Surveillance of waterborne diseases

1
Surveillance of waterborne diseases

• Implementation of the Protocol on Water and
  Health
• Mihály Kádár
• National Institute of Environmental Health,
  Budapest

ISEE, Balatonfödvár, 4-6 September, 2003
2
Main objectives of the Protocol

• To promote prevention, control and reduction of
  water-related diseases throughout the WHO/Euro
  region by
• Ensuring adequate drinking water supplies and
  sanitation
• Effective systems for surveillance and monitoring
  of water supply and services
• Giving special consideration to vulnerable groups
  of population
• Providing the public with information and raise
  public awareness
• Enhancing international cooperation in pursuing
  the above objectives
• Reviewing and assessment of progress.

3
Footsteps of work under the Protocol

• 1st Meeting of the Signatories to the Protocol
  Budapest, November, 2002
• 1st Meeting of the Working Group of Water and
  Health, Budapest, May, 2001
• 2nd Meeting of the Working Group of Water and
  Health, Budapest, October, 2002
• Small WG Meeting on the Evidence Base and
  Develoment of a Reporting Scheme for WRD
• Experts Worskhop on Goals and Strategies for WRD
  Surveillance
• Workshop on Health Risks in Aquifer Recharge
• Workshop on Rapid Environmental Health Risk
  Assessment
• 2nd Meeting of the Signatories to the Protocol,
  Geneve, July, 2003.

4
Draft Guidelines of the Surveillance for Water
Related Diseases (1)

• Framework

HEALTH TARGETS
Risk Management
Assessment of Risk
PUBLIC HEALTH STATUS
5
Draft Guidelines of the Surveillance for Water
Related Diseases (2)

• General overview
• Reactive system monitoirng and management of WRD
• Proactive systems monitoring and management of
  water quality
• Multi-level institutional outline and
  legal-political background
• Water-borne infectious diseases
• priority groups of pathogens/events in Europe and
  symptom-based definitions
• Managing information sources and reporting
• Outbreak investigation
• Water-borne diseases caused by chemical
  substances
• Origin/ways of contamination
• Monitoring strategies for chemicals and their
  health effects

6
Draft Guidelines of the Surveillance for Water
Related Diseases (3)

• Proactive surveillance-monitoring
• HACCP principle as an operational basis
• Most important groups of the Critical Control
  Points of a water supply system
• Source and catchment
• Chain of treatment
• Distribution system components and environment
• Domestic plumbing system and points of use

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WatSan_P1 Waste water treatment coverage
Percent of population with secondary sewage
treatment
Year
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WatSan_S1Exceedance of recreational water limit
values for microbiological parameters
Percent of exceedances
Year
9
WatSan_S2 Exceedance of WHO drinking water
guidelines for microbiological parameters
Percent of exceedances
Year
10
WatSan_S3 Exceedance of WHO drinking water
guidelines for chemical parameters
Percent of exceedances
Year
11
WatSan_E1 Outbreaks of waterborne diseases
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WatSan_E2  Diarrhoea morbidity in children
Case/100.000
Year
13
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