CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

HealthPracticesonCruiseShips:TrainingforEmployees Transcript

WaterborneIllnesses
TheCentersforDiseaseControlandPrevention'sVesselSanitationProgramisproudto bringtoyouthefollowingsession:WaterborneIllness.Whilethissessionprimarilyfor cruisevesselsunderthejurisdictionoftheVesselSanitationProgram,itmaybeusedby anyonewhoisinterestedinthistopic.Thissessionshouldnotbeusedtoreplaceexisting interactivetraining,butshouldbeusedasanadjuncttoacomprehensivetraining program.Waterborneillness. Learningobjectives.Attheendofthesession,youwillbeabletolistthepathogens associatedwithwaterborneillnessoutbreaks,listtheroutesoftransmissionfor waterbornepathogens,andlistthepreventionmethodsforspecificpathogens. Waterborneillnesses.Therearepotablewaterillnessesandrecreationalwaterillnesses, andwe'llbediscussingbothofthese. Waterborneoutbreakagents.Therearebacterialagents,viralagents,parasiticagents,and chemicalagentswhichcausewaterborneillness. Routesoftransmission.Waterborneillnessescanbecausedbyingestionorconsuming water, bydermalcontact, whichiscontactofthewaterwithskinormucousmembranes, orbyinhalation,whichisbybreathinginamistoraerosolizedwaterparticles. Bacterialpathogens.Wewillbediscussingeachoneofthesepathogensindetail:E.coli O157:H7,Salmonella,Salmonellatyphi,Shigella,Campylobacter,Vibriocholerae, Pseudomonas,andothers. Escherichiacoli.ThereareseveralpathogenicstrainsofEscherichiacoli,whichare classifiedunderenterovirulentE.coli.Theyareenterohemorrhagic,enteroinvasive, enterotoxigenic,enteropathogenic,andenteroaggregative.EscherichiacoliO157:H7,the basics.It'sabacteria.Itcausesdiarrhealillness,andit'sclassifiedasan enterohemorrhagicE.coli.Initsmostsevereform,itcancausehemorrhagiccolitis.The reservoirforthisbacteriaarecattle,deer,goats,andsheep.Humanscanalsobea reservoir.Itistypicallyassociatedwithcontaminatedfoodandwater. E.coliO157:H7 prevention.Preventionstrategiesforthispathogen includesourceprotection, halogenationofwater, orboilingwaterforoneminute.Salmonellaspecies,thebasics.It's abacteria.Itcausesdiarrhealillnessknownassalmonellosis.Humansandanimalsare thereservoir,andit'stypicallyassociatedwithcontaminatedfoodandwater. Salmonella

