WATER
BORNE
DISEASES



WATERBORNE DISEASES

CLINICAL FEATURES

CONTAMINATED WATER

CONTAMINANTS

DRINKING WATER

WATER PURIFICATION

WATER PURIFICATION STAGES

ETIOLOGIC AGENTS

TRANSMISSION

RELATED DISEASES

ROTAVIRUS DISEASES VACCINES

DEHYDRATION

CAUSES

SYMPTOMS

TREATMENTS

ORAL REHYDRATION THERAPY

ORAL REHYDRATION SOLUTIONS

HOME MADE RECIPES

INTERAGENCY DIARRHOEAL DISEASE KITS

WATERBORNE DISEASES LINKS



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SECTION 1



WATERBORNE
DISEASES



WATERBORNE
DISEASES
Waterborne diseases, according to
the World Health Organization, are
those which generally arise from the
contamination of water by feces or
urine, infected by pathogenic viruses
or bacteria, and which are directly
transmitted when unsafe water is drunk
or used in the preparation of food.



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SECTION 2



CLINICAL
FEATURES



Clinical Features A range
of syndromes,including:

acute dehydrating diarrhea
(cholera),
prolonged febrile illness
with abdominal symptoms
(typhoid fever),
acute bloody diarrhea
(dysentery),
chronic diarrhea
(Brainerd diarrhea).



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SECTION 3



CONTAMINATED
WATER



Any disease that can spread
through contaminated water.

The contamination
can involve:
bacterial,
viral,
protozoan organisms.

Infection can result not only from
drinking the water but also from
swimming in the water where it can
enter the body in other ways such
as through broken skin.

Many poorer countries have limited
uncontaminated water supplies so
waterborne disease is a huge health
issue worldwide.



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SECTION 4



CONTAMINANTS



CONTAMINANTS
Contaminants that may be in untreated
water include microorganisms such as:

viruses and bacteria;
inorganic contaminants
such as;
salts and metals;
pesticides and
herbicides;
organic chemical contaminants
from industrial processes and
petroleum use; and radioactive
contaminants.

Water quality
depends on;

the local geology
and ecosystem,

as well as human
uses such as sewage
dispersion,

industrial pollution,

use of bodies water
as a heat sink, and
overuse, (which may
lower the level of
the water).



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SECTION 5



DRINKING
WATER



DRINKING
WATER

Drinking water is water that is
intended to be ingested by humans.

Water of sufficient quality to serve
as drinking water is termed potable
water whether it is used as such or
not.

Although many fresh water sources are
utilised by humans, some contain
disease vectors or pathogens and cause
health problems if they do not meet
certain water quality guidelines.

The World Health Organization has set
international guidelines for drinking
water.

WATER QUALITY

Water quality is the chemical and
physical characterization of water.

The primary bases for such characterization
are parameters which relate to potability,
safety of human contact and for health of
ecosystems.

The vast majority of surface water on the
planet is neither potable nor toxic.



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SECTION 6



WATER
PURIFICATION



WATER
PURIFICATION

Water purification is the removal
of contaminants from raw water to
produce drinking water that is
pure enough for human consumption
or for industrial use.

Substances that are removed during
the process include parasites:

such as Giardia,
Cryptosporidium,
bacteria,
algae,
viruses,
fungi,
minerals
including:
toxic metals such as:
Lead, Copper etc.,
man-made chemical
pollutants.

Many contaminants can be dangerous,
depending on the quality standards,
others are removed to improve the:


water's smell,
taste,
appearance.

A small amount of disinfectant is
usually intentionally left in the
water at the end of the treatment
process to reduce the risk of the
re-contamination in the distribution
system.



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SECTION 7



WATER
PURIFICATION
STAGES



There are three
principal stages
in water purification.

Primary treatment:
Collecting and screening
including pumping from
rivers and initial
storage.

Secondary treatment:
Removal of fine solids
and the majority of
contaminants using
filters, coagulation,
flocculation and
membranes.

Tertiary treatment:
Polishing,
pH adjustment,
carbon treatment to
remove taste and smells,
disinfection, and the
temporary storage to
allow the disinfecting
agent to work.



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SECTION 8



ETIOLOGIC
AGENTS



Etiologic Agent
Common agents
include:
Vibrio cholerae,
Campylobacter,
Salmonella,
Shigella,
diarrheogenic
Escherichia coli.

Many deaths among infants
and young children are due
to dehydration, malnutrition,
or other complications of
waterborne bacterial infections.


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SECTION 9



WATER
BORNE
DISEASE
TRANSMISSION



Water borne diseases spread by
contamination of drinking water
systems with the urine and faeces
of infected animal or people.

This is likely to occur where public
and private drinking water systems
get their water from surface waters
(rain, creeks, rivers, lakes etc.),
which can be contaminated by infected
animals or people.

