WATERBORNE DISEASES

GROUP 2
General
Disease agents spread by water and food and may result to serious
health problems.
WHO estimates 80% of all diseases are from water sanitation.
1920- 2000: 1,836 waterborne outbreaks represent 882,592 health
cases in US
Most waterborne diseases resulted to typhoid fever (before 1940)
20-25% of people in US are very young, elderly, immunocompromised,
and critically ill persons and are often the victims of waterborne
diseases.
Water-and A.k.a. Intestinal or filth diseases
Foodborne Raw drinking water such as
groundwater supplies may be
Diseases contaminated by excreta or sewage
Excreta- contains pathogenic
microorganisms that can cause illness to
someone contaminated by it.
Inadequate water treatment system,
deficient distribution system, improper
waste water disposal, etc. are some of the
major causes of waterborne disease
outbreaks.
 Substance Dose to Cause Illness
Amount of the substance or pathogen ingested (toxicity level)
determines the development of illness in an individual.
If the resistance or susceptibility of an individual was not enough to
counter the dose of the toxics, it may result to acute or long-term
illness.
EFFECT OF ADDITIONAL DOSE OF
CATEGORY OF SUBSTANCE
CHEMICAL SUBSTANCE
NO EFFECT No increase in illnesses
NO THRESHOLD Increasing illnesses
THRESHOLD No apparent increase in illnesses at first
but then continuing increased doses show
increasing illnesses
NO-OBSERVED-EFFECT Below reference dose
The table contains a list various microorganisms and the
approximate infectious dose required to cause disease.
Microorganism Approximate Number of Organisms (Dose)
Required to Cause Disease
Campylobacter jejuni a 102 or less
Coxiella burnetib 107
Cryptosporidium 101-102 oocysts
Dracunculus, Ascaris, Schistosoma 1 cyst, egg, or larva
Entamoeba histolyticad 10-20 cysts, one in a susceptible host
Escherichia colib 108
Giardia f 5-102 cysts
Salmonella typhib'g 105 106
Salmonella typhimurium g 103-104
Shigellab,g 101-102
Staphylococcus aureusb 106-107 viable enterotoxin-producing cells per
T4brio choleraeb'g gram of food or milliliter of milk
Virus, pathogenic 106-109
1 plaque-forming unit (PFU) or more
 Summary of Characteristics and
Control of water and Food borne
Diseases
o In the view of the fact that water-and foodborne diseases result in
discomfort, disability, or even death, a better understanding of their
sources, method of transmission, control, and prevention is desirable.
o Special attention should be paid the subject of GASTROENTERITIS.
Three types of Gastroenteritis
[Link]
2. Inflammatory
3. Invasive
What is GASTROENTERITIS?

Inflammation of the stomach and small or large

intestines Results in vomiting and/or diarrhea
Often called "stomach flu

What causes viral gastroenteritis? Not

caused by the influenza viruses Caused by many
different viruses e.g. rotaviruses, adenoviruses,
caliciviruses, astroviruses, Norwalk virus, and a
group of Norwalk-like viruses (later called
calicivirus, norovirus)
Forms of GASTROENTERITIS, Symptoms, and Causative Agents
Gastroenteritis Symptoms Responsible Organisms

1. Non inflammatory Diarrhea and/or vomiting, no Bacteria: Staphylococcus

gastroenteritis fecal leukocytes, no blood in aureus ,a Bacillus cereus,a
stool, usually no fever. Clostridium perfringens , aClostridium
botulinuma
Viruses: noroviruses
Protozoa: Giardia lamblia
(intestinalis), Cryptosporidium
parvum
Algae: Pfiesteria
2. Inflammatory Diarrhea and/or vomiting, Bacteria: Vibrio cholerae,b
gastroenteritis fecal leukocytes present, enteropathogenic Escherichia
usually coli (EPEC), enteroaggregative
severe fever, no blood in stool. E. coli (EAggEC), Clostridium
dOcile, Shigella spp,
enterotoxigenic E. coli (ETEC)
Viruses: rotavirus, Calicivirusesb
Protozoa: Entamoeba dispar
Forms of GASTROENTERITIS, Symptoms, and Causative Agents
continuation

