Boil Order

The following presentation discusses water safety during a boil order and some of the most common parasites that can be transmitted in contaminated drinking water. Bacterial, viral, algal, and chemical contamination are also discussed, empowering learners to consider all aspects of how water is made potable, especially during times of disaster. This lecture also features practical knowledge of some of the hazards lurking in our plastics, and step-by-step instructions on various ways to safely disinfect and manage water for household use.

Boil Order © 2023 by E. Nomi is licensed under CC BY-NC-SA 4.0

Transcript

1. January 2023 BOIL ORDER Photos: thoughtco.com/what-is-the-boiling-point-of-water-607865, modified from Nohynková et al., 2006, Figure 4., modified from “Col Sem Of Oocysts Of Cryptosporidium Parvum” by A.B. Dowsett/science Photo Library, September 24th, 2018, on fineartamerica.com
2. A boil order, or boil water advisory, is a government issued public-health advisory to boil tap water before household use due to contamination of the water supply. Boil Order Photos: timesunion.com/news/article/Troy-issues-boil-water-advisory-12285126.php, wsp.com/en-CA/projects/village-of-middle-river-boil-water-advisory
3. Water supply can become contaminated by: • Flooding • A break in water lines • Cross-contamination with sewage • Loss in water system pressure1 Contamination Photos: punctualplumberdallas.com/blog/what-causes-your-water-line-to-break, thestar.com/news/world/2010/08/09/millions_suffer_as_pakistan_flood_disaster_worsens.html, sofrep.com/news/the- pic-of-the-day-flooding-continues-to-cause-devastation-across-midwest, fox47news.com/part-of-downtown-detroit-under-boil-water-advisory-after-water-main-break
4. Boil orders work in any situation where water quality could be compromised • Living in a disadvantaged or disaster-struck community • Camping or taking shelter Contamination Photos: samsylk.com/blog/jackson-miss-water-is-so-bad-they-have-to-shower-with-caution-video/, emergency-family-survival.com, who.int/southeastasia/news/detail/22-02-2018-working-for-clean- water-and-health-in-a-rohingya-refugee-camp Refugee camp Urban water system breakage Outdoor shelter
5. Parasites – • Cryptosporidium, Giardia, Entamoeba, Taenia 2, 3 Bacteria – • Vibrio cholerae, Shigella, Campylobacter, Legionella 2 Viruses – • Hepatitis A, Norovirus, SARS-CoV-2 coronavirus 2,4, 5,6 Algae – • Algal blooms can produce harmful cyanotoxins 7 Contaminants Photos modified from: dreamstime.com, istock.com
6. Parasites Photos modified from: marshallpumps.co.uk/giardia-water-parasite, “Col Sem Of Oocysts Of Cryptosporidium Parvum” by A.b. Dowsett/science Photo Library on fineartamerica.com, © David Ferguson on eurekaalert.org, thenepalidoctor.com/entamoeba-histolytica, masterroshsi.blogspot.com/2012/05/taenia-saginata-taenia-solium.html Taenia Cryptosporidium Entamoeba Giardia
7. Causes cryptosporidiosis8 One of most common water-bourne parasites8 Contracted by swallowing as few as 10 oocysts8,9 Spread in faeces • 10,000,000–100,000,000 oocysts shed in a single bowel movement8 Cryptosporidia Photo: “SEM of the intestines showing Cryptosporidia” © Moredun Animal Health / Science Photo Library on sciencephoto.com Scanning electron micrograph of Cryptosporidia on intestinal epithelia, x700 magnification
8. Trophozoite Cryptosporidia — Morphology Photos: Petry et al. 2009, Figure 1.b., Aldeyarbi, & Karanis, 2016, Fig. 8.c. Oocyst 500 nm 1 μm Amylopectin granule – stores energy Micronemes – secrete proteins for cell invasion Nucleus – contains genetic material
9. Ingested oocyst hatches in the gastrointestinal tract, releasing 4 sporozoites. Sporozoite = motile, elongated form that invades host cells10, 11 Cryptosporidia — Life Cycle Photo: "False-col Tem Of Cryptosporidia Sp." © London School Of Hygiene & Tropical Medicine, May 1, 2013, on fineartamerica.com oocyst sporozoites
10. Photo: justbalancinghealth.com/health-problems/treatment-for-common-cause-of-diarrhea-more-promising Cryptosporidia — Life Cycle trophozoite Sporozoites invade intestinal epithelia, form vacuoles, mature into trophozoites10, 11, 12 Trophozoite = activated, feeding stage that enters and parasitizes cells
11. Photo: "Intestinal Protozoan Parasites, Tem" © London School Of Hygiene & Tropical Medicine, May 13, 2013, on fineartamerica.com Cryptosporidia — Life Cycle meront merozoites Trophozoites mature, form meronts that produce 4-8 merozoites10, 11. Merozoite = life stage that undergoes asexual or sexual reproduction10, 11 Meronts containing merozoites
12. Photo: Borowski et al., 2009, Figure 2.D. Cryptosporidia — Life Cycle trophozoite merozoites Merozoites undergo asexual reproduction to form more trophozoites 10,11. Allows for rapid replication and establishment of infection10,11 1 μm
13. Merozoites undergo sexual reproduction by forming microgamonts ( ), which produce microgametes, and macrogamonts ( )11. Photo: Koh et al., 2014, Figure 4.H. & I. Cryptosporidia — Life Cycle merozoites microgametes macrogamont microgamont Microgamont Macrogamont 5 μm 8 μm
14. The microgamete fertilizes a macrogamont, forming a zygote11. Zygote matures into thin-walled oocyst (reinfects host) and a thick-walled oocyst (passed in faeces)11. Photo: healthtian.com/cryptosporidiosis Cryptosporidia — Life Cycle zygote thick wall thin wall Cysts on epithelia
15. Cryptosporidiosis Symptoms begin in 2–10 days8 • Includes diarrhoea, stomach cramps, dehydration, fever8 • Can last 1–4 weeks8 Treatment: • Nitazoxanide for treatment of diarrhoea8 • Patients with healthy immune systems can recover without treatment8 • Care must be taken to stay hydrated Photo: pillintrip.com, clipground.com, alamy.com
16. Clinical analysis of 3 stool samples collected on different days • Parasite is shed irregularly and can be difficult to detect8 Diagnosis Stool smear micrograph revealing Cryptosporidium parvum infection Photo: Public Health Image Library on wikidoc.org
17. Giardia Photo: Modified from "Giardia lamblia protozoan, SEM" © Ami Images/Science Photo Library on sciencephoto.com SEM of G. duodenalis trophozoite Causes giardiasis 13 Spreads in faeces13 Persists in environment for several months13 Main species affecting humans is G. duodenalis a.k.a. G. lamblia or G. intestinalis 13
18. Giardia — Morphology Photos: Modified from Melhorn, 2015, Figure 4.12 Trophozoite Cyst B = base of flagella N = nucleus VD = ventral disk F = flagella CW = cyst wall
19. Giardia — Life Cycle Cysts hatch in small intestine, each releasing two trophozoites 13 Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com cyst trophozoites
20. Giardia — Life Cycle Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com cyst trophozoites binary fission encystation feeding D trophozoites Trophozoites undergo binary fission and replicate13
21. Giardia — Life Cycle Trophozoites attach to intestinal epithelia by ventral disks , absorb nutrients from the intestinal lumen13,14 Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com feeding
22. Giardia — Life Cycle Trophozoites move to colon, mature into cysts and shed in faeces13 Photo: microspedia.blogspot.com/2017/09/giardia-cyst-under-microscope.html encystation
23. Symptoms begin in 1–2 weeks13 • Include greasy diarrhoea, cramps, nausea, and dehydration lasting 2–6 weeks13 • Impairs absorption of nutrients across intestine14,15 Treatment: • Nitroimidazole compounds, albendazole, or furazolidone13,15,16 • Rehydration therapy13 Giardiasis Photo: publicdomainfiles.com/show_file.php?id=13546270829533 SEM of Giardia causing damage to intestinal epithelia
