Drinking water and gastrointestinal disease: need of better understanding and an improvement in public health surveillance

Watershed integrity and associations with gastrointestinal illness in the United States

Gastrointestinal (GI) illnesses are associated with various environmental factors, such as water quality, stormwater runoff, agricultural runoff, sewer overflows, and wastewater treatment plant effluents. However, rather than assessing an individual factor alone, two indices incorporating a combination of ecological and environmental stressors were created to represent (1) overall watershed integrity, Index of Watershed Integrity (IWI) and (2) catchment integrity, Index of Catchment Integrity (ICI). These indices could provide a more comprehensive understanding of how watershed/catchment integrity potentially impact the rates of GI illness, compared to assessing an individual stressor alone. We utilized the IWI and ICI, as well as agricultural and urban land uses, to assess associations at the county level with the rates of GI illness in a population of adults over 65 years of age. Our findings demonstrated that both watershed and catchment integrity are associated with reduced hospitalizations for any GI outcomes, though association varied by urbanicity. We believe that improved versions of the IWI and ICI may potentially be useful indicators for public health analyses in other circumstances, particularly when considering rural areas or to capture the complex stressors impacting the ecological health of a watershed.

Multi-Drug Resistant Coliform: Water Sanitary Standards and Health Hazards

Water constitutes and sustains life; however, its pollution afflicts its necessity, further worsening its scarcity. Coliform is one of the largest groups of bacteria evident in fecally polluted water, a major public health concern. Coliform thrive as commensals in the gut of warm-blooded animals, and are indefinitely passed through their feces into the environment. They are also called as model organisms as their presence is indicative of the prevalence of other potential pathogens, thus coliform are and unanimously employed as adept indicators of fecal pollution. As only a limited accessible source of fresh water is available on the planet, its contamination severely affects its usability. Coliform densities vary geographically and seasonally which leads to the lack of universally uniform regulatory guidelines regarding water potability often leads to ineffective detection of these model organisms and the misinterpretation of water quality status. Remedial measures such as disinfection, reducing the nutrient concentration or re-population doesn’t hold context in huge lotic ecosystems such as freshwater rivers. There is also an escalating concern regarding the prevalence of multi-drug resistance in coliforms which renders antibiotic therapy incompetent. Antimicrobials are increasingly used in household, clinical, veterinary, animal husbandry and agricultural settings. Sub-optimal concentrations of these antimicrobials are unintentionally but regularly dispensed into the environment through seepages, sewages or runoffs from clinical or agricultural settings substantially adding to the ever-increasing pool of antibiotic resistance genes. When present below their minimum inhibitory concentration (MIC), these antimicrobials trigger the transfer of antibiotic-resistant genes that the coliform readily assimilate and further propagate to pathogens, the severity of which is evidenced by the high Multiple Antibiotic Resistance (MAR) index shown by the bacterial isolates procured from the environmental. This review attempts to assiduously anthologize the use of coliforms as water quality standards, their existent methods of detection and the issue of arising multi-drug resistance in them.

The Impact of Human Activities on Microbial Quality of Rivers in the Vhembe District, South Africa

Background: Water quality testing is dictated by microbial agents found at the time of sampling in reference to their acceptable risk levels. Human activities might contaminate valuable water resources and add to the microbial load present in water bodies. Therefore, the effects of human activities on the microbial quality of rivers collected from twelve catchments in the Vhembe District in South Africa were investigated, with samples analyzed for total coliform (TC) and Eschericha coli (E. coli) contents. Methods: Physical parameters and various human activities were recorded for each sampling site. The Quanti-Tray^® method was adopted for the assessment of TC and E. coli contents in the rivers over a two-year period. A multiplex polymerase chain (PCR) method was used to characterize the strains of E. coli found. Results: The microbial quality of the rivers was poor with both TC and E. coli contents found to be over acceptable limits set by the South African Department of Water and Sanitation (DWS). No significant difference (p > 0.05) was detected between TC and E. coli risks in dry and wet seasons. All six pathogenic E. coli strains were identified and Enteroaggregative E. coli (EAEC), atypical Enteropathogenic E. coli (a-EPEC) and Enterotoxigenic E. coli (ETEC) were the most prevalent E. coli strains detected (respectively, 87%, 86% and 83%). Conclusions: The study indicated that contamination in the majority of sampling sites, due to human activities such as car wash, animal grazing and farming, poses health risks to communities using the rivers for various domestic chores. It is therefore recommended that more education by the respective departments is done to avert pollution of rivers and prevent health risks to the communities in the Vhembe District.

Health surveillance: proposal for a tool to evaluate technological arrangements in local health systems

In order to identify the various meanings ascribed to health surveillance, the authors conducted a systematic review of articles published from January 1990 to August 2005 in the following databases: LILACS, SciELO, CAPES, MEDLINE, and Web of Science. A total of 144 abstracts were read and 18 full texts of Brazilian articles were selected for in-depth analysis, leading to the design of a typology for technological arrangements related to the various meanings: (i) traditional epidemiological surveillance, with communicable diseases as the main object; (ii) public health surveillance, as the municipal component of the national health surveillance system; and (iii) health surveillance, a technological mode of organizing health practices in a given territory. The proposed typology can contribute to research on surveillance practices in local health systems. It can also serve as a template for data collection and analysis. The meanings ascribed to the three types are discussed in light of public health's historical development as a field.

Cambio climático y salud pública: escenarios después de la entrada en vigor del Protocolo de Kioto

According to the reports of the intergovernmental panel for climatic change (IPCC) human beings of the present and near future are going to experiment, in fact we are already experimenting, important changes in the world climate. Conscious of the magnitude of the problem, international organizations have taken a series of initiatives headed to stop the climatic change and to reduce its impact. This willingness has been shaped into the agreements established in the Kyoto protocol, where countries commit to reduce greenhouse-effect gas emissions. Kyoto protocol has come into force on February 16th 2005 with the support of 141 signing countries. Among the major worries are the effects which climatic change may have upon health, such as: 1) changes in the morbidity- mortality related to temperature; 2) Effects on health related with extreme meteorological events (tornados, storms, hurricanes and extreme raining); 3) Air pollution and increase of associated health effects; d) Diseases transmitted by food and water and 4) Infectious diseases transmitted by vectors and by rodents. Even if all the countries in the world committed to the Kyoto Protocol, some consequences of the climatic change will be inevitable; among them some will have a negative impact on health. It would be necessary to adapt a key response strategy to minimize the impacts of climatic change and to reduce, at minimum cost, its adverse effects on health. From the Public Health position, a relevant role can and must be played concerning the understanding of the risks for health of such climatic changes, the design of surveillance systems to evaluate possible impacts, and the establishment of systems to prevent or reduce damages as well as the identification and development of investigation needs.