Gastroenteritis Symptoms Responsible Organisms

Invasive Invasion past epithelial layer of Gl Bacteria. Salmonella spp.,

gastroenteritis tract, may not have any diarrhea or Campylobacter jejuni,
vomiting, dysentery may be present enteroinvasive E. coli (EIEC),
(mucus containing bloody feces), enterohemorrhagic E. coli
fecal leukocytes present, fever: may (EHEC), Vibrio vulnificus,
not have any Gl tract problems but Yersinia spp., Franciscella
instead severe systemic problems. tularensis, Bacillus anthracis,
Helicobacter pylori
Viruses: unknown
Protozoa: Entamoeba histolytica
 Different forms of gastroenteritis typically display
common symptoms such as watery diarrhea, vomiting,
intestinal and stomach cramps, and muscular aches, all
of which create a nausea in the victim.
 Characteristics and Control of Water- and Foodborne
Diseases
Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control

B Botulism Clostridium Soil, dust, Improperly Gastrointestinal pain, 2hr-8 days, Boil home
a food botulinum and fruits, processed diarrhea or usually canned nonacid
c poisoning C. parabotulinum vegetables, canned constipation , 12-36hr food 5 min;
t that produce foods, mud, and bottled prostration, difficulty thoroughly
e toxin fish, animal foods in swallowing, double cook meats,
r and human containing vision, difficulty in fish, foods
i feces the respiration held over. Do
a toxin, also not taste
l other suspected food.
foods Store fish
t at <38F.
o
x
i
n
s
 Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control

B Staphylococ Staphylococci Skin, Contaminated Acute nausea, 1-6hr or Refrigerate promptly