24. Clinical analysis of stool samples13 Diagnosis Photo: Dr. Bobbi Pritt & Emily Fernholz, Case #157, on pathologyoutlines.com/topic/smallbowelgiardiasis.html Micrograph of trichrome stained stool specimen showing G. duodenalis infection in small bowel
25. Infects 50 million people worldwide, causing >100,000 deaths a year17 • Common in tropical climates, developing countries, and institutions with poor sanitation17, 18 Causes amoebic dysentery18 • Only 10%–20% of people infected develop symptoms of illness18 Photo: Modified from “Entamoeba Histolytica Protozoa” © Sinclair Stammers, July 28, 2016 on fineartamerica.com Entamoeba histolytica Entamoeba histolytica, differential interference contrast micrograph
26. Photos modified from: stepwards.com/?page_id=5948 and differencebetween.com/difference-between-wbc-and-amoeba, healio.com/news/infectious-disease/20140322/clemson-researcher-receives- nih-grant-to-study-entamoeba-histolytica E. histolytica — Morphology nucleus Cyst Trophozoite feeding vacuole – digests red blood cell meal chromatoid bar – condensed RNA pseudopod – used for motility 4 nuclei
27. Cystic stage = infective form • Survives in environment for prolonged periods. Thick wall confers resistance to desiccation and chlorine treatment19 • Cyst is ingested, wall is lysed by intestinal trypsin19 • Excystation occurs in less acidic conditions of caecum or lower part of illium19 • 8 trophozoites released per cyst19 E. histolytica — Life Cycle
28. Trophozoite stage = invasive form • Colonize the large intestine19 • Adhere to colonic epithelial cells via surface lectins that bind surface of intestinal epithelium19,20 • Invade and penetrate intestinal mucosa, killing cells and causing inflammation20 E. histolytica — Life Cycle
29. Trophozoite stage = invasive form • Can reach other areas of the body: liver, heart and brain, causing tissue necrosis and abscess formation20 • Matures into cyst • Cysts released in faeces E. histolytica — Life Cycle
30. Symptoms begin within 2–4 weeks18 • Diarrhea, abdominal pain • Severe infection: mucosal inflammation, ulcers, bloody stools, and necrosis leading to lesions and perforation of gut20 • Can migrate to liver and form abscess Treatment: • Metronidazole, followed by a luminal amebicide, including paromomycin or diiodohydroxyquin20 Photos: "Metronidazole Antibiotic Pills" © Tek Image, 2013, on fineartamerica.com, stock.adobe.com, gnhindia.com Amoebic Dysentary
31. Faecal microscopy20 PCR20 Serology: • Detection of antibodies at least a week into infection20 Colonoscopy followed by histologic examination20 Photos: modified from lstmed.ac.uk/intestinal-parasites/intestinal-parasites-entamoeba-histolytica, Yoon & Sumii, 2016, Figure 1.A. Diagnosis E. histolytica trophozoites in stool sample, wet mount Severe amoebic colitis in an HIV- infected patient (BMJ Case Reports, 2016)
32. Tapeworm that infects humans, pigs, and cows21 Infectious eggs and body segments are passed in faeces within 2 months of infection21,22 Most tapeworms grow 2–7 m over 2–3 years, can reach up to 25 m21,22,23 2 different routes of infection: • 1.) Ingesting raw infected pork/beef, causing taeniasis21 • 2.) Ingesting contaminated water, causing cysticercosis21 Photos: Li & Guo, 2016, Figure B, © 2016 Massachusetts Medical Society Taenia 6.2 m long beef tapeworm removed from human patient. Arrow indicates head.
33. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”) • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Photo: Flisser, 2013, Figure 1. Taenia
34. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”) • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Taenia Photo: Flisser, 2013, Figure 1.
35. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”) • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Taenia Photo: Flisser, 2013, Figure 1.
36. scolex = the head Attaches to intestinal wall with hooks24 Photos: healthjade.com/wp-content/uploads/2019/02/Taenia-solium.jpg, "False-col Lm Of Scolex Of Adult Pork Tapeworm" © Science Photo Library on fineartamerica.com, Spina et al., 2005, Figure 2. T. Solium — Morphology rostellum = 2 rows of hooks four cup shaped suckers
37. T. Solium — Morphology genital pore ovary gravid (pregnant) proglottids testes uterus longitudinal nerve mature proglottids Photos: healthjade.com/wp-content/uploads/2019/02/Taenia-solium.jpg, © Lance Wheeler, 2018 at Texas A&M College of Veterinary Medicine, Department of Veterinary Pathobiology Proglottids = segments containing and reproductive organs, mature and detach from posterior end24 • 1,000 proglottids/adult22 • 50,000 eggs/proglottid22
38. Pigs (intermediate host) infected by ingesting water or vegetation contaminated with eggs or gravid proglottids25 Oncospheres hatch from eggs in small intestine25,26 Photo: parasitewonders.blogspot.com/2015/08/answer-to-case-361.html T. solium — Life Cycle, Part 1 Oncosphere = infective 6-hooked embryo encased in keratin membrane27
39. Oncospheres invade the intestinal wall and migrate to muscles via bloodstream25,26 Oncospheres develop into cysticerci, survive for several years in animal25 Cysticercus = larva encased in fluid-filled sac containing an invaginated scolex T. solium — Life Cycle, Part 1
40. Humans (definitive host) ingest cysticerci in raw infected pork25 Cysticercus inverts body, attaches to the small intestine using scolex25 Evagination of scolex from cysticercus, releasing tapeworm Photo: © Lance Wheeler, 2018 at Texas A&M College of Veterinary Medicine, Department of Veterinary Pathobiology T. solium — Life Cycle, Part 1
41. Matures into into an adult tapeworm in 2 months, survives in host for 2–3 years21,25 T. solium — Life Cycle, Part 1
42. Grows longer, producing proglottids25 Proglottids mature, self- fertilize, produce eggs, and detach from posterior end25 Infectious eggs and proglottids shed in faeces25 T. solium — Life Cycle, Part 1
43. Photos: Kim & Chung, 2017, Figure 2., dir.indiamart.com/impcat/niclosamide-drug.html, ryvispharma.com, drugs.com Taeniasis Taenia asiatica in intestine Intestinal infection with adult tapeworms21 • Symptoms are usually mild or non-existent25,27 • Include abdominal pain, loss of appetite, weight loss25 Treatment • Single doses of praziquantel (10 mg/kg) or niclosamide (1–2 g)21 • Albendazole at 400 mg for 3 consecutive days21
44. Faecal microscopy: • Detection of eggs 2–3 months after infection is established25 • Taenia species can’t be identified by eggs alone 25 Observable expulsion of proglottids in faeces30 ELISA: • Detects genus-specific antigens in faeces30 • Not yet available outside the research setting25 Photos: cdc.gov/dpdx/taeniasis/index.html, wellnesslabinfo.blogspot.com/2015/04/parasite-in-our-body-tape-worms.html Diagnosis Taenia eggs in unstained wet mounts
45. Infection in humans can occur without contact with swine by ingesting eggs or gravid proglottids in contaminated water31 Oncospheres hatch in intestine, migrate to multiple tissues and organs31 Mature into cysticerci over 60–70 days31 T. solium — Life Cycle, Part 2
46. Tissue infection with T. solium larvae that migrate to muscle and organs (larva migrans)21 • Targets include muscles, skin, liver, heart, eyes, brain28,29,32 Symptoms depend on the location and load of infection, begin at variable times21,31 • Under skin: visible lumps31 • In muscle: usually do not cause symptoms31 • In nervous system (neurocysticercosis): severe headache, blindness, convulsions, epilepsy21,31 • Is major cause of adult onset seizures in most low-income countries21,31 Photos: Jakhere et al., 2011, Figures 1. & 3., ryvispharma.com Cysticercosis MRIs showing severe infection. Each white nodule is a cysticercus.
