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Water and the Public Health
Dr Kevin Kelleher
1
Number of Waterborne General
Outbreaks
(Numbers ill)
Acute inf. Gastroenteritis
Cryptosporidiosis
2004
1 (14)
4 (23)
Food Poisoning (bacterial
other than Salmonella)
Legionellosis
Leptospirosis
1 (5)
Noroviral Infection
VTEC infection
Total
6 (42)
2005
2006
2007 2008
1 (37)
2 (38) 2 (36) 2 (311)
2009
1 (15)
2010
2013
2011 2012** YTD**
1 (6)
1 (11) 3 (19)
1 (9)
1 (2)
1 (2)
1 (2)
1 (18)
1 (9)
4 (49) 4 (56)
1 (2)
1 (50)
1 (6)
4 (354) 1 (2)
1 (5)
2 (23) 4 (52)
2 (20) 2 (52) 3 (29) 6 (72) 3 (19)
Total
3 (66)
13 (444)
1 (9)
4 (8)
1 (5)
2 (68)
9 (95)
35 (695)
* includes all outbreaks where water was listed as either main or contributory Mode of
Transmission
** provisional data
Zero years left blank for ease of viewing
Source: CIDR as of 5th June 2013
2
Number of Waterborne Family
Outbreaks
(Numbers ill)
2004
2005
Cryptosporidiosis
2006
2007
2008
2 (8)
1 (2)
2 (5)
2009
2010
2011
1 (1)
3 (7)
2013
2012** YTD**
2 (4)
Giardiasis
11 (27)
1 (2)
Hepatitis A
1 (5)
1 (2)
1 (5)
Paratyphoid
1 (2)
Salmonellosis
Total
1 (2)
1 (2)
1 (2)
Shigellosis
1 (3)
1 (3)
Typhoid
1 (2)
1 (2)
VTEC
2 (5)
1 (2)
2 (4)
1 (2)
8 (32) 11 (20)
1 (1)
3 (5)
18 (31)
1 (2) 48 (104)
Total
2 (5)
2 (4)
5 (17)
2 (4)
10 (37) 12 (22)
4 (7)
6 (12) 20 (35)
2 (4) 65 (147)
* includes all outbreaks where water was listed as either main or contributory Mode of
Transmission
** provisional data
Zero years left blank for ease of viewing
Source: CIDR as of 5th June 2013
3
Trends in Notifications: 2004 to June 4th
2013 *
(Giardiasis, Cryptosporidiosis, VTEC Infection)
700
Giardiasis
Cryptosporidiosis
Verotoxigenic E. coli Infection
Number of notifications
600
500
400
300
200
100
0
2004
2005
2006
2007
2008
2009
Year
Source: CIDR as of June 4th 2013
Note: 2012 and 2013 YTD data are provisional
2010
2011
2012*
2013 to
4th June
4
Cryptosporidiosis Annual Notifications & CIR
Ireland: 2004-2012*
700
16.0
14.3
13.4
14.0
608
12.1
556
Number of cases
568
500
10.5
10.0
400
12.0
9.8
425
9.3
428
445
8.7
415
369
10.0
8.0
6.9
300
294
6.0
CIR per 100,000
600
200
4.0
100
2.0
0
0.0
2004
2005
2006
2007
2008
2009
2010
2011
2012*
Year
Number
Data source: CIDR as of June 4th 2013
Note: 2012 data provisional
CIR
5
Crude incidence rate per
100,000 population
Incidence Human VTEC Infection
by Member State, EU 2011
7
6.14
6
5
4
3
2
1.93
1
0
Data source: EFSA and ECDC EU Community Zoonosis Report with data from 2011 (includes only
those MS who reported data on this disease in 2011). Includes only confirmed cases
6
Annual number of confirmed and probable
VTEC cases by serogroup, Ireland 1999-to June
th 2013*
4
600
Total
500
O157
Number of cases
non-O157
400
300
200
100
0
year
Source of data: HPSC and DML PHL
Note: 2012 and 2013 data
7
Trend in notifications of VTEC and
VTEC-associated HUS, Ireland 2004 to
Jun 4th 2013*
Case definition change in 2012
-new possible category
-probable and confirmed redefined
on basis of symptom status
35
600
VTEC notifications
500
30
Notifications of confirmed VTEC
Notifications of VTEC-associated HUS
25
400
20
300
15
200
10
100
5
0
0
2004
2005
2006
Source of data: HPSC and DML PHL
Note: 2012 and 2013 data provisional
2007
2008
2009
year
2010
2011
VTEC notificaitons with HUS
Notifications of VTEC
2012* 2013 to
Jun 4th
8
Seasonal distribution VTEC notifications,
Ireland 2008 to Jun 4th 2013*
120
2008
2009
100
Number of notifications
2010
2011
80
2012*
2013 to Jun 4th
60
40
20
0
1
2
3
4
5
6
7
8
9
10
11
12
Month of notification
Source of data: HPSC and DML PHL
Note: 2012 and 2013 YTD data provisional
9
Mean annual VTEC-associated HUS
incidence by HSE-area, Ireland 2004-2012*
1.20
Mean annual HUS incidence
1.00
0.80
0.60
0.40
0.20
0.00
HSE-E
HSE-M
HSE-MW
HSE-NE
HSE-NW
HSE-SE
HSE-S
HSE-W
IE
HSE-area
Source of data: HPSC and DML PHL
Note: 2012* data provisional
10
Crude incidence rate VTEC O157 and nonO157 by HSE-area, Ireland 2010 vs 2012 vs to
Jun 4th 2013*
2012*
2010
12
O157
crude VTEC
incidence rate
Crude incidence rate
non-O157
10
8
6
4
2
0
E
M
MW
NE
NW
SE
S
W
20
18
16
14
12
10
8
6
4
2
0
O157
non-O157
E
M
MW
2013 Jan 1st to Jun 4th
NE
NW
HSE-area
SE
S
W
Crude incidence rate
14
O157
12
non-O157
10
8
6
4
2
0
E
Source of data: HPSC and DML PHL
Note 2012 and 2013 YTD data provisional
M
MW
NE
NW
HSE-area
SE
S
W
11
Number of VTEC outbreaks by principal
transmission route, 2004-2012*
160
140
Number of outbreaks
P-P =person-to-person
120
WB =waterborne +/- P-P
100
FB =foodborne +/- P-P
80
AC/ENV
=animal/environmental
contact +/- P-P
60
UNK/NS =unknown/not
specified
40
20
0
P-P
WB +/- P-P
FB +/- P-P
AC/ENV +/- P-P
Other
UNK/NS
Transmission route
Source: CIDR as of Jun4th 2013
Note 2012 data provisional
12
Lead
• 10mgms/L
• WHO no Safe level
• Main source of lead will be on consumer
side
• Does water Metering allow chance to
remediate
13
Future
•
•
•
•
Harvest 2020
Pharmaceutical residues
Endocrine Disrupting Chemicals
Climate Change
– Water Shortages
– Quality
14
Irish Water
•
•
•
•
And HSE
And Quality
Supervisory Role
Expertise
15
Water policy
•
•
•
•
•
Economic?
Social
Public v Private
Equity
Free allowance
16
Water and Public Health
– Water much better now than 20 years ago
• For most
– Active management
– Gap widening between haves and have-nots
– Time to concentrate on
• Have nots
• Waste
• Source
17