanitary authority’

drinking water regulations s i no 278 of 2007
Drinking Water RegulationsS.I. No. 278 of 2007

Protection of human health

  • Para 9 (1) Where a sanitary authority, in consultation with the HSE, considers that a supply of water intended for human consumption constitutes a potential danger to human health, the authority shall, subject to agreement with the HSE, ensure that …..
  • Para 9 (2) …. Subject to agreement with the HSE … the supervisory authority shall issue such direction to the relevant water supplier as it considers necessary….
drinking water regulations s i no 278 of 20071
Drinking Water Regulations S.I. No. 278 of 2007

Departures from standards

  • Para 11 (1) A departure from the parametric values…. may …. subject to the agreement of the HSE, be granted by the Agency……

Confirmed in writing by the Medical Officer of Health (EPA Handbook)

infectious disease regulations s i no 390 of 1981
Infectious Disease RegulationsS.I. No. 390 of 1981

Para 11 On becoming aware … of a case or a suspected case of an infectious disease or of a probable source of infection with such disease, a medical officer of health… shall make such enquiries and take such steps as are necessary … for investigating the nature and source of infection, for preventing the spread of such infection and for removing conditions favourable to such infection

other relevant legislation
Other Relevant Legislation
  • Food safety
    • Food Hygiene Regulation S.I. No. 205 of 1950
    • EC Regulation No 852/2004
      • hygiene of foodstuffs
      • requires the use of potable water in connection with the food business
      • S.I. No. 369 of 2006 gives effect in Irish law
  • Fluoridation Regulations S.I. No. 42 of 2007
current procedures
Current Procedures
  • Incidence Response Team
  • Water monitoring results
  • Acute infections
  • Increase/outbreak of
  • human illness
  • Routine

- Water Liaison Group

- Protocols/guidelines

- Water monitoring programme

- Surveillance of notifiable disease

environmental health service
Environmental Health Service

First point of contact with HSE

Water monitoring programme for local authorities

Water monitoring under food safety legislation

Fluoridation (Dentists)

Environmental expertise

laboratory services
Laboratory Services
  • Clinical Laboratories

- Patientspecimens

  • Public Health Laboratories

- Water & environmental specimens

  • Public Analyst Laboratories
  • Reference Laboratories
  • Consultant microbiologist
public health department
Public Health Department
  • Surveillance of notifiable infectious disease

- Receive notifications

- Enhanced surveillance

- case finding

- HPSC

  • Investigation

- Epidemiological studies – descriptive/analytical

- International evidence

- Expert advice

  • Staff

- Public Health Doctors – MOH

- Surveillance Scientists

- Communicable Disease Nurse

public health advice
Public Health Advice
  • Health and other professionals
  • Vulnerable groups

- Immunocompromised

- Infants

- Elderly

  • General public
  • Risk Communication
health protection surveillance centre
Health Protection Surveillance Centre

Collate date on notifiable infections at national level

Support preparation of national guidelines/advice/IT systems e.g. CIDR

Monitors trends

Annual reports. e.g.

protection of human health
Protection Of Human Health
  • Assessment of the risk

- Is there a problem

- what is the cause

  • Identification of the population affected

- Vulnerable groups

- Vulnerable sites

  • What can be done now
  • What can be done to stop it happening again
boil water notice
Boil Water Notice
  • Advantages – immediate and effective
  • Disadvantages

- Compliance

- Duration

- Criteria for lifting

- Resources

- Burns/scalds

- Alternative supplies

- Loss of confidence

factors contributing to these outbreaks
Factors contributing to these outbreaks

Wastewater contamination

Inadequate knowledge of source water hazards

Inadequate disinfection

Extreme weather (heavy rain & runoff)

Filtration failures

Cross-connections and distribution failures

Livestock/wildlife faecal contamination

Plant maintenance/treatment process changes

factors contributing to outbreak failures
Factors contributing to outbreak failures
  • “More than one mechanism was involved in contributing to each outbreak, and vulnerable conditions had often been in place for years, if not decades. In hindsight, all of these outbreaks were preventable, often with even a modest level of foresight and care.”
  • “ The preventive measures required are all things that we know how to do.”
relying on microbiological evidence of disease
Relying on Microbiological Evidence of Disease

Asymptomatic disease

An infected person may not visit doctor

The doctor may not seek a stool specimen

The patient may not provide a specimen

The appropriate test may not be requested

The test may be done incorrectly

The test may be unable to detect pathogens present

There may be delays in laboratory reporting.

the world s water supply
The World’s Water Supply

If all earth’s water fit in a gallon jug, available fresh water would equal just over a tablespoon – less than half of one percent of the total. About 97 percent of the planet’s water is seawater and another 2 percent is locked in icecaps and glaciers. Vast reserves of fresh water underlie earth’s surface, but much of it is too deep to economically tap.

references
References

Hrudley, S. E; Hrudley, E. J. (2007) Published Case Studies of Waterborne Disease Outbreaks – Evidence Of a Recurrent Threat. Critical Review. Water Environment Research, 79 (3), 233 – 245.

acknowledgments
Acknowledgments

Dr. BethAnn Roch, HSE South (SE).

Dr Tessa Greally, HSE West (MW)

water services national training group and national federation of group water schemes1

Water Services National Training Group and National Federation of Group Water Schemes

7th Annual Rural Water Services Conference

18th September 2008