47. • Corticosteroids (prednisolone, dexamethasone) to reduce inflammation28,31 Treatments: • Anticestodal drugs (albendazole, praziquantel)28,31 Cysticercosis Photos: ryvispharma.com, drugs.com, indiamart.com, myhealthyclick.com/wp-content/uploads/2020/07/dexamethason-for-coronavirus.jpg, Jakhere et al., 2011, Figures 1. & 3. • Antiepileptics (phenytoin, carbamazepine)28,31 • Surgery to remove cysts or to implant a shunt that redirects brain fluid28,31
48. Microscopic analysis of tissue biopsy31 Serology: • Immunoblot assay to detect IgG antibody responses to cysticerci30,31 Brain scans: • Magnetic resonance imaging (MRI)31 • Non-contrast computed tomography (CT) scan31 Photos: cdc.gov/dpdx/cysticercosis/index.html Figures A and B, Carpio, 1998, Figure 1. Diagnosis CT scan showing many active cysts Section of human brain tissue with a cysticercus
49. Vibrio cholerae Photos: “Cholera Bacteria” © Juergen Berger/Science Photo Library, September 11, 2018, on fineartamerica.com, sickholiday.com/food-poisoning/campylobacter,ssickholiday.com/food-poisoning/ campylobacter, pixels.com/featured/legionella-pneumophila-tem-eye-of-science Bacteria Legionella Campylobacter Shigella
50. Gram-negative, motile bacteria causing cholera • ≈ 1.3 to 4 million people around the world infected each year, with 21,000 – 143,000 deaths33,34 Symptoms begin in 12 hours – 5 days34 • Severe watery diarrhoea that causes dehydration, lethal within hours if left untreated34 • Shed in faeces for 1-10 days after infection34 Treatment: oral or intravenous hydration33 • Doxycycline for severe illness33 Photo: “Vibrio cholerae” © M. Stephen Trent, University of Georgia, on eurekalert.org/multimedia/827668 Vibrio cholerae
51. During the 1800’s, cholera spread across the world from its original reservoir in the Ganges delta, India, causing 6 pandemics and killing millions34. Partly due to prevalence of infection, cholera became one of the first pathogens understood to be transmitted in water35. Photos: alamy.com/stock-photo-pollution-cartoon-1866-ndeaths-dispensary-an-1866-cartoon-indicating-95462093.html, brewminate.com/the-blue-terror-british-troops-and-cholera-in-19th-century-india Vibrio cholerae Boil order from 1866, London
52. Immobile, rod-shaped, Gram-negative bacteria that cause bacillary dysentery (shigellosis)36 • 80–165 million cases and 600,000 deaths annually, world-wide37 Symptoms begin 1–2 days after infection and last 7 days36,37 • Watery, bloody, or mucoid diarrhea, fever, stomach cramps Can resolve within 5–7 days with supportive care alone37 • Immunocompromised patients can be treated with fluoroquinolone, azithromycin, or ceftriaxone37 Photos: atlas.sund.ku.dk/microatlas/veterinary/bacteria/Shigella_sonnei/shigellasonnei.jpg, gettyimages.com, vecteezy.com Shigella Gram stain of Shigella Shigella growing in culture
53. Gram-negative, motile bacteria causing campylobacteriosis38 • The most common bacterial cause of human gastroenteritis39 • ≈ 1 in 10 people are infected globally each year39 Symptoms begin 2 – 5 days after infection and last about 1 week38 • Diarrhea, fever, and stomach cramps • Generally mild and resolves on its own, except in young children and the immunocompromised39 Photo: "Campylobacter Jejuni Bacteria" © Steve Gschmeissner, July 1, 2016, on fineartamerica.com Campylobacter
54. Includes 60+ species of Gram-negative bacilli bacteria, all causing a form of pneumonia called legionellosis40,41,42 • Transmitted by inhaling aerosolized contaminated water41 Symptoms develop in 2–10 days, with variable severity:42 • Mild fever (also called Pontiac fever)41,42 • Acute lung infection (also called Legionnaires’ disease) with 10% mortality rate41,42,43 Global incidence of legionellosis is unknown42 Photos: James Gathany, 2005, on phil.cdc.gov (ID#: 7925), specialpathogenslab.com/wp-content/uploads/2020/05/legionnaires-disease.jpg Legionella X-ray of Legionella patient Legionella in culture under UV light
55. Can spread via faecal-oral route and contaminated water2,4,5,44,45 • Hepatitis A • Causes mild to severe inflammation of the liver • Most of those infected recover44 • Norovirus • Causes 1 in 5 cases of acute gastroenteritis world-wide45 • No specific medicines available, symptoms resolve in 1–3 days45 • SARS-CoV-2 coronavirus (COVID-19) • Causes acute respiratory illness • Shown to spread through plumbing systems of residential buildings via water aerosols5,46 Photos: "Sars-cov-2, Covid-19 Virus, Sem" © Science Source, September 7, 2020, on fineartamerica.com, ucl.ac.uk/infection-immunity/sites/infection_immunity/files/styles/large_image/public/1791-norovirus-virions-electron- micrograph.jpg, phil.cdc.gov/PHIL_Images/8153/8153_lores.jpg Viruses
56. Cyanobacteria = photosynthesizing bacteria informally called blue-green algae Produce a range of powerful poisons called cyanotoxins47 • Exposure can damage brain, internal organs, gastrointestinal tract, and skin47,48 • Symptoms range from headache, pneumonia, fever, vertigo, gastrointestinal distress, skin rashes, to hayfever, possibly linked to liver cancer47,48 Algal blooms Photos: ecokeith.blogspot.com/2013/10/cyanobacteria-in-pinto-lake.html, micropia.nl/nl/ontdek/nieuws/2016/3/25/bacterien-eerder-ontdekt-dan-gedacht
57. Boiling water does not remove most chemicals49 • Requires specific filtration or treatment Common sources:50,51,52,53,54 • Agriculture – pesticides, fertilizer, burning forests • Industry – manufacturing, resource extraction, construction • Pharmacy – antidepressants, antiepileptic drugs, hormones54 • Air emissions – waste incineration, fuel combustion Chemical Contamination Photos: awsassets.panda.org/img/pesticides_39194_363774.jpg, ak9.picdn.net/shutterstock/videos/19986109/thumb/1.jpg, fashionista.com/2017/11/riverblue-documentary-fashion-pollution
58. VOC = volatile organic compounds • Emitted as gas, enters water supply55 • Includes oil and petrolium products, paints, solvents, refrigerants55 POP = persistent organic pollutants • Do not degrade in environment, bioaccumulative, highly toxic51,53 • Includes DDT, polychlorinated biphenyls (PCBs), and dioxins51,53 Photos: vectairsystems.com/reduce-vocs-to-reduce-the-risk-in-homes, modified from lifegate.it/bandite_e_non_bandite Chemical Contamination
59. Heavy metals: acutely toxic, bio accumulative with long-lasting health impacts56 Photos: modified from familyhandyman.com/list/what-you-might-not-know-about-treated-lumber, theodoregray.com/P eriodicTable/Samples/080.14/s14s.JPG, thumbs.dreamstime.com/b/lead-chemical-element-periodic-table-science- symbol-lead-chemical-element-107765974.jpg • Highly carcinogenic • Skin lesions, pigmentation changes • Nervous system damage • Neurological damage • Severe physiological disruption • Widespread oxidative damage • Neurological damage • Behavioral disturbances • Cognitive impairment • Immune and endocrine disruption 56,57 56,57,58 56, 57 Chemical Contamination
60. Plastics can leach harmful chemicals into water:59, 60 Bisphenol A (BPA): common ingredient in plastic water and food containers, especially plastics #3, #6, and #759,60 • Mimics estrogen and interferes with endocrine system, causing behavioral issues, reproductive and immune disorders, obesity, and cancer59,61 Photos: wdy.h-cdn.co/assets/16/05/1454430555-bottles.jpg, blog.longevitywarehouse.com/wp-content/uploads/2015/03/recycle.jpg Chemical Contamination
61. Plastics can leach harmful chemicals into water:59, 60 Phthalates: softener for various plastics, found in PVC pipes, food containers, cosmetic additives, and industrial wastewater59,62,63,64 • Highly carcinogenic, linked to diabetes and autism spectrum disorders62,64 Photos: nbcnews.com/health/kids-health/chemical-phthalates-food-packaging-linked-lower-iq-kids-n265721, istock.com Chemical Contamination
