Reducing the Risks of Waterborne Microbial Contamination

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Reducing the Risks of Waterborne Microbial
Contamination
Judith L. Isaac-Renton, Director British Columbia
Public Health Laboratories, Professor Medical
Microbiology, University of British Columbia, CWN
Retreat, Victoria, June 2008
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Reducing the Risks of Waterborne Infections A
Public Health Perspective
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CWN Public Health Program

• Why study and address the risk of waterborne
  infections?
• International perspective
• Better systems for protection
• Emerging pathogens

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International Perspective
Source WHO World Health Report 2002. Countries
grouped by WHO Mortality Stratum, with Developing
Countries representing regions with High and Very
High Mortality, and Developed Countries
representing regions with Low and Very Low
Mortality.
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International Perspective
Source WHO World Health Report 2002. Countries
grouped by WHO Mortality Stratum, with Developing
Countries representing regions with High and Very
High Mortality, and Developed Countries
representing regions with Low and Very Low
Mortality.
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International Perspective
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Better Systems for Protection from Waterborne
Infections
Ways of Thinking of Risks
Systems to Try to Prevent Infections
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Multiple Barriers Within A Quality System

• Quality Management Systems (QMS)
• Water Safety Plans
• Integrated, highest standards in mind
• Multidisciplinary way of acting and thinking
• Commitment to continuous improvement in
• continuous cycle of Plan, Do, Check and Act
• Complementary to Multi-Barrier approach
• Source to Tap Catchment to Consumer

Plan
Do
Check
Act
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Source to Tap QMS Barriers

• Source protection
• Treatment
• Distribution systems
• Public Healths role

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Risk Models
Source (Watershed)
Water Safety Planning
Tap (Health)
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Rates of Enteric Infections by Water System
Types Policy Changes?
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Emerging Pathogens

• Microbiological contamination an international
  priority
• New waterborne pathogens

E.coli O157
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Percentage of Gastrointestinal (GI) Outbreaks
Identified by BCCDC Laboratory Services
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Emerging Pathogen Norovirus
FIG. Total number (left) and proportion (right)
of gastroenteritis outbreaks identified per year,
2000-2005. Courtesy, Lorraine McIntyre, EH, BCCDC
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Emerging Pathogens Norovirus
FIG. Norovirus outbreak rates in British Columbia
by Health Authority, 2000 to 2005. Courtesy,
Lorraine McIntyre
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Emerging Pathogens Norovirus
FIG. 5. Norovirus outbreaks in BC facilities,
2000-2005. Courtesy, Lorraine McIntyre, EH,
BCCDC,
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Role of Public Health

• Current Surveillance Inadequate
• Focus on disease identification
• After the water has been consumed
• Focus on epidemics little known about endemic
  spread
• Systems disjointed
• Systems slow and inaccurate

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Role of Public Health Audits and Monitoring
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Real-Time Monitoring
Physical Parameters
Biological Parameters
Public Health Parameters

• RCDs
• MSP
• OTCs

• Turbidity
• Rainfall
• Transport

• Indicators
• Pathogen Testing
• NAT/Genotyping

Remote biosensing, data in real time early
warnings interventions prevention of
infections
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Reducing the Risks of Waterborne Infections
Challenges to CWN

• Opportunities for international applications
• Help create and validate better systems for
  protecting the public health including hazard
  identification and risk assessment
• Better systems for real-time, effective
  monitoring of multiple barriers
• Vigilance pathogens emerging

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Thank You. Questions?