Factsheet 15 RS.pub

Transcript

1 15 Water Treatment NOTES USDA Water Quality Program, Cornell Cooperative Extension Cryptosporidium; a Waterborne Pathogen AND NEEN , S USAN D B , ARBARA A NN L EMLEY K ARLING Fact Sheet 15, July 1996, updated August 2004 Cryptosporidium? How is this disease diagnosed and treated? What is Cryptosporidium (crip-toe-spor-ID-ee-um) is a proto- Cryptosporidiosis cannot be diagnosed by symptoms zoan, a single-celled parasite that lives in the intes- alone. Watery diarrhea is a symptom of many intesti- tines of animals and people. This microscopic patho- nal diseases caused by bacteria, viruses, or parasites. gen causes a disease called cryptosporidiosis (crip- If Cryptosporidium is the suspected cause of an intes- tinal illness, the doctor should request a specific diag- toe-spor-id-ee-O-sis) . nostic test. The dormant (inactive) form of Cryptosporidium, called There is currently no drug that can cure crypto- an oocyst (O-o-sist), is excreted in the feces sporidiosis. People with competent immune systems (stool) of infected humans and animals. The tough- will recover on their own and appear to develop some walled oocysts survive under a wide range of environ- immunity to subsequent infections. Anti-diarrheal mental conditions. medicines may ease some of the symptoms. Anyone with diarrhea should drink plenty of fluids to prevent What are the symptoms of cryptosporidiosis? dehydration. The most common symptom of the disease is watery diarrhea. There may also be abdominal cramps, nau- How is the pathogen spread? sea, low-grade fever, dehydration, and weight loss. Symptoms usually develop 4 to 6 days after infection when you Cryptosporidium You can get infected with but may appear any time from 2 to 10 days after in- put anything in your mouth that has been in contact fection . with feces from an infected animal or person. When une systems are usually ill People with healthy imm large numbers of people get cryptosporidiosis, the with cryptosporidiosis for several days but rarely source of infection can sometimes be tracked down, more than two weeks. Some infected individuals may but it is impossible to determine the origin of many not even get sick. Some people with cryptosporidiosis individual cases of this disease. seem to recover, then get worse again. Those who are Crypto- Your hands may be contaminated with infected may shed oocysts in their stools for months, through person-to-person contact, perhaps sporidium . even after they no longer appear to be ill while changing a child’s diaper, caring for someone Cryptosporidiosis may cause complications for with diarrhea, or engaging in any activity that in- those with illnesses or conditions such as diabetes, body contaminated with volves touching areas of the alcoholism, or pregnancy. The effects of prolonged feces. n be dangerous, especially diarrhea and dehydration ca Cryptosporidiosis can be easily spread among peo- for the very young, the elderly, and the frail. ple in close social groups such as families, day care Cryptosporidiosis is most severe and long-lasting in centers, and nursing homes. People who work with immunocompromised individuals (those whose im- animals, especially young animals or animals with mune systems are weak), such as people infected with diarrhea, have a greater chance of exposure to the HIV (the virus that causes AIDS), cancer patients on parasite. You may pick up oocysts while handling a chemotherapy, transplant patients, or others taking litter box, soil, or any object contaminated with even medications that suppress the immune system. a small amount of feces.

2 in Carrollton, Georgia, be- In 1987, 13,000 people You can also get cryptosporidiosis by drinking wa- came ill with cryptosporidiosis. This was the first re- ter or eating food that h as been contaminated with port of its spread through a municipal water system oocysts. Drinking untreated surface water (such as that met all state and federal drinking water standards. streams, rivers, and lakes) or swallowing a small In the spring of 1993 in Milwaukee, Wisconsin, mu- amount of water when swimming, even in a chlorin- nicipal drinking water, again within standards, was ated pool, can cause cryptosporidiosis. The parasite contaminated with An estimated Cryptosporidium. may also be spread in uncooked foods, beverages, or 400,000 people became ill, and the disease contrib- ice prepared with contaminated water. Unwashed uted to the deaths of some AIDS patients. These out- fresh fruits or vegetables may carry oocysts if manure breaks focused attention on the risk of waterborne was used or animals grazed where the crop was cryptosporidiosis and the po ssible need for stricter grown. drinking water standards. People who are infected (or whose hands become contaminated) with Cryptosporidium can spread the disease to other people or pets if they are not careful How many people get cryptosporidiosis? about their hygiene. Frequent hand washing is the We do not know exactly how many cases of crypto- single most important thing people can do to avoid sporidiosis actually occur. Many people do not seek spreading cryptosporidiosis and other illnesses. It is medical attention or are not tested for this parasite especially important to wash thoroughly before pre- often goes undetected as the Cryptosporidium and so paring food, as well as after using the toilet. cause of an intestinal illness. Oocysts are not killed by typical household disin- Health professionals in some states are on the look- fectants, including bleach, but are killed at tempera- iosis through surveillance out for cases of cryptosporid tures over 160 °F (hotter than most domestic hot tap programs at hospitals, clinics, and labs. The Centers water). Thorough drying in a clothes dryer will kill for Disease Control and Prevention (CDC) in Atlanta, oocysts by desiccating them. Georgia, keep track of many disease-causing organ- isms and send out warnings and advice on controlling Is cryptosporidiosis a new disease? outbreaks to every health department in the United States. warnings and advice on controlling outbreaks Cryptosporidiosis has long been a veterinary problem, to every health department in the United States. predominantly in young farm animals such as calves. was first recognized as a cause of Cryptosporidium human disease in 1976 but was rarely reported in hu- in surface Cryptosporidium How prevalent is mans until 1982. The number of detected cases began water? to rise rapidly along with the AIDS epidemic and the Oocysts are present in most surface bodies of water development of methods to identify the parasite in (e.g., lakes, rivers) across the United States, many of stool samples. The earliest cases of human crypto- which supply public drinking water. Oocysts are more sporidiosis were diagnosed in animal handlers. An prevalent in surface waters when heavy rains increase outbreak at a day care center was first documented in runoff of wild and domestic animal wastes from the 1983. land or when sewage treatment plants are overloaded or break down. al waste that enters the city drinking water intake Figure 1: Cryptosporidium contamination originates from anim facility . 2