62. Plastics can leach harmful chemicals into water:59,60 Microplastics: particles of degraded plastic 5 mm diameter ≤ • Bioaccumulate and act as carriers for other pollutants65,66,67. Toxicity following ingestion requires further research67. Photos: nzherald.co.nz/world/microplastic-pollution-much-worse-than-feared, nist.gov/image/microplastic-pollution, news.yahoo.com/microplastic-polluting-rivers-seas-across-122447629.html Chemical Contamination
63. Making water safe for consumption follows three basic steps: Water Decontamination Photos: sciencenotes.org/does-boiling-water-get-hotter, modified from dreamstime.com Filter out solids Disinfect water Use and store
64. A chemical method to precipitate solids from cloudy water68 Flocculation Before + Coagulant + Flocculant negative charge neutral charge net of particles Agents added to water to encourage formation of solids (flocs) in a polymer “net”68. Solids can then be removed through filtration. Photos: inyopools.com/Blog/difference-pool-clarifier-flocculant, modified from dober.com/haloklear/resources/intern-view-how-flocculation-helps-filtration
65. Filters can be used to remove solids, pathogens, and pollutants from water Depending on size of filter pores, can also be used for disinfection Filtration Photos: modified from crystalquest.com/pages/what-is-ultrafiltration, modified from epicwaterfilters.com, ajayplumbing.com/whole-house-inline-water-filtration-system Stand-alone pitcher with filter or installation directly into plumbing
66. Ceramics can filter water through fine pores69 Silver coating on ceramic filter, pot, or tablet enhances disinfection69,70,71,72,73,74,75 • Silver ions released in water have antibacterial and antiviral capability, reduce infectivity of parasites70,69,70 • Variable effectiveness depending on clay composition, 60-70% reduction in diarrheal disease documented by users76 Limit for silver in drinking water = 100 g/L μ 70 • Silver in nanoparticle form (50 nm diameter) shows adverse health and environmental effects above 1 ppm73 Photos: modified from Bogler & Meierhofer, 2015, Figure 1., modified from McBean et al. 2018, Figure 1., gmanetwork.com/news/scitech/photo/49983/dost-s-homegrown-ceramic-water-filter/photo Filtration
67. Slow sand filtration: • One of the oldest and most effective water decontamination methods77, 78, 79 • 99 99.9999% reduction of − oocysts77 • 99 99.99% reduction of bacteria − 77 • Up to 99.9% reduction of viruses77 • 99.9% reduction of nanoplastics80 Activated charcoal can remove cyanotoxins and < 99% of chemical contamination81,82 Photos: cdc.gov/safewater/sand-filtration.html, thewaternetwork.com/_/water-treatment/blog-Jl6/case-study-6-4-drinking-water-through-household-level-bio-sand-filtration-in-pakistan-un-scap-policy- manual-2015-2FIxkTSlat0vARTkXFqlvA, modified from cleanwatergear.com/wp-content/uploads/2020/04/diy-water-filter.jpg Dirty water Rocks Course sand Charcoal Fine sand Cloth Clean water Filtration
68. Centers for Disease Control and Prevention: • Bring water to a full rolling boil for 1 minute (3 minutes at elevation > 6,500 feet)68 • Allow to cool, store in sterile, closed containers with a tight-fitting lid83 Disinfect - Heat Photos: shtfpreparedness.com/safe-drinking-water, voanews.com/a/south-african-firm-aims-to-supply-millions-with-solar-cookers/1495436, boil_on_electric_stove.istockphoto.com Heating by fire Heating by solar oven Heating by electric stove
69. World Health Organization: • Bring water to a rolling boil and immediately allow to cool84 Disinfect - Heat World Health Organization. (2015). Boil Water. WHO Press. Retrieved September 23, 2022 from https://apps.who.int/iris/re st/bitstreams/693418/retrieve Organism Temperature (°C) Inactivation Time (seconds) Escherichia coli 72 0.4 Vibrio cholerae 70 120 Campylobacter spp. 62 15 Legionella spp. 80 18-42 Hepatitis A 80 5 Cryptosporidium parvum 72 5-15 Giardia 70 600
70. Sunlight (ultraviolet radiation) kills microbes • UVA light (320–400 nm) absorbed by the cell, creates oxidative stress that damages lipids, proteins and DNA84 • UVB (290–320 nm) and UVC (220nm– 290nm) light directly damage DNA84 Disinfect - UV Photos: weuvcare.com/uv-education, modified from Huang & Zhou, 2020, Figure 1., wallpapermaiden.com/wallpaper/7167/sunshine-reflection-sea-horizon-waves-beach radiation cell base and sugar damage single-strand break double-strand break DNA
71. Solar disinfection: • Leave contaminated water in a transparent container and expose to strong sunlight for 6–8 hours if sunny, 2 days if cloudy85 • Single-use plastics are not designed for this purpose– degrade in sunlight and release various toxins60,86,87,88 • Glass containers preferable to plastic • Recommended to change plastic bottles after 6 months85 Disinfect - UV Photos: eleanorfoundation.co.uk/our-work/solar-disinfection-and-hand-washing, i.pinimg.com/originals/3f/e3/04/3fe30479fe35c8e39657fa81f3f2e8fd.jpg
72. UV Water Treatment System: • Mechanical unit installed into house plumbing that passes water through a UV chamber89 Disinfect - UV UV chamber Sediment filters Photos: ontariohvacandwater.com/uv-disinfection-systems, waterfilteruae.com/product/aqua-whole-house-three-stage-jumbo-water-filteration-with-uv
73. • Main method of disinfection for most municipal water sources90 • CDC defines safe level of chlorine up to 4 mg/L91 • Minimum 0.2 mg/L required for disinfection to work90 • WHO recommends dosing clear water at 2 mg/L and turbid water at 4 mg/L90 • Some studies show link between chlorinated water consumption and various cancers92,93,94,95,96,97,98,99,100,101,102,102,103 • Chlorine can be removed via filtration82 Disinfect - Chemicals Photos: modified from da Cruz Nizer et al., 2020, Figure 2. Chlorination forms hypochlorous acid in water, perforating cell membrane, damaging DNA, and disrupting cellular processes104,105
74. Iodine can be used during emergencies or travel as a temporary method for up to 3 weeks106,107 • Not recommended for pregnant women or those with thyroid problems107 Effective against bacteria and viruses; does not kill cryptosporidia107 • Available as 2% tincture:107,108 • 5 drops per L clear water, 10 drops per L cloudy water • Let sit for 30 minutes before use • Available as tetraglycine hydroperiodide tablet:106,108 • One tablet in 1 L water, or by manufacturer's instructions106,108 1-2 mg/day considered safe for most people, maximum levels for long-term remain undetermined106 Photos: gettyimages.com, preparednessadvice.com/iodine-tablets-for-water-purification Forms elemental iodine (I2 ) and hypoiodous acid (HIO) in water, acts as strong oxidant to disrupt proteins, nucleic acids, and metabolic pathways106,109 & Disinfect - Chemicals
75. To sanitize dishes during a boil order:68 • Wash and rinse the dishes as normal, using hot water. • In a separate basin, add 2 drops (0.1 mL) of unscented liquid bleach per liter warm water (1 teaspoon per gallon). • Must contain 5%–9% sodium hypochlorite83 • Soak the rinsed dishes in diluted bleach for at least one minute. • Let the dishes air dry completely, allowing chlorine to evaporate before next use. Disinfect Dishes - Bleach Add the concentrated bleach to the water Photo: fortheloveofclean.com/household-love/specialty-cleaning/how-to-sanitize-dishes
76. Household Management Use decontaminated water for:68 Use contaminated water for:68* * Given chemical contaminants are not present Drinking Brushing teeth Washing food Ice Washing dishes Laundry Cooking Showering Dishwashers – final rinse temperature of >66°C (150°F) Photos: modified from shutterstock.com/vectors