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

species,prevention.Preventionstrategiesforthispathogenincludesourceprotection, halogenationofwater,andalsoboilingwaterforoneminute. Salmonellatyphi,thebasics.It'sabacteria.Itcausesdiarrhealillness,alsoknownas typhoidfever.Andhumansarethereservoirforthispathogen.Salmonellatyphi, prevention.Preventionstrategiesforthispathogen includesourceprotection, halogenationofwater,andboilingwaterforoneminute. Shigellaspecies,thebasics.It'sabacteria.Itcausesdiarrhealillnessknownasshigellosis. Humansandprimatesarethereservoirforthispathogen.Shigellaspecies,intheUnited States twothirdsoftheshigellosisintheU.S.iscausedbyShigellasonnei,andthe remainingonethirdiscausedbyShigellaflexnieri.Indevelopingcountries,Shigella dysenteriaeistheprimarycauseofillnessassociatedwiththispathogen.Shigellaspecies, prevention.Preventionstrategiesforthispathogen includesourceprotection, halogenationofwater,andboilingwaterforoneminute. Campylobacter,thebasics.It'sabacteria.Itcausesdiarrhealillness.AndCampylobacter isprimarilyassociatedwithpoultry,animals,andhumans.Campylobacter,prevention. Preventionstrategiesforthispathogenincludesourceprotection,halogenationofwater, andboilingwaterforoneminute. Vibriocholerae,thebasics.It'sabacteria.Itcausesdiarrhealillness,alsoknownas cholera.Itistypicallyassociatedwithaquaticenvironments,shellstocks,andhuman. Vibriocholeraehasalsobeenassociatedwithshipballastwater, andtherewillbea discussionlateroninthispresentation ofanoutbreakassociatedwithshipballastwater. Vibriocholerae,prevention.Preventionstrategiesforthispathogenincludesource protection,halogenationofwater,andboilingwaterforoneminute. Legionella,thebasics.It'sabacteria.Itcausesarespiratoryillnessknownas legionellosis.Therearetwoillnessesassociatedwithlegionellosis:thefirst,Legionnaire's disease,whichcausesaseverepneumonia,andthesecond,Pontiacfever,whichisanon pneumoniaillnessit'stypicallyaninfluenzalikeillness,andit'slesssevere.Legionella isnaturallyfoundinwater,bothnaturalandartificialwatersources.Legionella, prevention.Maintaininghotwatersystemsatorabove50degreesCentigradeandcold waterbelow20degreesCentigradecanpreventorcontroltheproliferationofLegionella inwatersystems.Hotwaterintanksshouldbemaintainedbetween71and77degrees Centigrade.Properrecreationalwatersystemmaintenanceanddisinfection canprevent theproliferationofLegionellainrecreationalwatersystems.Itisimportanttoprevent waterstagnation.Thiscanbeaccomplishedbyeliminatingdeadendsindistribution systemsandinrecreationalwatersystems.Additionally,preventingbiofilmdevelopment isimportanttocontrolthisparticularpathogeninwatersystems.

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

Pseudomonas,thebasics.It'sabacteria.Itiscausedbydermalcontactwithwater. Itcan causedermatitis,whichisaninflammationoftheskin,oritcancauseotitis,whichisan infectionoftheear.Pseudomonasistypicallyassociatedwithsoilandwater. Pseudomonas,prevention.Propermaintenanceanddisinfectionofrecreationalwater systemsisimportantinpreventingPseudomonas. Viralpathogens.WewillbediscussingHepatitisAandNorovirusinthispresentation. HepatitisA,thebasics.It'savirus.Itcausesinflammationoftheliver.Andthereservoir forHepatitisAvirusishumans. HepatitisA,prevention.Preventionstrategiesforthispathogenincludesourceprotection andadequatedisinfection.FecalmattercanprotectHepatitisAvirusfromchlorine. Additionally,HepatitisAvirusisresistanttocombinedchlorines,soitisimportantto haveanadequatefreechlorineresidual. Norovirus,thebasics.It'savirus.Itcausesdiarrhealillness.Andhumansarethe reservoirforthisvirus.Norovirus,prevention.Preventionstrategiesforthispathogen includesourceprotection.Parasiticpathogens.Duringthispresentation,wewillbe discussingCryptosporidium,Giardia,andSchistosomatidae. Cryptosporidium,thebasics.It'saparasite.Itcausesdiarrhealillnessknownas crytpsporidiosis.Itistypicallyassociatedwithanimalsandhumans,anditcanbe acquiredthroughconsumingfecallycontaminatedfood,contactwithfecally contaminatedsoilandwater. Cryptosporidium,prevention.Preventionstrategiesforthis pathogenincludesourceprotection.ACTvalueof9,600isrequiredwhendealingwith fecallyaccidents.CTequalsaconcentration,inpartspermillion,whiletimeequalsa contacttimeinminutes.Cryptosporidiumcanalsobepreventedoreliminatedbyboiling waterforoneminute.Filtrationwithan"absolute"poresizeofonemicronorsmallercan eliminateCryptosporidium.Andreverseosmosisisknowntobeeffectiveaswell. Giardia,thebasics.Itisaparasite.Itcausesdiarrhealillnessknownasgiardiasis.Itis typicallyassociatedwithwater. Itisthemostcommonpathogeninwaterborneoutbreaks. Itcanalsobefoundinsoilandfood. Andhumansandanimalsarethereservoirforthis pathogen.Giardia,prevention.Preventionstrategiesforthispathogenincludesource protectionfiltration,coagulation,andhalogenationofdrinkingwater. Schistosomatidae,thebasics.Itisaparasite.Itisacquiredthroughdermalcontact, cercarialdermatitis.Itiscommonlyknownasswimmer'sitch.Thereservoirforthis pathogenareaquaticsnailsandbirds.Schistosomatidae,prevention.Preventionstrategies forthispathogenincludeeliminatingsnailswithamolluscicideorinterruptingthelife cycleoftheparasitebytreatingbirdswithanantihelmeticdrug.