3 Only laboratories with specialized capabilities can Watershed protection Crypto- Watershed protection is another barrier to oocysts in Cryptosporidium detect the presence of in drinking water. Land use controls such sporidium water. Unfortunately, current sampling and detection as septic system regulations and best management methods are unreliable. It is difficult to recover oo- practices to control runoff can help keep human and cysts trapped on the material used to filter water sam- animal wastes out of the water. ples. Looking at a sample under a microscope, it is not easy to determine whether an oocyst is alive or Water treatment regulations The U.S. Environmental Protection Agency (EPA) whether it is the species Cryptosporidium parvum that Cryptosporid- has set a standard of 99% removal of can infect humans. ium for public water systems "...using surface water The number of oocysts detected in raw (untreated) or groundwater under the direct influence of surface sampling time, and labora- water varies with location, water...[and] serving > 10,000..." people. This stan- tory methods. Water treatment plants remove most dard applies to smaller systems that provide water for but not always all oocysts from municipal drinking less than 10,000 people. water. It is not known exactly how many oocysts are sufficient to cause cryptos poridiosis, but the low numbers of oocysts sometimes present in drinking How can you tell if the tap water is safe? water are not considered cause for alarm in the gen- Properly drilled and maintained wells that tap into eral public. groundwater are unlikely to contain pathogens be- cause of the natural filtration that takes place as water How can we protect our water supplies from percolates down through the soil. But contaminants may flow into groundwater aquifers that lie beneath Cryptosporidium? coarse soils or fractured bedrock. Very shallow or Multiple barriers are needed to protect our water sup- nd springs can be contami- poorly constructed wells a plies from Cryptosporidium. Water treatment meth- nated with surface water runoff that carries disease- ods alone cannot solve the problem; watershed pro- causing microbes. It is important that the well be pro- tection and monitoring of water quality are critical. tected from surface contamination by an intact well Water treatment casing, proper seals, and a cap above ground. oocysts have tough walls that can Cryptosporidium The risk of waterborne cryptosporidiosis from pub- withstand many environmental stresses and are resis- lic drinking water varies depending on the quality of tant to the chemical disinfectants such as chlorine that the source water and type of water treatment. HIV- are traditionally used in municipal drinking water sys- infected persons should follow the guidelines issued tems and swimming pools. by the CDC and talk with their health care providers Physical removal of particles, including oocysts, about safe drinking water. When routine testing of from water by filtration is an important step in the public drinking water indicates potential danger, the municipal water treatment process. Typically, water health department or water utility will issue a "boil pumped from rivers or lakes into a treatment plant is water" notice. help settle out particles mixed with coagulants that suspended in the water. If sand filtration is used, even How can you make sure your own drinking more particles are removed. Finally, the clarified wa- ter is disinfected and piped to customers. water is safe? Ultraviolet (UV) light can be used to inactivate There are four measures you may wish to take to en- and another parasite, Cryptosporidium Giardia sure that your drinking water is safe: boil your water lamblia . Ozone is a strong disinfectant that kills pro- to kill pathogens, remove oocysts from your water tozoa if sufficient doses and contact times are used. with certain types of filters, treat water with a UV Both UV and ozone leave no residual for killing mi- light system, or drink certain types of bottled water. croorganisms in the distribution system, as does chlo- Boiling water is the best method of killing Crypto- rine. The high costs of new filtration, UV light, or sporidium and other waterborne pathogens; water to be weighed against the ozone treatment plants have should be brought to a rolling boil for at least one benefits of additional trea tment. Even well operated minute. It should be stored in the refrigerator in a water treatment plants cannot ensure that drinking clean bottle or pitcher with a lid. To prevent recon- Cryptosporidium water will be completely free of tamination, be careful not to touch the inside of the oocysts. water bottle or lid. 3

