National Academies Press: OpenBook

Indicators for Waterborne Pathogens (2004)

Chapter: Appendix A: Emerging and Reemerging Waterborne Pathogens

« Previous: 6 A Phased Approach to Monitoring Microbial Water Quality
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×

Appendix A
Emerging and Reemerging Waterborne Pathogens

This appendix addresses a requirement of the committee’s statement of task; specifically the requirement to “. . . define currently known waterborne pathogen classes and anticipate those emerging waterborne pathogens that are likely to be of public health concern.” For the purposes of this report, emerging and reemerging pathogens can be defined as recently identified waterborne pathogens or those pathogens that were once thought to be under control from a public health perspective but are reappearing and causing increased incidence or geographic range of infections in exposed human populations. In recent years, several such waterborne pathogens have arisen, including recognized pathogens from fecal sources and some “new” pathogens from environmental sources. Several factors contribute to the (re)emergence of waterborne pathogens in the United States (Theron and Cloete, 2002), including the following:

  • Changes in human demographics. There is an increasing number of “vulnerable subpopulations” in the United States such as infants, children, pregnant women, the elderly, and the immunocompromised (e.g., AIDS patients) who are particularly susceptible to infections resulting from exposure to waterborne pathogens compared to the general populace (see also NRC, 2001).

  • Changes in human behavior. Urbanization of rural areas allows infections arising in formerly isolated areas, which may once have remained obscure and localized, to reach large and densely populated areas. The use of heated drinking water with warm water reservoirs also promotes the emergence of waterborne pathogens because these systems are ideal habitats for a number of pathogens of public health concern, such as Legionella spp. (Lee and West, 1991).

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
  • Breakdown of public health systems. Although public health measures such as water and wastewater treatment act to minimize human exposure to waterborne pathogens and reduce the incidence of waterborne disease, these systems can and do fail on occasion—often with extensive public health ramifications. Such breakdowns also provide opportunities for pathogens to reemerge.

  • Microbial adaptation. Microbes are constantly evolving in response to changing environments and environmental conditions. With the increasing use and release of antibiotics and drugs into our waterways, strains of microorganisms that are antibiotic- or drug-resistant have also been increasingly identified (see Chapter 3 for further information).

  • Changes in agricultural practices. Intensive farming operations (especially concentrated/confined animal feeding operations, or CAFOs) result in high concentrations of animal wastes, which in turn lead to increased pollution of our nation’s waters by runoff and intentional (point source) discharges. This is of public health concern because a number of pathogens (e.g., Cryptosporidium) routinely contained in such fecal sources can be transmitted to humans through inadequately treated drinking water or through recreational water exposure.

Throughout this report, waterborne pathogens (including those that can be considered emerging or reemerging) can be categorized into four groups: viruses, bacteria, protozoa, and others. (“Others” include cyanobacterial toxins and protists; however, this group is not discussed extensively in this report for reasons outlined in Chapter 1.) Indeed, Chapter 3 on the ecology and evolution of waterborne pathogens and indicator organisms is divided into separate sections for viruses, bacteria, and protozoa. The issue of new and (re)emerging waterborne pathogens has been reviewed in several published reports and articles (EPA, 1998; LeChevallier et al., 1999; Szewzyk et al., 2000; Theron and Cloete, 2002) from a public health and/or water treatment perspective. Therefore, in response to the statement of task, this appendix includes a brief summary of the health effects and mode of transmission of select emerging and reemerging waterborne pathogens in all four groups taken from these and other sources (see Table A-1). Lastly, several of the waterborne pathogens listed in Table A-1 are discussed to some extent (in some cases extensively) elsewhere in this report.

REFERENCES

EPA (U.S. Environmental Protection Agency). 1998. Announcement of the Drinking Water Contaminant Candidate List; Notice. Federal Register 61(94): 24354-24388.


Hilton, C., K. Holmes, K. Spears, L.P. Mansfield, A. Hargreaves, and S.J. Forsythe. 2000. Arcobacter, newly emerging food and waterborne pathogens. Presentation at SGM Warwick, April 12.