77. Store water in sanitized, food-grade storage containers with lids that can be closed securely68 Store at least 4–5 liters (1 gallon) of water per person per day68 Recommended to store 3 days worth for drinking and sanitation during emergencies68 Single-use plastics, such as PET water bottles, should not be re-used or stored long-term110,111 Storage Photos: img.diytrade.com/cdimg/1469588/21772279/0/1306833994,rotodynamics.com/wp-content/uploads/2020/08/ custom-water-tanks.jpg, i.ndtvimg.com/i/2017-06/clay-pot-natural-cooling_696x400_61497441665.jpg,indiamart.com/ proddetail/water-storage-clay-pot-8683683730.html,Shachee Gandhi on pinterest.com, cdc.gov/safewater/storage.html
78. Most plastics contain chemical additives that can leach out112,113,114,115,116,117,118,119 •Includes more chemicals than currently considered in public health science and policies112 #1 Polyethylene terephthalate can leach toxic antimony when heated, degrades with time86,87,119 #2,3 High-density polyethylene and polyvinyl chloride can leach phthalates64,87,118 #6 Polystyrene can leach styrene, a suspected carcinogen, when heated87,120 #7 “Other” plastics likely to leach BPA, phthalates, and other toxins when heated87,118 • Higher risks associated with #3, #6, #7 plastics87 • Lower risks associated with #2, #4 (low-density polyethylene), #5 (polypropylene) plastics87,121 Most plastics used in food containers and water bottles can release estrogen-mimicing chemicals if used repeatedly over time112,119 A Note on Plastics
79. 1.) United States Environmental Protection Agency. (2020, February 27). Public Notification - Drinking Water System Pressure Loss Boil Advisory Template. US EPA. Retrieved September 20, 2022 from https://www.epa.gov/system/files/documents/2023-04/PN_PressureLoss_BoilAdvisory.pdf 2.) BF Environmental Consultants, Inc. (n.d.). Get Informed | Waterborne Pathogens. Know Your H2O Water Research Center. Retrieved September 15, 2022 from https://www.knowyourh2o.com/indoor-6/waterborne-pathogens 3.) Shapiro, K., Bahia-Oliveira, L., Dixon, B., Dumètre, A., de Wit, L. A., VanWormer, E., & Villena, I. (2019). Environmental transmission of Toxoplasma gondii: Oocysts in water, soil and food. Food and waterborne parasitology, 15, e00049. https://doi.org/10.1016/j.fawpar.2019.e00049 4.) Castelo, J. (2021, December 13). 11 Common Waterborne Diseases: Symptoms and Prevention. World Water Reserve. Retrieved September 15, 2022 from https://worldwaterreserve.com/common-waterborne-diseases/ 5.) Tran, H. N., Le, G. T., Nguyen, D. T., Juang, R. S., Rinklebe, J., Bhatnagar, A., Lima, E. C., Iqbal, H., Sarmah, A. K., & Chao, H. P. (2021). SARS-CoV-2 coronavirus in water and wastewater: A critical review about presence and concern. Environmental research, 193, 110265. https://doi.org/10.1016/j.envres.2020.110265 6.) Chen, L., Deng, Y., Dong, S., Wang, H., Li, P., Zhang, H., & Chu, W. (2021). The occurrence and control of waterborne viruses in drinking water treatment: A review. Chemosphere, 281, 130728. https://doi.org/10.1016/j.chemosphere.2021.130728 7.) United States Environmental Protection Agency. (2022, June 16). Ground Water and Drinking Water | Managing Cyanotoxins in Public Drinking Water Systems. US EPA. Retrieved September 19, 2022 from https://www.epa.gov/ground-water-and-drinking-water/managing-cyanotoxins-public-drinking-water-systems 8.) Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases. (2019, July 1). Parasites - Cryptosporidium (also known as “ Crypto”). CDC. Retrieved September 27, 2022, from https://www.cdc.gov/parasites/crypto/general.html 9.) Morris, A., Robinson, G., Swain, M. T., & Chalmers, R. M. (2019). Direct Sequencing of Cryptosporidium in Stool Samples for Public Health. Frontiers in public health, 7, 360. https://doi.org/10.3389/fpubh.2019.00360 10.) Zein, Umar. (2002). Cryptosporidiosis Identification and Treatment as a Reemerging Disease. Sumatera Utara University. Retrieved September 27, 2022 from https://www.researchgate.net/publication/42321313_Cryptosporidiosis_Identification_and_Treatment_as_a_Reemerging_Disease References
80. 11.) Centers for Disase Control and Prevention. (2019, May 20). Cryptosporidiosis. DPDx - Laboratory Identification of Parasites of Public Health Concern, CDC. Retrieved September 29, 2022 from https://www.cdc.gov/dpdx/cryptosporidiosis/index.html 12.) Gerace, E., Lo Presti, V., & Biondo, C. (2019). Cryptosporidium Infection: Epidemiology, Pathogenesis, and Differential Diagnosis. European journal of microbiology & immunology, 9(4), 119– 123. https://doi.org/10.1556/1886.2019.00019 13.) Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases. (2022, May 19). Parasites - Giardia. Retrieved October 6, 2022, from https://www.cdc.gov/parasites/giardia/index.html 14.) Nain, C. K., Dutt, P., & Vinayak, V. K. (1991). Alterations in enzymatic activities of the intestinal mucosa during the course of Giardia lamblia infection in mice. Annals of Tropical Medicine & Parasitology, 85(5), 515–522. https://doi.org/10.1080/00034983.1991.11812602 15.) Vivancos , V., Gonzalez-Alvarez , I., Bermejo, M., & Gonzalez-Alvarez, M. (2018). Giardiasis: characteristics, pathogenesis and new insights about treatment. Current Topics in Medicinal Chemistry, 18. https://doi.org/10.2174/1568026618666181002095314 16.) Mohammed, S. E. A., Kabashi, A. S., Koko, W. S., & Azim, M. K. (2015). Antigiardial activity of glycoproteins and glycopeptides from Ziziphus honey. Natural Product Research, 29(22), 2100– 2102. https://doi.org/10.1080/14786419.2014.986659 17.) Kantor, M., Abrantes, A., Estevez, A., Schiller, A., Torrent, J., Gascon, J., Hernandez, R., & Ochner, C. (2018). Entamoeba Histolytica: Updates in Clinical Manifestation, Pathogenesis, and Vaccine Development. Canadian journal of gastroenterology & hepatology, 2018, 4601420. https://doi.org/10.1155/2018/4601420 18.) Centers for Disease Control and Prevention. (2021, December 3). Parasites - Amebiasis - Entamoeba histolytica Infection. CDC. Retrieved November 15, 2022 from https://www.cdc.gov/parasites/amebiasis/ 19.) Karki, G. (2019, July 30). Entamoeba histolytica: Morphology, life cycle, Pathogenesis, clinical manifestation, lab diagnosis and Treatment. Online Biology Notes. Retrieved November 15, 2022 from https://www.onlinebiologynotes.com/entamoeba-histolytica-morphology-life-cycle-pathogenesis-clinical-manifestation-lab-diagnosis-treatment/ 20.) Chou, A., Austin, R.L. Entamoeba Histolytica. [Updated 2022 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557718/ References
81. 21.) World Health Organization. (2022, January 11). Taeniasis/Cysticercosis. WHO. Retrieved Dec 16, 2022 from https://www.who.int/news-room/fact-sheets/detail/taeniasis- cysticercosis 22.) Centers for Disease Control. (2017, December 18). Taeniasis. DPDx - Laboratory Identification of Parasites of Public Health Concern. Retrieved Dec 16, 2022 from https://www.cdc.gov/dpdx/taeniasis/index.html 23.) Shah, R. (2016, May 2). Taenia Solium: Habitat, Structure and Life History. Biology Discussion. Retrieved Dec 28, 2022 from https://www.biologydiscussion.com/invertebrate- zoology/phylum-platyhelminthes/taenia-solium-habitat-structure-and-life-history/28918 24.) Eom, K. S., Rim, H. J., & Jeon, H. K. (2020). Taenia asiatica: Historical overview of taeniasis and cysticercosis with molecular characterization. Advances in Parasitology. https://doi.org/10.1016/bs.apar.2019.12.004 25.) Centers for Disease Control and Prevention. (2020, September 29). Parasites - Taeniasis. CDC. Retrieved Dec 16, 2022 from https://www.cdc.gov/parasites/taeniasis/ 26.) Verastegui, M., Gilman, R. H., Arana, Y., Barber, D., Velásquez, J., Farfán, M., Chile, N., Kosek, J. C., Kosek, M., Garcia, H. H., Gonzalez, A., & Cysticercosis Working Group in Peru. (2007). Taenia solium oncosphere adhesion to intestinal epithelial and Chinese hamster ovary cells in vitro. Infection and immunity, 75(11), 5158–5166. https://doi.org/10.1128/IAI.01175-06 27.) García, H. H., Gonzalez, A. E., Evans, C. A., & Gilman, R. H. (2003). Taenia solium cysticercosis. The Lancet, 362(9383), 547–556. https://doi.org/10.1016/s0140- 6736(03)14117-7 28.) Cleveland Clinic. (2022, July 26). Cysticercosis: Overview, Symptoms & Treatment. Retrieved Dec 28, 2022 from https://my.clevelandclinic.org/health/diseases/23534-cysticercosis 29.) Neupane, L. (2022, January 2). Taenia solium- Life history, development and adaptations. Microbe Notes. Retrieved Dec 28, 2022 from https://microbenotes.com/taenia-solium-life- history-development-adaptations 30.) Raoul, F., Li, T., Sako, Y., Chen, X., Long, C., Yanagida, T., Wu, Y., Nakao, M., Okamoto, M., Craig, P. S., Giraudoux, P., & Ito, A. (2013). Advances in diagnosis and spatial analysis of cysticercosis and taeniasis. Parasitology, 140(13), 1578–1588. https://doi.org/10.1017/S0031182013001303 References