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

Chemicalillnesses.Chemicalillnessesassociatedwithpotablewaterandrecreational wateraretoonumeroustoitemize.Theyaretypicallyassociatedwithcrossconnections andrunoff.Somechemicalcontaminationcanoccurnaturally. Waterborneillnessassociatedwithdrinkingwater byetiologicagent,UnitedStates1999 to2000. Aswecanseefromthisslide,51%oftheoutbreakswereassociatedwiththe pathogenswejustdiscussed. Thefollowingslidewilldiscusswaterborneoutbreaksthathaveoccurredbothinthe UnitedStatesandalsoinEurope.CAPTAINCAGLE:Waterborneoutbreaks.Inthe followingslides,we'llbediscussingpotablewater andrecreationalwateroutbreaks. Potablewateroutbreaks. What:cholera.Who:thisresultedingreaterthan10,000fatalities.When:1854.Where: inSoho,England.Why:poorsanitaryconditionsofcitywatersystem.Thiswastheresult ofcontamination ofthecity'swatersupplyfromcesspits.Inthemiddleofthe19th century,1854,Sohohadbecomeanunsanitaryplace.Underneaththefloorboardsofthe overcrowdedcellarslurkedaseaofcesspitsasoldasthehouses,andmanyofthesehad neverbeendrained.Itwasonlyamatteroftimeforabigoutbreaktooccur. Itfinallydid sointhesummerof1854.WhenawaveofAsiaticcholerafirsthitEnglandinlate1831, itwasthoughttobespreadbymiasmaintheatmosphere.BythetimeoftheSoho outbreak23yearslater,medicalknowledgeaboutthediseasehasbarelychanged,though oneman,Dr.JohnSnow,apioneerofscienceofepidemiology,hadrecentlypublisheda reportspeculatingthatitwasspreadbycontaminatedwater. What:typhoid.Who:1,000individualswereinfected.When:1885.Where:thisoccurred inPlymouth,Pennsylvania.Why:asaresultofcontaminatedwaterpumpedintothecity's watersupply. Deathratefortyphoidfever,UnitedStates,1900 to1960. Thisslidedepictsthereduction intyphoidfevercasesintheUnitedStates. Thefirstsystemtobechlorinatedinthe UnitedStateswasBoonton,NewJersey,in1908. Chlorinestandardswerethen introducedin1914.InWheeling,WestVirginia,in1918to1919, therewere approximately155to200casesoftyphoidfeverper100,000population.Afterthe introductionofchlorinationinthefirstpartof1919, therewereonlysevencasesper 100,000. Indevelopingcountries,80%ofalldiseasesarecausedbyconsumingwater contaminatedwithpathogensandpollutants.Thisslidedepictsthatcorrelation.Onthe lefthandoftheslideshowsaccesstosafepotabledrinkingwater,whiletherighthand sideshowsdeathratesforchildrenunderfive.Youcan seeadirectcorrelation toaccess tothesafepotabledrinkingwaterandthereductioninthosedeathrates. What:E.coliO157:H7.Whodiditaffect? Therewere243cases,32hospitalizations,and fourdeaths.When:1989.Where:Cabool,Missouri.Why:therewasnodisinfectionof