LeChevallier, M.W., M. Abbaszdegan, A.K. Camper, G. Izaguirre, M. Stewart, D. Naumovitz, M. Mardhall, C.R. Sterling, P. Payment, E.W. Rice, C.J. Hurst, S. Schaub, T.R. Slifko, J.B. Rose, H.V. Smith, and D.B. Smith. 1999. Emerging pathogens: Names to know and bugs to watch out for. Journal of the American Water Works Association 91(9): 136-172.

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×

Lee, J.V., and A.A. West. 1991. Survival and growth of Legionella species in the environment. Journal of Applied Bacteriology Symposium Supplement 70: 121S-129S.


NRC (National Research Council). 2001. Classifying Drinking Water Contaminants for Regulatory Consideration. Washington, D.C.: National Academy Press.


Szewzyk, U., R. Szewzyk, and K.H. Schleifer. 2000. Microbiological safety of drinking water. Annual Review of Microbiology 54: 81-127.


Theron, J., and T.E. Cloete. 2002. Emerging waterborne infections: Contributing factors, agents, and detection tools. Critical Reviews in Microbiology 28: 1-26.

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×

TABLE A-1 Emerging and Reemerging Waterborne Pathogens of Public Health Concern

Waterborne Pathogen

Health Effects

Mode of Transmission

References and URLs

Viruses

Adenoviruses

Respiratory infections; gastroenteritis; febrile (fever-related) disease with conjunctivitis

Fecal-oral transmission; waterborne transmission

http://www.ce.berkeley.edu/~nelson/ce210a/Adenovirus/CE210a-adenovirus-k.htm; http://www.cdc.gov/ncidod/dvrd/revb/respiratory/eadfeat.htm; EPA, 1998

Astrovirus

Diarrhea

Fecal-oral transmission

Szewzyk et al., 2000

Coxsackieviruses

Diarrhea and vomiting; skin rashes; myocarditis and pericarditis (inflammation of the heart tissue and the membranous sac enveloping the heart, respectively); aseptic meningitis

Person-to-person transmission; fecal-oral transmission; contaminated water, particularly recreational water

http://www.awwarf.com/newprojects/pathogens/COXSACKI.html; EPA, 1998

Echoviruses

Subclinical infections; myocarditis; aseptic meningitis

Fecal-oral route

EPA, 1998

Enteroviruses

Gastroenteritis; poliomyelitis (inflammation of the gray matter of the spinal cord); meningitis; respiratory disease; diabetes; encephalitis (inflammation of the brain)

Fecal-oral route or respiratory route

LeChevallier et al., 1999; Theron and Cloete, 2002

Hepatitis viruses

Gastroenteritis

Fecal-oral route; fecally contaminated water and food; person-to-person transmission

LeChevallier et al., 1999

Norwalk/Caliciviruses

Diarrhea and vomiting

Contaminated surface water, groundwater, ice; contaminated shellfish; swimming in water containing sewage

EPA, 1998; LeChevallier et al., 1999

Rotavirus

Diarrhea

Fecally contaminated surface water

Szewzyk et al., 2000; Theron and Cloete, 2002

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×

Bacteria

Arcobacter

Diarrhea

Drinking water reservoirs and treatment plants

Hilton et al., 2000

Aeromonas hydrophila

Gastroenteritis

Drinking water biofilms

EPA, 1998; Theron and Cloete, 2002

Campylobacter (including C. jejuni, C. coli, and related species)

Acute gastroenteritis

Contaminated poultry products; unpasteurized milk; water

LeChevallier, et al., 1999; Szewzyk et al., 2000; Theron and Cloete, 2002

Helicobacter pylori

Gastroduodenal disease including chronic active gastritis; peptic and duodenal ulcer disease; gastric cancer

Unknown; fecal-oral transmission is highly probable

EPA, 1998; LeChevallier et al., 1999; Theron and Cloete, 2002

Legionella spp.