82. 31.) Centers for Disease Control and Prevention. (2022, June 8). Parasites - Cysticercosis. CDC. Retrieved Dec 29, 2022 from https://www.cdc.gov/parasites/cysticercosis 32.) National Organization for Rare Disorders. (2021, June 9). Cysticercosis. NORD. Retrieved Dec 30, 2022 from https://rarediseases.org/rare-diseases/cysticercosis 33.) Centers for Disease Control.(2022, November 14). Cholera - Vibrio cholerae infection. CDC. Retrieved Dec 28, 2022 from https://www.cdc.gov/cholera/index.html 34.) World Health Organization. (2022, March 30). Cholera. WHO. Retrieved Dec 28, 2022 from https://www.who.int/news-room/fact-sheets/detail/cholera 35.) National Institutes of Health. (n.d.). Cholera. Office of NIH History and Stetten Museum. Retrieved Dec 27, 2022 from https://history.nih.gov/display/history/Cholera 36.) Centers for Disease Control. (2020, October 7). Shigella – Shigellosis. CDC. Retrieved Dec 25, 2022 from https://www.cdc.gov/shigella/index.html 37.) Watkins, L. K. F. and Appiah, G. D. (2017). Chapter 4 - Travel-Related Infectious Diseases - Shigellosis. In G.W. Brunette & J.B. Nemhauser(Eds.), CDC Yellow Book 2020: Health Information for International Travel. Oxford University Press. Retrieved Dec 27, 2022 from https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious- diseases/shigellosis 38.) Centers for Disease Control. (2021, April 14). Campylobacter (Campylobacteriosis). CDC. Retrieved Dec 28, 2022 from https://www.cdc.gov/campylobacter/index.html 39.) World Health Organization. (2020, May 1). Campylobacter. WHO. Retrieved Dec 28, 2022 from https://www.who.int/news-room/fact-sheets/detail/campylobacter 40.) Centers for Disease Control. (2021, March 25). Legionnaires Disease and Pontiac Fever. CDC. Retrieved Dec 28, 2022 from https://www.cdc.gov/legionella/ References
83. 41.) Winn, W.C. Legionella. (1996). Chapter 40. In S. Baron (Ed.), Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston. Retrieved Dec 28, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK7619/ 42.) World Health Organization. (2007). Bartram, J. (Ed.). Legionella and the prevention of legionellosis. WHO. Retrieved Dec 28, 2022 from https://www.who.int/publications- detail-redirect/9241562978 43.) Collier, S. A., Deng, L., Adam, E. A., Benedict, K. M., Beshearse, E. M., Blackstock, A. J....Beach, M. J. (2021). Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerging Infectious Diseases, 27(1), 140-149. https://doi.org/10.3201/eid2701.190676 44.) World Health Organization. (2022, June 24). Hepatitis A. WHO. Retrieved Jan 5, 2023 from https://www.who.int/news-room/fact-sheets/detail/hepatitis-a 45.) Centers for Disease Control. (2022, May 4). Norovirus. CDC. Retrieved Jan 5, 2023 from https://www.cdc.gov/norovirus/index.html 46.) Gormley, M., Aspray, T. J., & Kelly, D. A. (2020). COVID-19: mitigating transmission via wastewater plumbing systems. The Lancet. Global health, 8(5), e643. https://doi.org/10.1016/S2214-109X(20)30112-1 47.) Ibelings, B. W., Backer, L. C., Kardinaal, W. E., & Chorus, I. (2015). Current approaches to cyanotoxin risk assessment and risk management around the globe. Harmful algae, 49, 63–74. https://doi.org/10.1016/j.hal.2014.10.002 48.) Stewart, I., Webb, P.M., Schluter, P.J. et al. Recreational and occupational field exposure to freshwater cyanobacteria – a review of anecdotal and case reports, epidemiological studies and the challenges for epidemiologic assessment. Environ Health 5, 6 (2006). https://doi.org/10.1186/1476-069X-5-6 49.) Centers for Disease Control and Prevention. (2022, November 16). Making Water Safe in an Emergency. CDC. Retrieved Jan 12, 2023 from https://www.cdc.gov/healthywater/emergency/making-water-safe.html 50.) Pachaiappan, R., Cornejo-Ponce, L., Rajendran, R., Manavalan, K., Femilaa Rajan, V., & Awad, F. (2022). A review on biofiltration techniques: recent advancements in the removal of volatile organic compounds and heavy metals in the treatment of polluted water. Bioengineered, 13(4), 8432–8477. https://doi.org/10.1080/21655979.2022.2050538 References
84. 51.) Aravind Kumar, J., Krithiga, T., Sathish, S., Renita, A. A., Prabu, D., Lokesh, S., Geetha, R., Namasivayam, S. K. R., & Sillanpaa, M. (2022). Persistent organic pollutants in water resources: Fate, occurrence, characterization and risk analysis. The Science of the total environment, 831, 154808. https://doi.org/10.1016/j.scitotenv.2022.154808 52.) Centers for Disease Control and Prevention. (2022, Aug 23). Chemicals That Can Contaminate Tap Water. Drinking Water. CDC. Retrieved Jan 12, 2023 from https://www.cdc.gov/healthywater/drinking/contamination/chemicals.html 53.) Ritter, L., Solomon, K.R., Forget, J., Stemeroff, M., O'Leary, C. (n.d.). Persistent organic pollutants. United Nations Environment Programme. Archived from the original on 26 September, 2007. Retrieved Jan 12, 2023 from https://web.archive.org/web/20070926101350/http://www.chem.unep.ch/pops/ritter/en/ritteren.pdf 54.) Kondor, A. C., Molnár, É., Jakab, G., Vancsik, A., Filep, T., Szeberényi, J., Szabó, L., Maász, G., Pirger, Z., Weiperth, A., Ferincz, Á., Staszny, Á., Dobosy, P., Horváthné Kiss, K., Hatvani, I. G., & Szalai, Z. (2022). Pharmaceuticals in water and sediment of small streams under the pressure of urbanization: Concentrations, interactions, and risks. The Science of the total environment, 808, 152160. https://doi.org/10.1016/j.scitotenv.2021.152160 55.) United States Environmental Protection Agency. (2022, December 27). What are volatile organic compounds (VOCs)? US EPA. Retrieved Jan 12, 2023 from https://www.epa.gov/indoor-air- quality-iaq/what-are-volatile-organic-compounds-vocs 56.) Mawari, G., Kumar, N., Sarkar, S., Frank, A. L., Daga, M. K., Singh, M. M., Joshi, T. K., & Singh, I. (2022). Human Health Risk Assessment due to Heavy Metals in Ground and Surface Water and Association of Diseases With Drinking Water Sources: A Study From Maharashtra, India. Environmental health insights, 16, 11786302221146020. https://doi.org/10.1177/11786302221146020 57.) Järup, L. (2003). Hazards of heavy metal contamination. British medical bulletin, 68, 167–182. https://doi.org/10.1093/bmb/ldg032 58.) World Health Organization. (2005). Mercury in Drinking-water. (WHO/SDE/WSH/05.08/10) WHO. https://www.who.int/docs/default-source/wash-documents/wash-chemicals/mercury- background-document.pdf 59.) Stenmarck, Åsa & Belleza, Elin & Fråne, Anna & Busch, Niels & Larsen, Åge & Wahlström, Margareta. (2017). Hazardous substances in plastics. 10.6027/TN2017-505. 60.) Melgar, D. (2021, January 25). Toxic chemicals in single-use plastics are harming human health. United States Public Interest Research Group. Retrieved Jan 8, 2023, from https://pirg.org/edfund/articles/toxic-chemicals-in-single-use-plastics-are-harming-human-health/ References
