Sunday, February 26, 2017

Wondering About Water Quality

Have you ever wondered about what's in your water? Have you ever feared about the diseases you could get from getting the simple act of drinking a glass of water? According to a Chapman University Blog, 27.9% of Americans have a fear of pollution in drinking water. That's the 26th fear listed out of about 79 different fears. Now depending on where the randomly sampled participants are from, some have bigger reasons to be afraid than others.

According to the Ohio Department of Health (ODH), many Ohio residents get their water from ground or surface water. If a resident does, they must have the source tested for basic contaminants as soon as construction or any other alteration is made and they must then take special precautions to ensure the water stays okay to drink during the system's lifespan. ODH lists three tests that must be passed in order for a system to get approved by the owner's local health district:

  • Total Coliform Bacteria - evaluates the cleanliness and/or condition of water wells. Also, determines if a disinfection system is working correctly.
  • E. coli - indicates sanitary condition of the supply.
  • Nitrates
But what this blog will be focusing on is 6 different things that can affect a private water supply, or really any water supply if the conditions are right.

According to the ODH, there are actually 16 different species of coliform bacteria and most of them are relatively harmless. In fact, coliform is found in the intestines of warm-blooded and cold-blooded animals, including humans, where it aids with digestion. These 16 species are known as total coliform bacteria and typically live in large numbers. 

A subgroup of the bacteria is called fecal coliform, and it is within this subgroup that harm to health comes into play. To begin, the subgroup is defined as separate because they are only found in warm-blooded animals fecal waste and they grow at higher temperatures than the bacteria in the total coliform group. One species of the six fecal coliform species is E. coli. Within the E. coli species, one rare strain is found to cause dangerous outbreaks and illness. The ODH has emphasized the fact that this strain is rare, but also mentions how it is often covered by the news because of the potential outbreaks it can cause.

It is because of the fecal strains that water must be tested for it. Domestic sewage and other sources containing animal and human waste can contaminate water which then soils absorb. If a human were to eat a plant that has grown by a contaminated water source or drinks from a contaminated source, he/she could get sick. The key word is could - ODH reported that a person does not automatically become sick, but if the organisms are present in the water, other disease-causing organisms could be present too. If a person were to become sick from the contaminated water, the ODH reports that the person will probably experience diarrhea and cramps. 

The best way to prevent a coliform bacterial contamination it depends on the water source. For groundwater, wells should be built well enough to have minimal or no bacteria, but if some were to be found, all that can be done is to have the well professionally cleaned to clear any mineral and bacterial slimes that have built up. For springs, ponds, and cisterns (an artificial, underground tank that stores rainwater, according to Merriam-Webster), owners should filter the water, as well as use treatment devices. If bacteria is still found then the owner needs to make sure the disinfection system is working properly and is maintained. 

On top of prevention, the ODH has standards for private water systems regarding both total coliform bacteria and fecal coliform bacteria, specifically the E. Coli species. For the latter, pretty much all water samples are looked at for E. Coli because the test is quick - with results being available in just one day - and inexpensive. Within the total coliform species, there are two standards depending on the water system being used, how it was constructed and whether disinfection is required. If the system is newer or recently altered it is required to meet "a coliform count standard." If a system requires continuous disinfection, then it is required to meet "a total coliform negative standard," which just ensures the equipment used to disinfect is working correctly.


Coliform bacteria is categorized under microbiological contaminants on the ODH page about water quality. The next category is known as Primary Pathogenic microorganisms, or microorganisms that can cause disease in healthy people with dose and exposure. E. Coli is listed under this group as well as under microbiological contaminants. There are three other disease causing things listed under this primary pathogenic group that this blog will touch on: Cryptosporidium, Giardia, and Harmful Algal Bloom Cyanotoxins. 