Runoff from landfills,
septic fields,
sewer pipes,
residential
industrial developments
can also sometimes
contaminate surface water.

Contaminated surface water
sources and large poorly
functioning municipal water
distribution systems contribute
to transmission of waterborne
bacterial diseases.

Chlorination and safe water
handling can eliminate the
risk of waterborne bacterial
diseases.

Centralized water treatment and
distribution systems are expensive
and take years to complete.

To provide the under-served with
potable water in the short term
requires innovative practical
solutions such as point-of-use
disinfection and safe water
storage vessels.



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SECTION 10



WATER
RELATED
DISEASES



Water realated diseases:

Anaemia
Arsenicosis
Ascariasis
Botulism
Campylobacteriosis
Cholera
Cryptosporiodiosis
Cyanobacterial toxins
Dengue
Diarrhoea
Dracunculiasis
Fluorosis
Giardiasis
Hepatitis
Hookworm infection
Japanese encephalitis
Lead poisoning
Legionellosis
Leptospirosis
Lymphatic filariasis
Malaria
Malnutrition
Methaemoglobinemia
Onchocerciasis
Polio
Ring Worm or Tinea
Scabies
Schistomiasis
Trachoma
Trichuriasis
Typhoid.

Dimension of
the problem:

In developing countries four-fifths
of all the illnesses are caused by
water-borne diseases, with diarrhoea
being the leading cause of childhood
death.



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SECTION 10A



ROTAVIRUS
DISEASES
AND
VACCINES



Key Facts:
Worldwide, almost every child
will have at least one rotavirus
infection before he or she is
five years old.

The virus is so contagious and
resilient that providing clean
water and promoting proper
hygiene do not significantly
reduce incidence, which is
nearly the same in the
industrialized and developing
countries.

Additionally, because rotavirus
usually causes profuse vomiting,
ORS/ORT is difficult to administer.


Oral rehydration therapy, ORT,

Oral rehydration salts
or solutions (ORS),
or oral electrolyte).



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SECTION 11



DEHYDRATION



Dehydration, which means that too
much liquid has been drained out
of the child's body.

To replace the liquid being lost
it is essential to give the child
extra drinks as soon as diarrhoea
starts.

Medically, dehydration is a serious
and potentially life-threatening
condition in which the body contains
an insufficient volume of water for
normal functioning.

In humans, dehydration can be caused
by a wide range of diseases and states
that impair water homeostasis in the
body.



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SECTION 11A



CAUSES



DEHYDRATION

External or
stress-related
causes:

Prolonged physical activity
without consuming adequate
water, especially in a hot
environment,

Prolonged exposure to dry air,
in high-flying airplanes,

Survival situations, especially
desert survival conditions,

Blood loss or hypotension
due to physical trauma,

Diarrhea,

Hyperthermia,

Shock,
(hypovolemic),

Vomiting,

Burns,

Infectious diseases,

Cholera,

Gastroenteritis,

Shigellosis,

Yellow fever,

Malnutrition,

Electrolyte imbalance,

Hypernatremia,
also caused by dehydration,

Hyponatremia,
especially from restricted
salt diets,

Consumption of alcohol,
caffeine or other
diuretic substances,

Fasting,

Recent rapid weight loss
may reflect progressive
depletion of fluid volume.
The loss of 1 L of fluid
results in a weight loss
of 1 kg, or 2.2 lb.

Patient refusal of nutrition
and hydration,

Other causes of obligate
water loss,

Severe hyperglycemia,
especially in Diabetes
mellitus,

Glycosuria.



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SECTION 11B



SYMPTOMS



Symptoms may include;
headaches similar to
what is experienced
during a hangover:
a sudden episode
of visual snow,
decreased blood
pressure (hypotension),
dizziness or fainting
when standing up due
to orthostatic
hypotension.

Untreated dehydration
generally results in
delirium,
unconsciousness,
and in extreme
cases death.



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SECTION 11C



TREATMENT



Courtesy:
Centers for Disease
Control and Prevention.

The best treatment for minor dehydration
is drinking water and stopping fluid loss.

Water is preferable to sport drinks and
other commercially-sold rehydration fluids,
as the balance of electrolytes they provide
may not match the replacement requirements
of the individual.

To stop fluid loss from vomitting and diarrhea,
avoid solid foods and drink only clear liquids.

In more severe cases, correction of a dehydrated
state is accomplished by the replenishment of
necessary water and electrolytes (rehydration,
through oral rehydration therapy or intravenous
therapy).

When dehydrated, unnecessary sweating should
be avoided, as it wastes water. If there is only
dry food, it is better not to eat, as water is
necessary for digestion.

