Chlorine works: 12 dead, 87 sick from Legionnaires’ linked to Michigan water supply 2014-15

An outbreak of Legionnaires’ disease that killed 12 people and sickened at least 87 in Flint, Mich., in 2014 and 2015 was caused by low chlorine levels in the municipal water system, scientists have confirmed. It’s the most detailed evidence yet linking the bacterial disease to the city’s broader water crisis.

Rebecca Hersher of NPR reports that in April 2014, Flint’s water source switched from Lake Huron to the Flint River. Almost immediately, residents noticed tap water was discolored and acrid-smelling. By 2015, scientists uncovered that the water was contaminated with lead and other heavy metals.

Just months after the water source changed, hospitals were reporting large numbers of people with Legionnaires’ disease.

“It’s a pneumonia, but what’s different about it is, we don’t share it like we do the flu or common cold,” explains Michele Swanson of the University of Michigan, who has been studying Legionnaires’ for 25 years. “It’s caused by a bacterium,Legionella pneumophila, that grows in water.”

The bug can enter the lungs through tiny droplets, like ones dispersed by an outdoor fountain or sprinkler system, or accidentally inhaled if a person chokes while drinking.

“If you don’t have a robust immune system, the microbe can cause a lethal pneumonia,” she says. In a normal year, the disease is relatively rare — about six to 12 cases per year in the Flint area, according to Swanson. During the water crisis, that jumped up to about 45 cases per year.

Although the outbreak of Legionnaires’ happened at the same time as the Flint water crisis, it was initially unclear how the two were connected. After earlier research suggested that chlorine levels might be the key, Swanson and colleagues at the University of Michigan in Ann Arbor, Sammy Zahran of Colorado State University and a team of researchers at Wayne State University in Detroit, began analyzing detailed water and epidemiological data from the six-year period before, during and after the crisis.

“We know that Legionella is sensitive to chlorine in the laboratory,” says Swanson. The chlorine makes it difficult for the bacteria to replicate, which is one reason water companies often add chlorine to their systems. But when Flint’s water source changed, the chlorine level dropped and cases of Legionnaires’ disease spiked. “It was the change in water source that caused this Legionnaires’ outbreak,” Swanson says.

The new research was published in a pair of studies in the Proceedings of the National Academy of Sciences and the journal mBio on Monday. The conclusion may bolster parts of the case being brought against Nick Lyon, the former Michigan Department of Health and Human Services director, who is being tried for involuntary manslaughter in connection with the Legionnaires’ deaths.

From April 2014 to October 2015, the Flint River served as Flint’s water source. During the same period, cases of Legionnaires’ disease increased from less than a dozen per year to about 45 per year, and 12 people died of the waterborne disease.

The new studies also suggest that a complex set of factors may be responsible for low chlorine levels during the crisis. In addition to killing microbes, chlorine can react with heavy metals like lead and iron, and with organic matter from a river. That means lead and iron in the water may have decreased the amount of chlorine available to kill bacteria.

400 sick: Now the water is chlorinated in Nousis, Finland

(Something may be lost in translation; thanks to our Scandanavian correspondent for passing along these stories.)

About 400 people in Nousis, Finland — a town of 4,800 — fell as a result of contaminated drinking water.

The municipality’s health authorities state that the situation was worst 23-27 January when more than 50 cases were recorded every day. The number of new cases has decreased steadily.

Last weekend, a ban on drinking water was introduced.

A leakage has been found to be behind the epidemic; the leak caused sewage and drinking water to mix.

Last night, chlorination of the water pipeline began. Day care centers, schools, retirement homes and health centers are in the first place in a hurry for redevelopment, and on Tuesday the chlorination of the water to households begins.

In tests taken by people who have fallen ill after drinking the municipality’s water pipeline, at least noro, sapo and astroviruses have been found.

Some of the patients had had two different viruses.

Individual cases of ETEC and EHEC bacteria and of the bacterium Plesiomonas shigelloides were also found in the patient samples.

In water analyzes only sapovirus has been found, and therefore it has not been possible to confirm that the other disease have come from the water.

“I contacted the municipality when the water was grayed out, but they then certified me that it was safe to drink,” said resident Jutta Holmevaara.

“Then it started coming out ‘from both ends.’ It continued as long as I drank the water.

“It took five days before I noticed that they had announced that it was worth boiling the water. I had fever for several days. I still do not feel completely healthy.”

Raw water: It’s a thing

In Australia, communities at the suburb level have the power to decide whether to fluoridate water or not.

Every time I go to the dentist, he tells me the same story: I can tell where you’re from by your teeth, no fluoride means more business for me.

