Animal Waste, Water Quality and Human Health

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8Exposure interventionsJulie Kinzelman and Calum Mcphail8.1 A CONCEPTUAL FRAMEWORK FOR EXPOSUREINTERVENTIONSEvidence from epidemiological studies (Chapter 11) supports clear associationsbetween faecal indicator organism density and exposure risk in waterscontaminated with human sewage, but the utility of these pathogen indicators inbodies of water contaminated with animal waste and other non-point sourcepollution has been questioned (Kay et al. 1994, WHO 2001, Shuval 2003, Wadeet al. 2006, Colford et al. 2007, US EPA 2009a). In this context, therefore, theresults of such studies may be inconclusive, yet the reality of risks to humanhealth associated with waterborne disease transmission remains irrefutable(Cotruvo et al. 2004, Craun et al. 2004, US EPA 2009b). Diffuse sources ofcontamination are commonplace; impacting both urban and rural settings indeveloped and developing nations alike. By some estimations, 99 per cent of allfaecal contamination reaching surface waters is derived from the excreta of© 2012 World Health Organization (WHO). Animal Waste, Water Quality and Human Health. Editedby Al Dufour, Jamie Bartram, Robert Bos and Victor Gannon. ISBN: 9781780401232. Published byIWA Publishing, London, UK.
284Animal Waste, Water Quality and Human Healthpoultry, cattle, hogs and birds, but the nature and magnitude of these risks islargely unknown (Steven Esrey, UNICEF, pers. comm.). Therefore, the utility oftraditional faecal indicators may be rightly questioned when assessing waterquality throughout much of the world (Scott et al. 2002). The diversity ofpotential inputs necessitates a multi-tiered approach to identify the pollutantsources and to establish a framework for the assessment of the risks that thesesource may pose in exposed populations (Molina 2007).Multi-tiered approaches such as those combining sanitary surveys with expandedmonitoring programmes, including assessments of traditional faecal indicatororganisms and tracking of microbial sources (source attribution), may provide thisconceptual framework for risk assessment (Ruecker et al. 2007). Identification ofpollution sources and quantifying the plausibility of illness from each source arenecessary steps in the development of effective exposure or managementinterventions. Trends in animal husbandry and agricultural practices haveincreased the potential for large scale contamination events and the socio-politicalcontext in which these serious incidents occur is often outside the realm of formalpublic health and epidemiological investigations (Ali 2004, Hubbard et al. 2004).Large scale contamination events may also be exacerbated by climate changeeffects such as projected increases in average precipitation (WHO 2009). Theimpacts of climate change on the epidemiology of waterborne diseases arethrough increased flooding, heavy rainfall and increased temperatures which canexpand the range and geographic distribution of known pathogens (WHO 2003).Scientific studies have linked substantial increases in microbial loads inwatercourses and drinking-water reservoirs as a result of extreme rainfall and theresulting runoff (Kistemann et al. 2002). This was the case in 2000 whenCanada had one of the largest outbreaks of waterborne disease in NorthAmerica. Over 2300 people became ill and seven died in Walkerton, Ontario asa result of consuming contaminated drinking-water following heavy rains (Auldet al. 2004). In a 2005 study Schuster and colleagues analyzed information onCanadian waterborne outbreaks occurring between 1974 and 2001 (Schusteret al. 2005). They found that severe weather events and close proximity toanimal populations were correlated with disease outbreaks that could be trackeddown to drinking-water supplies. The geographic distribution of climate changewill show significant variation and human exposure will be “location-specificand path-dependent” (Yohe & Tol 2002, Hess et al. 2008). Therefore, inaddressing potential environmental or behavioural human exposureinterventions, the historic relationships with land use and (agri-)culturaltraditions must be considered (Hess et al. 2008).The advent of climate change is not the only development that may increase thelikelihood of direct and indirect waterborne disease transmission originating from
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3Zoonotic waterborne pathogen loads
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Zoonotic waterborne pathogen loads
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the cause of a variety of food- and
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4Zoonotic waterbornepathogens in li
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controlling E. coli-associated diar
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5Transport of microbial pollution i
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Transport of microbial pollution in
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Page 268 and 269: 7ExposureWill Robertson and Gordon
Page 270 and 271: Exposure 259main components influen
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Page 274 and 275: Exposure 263contact activities, the
Page 276 and 277: Exposure 265Table 7.1 Notable studi
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Page 280 and 281: Exposure 269water than zoonotic pat
Page 282 and 283: Exposure 2711999). As suggested by
Page 284 and 285: Exposure 273leptospirosis is primar
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Page 288 and 289: Exposure 277duodenalis in surface w
Page 290 and 291: Exposure 279Keeley, A. and Faulkner
Page 292: Exposure 281Schultz-Fademrecht, C.,
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IndexAgricultural runoff, 122, 168,
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Index 463Biogas, 137-139, 291Bio-se
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Index 465Critical control points, 1
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Index 467290-291, 293, 295, 300, 30
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Index 469Hazard detection, 285Hazar
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Index 471pathogens, 2, 4-14, 17-21,
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Index 473Probiotics, 132-133Protozo
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Index 475Molecular, 16, 19, 22, 27,
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Animal Waste, Water Quality and Human Health

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