1887. Estimating the Burden of Waterborne Disease in the United States

Background Treatment of drinking water is one of the greatest US public health achievements of the twentieth century and provides a safe, reliable water supply. However, waterborne disease and outbreaks continue to occur, and are associated with a variety of water sources and exposure routes. New estimates of the burden of waterborne disease in the United States will direct prevention activities and set public health goals. Methods We chose 17 waterborne diseases for which domestic waterborne transmission was plausible, substantial burden of illness or death was likely, and data were available. Diseases included were campylobacteriosis, cryptosporidiosis, giardiasis, Legionnaires’ disease, norovirus infection, nontuberculous mycobacteria [NTM] infection, otitis externa, Pseudomonas pneumonia and septicemia, salmonellosis, Shiga toxin-producing E. coli infection, shigellosis, and vibriosis. Adapting previously used methods, disease-specific multipliers were used to adjust the reported/documented number of cases of each disease for under-reporting, under-diagnosis, proportion domestically acquired, and proportion transmitted via water, to generate point estimates with 95% credible intervals (CrI). Data sources included surveillance data, population studies, and expert judgment if no other data were available. We estimated the number of illnesses, ED visits, hospitalizations, and deaths, and costs of ED visits and hospitalizations due to waterborne disease in the United States in 2014. Results 7.2 million waterborne illnesses (CrI 3.9–12.0 million) from the selected diseases occur annually, including 600,000 (CrI 365,000–865,000) ED visits, 120,000 (CrI 85,000–150,000) hospitalizations, and 6,500 deaths (CrI 4,300–8,900) deaths, incurring US$3.2 billion (2014 dollars) in direct healthcare costs. Hospitalizations and deaths were predominantly caused by environmental pathogens commonly associated with biofilm in plumbing systems (NTM, Pseudomonas, Legionella) costing US$2 billion annually. Conclusion Millions of domestically acquired waterborne illnesses from these 17 infections occur in the United States each year, and incur billions of dollars in healthcare costs. Disclosures All Authors: No reported Disclosures.

Surveillance of the drinking water quality din the Legal Amazon: analysis of vulnerable areas

Low quality drinking water has been directly correlated to the occurrence of waterborne illnesses in northern Brazil. To minimize health risks related to the water supply, the Ministry of Health has proposed the implementation of the National Program for the Surveillance of Drinking Water Quality (VIGIAGUA) in Brazilian municipalities. Focusing on the Legal Amazon region, the present study demonstrates a historical account of the percentage of municipalities included in the VIGIAGUA program in place, which in 2013 reached 45.1% of the region municipalities. This study also identifies vulnerable areas in terms of the water quality in the states of Amapá, Amazonas and Maranhão. With this analysis of the current status of the drinking water supply, this study intends to support and direct the strategic efforts of environmental health monitoring in the region.

Review: Approaches to the Viral Extraction, Detection, and Identification of Hepatitis Viruses, HAV and HEV, in Foods

Although the incidence rate of hepatitis A virus (HAV) infection has been on the decline in developed countries, in part due to immunization availability, high profile outbreaks continue to be reported. Hepatitis E virus has been recognized as an emerging pathogen in industrialized countries. While associated with waterborne illnesses, particularly in undeveloped countries, several animal species have been identified as reservoirs for the virus. Consequently, the potential of zoonotic transmission exists as a function of the consumption of infected animals. In this review we provide a comparative overview of these two virus species with regard to their known virus properties, discuss extraction methodologies, and describe some basic principles and methodology applied toward the isolation of these viruses (as particles or their isolated genomes) from food commodities. We also discuss the challenges that remain as experimental hurdles to extraction of such viruses from food. As HAV has been the most extensively studied with regard to virus detection in foods, it often serves as a model virus for current and future development of sample preparation methodology for foodborne virus detection. Lastly, we discuss the application and role of current and developing technologies in the post-extraction detection and identification of these viruses from foods.

Risk behaviors and self-reported illnesses among Pacific Northwest surfers

Although surfers have high incidental exposure to marine waters, no studies have investigated if surfer risk behaviors (such as surfing during advisories, near an outfall, during a rain event, or use of personal protective equipment) increase or decrease the risk of acquiring waterborne illnesses. We used a web-based survey to assess the association between risk-based behaviors and self-reported illnesses among Pacific Northwest surfers. Commonly reported illnesses include: ear infection or discharge (38%), sore throat or a cough (28%), diarrhea (16%), fever (10.5%), and vomiting (7%). Surfing often during rain events was associated with an increased likelihood of diarrhea (OR = 2.7; 95% CI: 1.4–5.47), sore throat (OR = 1.26; 95% CI: 1.01–2.05), and ear infection (OR = 1.39; 95% CI: 1.01–2.32). Surfing during a health advisory was associated with increased likelihood of diarrhea (OR = 1.94; 95% CI: 1.03–4.64) and sore throat (OR = 2.32; 95% CI: 1.23–4.40). Other behaviors associated with increased illnesses include body surfing, surfing near an outfall, frequency of surfing, and use of ear plugs. Approximately 40% of surfers were unaware if they had surfed during an active health advisory and 29% knowingly surfed during advisories, suggesting the need to engage this population about potential harm and behaviors that may increase health risk.

A Systems Biology Approach to Infectious Disease Research: Innovating the Pathogen-Host Research Paradigm

ABSTRACT The twentieth century was marked by extraordinary advances in our understanding of microbes and infectious disease, but pandemics remain, food and waterborne illnesses are frequent, multidrug-resistant microbes are on the rise, and the needed drugs and vaccines have not been developed. The scientific approaches of the past—including the intense focus on individual genes and proteins typical of molecular biology—have not been sufficient to address these challenges. The first decade of the twenty-first century has seen remarkable innovations in technology and computational methods. These new tools provide nearly comprehensive views of complex biological systems and can provide a correspondingly deeper understanding of pathogen-host interactions. To take full advantage of these innovations, the National Institute of Allergy and Infectious Diseases recently initiated the Systems Biology Program for Infectious Disease Research. As participants of the Systems Biology Program, we think that the time is at hand to redefine the pathogen-host research paradigm.

A Multidimensional Measure of Diarrheal Disease Load Changes Resulting from Access to Improved Water Sources in Honduras

Waterborne illnesses continue to be a major source of morbidity and mortality in developing countries. A myriad of interventions to improve both access and quality of water for household use has been used. The impact of these interventions is most commonly measured by self-reported frequencies of diarrhea, a method prone to significant reporting bias.