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

thecity'swatersupply duringheavyrains,whenrunoffranthroughcattlemanureand washedintothewellsystem. What:Cryptosporidium.Whodiditaffect? 370,000casesper800,000population with over4,400hospitalizationsandmorethan100deaths.When:1993.Where:Milwaukee, Wisconsin.Why:duringheavyrains,thecity'sfiltrationsystemwasoverwhelmed,and theCryptosporidiumoocystspassedthroughthatsystem andinfectedthewatersupply throughoutthecity. What:Vibriocholera.Who:therewerenoindividualsaffected. Thisaffectedtheshellfish suppliesinMobileBay.When:1992.Where:Alabama.Why:therewascontaminated ballastwaterincargoships.Thecorrectiveaction wastheFDArecommendedtheU.S. CoastGuard tohaveshipsdumpedandchangeballastwater athighseasbeforeentering port. What:aphotochemicalcontamination.Who:544illindividualsandonedeath.Whendid thisoccur? In1978.Where:aboardaU.S.aircraftcarrier.Why:thiswastheresultofan unprotectedcrossconnectionbetweenthevessel'spotablewatersupply andaphoto chemicaldevelopmentsystem. What:Legionella.Who:thereweretwofatalities.When:January1999.Where:acargo vesselunderrepair.Why:mechanicswereexposedtoLegionellapneumophiliainaship's freshwaterpump. What:Norovirus.Who:48outbreaks,200to5,500cases.Samplesfrom28outbreaksare available.Noroviruscaused18oftheseoutbreaks. When:1998to2003.Where:in Finland.Why:mostlikelycausedbysewagecontamination ofsurfacewatersystems. Waterbornediseaseassociatedwithships,1970to2003.Asyoucanseeonthisslide,15 oftheoutbreakswereassociatedwithpathogenicorganismsthatwediscussedearlier.21 oftheseoutbreaksweretheresultofchemicalcontaminationofthewatersupplies. Recreationalwaterillnessoutbreaks. What:Cryptosporidium.Whodiditaffect? Therewere369cases.When:Julyof1997. Where:Minnesota.Whydidthisoccur? Thiswasaninadequatelytreateddecorative fountain thathadbeenconvertedtoarecreationalfountain.Correctiveaction:the recreationfountain wasswitchedbacktoadecorativefountain.What:Cryptosporidium. Who:47initialcases.Thisquicklyspreadto3,000ill with711positivefor Cryptosporidium.When:August2005. Where:inSeneca,NewYork. Why: Cryptosporidiumoocystswerefoundinaninadequatelytreatedsystemforasplashzone. Correctiveaction:implementationofnewguidelinesfornonpoolfacilitiessuchasspray pads.

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

What:Cryptosporidium.Who:1,000cases.When:inthesummerof2000.Where:this occurredinOhioandNebraska.Why:theexactcausewasundetermined.However,the swallowingofwater, fecalaccidentsfiveinOhioswimmingwhilesymptomatic 18%inNebraskawereindicatedascontributingfactors. What:Pseudomonasdermatitis.Asyoucanseefromthisslide,wehavetwooutbreaksof Pseudomonasdermatitis.Inthefirstcasesonyourleft,itaffected19individuals.When: inFebruaryof1999.Where:inColorado. Why:Pseudomonasinahottub dueto inadequatechlorinelevels.Ontherighthandside,youcanseewehaveninecases. When:Februaryof2000.Where:inMaine.Andwhy:again,Pseudomonaswasgrowing inahottub duetoinadequatechlorinelevels. What:Legionella.Whomdiditaffect? Therewere15cases.When:Octoberof1996. Where:inVirginia.Why:awhirlpoolspadisplayataretailstore testedpositivefor Legionella.Thecorrectiveaction:thewhirlpoolspasanddisplaysweretobeinspected andmaintained. Resourcesandreferences.ForfurtherinformationabouttheCentersforDiseaseControl andPrevention,pleasevisitwww.cdc.gov.Forfurtherinformation abouttheFoodand DrugAdministration,pleasevisitwww.fda.gov.Someofthematerialintheseslideswas takenfrom"WaterbornePathogens,"AmericanWaterWorksAssociationmanual48,and the"JournalofWaterandHealth."