For severe cases of dehydration where fainting,
unconsciousness, or any other severely inhibiting
symptom is present (the patient is incapable of
standing or thinking clearly), emergency attention
is required.

Fluids containing a proper balance of replacement
electrolytes are given orally or intravenously with
continuing assessment of electrolyte status; complete
resolution is the norm in all but the most extreme
cases.



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SECTION 12



ORAL
REHYDRATION
THERAPY



Oral rehydration therapy, ORT,
oral rehydration salts,
solutions (ORS),
oral electrolyte.



Oral rehydration therapy,
ORT, oral rehydration salts
solutions (ORS),
oral electrolyte),

is a simple, cheap, and effective treatment
for diarrhea-related dehydration, for example
due to cholera or rotavirus.

It consists of a solution of salts and other
substances such as glucose, sucrose, citrates
or molasses, which is administered orally.

It is used around the world, but is most
important in the Third World, where it
saves millions of children from diarrhea
still their leading cause of death.

Oral rehydration therapy is widely considered to
be the best method for combating the dehydration
caused by diarrhea and/or vomiting.

Various diseases cause damage to the intestine,
allowing water to flow from the blood into the
intestine, depleting the body of both fluid and
electrolytes.

This may be a direct destruction of the cells
lining the intestine (the enterocytes),

a toxic effect causing them to lose
their microvilli (the brush border),

a toxic effect (by an enterotoxin)
causing them to secrete water.

In the human body, water is absorbed and
secreted passively; it follows the movement
of salts, based on a principle called osmosis.

So, in many cases, diarrhea is caused by
intestine cells secreting salts (primarily
sodium) and water following passively along.

Simply drinking water is
ineffective for 2 reasons:

(1) the large intestine is
usually secreting instead
of absorbing water,

(2) electrolyte losses
also need compensating.

As such, the standard treatment is to restore
fluids intravenously with water and salts.

This requires trained personnel and materials
which are not sufficiently available in the
Third World.



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SECTION 12A



ORAL
REHYDRATION
SOLUTIONS



Oral
Rehydration
Solutions:
Made at Home.



ORAL
REHYDRATION
SOLUTIONS

To prevent too much liquid being
lost from the child's body, an
effective oral rehydration solution
can be made using ingredients found
in almost every household. One of
these drinks should be given to the
child every time a watery stool is
passed.

Ideally these drinks
(preferably those that
have been boiled)
should contain:

starches and/or
sugars as a source
of glucose and energy,

some sodium and
preferably some
potassium.

The following traditional remedies
make highly effective oral rehydration
solutions and are suitable drinks to
prevent a child from losing too much
liquid during diarrhoea:

Breastmilk,

Gruels, (diluted mixtures
of cooked cereals and
water)

Carrot Soup,

Rice water congee.

A very suitable and effective
simple solution for rehydrating
a child can also be made by using
salt and sugar, if these ingredients
are available.

If possible, add 1/2 cup orange juice
or some mashed banana to improve the
taste and provide some potassium.

Molasses and other forms of raw sugar
can be used instead of white sugar,
and these contain more potassium than
white sugar.

If none of these
drinks is available,
other alternatives are:

Fresh fruit juice
Weak tea
Green coconut water
If nothing else is available,
give water from the cleanest
possible source,
(if possible brought to the
boil and then cooled).



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SECTION 12B



HOME
MADE
ORS
RECIPES



The
"simple solution"
Home made
ORS recipe.



HOME
MADE
ORS
RECIPES

Preparing a 1 (one) litre oral
rehydration solution [ORS] using
Salt, Sugar and Water at Home.

Mix an oral rehydration solution using
one of the following recipes; depending
on ingredients and container availability:

Ingredients:

one level teaspoon
of salt,

eight level teaspoons
of sugar,

one litre of clean
drinking or boiled
water and then cooled,

5 cupfuls (each cup
about 200 ml.),

Preparation Method:

Stir the mixture till the
salt and sugar dissolve.

Questions on
Solutions
made at Home.

Q. How do I measure the Salt and Sugar?

Different countries and different
communities use various methods
for measuring the salt and sugar.

Finger pinch and hand measuring,
and the use of local teaspoons
can be taught successfully.
A plastic measuring spoon is
available from Teaching Aids at
Low Cost (TALC) with proportions
to make up 200 ml of sugar/salt
solution.
Whatever method is used, people
need to be carefully instructed
in how to mix and use the
solutions.

Do not use
too much salt.

If the solution has too much salt
the child may refuse to drink it.
Also, too much salt can, in
extreme cases, cause convulsions.
Too little salt does no harm but
is less effective in preventing
dehydration.

A rough guide to the amount of salt
is that the solution should taste
no saltier than tears.

Q. How much solution do I feed?

Feed after every loose motion.