Cryptosporidium
According to the Centers for Disease Control and Prevention (CDC), Cryptosporidium is a microscopic parasite that lives in the intestine of infected humans and animals. It is passed by the stool of the infected being. Many would think that chlorine-based disinfectants would kill the parasite, but unfortunately, this parasite is resistant. On top of the resistance, the parasite is equipped with an outer shell that gives it the ability to live outside a body for long amounts of time. The disease that Cryptosporidium causes is known as Cryptosporidiosis, but both are commonly called Crypto. The disease is categorized as a diarrheal disease and is one of the most common causes of waterborne disease over the past two decades. This disease is found all over the world, including the US. 

To prevent getting Crypto, the CDC recommends practicing good hygiene, avoiding potentially contaminated water, being extra cautious while traveling and avoid sexual contact with feces during sex. Additionally, it is asked that if a person were to have diarrhea not to swim, and if infected not to swim for an additional two weeks. If a child has diarrhea, it is recommended to keep them away from child care facilities until it stops. Finally, the CDC asks that children are taken out of pools every sixty minutes for a bathroom break and babies' diapers are checked every thirty to sixty minutes. 

If a healthy person were to get Crypto, according to the CDC, no treatment is really necessary. It is only recommended to drink fluids to manage diarrhea and prevent dehydration. A way to remove Crypto parasites is with a water filter, but it has to be designed to remove them. Any filter that is reverse osmosis or has an absolute pore size of less than 1 micron should remove Crypto. Also "tested and certified to NSF/ANSI Standard 53 or 58" removal or reduction should also remove Crypto. 

Giardia
According to the CDC, like Crypto, Giardia is also a parasite that is found in the intestine and gets passed through feces. Giardia also has a protective outer shell that allows it to live outside the body for longer periods of time. The diarrheal sickness giardia causes is called Giardiasis, and it too is one of the most common causes of waterborne diseases. Unlike Crypto, though, giardia are found mostly in the US. 
Photo (by Allison Cook) of a picture from the
CDC's website. This shows Giardia at a
microscopic level. These parasites cause a
disease known as Giardiasis, which is very
similar to Crypto in effect.
The prevention methods for giardia are very similar to those recommended by the CDC for Crypto, such as practicing good hygiene, avoiding potentially contaminated water and avoid contact with feces during sex. In addition, CDC also warns about washing foods with contaminated water and recommends avoiding eating uncooked foods when traveling to places with poorer water and food treatment. Finally, the CDC asks that in areas where either the sick pet or person was be cleaned. CDC asks that when disinfecting, cleaning hard surfaces and cleaning carpets and softer material covered furniture, that gloves are used.

The best treatment, according to the CDC, for a giardia infection is to take medication. Depending on an infected person's past, immune system status and nutrition different drugs work better than others, which is why it is recommended to talk with a doctor about the options for treatment. 

As for removing Giardia, the CDC does not talk about the parasite's resistant to chlorine-based disinfectants but recommends a very similar process as the process to remove Crypto. 

Harmful Algal Bloom Cyanotoxins
According to the ODH, certain species of cyanobacteria are what cause the harmful algal blooms (HAB). Cyanobacteria, also known as "blue-green algae," are actually naturally found in Ohio's lakes, slow-moving streams, and ponds, and many of the species are non-toxic. For a HAB to occur the conditions have to be just right: shallow water, sunlight, warm temperatures, and an excessive amount of phosphorous and nitrogen.
Photo (by Allison Cook) of a picture from the ODH. While the water in this picture
looks almost like a painting, it is actually a HAB. The coloring illustrates why
the algae got the name "blue-green algae."
Those cyanobacteria that are toxic are called Cyanotoxins and are divided into three subcategories: neurotoxins, dermatotoxins, and hepatotoxins. Neurotoxins cause problems with the nervous system, dermatotoxins cause skin problems and hepatotoxins cause problems in the liver. The ODH lists three common ways that people come into contact with HABs: Drinking contaminated water, whether it be during a drinking water advisory or accidentally during a recreational activity in the contaminated water, inhaling, in the form of mist, and skin contact.