In an America dominated by indulgence, privilege and the nonsensical, raw water is a thing.

Nellie Bowles of the New York Times writes at Rainbow Grocery, a cooperative in Culver, Oregon, one brand of water is so popular that it’s often out of stock. But one recent evening, there was a glittering rack of it: glass orbs containing 2.5 gallons of what is billed as “raw water” — unfiltered, untreated, unsterilized spring water, $36.99 each and $14.99 per refill, bottled and marketed by a small company called Live Water.

“It has a vaguely mild sweetness, a nice smooth mouth feel, nothing that overwhelms the flavor profile,” said Kevin Freeman, a shift manager at the store. “Bottled water’s controversial. We’ve curtailed our water selection. But this is totally outside that whole realm.”

Here on the West Coast and in other pockets around the country, many people are looking to get off the water grid.

Start-ups like Live Water in Oregon and Tourmaline Spring in Maine have emerged in the last few years to deliver untreated water on demand. An Arizona company, Zero Mass Water, which installs systems allowing people to collect water directly from the atmosphere around their homes, began taking orders in November from across the United States. It has raised $24 million in venture capital.

And Liquid Eden, a water store that opened in San Diego three years ago, offers a variety of options, including fluoride-free, chlorine-free and a “mineral electrolyte alkaline” drinking water that goes for $2.50 a gallon.

What adherents share is a wariness of tap water, particularly the fluoride added to it and the lead pipes that some of it passes through. They contend that the wrong kind of filtration removes beneficial minerals. Even traditional bottled spring water is treated with ultraviolet light or ozone gas and passed through filters to remove algae. That, they say, kills healthful bacteria — “probiotics” in raw-water parlance.

The quest for pure water is hardly new; people have been drinking from natural springs and collecting rainwater from time immemorial. The crusade against adding fluoride to public water began in the 1950s among Americans who saw danger in the protective measures that had been adopted over decades to protect the populace from disease and contamination.

But the off-grid water movement has become more than the fringe phenomenon it once was, with sophisticated marketing, cultural cachet, millions of dollars in funding and influential supporters from Silicon Valley.

Sounds like Walkerton: More than 750,000 in NZ exposed to potentially unsafe drinking water

Same old, same old.

Tracy Watkins of Stuff writes complacency, inept officials – a Government inquiry paints a frightening picture of the state of New Zealand’s drinking water, with at least 750,000 of New Zealanders drinking from supplies that are “not demonstrably safe” – a figure described as likely to be a “significant underestimate.”

The inquiry was sparked by the 2016 Havelock North gastro outbreak, which has now been linked to four deaths, and calls for a major overhaul of water supplies, including mandatory treatment.

The Government has now written urgently to all mayors and district health boards asking to check the water they are supplying meets current standards after the inquiry revealed 20 per cent of water supplies were not up to standard.

That 20 per cent affects 759,000 people, of which 92,000 are at risk of bacterial infection, 681,000 of protozoal infection and 59,000 at risk from the long term effects of exposure to chemicals through their water supply.

But that figure was likely to understate the problem, as it did not include more than 600,000 people who drink water from self-suppliers or temporary suppliers, or tourists to places like Punakaiki on the West Coast, which is under a permanent “boil water” notice.

The inquiry found that complacency about the state of New Zealand’s drinking water was common, yet the evidence showed that in many cases it was safer to drink tap water overseas than here.

But its most damning findings related to the Ministry of Health, which it described as inept and negligent in its oversight of a system in which non-compliance with safe standards was high.

The risks for contamination of the water supplies were detailed by the inquiry including damaged pipes, a huge number of private and unknown bores, and the close proximity of sewerage to drinking water assets, a factor that caused surprise among overseas experts.

The second part of the inquiry looked at broader water quality issues.

It found that lessons from Havelock North appeared not to have been learned – compliance figures in the 2016-17 period were still “alarmingly low” and “do not appear to reflect any increased vigilance by suppliers in the aftermath of [that] outbreak”.

“The inquiry found the falling compliance levels with the bacteriological and chemical standards particularly concerning. The decrease in compliance with the bacteriological standards results from an increased number of transgressions, an increased number of supplies with ineffective, delayed or unknown remedial action following transgressions, and an increased number of supplies with inadequate monitoring.

“Twenty-seven supplies failed entirely to take any remedial action after a transgression. In the aftermath of the bacteriological outbreak in Havelock North, these failures to respond effectively to transgressions or to monitor adequately are surprising and unacceptable.”

50+sick: Norovirus in Sweden water

(Something may be lost in translation)

Thanks to our Swedish correspondent who forwarded the stories about a norovirus outbreak in Saxdalen linked to drinking water.

