“It’s no longer just about ingesting water,” said study co-author Vince Hill, head of the CDC’s water-borne disease prevention branch. “We’ve captured a more modern picture of what water-borne disease looks like in the United States today.”
According to the report, the biofilm, a mixture of bacteria, fungi, amoebas and other microorganisms in the form of glue, is established within some of the 6 million kilometers of plumbing that support alcohol systems, sanitation, hygiene , cooling and heating of U.S. buildings published Wednesday in Emerging Infectious Diseases magazine.
“If you’ve ever felt this viscous film in your teeth when you haven’t washed it in a while, this is a biofilm,” said lead author Sarah Collier, a CDC analytical epidemiologist. “Biofilms tend to form wherever there are microbes and water.”
Robust bioflimes can provide a safe haven for microbes, protecting them from disinfectants in the water, Hill said. This is how water-borne pathogens such as the bacterium Legionella (which causes legionnaires’ disease) are potentially deadly. grow and escape in the air, get sick and kill thousands of people every year.
In fact, the report found that more than 90% of all deaths and most hospitalizations for water-borne diseases are caused by only three airborne pathogens thriving in biofilms.
“It’s kind of a paradigm shift for us:‘ Wow, there are things that grow within these pipes, ’either within the water service system or within the home,” Hill said.
“So this is kind of the new frontier we recognize,” Collier added. “And we believe this is an area where we can help prevent disease.”
More than 3 billion in health care costs
The CDC team estimated the total number of illnesses, emergency room visits, hospitalizations, deaths, and direct health costs for 17 water-borne infectious diseases that can be found in domestic and industrial plumbing, in bathtubs. hydromassage, in recreational pools and water parks.
It was the first report to examine diseases from all water sources (drinking, recreational and environmental) and from all routes of exposure (ingestion, contact and inhalation), Hill said.
The analysis showed that more than 7 million water-borne diseases occur each year, resulting in more than 600,000 annual emergency room visits, 118,000 hospitalizations and 6,630 deaths, totaling $ 3.3 billion in direct costs. ‘medical care.
Otitis externa, better known as the swimmer’s ear, was the most common disease, accounting for 4.7 million or 65% of water-borne diseases annually and 20% of hospitalizations. Norovirus infections, which cause vomiting and diarrhea, were the second most common, with 1.3 million cases, followed by giardiasis of diarrheal disease with just over 400,000 cases per year.
Although much less common, the pathogens associated with the biofilm were responsible for the largest number of hospitalizations and deaths, which cost the U.S. health care system $ 2.39 million annually.
Legionella bacteria, responsible for outbreaks of pneumonia-like disease called Legionnaires’ disease and a mild flu-like illness called Pontiac fever, caused 995 deaths (15%) each year, according to the report.
Pseudomonas pneumonia was responsible for 15,500 hospitalizations and 730 deaths each year, at an annual cost of US $ 453 million.
People would come into contact with these airborne diseases through showers, building cooling towers and outdoor decorative fountains, among other sources, according to the report.
Because cryptosporidium is “extremely resistant to chlorine” and highly infectious at low doses, it has become the leading cause of outbreaks associated with treated aquatic sites, according to the report.
An infrastructure challenge
Efforts in the United States to improve water safety “is recognized as one of the greatest public health achievements of the 20th century,” according to the report. Outbreaks of feces-infested drinking water, including cholera and typhus, were common in the 19th and early 20th centuries, but have now disappeared.
“Over the past 40 years, we have seen a significant decrease in water-borne diseases, but complexities have increased with more building plumbing problems and more recreational water problems,” said J. Alan Roberson , executive director of the Association of Potable Water Administrators, who did not participate in the study.
At the same time, funding has remained constant or decreased for research, infrastructure, regulations, and the ability to increase compliance with existing regulations, both at the federal and state levels, Roberson said.
There is also the problem of aging pipes and the challenges of private wells or unregulated water systems that serve about 43 million people.
“Drinking water from the treatment plant to the water meter is highly regulated and a lot of work is done to make sure it is safe,” Collier said. “Although, once at home or in a building, it is the responsibility of the individual owner or the owner of the building to make sure it is safe.”
Consumers can do their part, Roberson said, by understanding their home plumbing system starting with where the water enters their home, the materials that make up the plumbing, and how water is distributed throughout the home.
“Although not part of this report, the country has about 6 million lead service lines and ownership of these service lines is typically divided between the water system and the property owner. Roberson said. “Therefore, the elimination of all of these lines is another public health initiative that will require a collaborative effort in a large number of communities.”
Steps to follow
Setting the hot water heater to a higher temperature of 130 to 140 degrees Fahrenheit can kill many harmful germs, according to the CDC, “but it also increases the risk of scalding. If you set the water heater above 120 ° F, be sure to take extra precautions to mix hot and cold water (using thermostatic valves) in the faucet or shower to prevent scalding. “
Regular washing of your water heater can also extend its shelf life, according to the CDC.
Even well-treated tap water “is not sterile nor is it completely devoid of microbes,” Hill said. “Therefore, if you use it for medical medical purposes or for your personal care, such as C-paps or humidifiers or nasal rinses, you will need to disinfect the water or use distilled water.”
Humidifiers should be emptied daily of water and cleaned properly on a regular basis. “Consider using distilled or pre-boiled (and chilled) water or water disinfected with chlorine bleach in portable humidifiers,” the CDC suggests.
Use only distilled, previously boiled, or filtered water to rinse your breasts with clean pots, the CDC says, but be careful to choose a filter that can trap small microorganisms.