85. 61.) Duke University Medical Center. (2013, February 25). BPA may affect the developing brain by disrupting gene regulation. ScienceDaily. Retrieved January 12, 2023 from www.sciencedaily.com/releases/2013/02/130225153122.htm 62.) Dueñas-Moreno, J., Mora, A., Cervantes-Avilés, P., & Mahlknecht, J. (2022). Groundwater contamination pathways of phthalates and bisphenol A: origin, characteristics, transport, and fate - A review. Environment international, 170, 107550. https://doi.org/10.1016/j.envint.2022.107550 63.) Pagoni, A., Arvaniti, O. S., & Kalantzi, O. I. (2022). Exposure to phthalates from personal care products: Urinary levels and predictors of exposure. Environmental research, 212(Pt A), 113194. https://doi.org/10.1016/j.envres.2022.113194 64.) Net, S., Sempéré, R., Delmont, A., Paluselli, A., & Ouddane, B. (2015). Occurrence, Fate, Behavior and Ecotoxicological State of Phthalates in Different Environmental Matrices. Environmental Science & Technology, 49(7), 4019–4035. https://doi.org/10.1021/es505233b 65.) Koelmans, A. A., Mohamed Nor, N. H., Hermsen, E., Kooi, M., Mintenig, S. M., & De France, J. (2019). Microplastics in freshwaters and drinking water: Critical review and assessment of data quality. Water research, 155, 410–422. https://doi.org/10.1016/j.watres.2019.02.054 66.) Xue, J., Samaei, S. H., Chen, J., Doucet, A., & Ng, K. T. W. (2022). What have we known so far about microplastics in drinking water treatment? A timely review. Frontiers of environmental science & engineering, 16(5), 58. https://doi.org/10.1007/s11783-021-1492-5 67.) World Health Organization. (2019). Microplastics in drinking-water. Geneva: World Health Organization. 2019. Licence: CC BY-NC-SA 3.0 IGO. 68.) Centers for Disase Control and Prevention. (2022, May 9). Water, Sanitation, & Hygiene (WASH)-related Emergencies & Outbreaks. CDC. Retrieved September 29, 2022 from https://www.cdc.gov/healthywater/emergency/index.html 69.) Oyanedel-Craver, V. A., & Smith, J. A. (2008). Sustainable Colloidal-Silver-Impregnated Ceramic Filter for Point-of-Use Water Treatment. Environmental Science & Technology, 42(3), 927–933. https://doi.org/10.1021/es071268u 70.) Ehdaie, B., Rento, C. T., Son, V., Turner, S. S., Samie, A., Dillingham, R. A., & Smith, J. A. (2017). Evaluation of a Silver-Embedded Ceramic Tablet as a Primary and Secondary Point- of-Use Water Purification Technology in Limpopo Province, S. Africa. PloS one, 12(1), e0169502. https://doi.org/10.1371/journal.pone.0169502 References
86. 71.) Van Der Laan, H., Van Halem, D., Smeets, P., Soppe, A., Kroesbergen, J., Wubbels, G. H., Nederstigt, J., Gensburger, I., & Heijman, S. (2014). Bacteria and virus removal effectiveness of ceramic pot filters with different silver applications in a long term experiment. Water Research, 51, 47–54. https://doi.org/10.1016/j.watres.2013.11.010 72.) Ehdaie, B., Su, Y., Swami, N. S., & Smith, J. A. (2020). Protozoa and virus disinfection by Silver- and Copper-Embedded ceramic tablets for water purification. Journal of Environmental Engineering, 146(4). https://doi.org/10.1061/(asce)ee.1943-7870.0001664 73.) Rezvani, E., Rafferty, A., McGuinness, C., & Kennedy, J. E. (2019). Adverse effects of nanosilver on human health and the environment. Acta Biomaterialia, 94, 145–159. https://doi.org/10.1016/j.actbio.2019.05.042 74.) Fewtrell, L., Majuru, B., & Hunter, P. R. (2017). A re-assessment of the safety of silver in household water treatment: rapid systematic review of mammalian in vivo genotoxicity studies. Environmental health: a global access science source, 16(1), 66. https://doi.org/10.1186/s12940-017-0279-4 75.) Mahlangu, O., Mamba, B., & Momba, M. (2012). Efficiency of Silver Impregnated Porous Pot (SIPP) filters for production of clean potable water. International journal of environmental research and public health, 9(9), 3014–3029. https://doi.org/10.3390/ijerph9093014 76.) Centers for Disease Control. (2008). Household Water Treatment Options in Developing Countries: Ceramic Filtration. CDC. Retrieved Jan 19, 2023 from https://www.cdc.gov/safewater/publications_pages/options-ceramic.pdf 77.) Bai, X., Dinkla, I. J. T., & Muyzer, G. (2022). Microbial ecology of biofiltration used for producing safe drinking water. Applied microbiology and biotechnology, 106(13-16), 4813–4829. https://doi.org/10.1007/s00253-022-12013-x 78.) Hijnen, W., Dullemont, Y., Schijven, J., Hanzens-Brouwer, A. J., Rosielle, M., & Medema, G. (2007). Removal and fate of Cryptosporidium parvum, Clostridium perfringens and small-sized centric diatoms (Stephanodiscus hantzschii) in slow sand filters. Water Research, 41(10), 2151–2162. https://doi.org/10.1016/j.watres.2007.01.056 79.) Haig, S., Collins, G., Davies, R. L., Dorea, C. C., & Quince, C. (2011). Biological aspects of slow sand filtration: past, present and future. Water Science & Technology: Water Supply, 11(4), 468–472. https://doi.org/10.2166/ws.2011.076. 80.) Pulido-Reyes, G., Magherini, L., Bianco, C., Sethi, R., von Gunten, U., Kaegi, R., & Mitrano, D. M. (2022). Nanoplastics removal during drinking water treatment: Laboratory- and pilot-scale experiments and modeling. Journal of hazardous materials, 436, 129011. https://doi.org/10.1016/j.jhazmat.2022.129011 References
87. 81.) United States Environmental Protection Agency. (2022, November 1). Summary of Cyanotoxins Treatment in Drinking Water. Retrieved Jan 29, 2023 from https://www.epa.gov/ground- water-and-drinking-water/summary-cyanotoxins-treatment-drinking-water 82.) Stricklin, T. (2020, June 01). Activated Carbon Filters: What Do They Remove from Water? SpringWell Water Filtration Systems. Retrieved Jan 11, 2023 from https://www.springwellwater.com/activated-carbon-filters-remove/ 83.) Centers for Disase Control and Prevention. (2022, May 12). Making Water Safe in an Emergency. Water, Sanitation, & Hygiene (WASH)-related Emergencies & Outbreaks. Retrieved Oct 6, 2022 from https://www.cdc.gov/healthywater/emergency/making-water-safe.html 84.) World Health Organization. (2011). Guidelines for drinking-water quality, 4th edition. WHO Press. Retrieved September 23, 2022 from https://apps.who.int/iris/rest/bitstreams/53080/retrieve 85.) Marugán, J., Giannakis, S., McGuigan, K. G., & Polo-López, I. (2020). Solar Disinfection as a Water Treatment Technology. Clean Water and Sanitation, 1–16. http://dx.doi.org/10.1007/978- 3-319-70061-8_125-1 86.) Chapa-Martínez, C. A., Hinojosa-Reyes, L., Hernández-Ramírez, A., Ruiz-Ruiz, E., Maya-Treviño, L., & Guzmán-Mar, J. L. (2016). An evaluation of the migration of antimony from polyethylene terephthalate (PET) plastic used for bottled drinking water. Science of The Total Environment, 565, 511–518. https://doi.org/10.1016/j.scitotenv.2016.04.184 87.) Schwartz, L. (2016, Mar 23). 7 Types of Plastic Wreaking Havoc on Our Health. EcoWatch. Retrieved Jan 24, 2023 from https://www.ecowatch.com/7-types-of-plastic-wreaking-havoc-on- our-health-1882198584.html 88.) Vermillion, S. (2020, Jan. 28). What Are Single-use Plastics and Should They Be Banned? HowStuffWorks. Retrieved Jan 25, 2023, from https://science.howstuffworks.com/environmental/conservation/issues/single-use-plastics.htm 89.) Wright, H., Salveson, A., Sotirakos, B. (2019, July 7). UV Regulations: Wastewater and Reuse. UV Solutions. Retrieved January 29, 2023 from https://uvsolutionsmag.com/articles/2019/uv- regulations-wastewater-and-reuse/ 90.) Murphy, J. L., Ayers, T. L., Knee, J., Oremo, J., Odhiambo, A., Faith, S. H., … Quick, R. E. (2016). Evaluating four measures of water quality in clay pots and plastic safe storage containers in Kenya. Water Research, 104, 312–319. https://doi.org/10.1016/j.watres.2016.08.022 References