Anders Lindblom, Disease Prevention Officer in Dalarna, said, “Probably the cause of the stomach disorder in the Saxdalen winter calf virus (calicivirus). The virus that causes winter rheumatoid arthritis is highly contagious and spreads apart from water and food, even from person to person.”

It’s norovirus. But different countries call it different things.

Our correspondent adds, “In Saxdalen in middle Sweden, the drinking water is contaminated with norovirus. The contamination source is probably poorly maintained sewage pipe system. So far is at least 50 people (10% of the population) infected.”

Media reports note, “The stool sample we received indicates that it is calicivirus and unfortunately it will take some time to get the water approved,” says Göran Eriksson, environmental manager in Ludvika municipality.

“He tells us that the cause of the pollution is probably that a drainage pipe in very bad condition polluted the soil at a place where a drinking water pipeline had previously broken.

“Ludvika municipality still recommends people living in Saxdalen to boil the water you plan to drink and cook with.”

‘Look where some people poo’ Global citizen’s Taylor Swift parody

Yasmine Gray of Billboard writes  Global Citizen — a social action platform dedicated to solving the world’s biggest problems — released a Taylor Swift parody video for a cause. Bringing attention to one of the most pressing issues in global development, the “Look What You Made Me Do” spoof draws attention to sanitation and toilet access.

Worldwide, 4.5 billion people lack access to safe and working toilets and sanitation, while 892 million people are forced to defecate outside in the open or into bodies of water. Poor sanitation is linked to the transmission of many deadly diseases, including cholera, diarrhea, dysentery, hepatitis A, typhoid, and polio, and 3.4 million people — mostly children — die from water-related diseases each year, with one in nine child deaths caused by diarrhea.

“Look Where Some People Poo” is the latest in a series of musical parodies Global Citizen has created to educate and inspire people around the world to take action. Past videos have included an Adele parody about calling Congress and a Bruno Mars parody concerning women’s rights.

Ahead of World Toilet Day (Nov. 19), the organization is asking supporters to sign a petition calling on the World Bank to commit to prioritizing basic sanitation.

 

 

Water water everywhere, but is it safe?

Potable water and the U.S. Centers for Disease Control: two things we take for granted.

CDC reports that during 2013–2014, a total of 42 drinking water–associated outbreaks were reported, resulting in at least 1,006 cases of illness, 124 hospitalizations, and 13 deaths. Legionella was responsible for 57% of outbreaks and 13% of illnesses, and chemicals/toxins and parasites together accounted for 29% of outbreaks and 79% of illnesses. Eight outbreaks caused by parasites resulted in 289 (29%) cases, among which 279 (97%) were caused by Cryptosporidium and 10 (3%) were caused by Giardia duodenalis. Chemicals or toxins were implicated in four outbreaks involving 499 cases, with 13 hospitalizations, including the first outbreaks associated with algal toxins.

To provide information about drinking water–associated waterborne disease outbreaks in the United States in which the first illness occurred in 2013 or 2014 (https://www.cdc.gov/healthywater/surveillance/drinking-surveillance-reports.html), CDC analyzed outbreaks reported to the CDC Waterborne Disease and Outbreak Surveillance System through NORS (https://www.cdc.gov/nors/about.html) as of December 31, 2015. For an event to be defined as a waterborne disease outbreak, two or more cases must be linked epidemiologically by time, location of water exposure, and illness characteristics; and the epidemiologic evidence must implicate water exposure as the probable source of illness. Data requested for each outbreak include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated water system; 4) the setting of exposure; and 5) relevant epidemiologic and environmental data needed to understand the outbreak occurrences and for determining the deficiency classification.§ One previously unreported outbreak with onset date of first illness in 2012 is presented but is not included in the analysis of outbreaks that occurred during 2013–2014.

Public health officials from 19 states reported 42 outbreaks associated with drinking water during the surveillance period (Table 1) (https://www.cdc.gov/healthywater/surveillance/drinking-water-tables-figures.html).

One outbreak reported during 2013–2014 in an individual system led to 100 estimated illnesses associated with a wedding. The public health challenges highlighted here underscore the need for rapid detection, identification of the cause, and response when drinking water is contaminated by infectious pathogens, chemicals, or toxins to prevent and control waterborne illness and outbreaks.

Two stricken with Giardia in Norway

Many thanks to our Norwegian correspondent who reports that two people admitted to Haukeland Hospital have been diagnosed with Giardia infection.

“We have two confirmed cases, but it is possibly a third too. It is too early to say anything about the source of infection,” says Surveillance Authority in Bergen municipality Kari Stidal Øystese.