4 Cryptosporidium Water can be filtered to remove How can you avoid getting cryptosporidiosis? Giardia and cysts. Point-of-use filters may be used to You can minimize the chances of getting infected treat the water for drinking or preparing foods. They with Cryptosporidium (and numerous other patho- may be either attached to a faucet or have a pour- gens) by always practicing good hygiene, especially through design. Only filters with an "absolute" (not after possible exposure to sources of infection. People or smaller ) "nominal") pore size of one micron (1 μ with compromised immune systems must consistently will remove all the oocysts (viruses, however, can take precautions exposure to Cryptosporid- to avoid pass through a 1 μ filter). The pores of reverse osmo- ium. sis (RO) membranes are too small for oocysts to pass • Wash your hands thoroughly with soap and water through. NSF International, an independent, nonprofit (and supervise children’s hand washing) testing agency, publishes lists of filters and RO units • after using the toilet or changing diapers. certified for "cyst reduction." Follow the manufac- after handling animals or cleaning up feces. • turer’s instructions that are supplied with water treat- ment equipment to prevent clogging and ensure • after working in dirt or touching any objects such proper filtration. The filter cartridge(s) and membrane as shoes that may have been contaminated with will need to be replaced periodically. Improper main- fecal matter. tenance can actually increase health risks. before preparing, serving, or eating food. • UV light water treatment systems can inactivate Avoid drinking untreated water from lakes, • Giardia and Cryptosporidium cysts. NSF Interna- streams, and other surface water bodies. tional has developed standards for these systems, and Because of possible contamination with manure, • certified systems can be found on the NSF website at peel or rinse fruits or vegetables to be eaten raw. www.nsf.org. For more information on these systems, • Take extra care in selecting food and drink when see our fact sheet entitled "Ultraviolet Radiation for traveling to places with poor sanitation. Disinfecting Household Drinking Water". • Follow any water advisories issued by local health departments, state authorities, or the na- Isn’t all bottled water safe to drink? tional Centers for Disease Control and Preven- Under current standards, bottled water is not neces- tion. sarily any safer than tap water. Bottled water from To treat contaminated water before drinking it, • deep wells (groundwater sources) has a very low like- bring it to a rolling boil for at least one minute to lihood of containing oocysts, but bottled water from a kill oocysts or remove them with a filter with an surface water source has the same risk of containing absolute pore size of one micron or smaller. oocysts as tap water from that source unless it is treated before bottling. Read the label on bottled water for information For more information about the water source and treatment. Water can be distilled or pasteurized to kill all pathogens before Contact your state or local health department. • bottling. Oocysts can be inactivated by UV or ozona- Call the water utility serving your area. • tion. Oocysts can also be removed by reverse osmosis or a filter with an absolute one-micron rating. Other • Contact the Cooperative Extension office in your micro filtration or ion-exchange methods or treatment county. with chlorine or carbon dioxide promise cannot Call the U.S. Environmental Protection Agency • crypto-free water. Safe Drinking Water Hotline at 1-800-426-4791. The heat of pasteurization will kill all pathogens in • Call the CDC AIDS Hotline at 1-800-342-AIDS. nd canned bubbly drinks dairy products. Bottled a For a listing of drinking water treatment units that such as sodas and beer are usually heated or filtered meet NSF standards, go to the NSF website at Cryptosporidium. enough to kill or remove www.nsf.org. 4

5 Selected Reference U.S. Environmental Protection Agency. 2002. List of Contaminants and their MCLs . www.epa.gov/safewater/mcl.html#mcls (July 2004). Center for Disease Control Factsheet Cryptosporidium Infection http://www.cdc.gov/ncidod/dpd/parasites/ cryptosporidiosis/factsht_cryptosporidiosis.htm (December 2004) Center for Food Safety and Drug Administration Cryptosporidium parvum The bad bug book: http://vm.cfsan.fda.gov/~mow/chap24.html (December 2004) Written by Barbara Kneen, fo rmer extension associate, ion associate, and Ann Lem- Susan Darling, former extens e Department of Textiles and ley, professor and Char of th Apparel, College of Human Ecology, Cornell University, Ithaca, NY 14853, under the sponsorship of the U.S. De- partment of Agriculture’s Working Group on Water Qual- ity. The information in this fact sheet is not intended as medi- cal advice for individual problems. Illustration by Margaret Nelson. This publication is issued to further Cooperative Extension work mandated by acts of Congress of May 8 and June 30, 1914. It was produced with the cooperation of the U.S. Department of Agriculture; Cornell Cooperative Extension; and the College of Agriculture and Life Sciences, the Col- lege of Human Ecology, and the College of Veterinary Medicine at Cornell University. Cornell Cooperative Ex- tension provides equal program and employment opportu- nities. Helene R. Dillard, Director 329WQFS6 9/100 5/96 5C CUPS MS50490 ©2000 Cornell Cooperative Extension 5

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