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Boil Order

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

The University of Nomi

February 07, 2024
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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  19. Giardia — Life Cycle
    Cysts hatch in small intestine, each releasing two trophozoites 13
    Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com
    cyst
    trophozoites

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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)

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  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.

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  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

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  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.

    View full-size slide

  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.

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  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

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  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

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  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

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  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

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  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

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  41. Matures into into an adult
    tapeworm in 2 months,
    survives in host for 2–3
    years21,25
    T. solium — Life Cycle, Part 1

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  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

    View full-size slide

  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

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  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

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  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

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  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.

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  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

    View full-size slide

  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

    View full-size slide

  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

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  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

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  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

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  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

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  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

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  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

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  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

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  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

    View full-size slide

  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

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  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

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  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

    View full-size slide

  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

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  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

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  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

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  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide

  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

    View full-size slide