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National Rural Water Association
The National Rural Water Association is the country’s largest public drinking water and sanitation supply organization with over
30,000 members. Safe drinking water and sanitation are generally recognized as the most essential public health, public welfare
and civic necessities.
Contact: Mike Keegan, Analyst <[email protected]>
(Washington, DC)
(10/24/2014) Rural Water Advisory: Update on Ebola Information
for Water and Wastewater Utilities
State Rural Water Associations:
NRWA participated on the U.S. Department of Homeland Security (DHS) Office of Infrastructure
Protection’s teleconference on the Ebola response this afternoon. Health experts from DHS and
the Centers for Disease Control and Prevention (CDC) provided updates on Ebola information
related to the critical infrastructure community during the teleconference. The link to replay the
teleconference will be circulated as soon as it is released. A number of questions were posed
concerning the risk to wastewater treatment personnel from Ebola and the survivability of Ebola in
water and sewage. Relevant information provided during the teleconference (and from a
separate CDC teleconference last week) includes:

The Occupational Safety & Health Administration (OSHA) Guidance for Workers and
Employers in Non-Healthcare/Non-Laboratory Settings includes guidance for appropriate
protective equipment (OSHA Fact Sheet).

“Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dry
surfaces, such as doorknobs and countertops, can survive for several hours; however,
virus in body fluids (such as blood) can survive up to several days at room temperature”
(CDC).

CDC will soon release an “Interim Guidance for Workers Handling Untreated Sewage from
Ebola Cases in the United States” for personnel working with sewage servicing Ebola
related facilities and patients that will include safety procedures for sewage workers and
Ebola survivability in sewage findings. NRWA speculates the document could be released
within a week. NRWA has requested for CDC experts to address our constituency directly
in a webcast and will notify you when this is scheduled.

A participant on the call mentioned that some virologists (e.g., Chuck Haas, Kellogg
Schwab) have questioned the Water Research Foundation statement that “The Ebola
virus can only replicate within host cells. Therefore, it cannot survive long in water
because it does not have its host — either a human or an animal. Because of Ebola’s
fragility when separated from its host, bodily fluids flushed by an infected person would not
contaminate the water supply. Researchers believe that Ebola survives in water for only a
matter of minutes. This is because water does not provide the same environment as our
bodily fluids, which have higher salt concentrations. Once in water, the host cell will take in
water in an attempt to equalize the osmotic pressure, causing the cell to swell and burst,
thus killing the virus.”

The EPA report "Persistence of Categories A and B Select Agents in Environmental
Matrices" has reported that Ebola can survive on some surfaces, especially at low
temperatures, for days (EPA report).
(10/17/2014) Rural Water Advisory: CDC Ebola Safety Guidance
for Sewage Workers
State Rural Water Associations:
The U.S. Centers for Disease Control and Prevention (CDC) will soon release an Interim
Guidance for personnel working with sewage servicing Ebola related facilities and patients.
Yesterday, the CDC briefed national water associations on the Interim Guidance which is in final
draft form, awaiting final CDC approval before public release. CDC explained the comprehensive
content of the guidance including: safety procedures for sewage workers and Ebola survivability
in sewage. CDC did not indicate a release date for the guidance. Based on previous CDC final
review processes, NRWA speculates the document could be released within a week.
(10/15/2014) Rural Water Advisory: Ebola and Public Wastewater
Systems
State Rural Water Associations:
The U.S. Centers for Disease Control and Prevention (CDC) recommends disposal of Ebola
related waste to public wastewater systems (see below). The CDC does not have guidance for
wastewater operations specialists and employees related specifically to Ebola. The CDC and the
World Health Organization conclude that Ebola is not a foodborne, waterborne or airborne illness,
it is transmitted through direct contact with infected bodily fluids and Ebola infected cells don't live
long in water because it does not have the same salt concentration as bodily fluids. On October
13, 2014, the CDC indicated it is reconsidering its approach to decontamination and equipment
procedures for all health workers (see article below). NRWA is in contact with the CDC and the
U.S. EPA regarding any additional guidance for wastewater or drinking water employees, and will
be distributing all related guidance.
CDC Guidance on Safety of Ebola and Sanitation Systems:
 "Sanitary sewers may be used for the safe disposal of patient waste. Additionally, sewage
handling processes (e.g., anaerobic digestion, composting, and disinfection) in the United
States are designed to inactivate infectious agents." Interim Guidance for Environmental
Infection Control in Hospitals for Ebola Virus, August 1, 2014, CDC