Depending on how a person is exposed, will impact how the person is affected. Drinking contaminated water has the most severe effects, including severe diarrhea and vomiting, difficulty breathing, kidney, neuro and/or liver toxicity, and potentially death. Skin contact may cause hives, rashes, and/or blisters. Inhaling contaminated water could cause a sore throat, allergic reactions, asthma-like reaction and/or runny eyes and nose. It is also important to note that humans are not the only ones who can get sick because of HABs, pets are at risk too. For both humans and animals, it is recommended to seek medical help if they are thought to be infected.
Photo (by Allison Cook) of picture from ODH. Recreation is one of the main ways
people are exposed to HAB waters. The health effects most likely to be contracted
from recreational activity are less problematic so long as the individual does not
drink or swallow the water. Still, it is advised to be cautious if recreating in or by
HAB infected waters since skin contact and inhaling mist caused by the recreation
activity can still cause issues for an individual.
The ODH lists two types of advisories that come with HAB-contaminated water, and each advisory depends on the type of toxins causing the bloom. The first advisory is a drinking advisory. If 0.3 μg/L (micrograms per liter) of Microcystin, 20 μg/L of Anatoxin-a, 0.7 μg/L of Cylindrospermopsin or 0.2 μg/L of Saxitoxin are found it is advised that children under the age of 5, the elderly, pregnant or nursing woman, people with liver problems, people with immune system problems, and people undergoing dialysis treatment do not drink the water. When levels, respective to the order the toxins were listed previously, hit 1.6 μg/L, 20 μg/L, 3 μg/L and 0.2 μg/L all people, pets, and livestock are told not to drink the water. The second advisory type is recreational. When toxins hit 6 μg/L, 80 μg/L, 5 μg/L, and 0.8 μg/L, respectively, then it is considered a "Recreational Public Health Advisory" and a sign must be posted to warn people. When toxins hit 20 μg/L, 300 μg/L, 20 μg/L, and 3 μg/L, respectively, then the advisory is a "Recreational No Contact Advisory," which means a sign is posted telling people the levels are above the threshold and going in the water is not recommended. 


The next category after primary pathogenic microorganisms is "Opportunistic Pathogens," which normally do not harm people who are healthy but instead are just a problem in populations such as the elderly, those with compromised immune systems and infants. Next are "Inorganic Chemical contaminants," such as metals like lead and iron, and then organic chemical contaminants. Finally, a category called "Radionuclides"comes up. This blog will look into Radon, which is one of five things listed in this group.

Radon
According to the EPA, Radon is a radioactive gas that naturally occurs and can cause cancer. It is formed from the breakdown of uranium underground. It has no taste, color or odor so it is very difficult to detect. While there are actually two main sources of radon, both air and water, this blog post's focus is on water quality, so we will only look at Radon in drinking water.

Radon tends to enter the water through dissolving and accumulating in groundwater and therefore can get into well water. It is when the water is used in a house that some of the gas escapes into the air. There is an emphasis on the fact that radon is only a problem for homes that get their water from underground sources because radon in surface water escapes into the air long before it reaches the tap. If exposed to radon through drinking water, people are at a higher risk of getting lung cancer over the course of their lifetime. 

While the EPA reports that there is no federally enforced standard currently for radon in drinking water, they have made a proposal. The proposal requests that any public water source that contains more than 4,000 pCi/L (picoCuries per liter) be shut down. This proposal will also force States to take action in lowering radon levels.


The final water quality issue we will look at is Turbidity, which is under the ODH's "Other Parameters" category. 


According to the Water System Council, turbidity is the cloudiness of the water. The cause of the cloudiness can come from a variety of fairly harmless sources or from increased levels of disease-causing organisms. If it is caused by high levels of organic matter than it may be difficult to successfully disinfect the water.