a cus that produce mucous custard vomiting, and longer, prepared food in
x food entero-toxin, membranes, pastries, prostration; average shallow
t poisoning Staphylococcus pus, dust, cooked or diarrhea, 2-4 hr containers at a
e aureus. (Toxin air, processed abdominal temperature
r is stable at sputum, and meats, cramps. below 45F. Discard
i boiling throat poultry, dairy Usually leftover food. Avoid
a temperature.) products, explosive in handling food.
l hollandaise nature, Educate
t sauce, followed by foodhandlers in
o salads, milk rapid recovery personal
x of those hygiene and sanitation
i afflicted.
n
s
 Disease Specific Reservoir Common Symptoms Incuba Prevention
Agent Vehicle in Brief tion and Control
Period
Clostridium Clostridium Soil, Contaminated Sudden abdominal 8-22hr, Cook foods
perfringens perfringens gastrointes food, pain, then diarrhea usually thoroughly,
food ([Link]), a tinal inadequately and 10-12 cool rapidly, and
poisoning sporeformer. tract of heated meats, nausea hr refrigerate
(Certain man including Ingestion of large promptly foods
spores and roasts, numbers of not consumed.
are heat animals, stews, beef, vegetative Cool foods
resistant.) cattle, poultry, cells that grow in in shallow
poultry, gravies, intestine and form containers, cut
pigs, improperly spores. Cast off cell up large pieces.
vermin, held or releases toxin Reheat
and wastes cooled food causing thoroughly to 165
symptoms. F
before reserving.
Educate
cooks.
 Disease Specific Reservoir Common Symptoms Incuba Prevention
Agent Vehicle in Brief tion and Control
Period
Bacillus cereus Bacillus pores Inadequately Symptoms 6-16hr Prevent food
food cereus, toxin found in refrigerated in Brief contamination.
poisoning heat labile wide cooked foods Diarrhea, Cool food
diarrheal type variety of and cramps; rapidly in
cereals, subsequently vomiting shallow
spices, inadequately sometimes containers,
vegetables, reheated reheat rapidly.
and
milk
Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control
Bacillus Bacillus Same as Boiled Vomiting, 1-6 hr Same as diarrhea. Some
cereus cereus, diarrheal and fried diarrhea,nau spores, if present in
food toxin heat rice sea, large
poisoning stable sometimes numbers may survive
Vomiting Ultra
type high temperture (UHT)
and
High temperature-short
time
(HTST) pasteurization.
 Specific Reservoir Common Symptoms Disease Prevention
Agent Vehicle in Brief and Control
Gastroent Cyano- Nutrient- Ingestion and Tremors, 7-14 days Water treatment
eritis, bacteria rich body contact hypersalivation, may
dermatitis surface involving waters ataxia, diarrhea involve
,centralne waters, containing dense (ingestion); rash, microscreening,
rvous aquatic cyanobacterial eye coagulation,
system sediments, cell irritation, asthma filtration;
disorders soils mass (skin contact) distribution
system should
be monitored for
accumulation of
cell
residues and
flushed
Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control
Salmonel Salmonella Hogs, Contaminated Abdominal 6-48 hr Protect storage of
losis typhimurium, cattle, and sliced cooked pain, usually 2-24 food.
(Salmonell S. newport, other meat, salads, diarrhea hr Thoroughly cook
a S. enteritidis, livestock, uncooked (persists [Link]
infection S. poultry, meats, several days), rodents, pets, and
montevideo, pets, equipment, chills, carriers. Similar
others eggs, warmed-over fever, measures
carriers, foods, milk and vomiting, as in Straphylococcus,
powdered milk products, and Poultry, water, and
eggs, water, eggs nausea meat
turtles, sanitation. Do not eat
animal raw
feed, and eggs or ground beef,
rodents Refrigerate foods.
Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control
Typhoid Typhoid Feces and Contaminated General Average 14 Protect and purify water
fever bacillus, urine water, milk infection days, supply. Pasteurize milk
Salmonella of typhoid and characterized usually and milk products.
typhi carrier or milk by 7-21 days Sanitary sewage disposal.
patient products, continued Educate food-handlers.
shellfish, and fever, usually Food, fly, shellfish
foods; flies rose spots on control.
the trunk, Supervise carriers.
diarrheal Personal hygiene. Isolate
disturbances patients.
 Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control
B Paratyp Salmonella Feces and Contaminate General 1-10 days Similar
a hoid paratyphi A, S urineof d infection for gastroen- preventive and
c fever schott mulleri B. carrier water, milk characterized by teritis; 1-3 control measures
t S. orpatient and milk continued fever, weeks for as in
e hirschfeldii C products, diarrheal enteric fever typhoid fever
ri shellfish, disturbances, and
a andfoods; sometimes rose salmonellosis
flies spots
on trunk, other
symptoms
 Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control

B Shigellosis Genus, Feces of Contamin Acute onset 1-7 days, Food, water,
a (Bacillary Shigella, i.e., carriers ated with diarrhea, usually less sewage
c dystentery) flexneri, sonnei, and water or fever, than 4 days sanitation as in
t boydii, infected foods, tenesmus, typhoid.
e dysenteriae persons milk and frequent Pasteurize milk
r milk stools (boil for
i products, containing infants). Control
a flies, blood flies;
person- and mucus supervise
to-person carriers.
Personal hygiene.
 Disease Specific Reservoir Common Symptoms Incubation Prevention
Agent Vehicle in Brief Period and Control
B Cholera Vibrio Feces vomitus; Contaminated Diarrhea, rice- A few Similar to
a comma carriers water, raw water stools, hours-5 typhoid.
c foods, vomiting, thirst, days, Quarantine.
t flies, shellfish pain coma usually 3 Isolate
e patients.
r Vaccine of
i limited value.
a