88. 91.) Centers for Disease Control. (2020). Water Disinfection with Chlorine and Chloramine. CDC. Retrieved January 29, 2023 from https://www.cdc.gov/healthywater/drinking/public/water_disinfection.html 92.) Tafesse, N., Porcelli, M., Gari, S. R., & Ambelu, A. (2022). Prevalence and Trends of Drinking Water Disinfection Byproducts-Related Cancers in Addis Ababa, Ethiopia. Environmental health insights, 16, 11786302221112569. https://doi.org/10.1177/11786302221112569 93.) Garner, E., Zhu, N., Strom, L., Edwards, M., & Pruden, A. (2016). A human exposome framework for guiding risk management and holistic assessment of recycled water quality. Environmental Science, 2(4), 580–598. https://doi.org/10.1039/c6ew00031b 94.) Cragle, D. L. (1984). A casecontrol study of colon cancer and water chlorination in North Carolina. Water Chlorination-Chemistry, Environmental Impact and Health Effects, 5, 153-159. 95.) Doyle, T. J., Wang, Z., Cerhan, J. R., Hong, C. P., Sellers, T. A., Kushi, L. H., & Folsom, A. R. (1997). The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study. American Journal of Public Health, 87(7), 1168–1176. https://doi.org/10.2105/ajph.87.7.1168 96.) Sasada, T., Hinoi, T., Saito, Y., Adachi, T., Takakura, Y., Kawaguchi, Y., Sotomaru, Y., Sentani, K., Oue, N., Yasui, W., & Ohdan, H. (2015). Chlorinated Water Modulates the Development of Colorectal Tumors with Chromosomal Instability and Gut Microbiota in Apc-Deficient Mice. PLOS ONE, 10(7), e0132435. https://doi.org/10.1371/journal.pone.0132435 97.) Rahman, B., Cowie, C., Driscoll, T., Summerhayes, R., Armstrong, B. K., & Clements, M. (2014). Colon and rectal cancer incidence and water trihalomethane concentrations in New South Wales, Australia. BMC Cancer, 14(1). https://doi.org/10.1186/1471-2407-14-445 98.) Young, T. B., Kanarek, M. S., & Tsiatis, A. A. (1981). Epidemiologic study of drinking water chlorination and Wisconsin female cancer mortality. Journal of the National Cancer Institute, 67(6), 1191–1198. 99.) Jones, R. R., Weyer, P. J., DellaValle, C. T., Robien, K., Cantor, K. P., Krasner, S. W., Freeman, L. E. B., & Ward, M. H. (2017). Ingested nitrate, disinfection by-products, and kidney cancer risk in older women. Epidemiology, 28(5), 703–711. https://doi.org/10.1097/ede.0000000000000647 100.) Flaten, T. P. (1992). Chlorination of drinking water and cancer incidence in Norway. International Journal of Epidemiology, 21(1), 6–15. https://doi.org/10.1093/ije/21.1.6 References
89. 101.) Sasada, T., Hinoi, T., Saito, Y., Adachi, T., Takakura, Y., Kawaguchi, Y., Sotomaru, Y., Sentani, K., Oue, N., Yasui, W., & Ohdan, H. (2015). Chlorinated Water Modulates the Development of Colorectal Tumors with Chromosomal Instability and Gut Microbiota in Apc-Deficient Mice. PLOS ONE, 10(7), e0132435. https://doi.org/10.1371/journal.pone.0132435 102.) King, W. D., Marrett, L. D., & Woolcott, C. G. (2000). Case-control study of colon and rectal cancers and chlorination by-products in treated water. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 9(8), 813–818. 103.) International Agency for Research on Cancer. (1991). Chlorinated Drinking-Water; chlorination by- Products; some other halogenated compounds; cobalt and cobalt compounds. NCBI Bookshelf. Retrieved Jan 25, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK506913/ 104.) Hancock, N. (2021, February 18). What is Chlorination? Safe Drinking Water Foundation. Retrieved Jan 25, 2023, from https://www.safewater.org/fact-sheets-1/2017/1/23/what- is-chlorination 105.) da Cruz Nizer, W. S., Inkovskiy, V., & Overhage, J. (2020). Surviving Reactive Chlorine Stress: Responses of Gram-Negative Bacteria to Hypochlorous Acid. Microorganisms, 8(8), 1220. https://doi.org/10.3390/microorganisms8081220 106.) Backer, H., & Hollowell, J. (2000). Use of iodine for water disinfection: iodine toxicity and maximum recommended dose. Environmental Health Perspectives, 108(8), 679–684. https://doi.org/10.1289/ehp.00108679 107.) United States Environmental Protection Agency. (2022, July 6). Emergency Disinfection of Drinking Water. Retrieved Jan 29, 2023 from https://www.epa.gov/ground-water-and- drinking-water/emergency-disinfection-drinking-water 108.) Goodyer, L., & Behrens, R. H. (2006). Safety of iodine based water sterilization for travelers. Journal of Travel Medicine, 7(1), 38. https://doi.org/10.2310/7060.2000.00012 109.) Pesticide Research Institute. (2015). Iodine: Livestock (Technical Evaluation Report). National Organic Standards Board. Retrieved Jan 29, 2023 from https://www.ams.usda.gov/sites/default/files/media/Iodine%20TR%202015.pdf 110.) Allafi A. R. (2020). The effect of temperature and storage time on the migration of antimony from polyethylene terephthalate (PET) into commercial bottled water in Kuwait. Acta bio- medica : Atenei Parmensis, 91(4), e2020105. https://doi.org/10.23750/abm.v91i4.8463 References
90. 111.) Yang, C. Z., Yaniger, S. I., Jordan, V. C., Klein, D. J., & Bittner, G. D. (2011). Most plastic products release estrogenic chemicals: a potential health problem that can be solved. Environmental health perspectives, 119(7), 989–996. https://doi.org/10.1289/ehp.1003220 112.) Zimmermann, L., Bartosova, Z., Braun, K., Oehlmann, J., Völker, C., & Wagner, M. (2021). Plastic Products Leach Chemicals That Induce In Vitro Toxicity under Realistic Use Conditions. Environmental science & technology, 55(17), 11814–11823. https://doi.org/10.1021/acs.est.1c01103 113.) Wagner, M., & Oehlmann, J. (2009). Endocrine disruptors in bottled mineral water: total estrogenic burden and migration from plastic bottles. Environmental science and pollution research international, 16(3), 278–286. https://doi.org/10.1007/s11356-009-0107-7 114.) Flaws, J., Damdimopoulou, P., Patisaul, H. B., Gore, A., Raetzman, L., Vandenberg, L. N. (2020). Plastics Pose a Threat to Human Health: Authoritative Reports Shows Plastics and Microplastics are Pervasive Sources of Exposure to Dangerous Endocrine-disrupting Chemicals. International Pollutants Elimination Network. Retrieved Jan 23, 2023, from https://ipen.org/sites/default/files/documents/edc_guide_2020_v1_6ew-en.pdf 115.) Shotyk, W., Krachler, M., & Chen, B. (2006). Contamination of Canadian and European bottled waters with antimony from PET containers. Journal of Environmental Monitoring, 8(2), 288. https://doi.org/10.1039/b517844b 116.) Kibria, M. G., Masuk, N. I., Safayet, R., Nguyen, H. Q., & Mourshed, M. (2023). Plastic Waste: Challenges and Opportunities to Mitigate Pollution and Effective Management. International Journal of Environmental Research, 17(1), 20. https://doi.org/10.1007/s41742-023-00507-z 117.) Porta R. (2021). Anthropocene, the plastic age and future perspectives. FEBS open bio, 11(4), 948–953. https://doi.org/10.1002/2211-5463.13122 118.) Guart, A., Bono-Blay, F., Borrell, A. J., & Lacorte, S. (2014). Effect of bottling and storage on the migration of plastic constituents in Spanish bottled waters. Food Chemistry, 156, 73–80. https://doi.org/10.1016/j.foodchem.2014.01.075 119.) Yang, C. Z., Yaniger, S. I., Jordan, V. C., Klein, D. J., & Bittner, G. D. (2011). Most plastic products release estrogenic chemicals: a potential health problem that can be solved. Environmental health perspectives, 119(7), 989–996. https://doi.org/10.1289/ehp.1003220 120.) Ahmad, M., & Bajahlan, A. S. (2007). Leaching of styrene and other aromatic compounds in drinking water from PS bottles. Journal of environmental sciences (China), 19(4), 421–426. https://doi.org/10.1016/s1001-0742(07)60070-9 121.) Goodmann, W. (2022, March 11). Food Grade Plastic: Which Plastics Are Safe For Food Storage. Palmetto Industries. Retrieved Jan 25, 2023, from https://www.palmetto-industries.com/safe-food-grade-plastic/ References