Post on 06-Dec-2021
The Domestic Public Health Impact of Climate Change: U.S. Perspective on Waterborne Disease Transmission
Michael J. Beach, Ph. D.Centers for Disease Control
and Prevention
Potential U.S. Health Effects of Climate Change
Climate change:
• Temperature rise• Sea level rise• Hydrologic
extremes
HEAT Heat stress, cardiovascular failure
SEVERE WEATHER Injuries, fatalities
AIR POLLUTION Asthma, cardiovascular disease
ALLERGIES Respiratory allergies, poison ivy
VECTOR-BORNE DISEASES Malaria, dengue, encephalitis, hantavirus, Rift Valley fever
WATER-BORNE DISEASES Cryptosporidiosis, Naegleria, Campylobacteriosis, vibriosis leptospirosis
WATER AND FOOD SUPPLY Malnutrition, diarrhea, algal blooms, hygiene-related disease
MENTAL HEALTH Anxiety, post-traumatic stress, despair, depression
ENVIRONMENTAL REFUGEES Forced migration, civil conflict
Adapted from J. Patz
Potential Climate Change-related Events Impacting Waterborne Disease
• Environmental change/disturbance• Extreme weather events
• Flood: CSO, SSOs•Drought: soil/geologic changes
• Re-use of water and wastewater• Urbanization
• Increased cooling system usage•Exploitation of man-made habitats
• Legionella, Mycobacterium
Potential Climate Change-related Events Impacting Waterborne Disease
• Increasing water temperatures and/or nutrients• Enhanced growth of pathogens• Naegleria, Vibrio, Pseudomonas, HAB
• HAB-Related Illness Surveillance System (HABISS)• Environmental data, animal and human
illness • All recreational water indicators Increasing
recreational activities• Swimming pools, ambient waters
Waterborne-Disease Surveillance:Real World
• Not all water-related pathogens and chemicals are nationally notifiable
• Most water-related pathogens and chemicals have multiple modes of transmission
• Most individual cases are not investigated so mode of transmission is unknown
• Reported cases represent only a small portion of the burden of disease
• Water quality databases have no connection to health effects data
Are There Surrogates for Waterborne Disease Case
Reporting?
• Outbreaks can serve as indicators for trends in waterborne disease transmission in the U.S. and can connect health effects with water quality data
0
10
20
30
40
50
60
1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001* 2004
Year
Num
ber o
f WB
DO
S_
National Waterborne Disease and Outbreak Surveillance System
• Collaborative surveillance system• CDC, EPA, CSTE since 1971
• State/local DOH’s have 10 responsibility for detecting, investigating, reporting WBDOs
Waterborne Disease and Outbreak Surveillance System: Usefulness
• Disease control• Identify contaminated water sources
• Knowledge of disease causation• Identify etiologic agents (old and new)
• Trend identification• Etiologic agents, water sources, deficiencies
• Guidance and evaluation• Evaluate the adequacy of current technologies
for providing safe water• Establish research priorities• Assess effectiveness of water regulations/codes
Drinking Water-Associated Outbreaks, United States, 1971-2004
0
10
20
30
40
50
60
1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001* 2004
Year
Num
ber o
f WB
DO
S_
N=803, MMWR (2006) 55(SS12):31-65
•Beginning in 2003, mixed agents of more than 1 etiologic agent type were included in the surveillance system. However, the first observation is a previously unreported outbreak in 2002.
•† Beginning in 2001, Legionnaires’ disease was added to the surveillance system, and Legionellaspecies were classified separately in this figure.
Public, surface water Private, groundwater
Opportunities for Improvement:Needed ASTHO Assistance
• Support CSTE in making WBDO’s nationally notifiable in your state
• Support deployment of National Outbreak Reporting System (NORS) from CDC• Expanded version of Foodborne Outbreak Reporting
System (eFORS)• Put an emphasis on improved detection,
investigation, and reporting of WBDOs• Training• Improved risk factor data collection
Acknowledgements
DPD• Michael Beach• Sharon Roy• Jonathan Yoder• Michele Hlavsa
EPA• Rebecca Calderon• Gunther Craun