Legionnaires disease (severe lung inflammation) and Pontiac fever (influenza-like form of disease)

Source water to drinking water

Szewzyk et al., 2000

Mycobacterium avium complex

Pulmonary disease

Drinking water treatment and distribution system

EPA, 1998; LeChevallier et al., 1999

Pathogenic Escherichia coli

Hemorrhagic colitis (bleeding from inflamed colon) with bloody diarrhea and hemolytic-uremic syndrome (acute illness following a respiratory infection causing bloody diarrhea)

Contact with contaminated beef or dairy products

LeChevallier et al., 1999; Szewzyk et al., 2000; Theron and Cloete, 2002

Pseudomonas aeruginosa

Nosocomial infections (infections associated with hospital stays) in immunocompromised patients and patients with underlying diseases such as wound and urinary tract infections and pneumonia; tracheobronchitis in cystic fibrosis patients

Water exposed to fecal contamination; surface waters influenced by wastewater discharge; nutrient-rich water

Szewzyk et al., 2000

Yersinia enterocolitica

Gastrointestinal infections

Unknown; contaminated food and water are the most likely sources

Szewzyk et al., 2000; Theron and Cloete, 2002

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×

Waterborne Pathogen

Health Effects

Mode of Transmission

References and URLs

Protozoa

Acanthamoeba

Granulomatous amoebic encephalitis (swelling of the brain characterized by granulation tissue) in immunosuppressed people; keratitis (severe and potentially blinding infection of the cornea)

Contamination of contact lens or storage case

http://www.awwarf.com/newprojects/pathegeons/ACANTHAM.html; EPA, 1998

Cryptosporidium parvum

Subclinical infections and self-limiting diarrhea in healthy adults; severe diarrhea in infants and immunocompromised persons

Drinking water

Szewzyk et al., 2000; Theron and Cloete, 2002

Cyclospora cayetanensis

Diarrhea, abdominal cramping, decreased appetite, and low-grade fever that can last for several weeks

Unknown; fecal-oral route either directly or via water is thought to be highly probable

LeChevallier et al., 1999

Giardia lamblia

Subclinical infections and self-limiting diarrhea in healthy adults; severe diarrhea in infants and immunocompromised persons

Drinking water

Szewzyk et al., 2000; Theron and Cloete, 2002

Microsporidia

Diarrhea and cholangiopathy (infection of bile ducts) in immunocompromised persons

Surface water; sewage-contaminated waters

EPA, 1998; LeChevallier et al., 1999; Szewzyk et al., 2000

Toxoplasma gondii

Flu-like illness and/or swollen glands in the neck, armpits, or groin

Water contaminated by cats

LeChevallier et al., 1999

Other

Cyanobacteria toxins

Poisoning; gastrointestinal disease

Nutrient-rich surface water

EPA, 1998; LeChevallier et al., 1999; Szewzyk et al., 2000

Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 267
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 268
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 269
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 270
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 271
Suggested Citation:"Appendix A: Emerging and Reemerging Waterborne Pathogens." National Research Council. 2004. Indicators for Waterborne Pathogens. Washington, DC: The National Academies Press. doi: 10.17226/11010.
×
Page 272
Next: Appendix B: Review of Previous Reports »
Indicators for Waterborne Pathogens Get This Book
×
Buy Paperback | $75.00 Buy Ebook | $59.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Recent and forecasted advances in microbiology, molecular biology, and analytical chemistry have made it timely to reassess the current paradigm of relying predominantly or exclusively on traditional bacterial indicators for all types of waterborne pathogens.Β Nonetheless, indicator approaches will still be required for the foreseeable future because it is not practical or feasible to monitor for the complete spectrum of microorganisms that may occur in water, and many known pathogens are difficult to detect directly and reliably in water samples.Β

This comprehensive report recommends the development and use of a β€œtool box” approach by the U.S Environmental Protection Agency and others for assessing microbial water quality in which available indicator organisms (and/or pathogens in some cases) and detection method(s) are matched to the requirements of a particular application.Β The report further recommends the use of a phased, three-level monitoring framework to support the selection of indicators and indicator approaches.Β

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!