Bergen is sensitive to Giardia outbreaks because in autumn 2004, the drinking water was infected by the Giardia parasite and approximately 5,000 people from Bergen became sick, and many have suffered after-effects for years.

In 2006, a SINTEF report commissioned drainage systems related to the buildings at Knatten, Starefossen and Tarlebøveien, triggered the epidemic. Local authority Torgeir Landvik would blame the dog owners for the fact that thousands of mountain people were infected by Giardia in the fall of 2004. But in 2015, an expert group picked up the dog-kit theory. “Based on available knowledge, Giardia infection from humans is still the most likely cause of the outbreak of disease and long-term strokes,” said the group’s conclusion.

A large community outbreak of waterborne giardiasis- delayed detection in a non-endemic urban area

BMC Public Health, 2006, 6:141,   Karin Nygård, Barbara Schimmer, Øystein Søbstad, Anna Walde, Ingvar Tveit, Nina Langeland, Trygve Hausken and Preben Aavitsland, https://doi.org/10.1186/1471-2458-6-141

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-141

Background

Giardia is not endemic in Norway, and more than 90% of reported cases acquire the infection abroad. In late October 2004, an increase in laboratory confirmed cases of giardiasis was reported in the city of Bergen. An investigation was started to determine the source and extent of the outbreak in order to implement control measures.

Methods

Cases were identified through the laboratory conducting giardia diagnostics in the area. All laboratory-confirmed cases were mapped based on address of residence, and attack rates and relative risks were calculated for each water supply zone. A case control study was conducted among people living in the central area of Bergen using age- and sex matched controls randomly selected from the population register.

Results

The outbreak investigation showed that the outbreak started in late August and peaked in early October. A total of 1300 laboratory-confirmed cases were reported. Data from the Norwegian Prescription Database gave an estimate of 2500 cases treated for giardiasis probably linked to the outbreak. There was a predominance of women aged 20–29 years, with few children or elderly. The risk of infection for persons receiving water from the water supply serving Bergen city centre was significantly higher than for those receiving water from other supplies. Leaking sewage pipes combined with insufficient water treatment was the likely cause of the outbreak.

Conclusion

Late detection contributed to the large public health impact of this outbreak. Passive surveillance of laboratory-confirmed cases is not sufficient for timely detection of outbreaks with non-endemic infections.

Hare fever in Norway

(Something may be lost in translation.)

The veterinary institute has recently diagnosed hare fever (tularemia) with many hares and one dog – all from southern Norway. This indicates that the disease is relatively widespread in this area and people should be aware of it.

Harane with hare fever has been submitted from Agder, northern part of Buskerud and Inner Sogn during the last weeks. Tularemia (harepest) obsessed infection with the bacterium Francisella tularensis.

The bacterium can infect humans and many different animal species. The hare is particularly sensitive to infection and dying usually by blood poisoning few days after he has been infected. Dogs can be infected by catching or by eating smokers. Commonly, they develop transient disease.

Harepest (tularemia) is a disease that can be transmitted from animals to humans. Often it happens via drinking water, for example if dead mice or lem infect wells, streams and other water sources.

The danger of being infected with tularemia or other waterborne disease will always be present. After a lean year, the following year there may be dead animals still infectious. We therefore recommend that you follow the advice and measures for drinking water listed below for safety. It will prevent hare fever and other diseases from drinking water, especially the drinking water that is extracted from wells and other sources in nature.

‘Pathetic’ £450,000 fine because of crypto in UK water supply

Ed Walker of Blog Preston writes the reason why Prestonians couldn’t drink their water without boiling it for a month has finally been revealed.

United Utilities has been fined after a cryptosporidium outbreak at its Franklaw treatment plants to the north of Preston,

The Drinking Water Inspectorate found the problems came from the Franklaw works using a different reservoir to source water

Rainwater running off agricultural land was able to access an underground water tank at Barnacre.

A ‘planned change in operations’ allowed the entry of the contaminated water into the treatment process.

Traces of cryptosporidium were detected in the water at Franklaw triggering a shut off of supplies for 700,000 people across Lancashire.

Supplies for many were knocked out for a month during the summer of 2015 as engineers worked to fix the issue.

At Preston Crown Court the hearing fined United Utilities £300,000 and additional costs of £150,000 were also agreed. The firm had pleaded guilty to supplying water unfit for human consumption.

United Utilities was criticised for not acting fast enough to issue the boil water warning to households and businesses.

It has since paid out £20million in compensation to customers through reduced water bills.

The fine was branded ‘pathetic’ by Preston MP Mark Hendrick.