"For equipment that drains directly into the sewer system, the United States sanitary
sewer system handling processes (e.g., anaerobic digestion, composting, disinfection) are
designed to safely inactivate infectious agents."

Interim Guidance for Specimen Collection, Transport, Testing, and Submission for
Persons Under Investigation for Ebola Virus Disease in the United States, October 6,
2014, CDC
"C.D.C. Rethinking Methods to Stop Spread of Ebola" New York Times, Oct. 13, 2014

"The transmission of the Ebola virus to a nurse here forced the Centers for Disease
Control and Prevention on Monday to reconsider its approach to containing the disease,
with state and federal officials re-examining whether equipment and procedures were
adequate or too loosely followed, and whether more decontamination steps are necessary
when health workers leave isolation units... State and federal health officials seemed to
be, in a sense, starting over, two weeks after Mr. Duncan’s diagnosis of Ebola on Sept.
30. They were now identifying, assessing and learning more about a group of health care
workers they had largely ignored, to the point that they spent more than 24 hours simply
trying to identify who they were... Concern was also evident in Louisiana, where a state
judge granted the state attorney general, Buddy Caldwell, a temporary restraining order on
Monday blocking the dumping of Mr. Duncan’s incinerated personal items in a hazardouswaste landfill in Calcasieu Parish..."
(10/8/2014) Rural Water Advisory: New U.S. DHS Report Features
Cyber Incident at Water Utility
State Rural Water Associations:
Today, the Department of Homeland Security’s Industrial Control Systems Cyber Emergency
Response Team (ICS-CERT) released their "Monitor" report (attached). The report features a
newly disclosed cyber incident at a water utility. The utility reported that a control system
maintenance employee had improperly accessed the control system on at least four separate
occasions and possibly caused an overflow of the system’s wastewater treatment process.
Additionally, a September 25, 1994, ICS-CERT report (attached) characterizes possible impacts
and consequences of cyber-based penetrations in water systems. This report finds that a cyber
attack could create excess dose of chlorine, no chlorine, damage pumps, bypass in the treatment
process, change real-time data within a SCADA system, or loss of the SCADA.
(10/8/2104) Rural Water Advisory: Ebola Cannot Spread Through
the Drinking Water Supply
State Rural Water Associations:
In response to inquires about the ability of Ebola to be spread in drinking water supplies, the
National Rural Water Association is distributing the following resources and information that
conclude Ebola cannot spread through the drinking water supply.
 Ebola is not a foodborne, waterborne, or airborne illness (WHO).
 Ebola spreads in human populations through human-to-human transmission, through
direct contact with infected bodily fluids including blood, vomit, or feces (WHO).
 Ebola can’t survive in drinking water because Ebola infected cells don't live long inside a
liquid that doesn't have the same salt concentration as bodily fluids (NPR).
Resources:
World Health Organization (WHO) Website
World Health Organization (WHO) Fact Sheet
Centers for Disease Control and Prevention Website
National Public Radio (NPR) Analysis
National Rural Water Association
Contact: Mike Keegan <[email protected]>, Analyst
(Washington, DC)
The National Rural Water Association is the country’s largest public drinking water and sanitation supply organization with
over 30,000 members. Safe drinking water and sanitation are generally recognized as the most essential public health,
public welfare and civic necessities.