Adults and large children should
drink at least 3 quarts or liters
of ORS a day until they are well.

Each Feeding:

For a child under the age of two
Between a quarter and a half of
a large cup.

For older children
Between a half and a whole large
cup.

For Severe Dehydration:

Drink sips of the ORS (or give the
ORS solution to the conscious
dehydrated person) every 5 minutes
until urination becomes normal.

It's normal to urinate
four or five times a day.

Q. How do I feed the solution?

Give it slowly, preferably with a
teaspoon.
If the child vomits it, give it again.
The drink should be given from a cup
(feeding bottles are difficult to clean
properly).
Remember to feed sips of the liquid slowly.

Q. What if the child vomits?

If the child vomits, wait for ten
minutes and then begin again.
Continue to try to feed the drink
to the child slowly, small sips at
a time.

The body will retain some of the
fluids and salts needed even though
there is vomiting.

Q. For how long do I feed the liquids?

Extra liquids should be given until
the diarrhoea has stopped.
This will usually take between three
and five days.

Q. How do I store the ORS solution?

Store the liquid in a cool place.
Chilling the ORS may help.
If the child still needs ORS after
24 hours, make a fresh solution.

10 Things you
should know about
Rehydrating a
child.

Wash your hands with soap
and water before preparing
solution.

Prepare a solution, in a
clean pot, by mixing.

one teaspoon salt and
8 teaspoons sugar,
or
1 packet of Oral
Rehydration Salts (ORS)
with one litre of clean
drinking or boiled water
(after cooled).

Stir the mixture till
all the contents dissolve.

Wash your hands and the
baby's hands with soap
and water before feeding
solution.

Give the sick child as much
of the solution as it needs,
in small amounts frequently.

Give child alternately other
fluids - such as breast milk
and juices.

Continue to give solids if child
is four months or older.

If the child still needs ORS after
24 hours, make a fresh solution.

ORS does not stop diarrhoea.
It prevents the body from drying up.
The diarrhoea will stop by itself.

If child vomits, wait ten minutes
and give it ORS again.
Usually vomiting will stop.

If diarrhoea increases and /or vomiting
persists, take child over to a health
clinic.

Footnote:

People often refer to
home-prepared oral
rehydration solutions
as "home-brew."

This should be discouraged
because the word brew implies:

either fermenting which in fact is
an obstacle to some home-prepared
solutions especially those made with
rice-powder,

or it implies boiling (as in tea)
which, especially with sugar and
salt or using packets of ORS,
should not be done because it
decomposes the sugar, or
caramelises.



WORLD
HEALTH
ORGANIZATION
http://www.who.int/en/



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SECTION 13



INTERAGENCY
DIARRHOEAL
DISEASE
KITS



Basic module:


Drugs:
ORS, as well as Ringer Lactate
for ten severe cases only,
(with an average of eight
litres per patient)

Cholera: Doxycycline
(65 adults), Erythromycin
(60 children)

Shigella: Ciprofloxacin
(100 adults and 100 children),
following the Dhaka
recommendations,

Disinfectant:

Renewable supplies,
including culture
swabs.

Equipment:
Documents on diarrhoeal
disease management
in emergencies.

ORS module:

ORS for 400 cholera
patients with no
or with moderate
dehydration.
This material covers
the needs for two ORUs.

Infusion module:

Ringer Lactate with IV
giving sets for 90 severe
cholera cases,
(with an average of eight
litres per patient)

In case of local purchase
infusion AND giving set
have to be ordered.



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REHYDRATION
LINKS



Adventure Medical
http://www.packinglight.net/

Adventure Medical Kits
http://www.adventuremedicalkits.com/

Rehydration Project
http://www.rehydrate.org/



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SECTION 14



WATERBORNE
DISEASES
LINKS



Green Pages
http://www.eco-web.com/

Health On the Net
http://www.hon.ch/

INFO FOR HEALTH
http://www.infoforhealth.org/

Ingenta Connect
http://www.ingentaconnect.com/

Lenntech
http://www.lenntech.com/

National Institute of Allergy
and Infectious Diseases NIAID
http://www.niaid.nih.gov/

National Foundation for
Infectious Diseases, NFID
http://www.nfid.org/

Pure Water for the World
http://www.purewaterfortheworld.org/



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Safe Water International
http://www.safewaterintl.org/

U.S. Environmental
Protection Agency
http://www.epa.gov/

Waterborne Disease Center
http://www.waterbornediseases.org/

Water Health Connection
http://www.waterhealthconnection.org/

Water Technology Online
http://www.watertechonline.com/

WEB MD
http://www.webmd.com/

Wrong Diagnosis.com
http://www.wrongdiagnosis.com/


WORLD
HEALTH
ORGANIZATION
http://www.who.int/en/


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