The Water System Council reported that higher levels of turbidity usually mean higher levels of disease-causing microorganisms, which means that health effects can range from nausea to cramps to diarrhea to headaches.
Photo (by Allison Cook) of a picture from Google Images. This shows the
different levels of turbidity in water. According to the Water System Council
it is more effective to treat water at lower turbidities than at higher ones.
The EPA's standard, according to the Water System Council, is 1 NTU for drinking water standard. NTU stands for nephelolometric turbidity unit, and it is the amount of light that can pass through a water sample. The more particle means a higher number. Most well owners will not notice levels below 5 NTU.

Friday, February 17, 2017

Lead the Fight Against Lead Poisoning by Getting the Facts

153,010. That's the number of Ohio children, under the age of 6, that were tested for lead poisoning in 2014 according to the Ohio Department of Health's Annual Report for 2015.

Lead poisoning, according to Merriam-Webster Dictionary, is when someone is chronically intoxicated due to the body absorbing the heavy metal. Symptoms of this type of poisoning include abdominal pain, weakening of limbs or paralysis of muscles, lack of appetite, nausea, diarrhea, and fatigue.

According to the Ohio Department of Health (ODH), lead poisoning is a serious threat in the state of Ohio. While there are several potential sources in our environment - including cosmetics, foods, and contaminated soils and water - the most probable cause seems to be from lead-based paint. This is specifically a problem in houses with lead-based paint, which could be any home built prior to 1978. Not every home containing the lead-based paint is at risk of giving it's residents the poisoning. Only when the paint begins to deteriorate and becomes part of the dust that it becomes a problem. By keeping the house clean and the paint maintained, you can decrease the chance of exposure.
A photo of the photo-collage created by the Summit Count Public Health on
their annual report. The house being worked on was originally a home with
lead-based paint and its residents were found to have lead poisoning.
Being tested is another way to help prevent lead poisoning in both children and adults. 26,111 Ohio adults, or people over the age of 16, and 154,880 children were tested in 2011. That is roughly 1.57% of the population in 2011 (population total according to the US Census Bureau).

To break the numbers down even further, the reports look at the confirmed levels of lead in the children tested's blood. While there isn't a "safe level" of lead, the government has stated that 5μg/dL, or 5 micrograms per deciliter, is the point that the child is said to have lead poisoning. In other words, when a child is tested and his/her blood is found to have 5μg/dL of lead, they are considered to have elevated blood levels. This threshold was recently lowered from 10μg/dL in November 2014.

In 2014 3%, or 4,596 tested children, were confirmed to have 5μg/dL of lead in their blood or higher, and 0.85%, or 1,298 tested children, were confirmed to have 10μg/dL or higher. Now, it is important to remember that this is all of Ohio. If we were to look at the ODH's County Data Sheet and, for example, look at Summit County, which contains the major Ohio city of Akron, we would find that in this county 154,440 children were tested in 2012. Of those 9,039 children were found to have at least 5μg/dL. That is 5.85% of the children tested. According to the Summit County Public Health's 2015 Annual Report, Summit County was given a "lead hazard control grant" and with the money from the grant 50 homes have been made lead safe.
Above: A photo of a picture of Summit County off
the ODH Annual Report. Below is a legend describing
the colors. on the map. As you can see, the main city of
Akron has the darkest colors which indicate that there is
a very high probability that a child will have an elevated
level of lead in his or her blood.

Aside from being having awareness in your home about when the house was made, if it's walls are painted with lead-based paint, and therefore keeping the paint maintained and your house clean, and having children tested, what else can be done? Well, being knowledgeable of the topic. Throughout the annual report, there are many references and "advertisements" for talks and ways to donate to the cause.
A photo of the "advertisements" in the ODH's Annual
Report. These advocate being aware of your home and
environment, getting your children tested and being
knowledgeable of lead poisoning. 

Sunday, February 12, 2017

Zap Away Zika with Knowledge

Zika is a disease that comes from a mosquito known as the Aedes mosquito. According to a New York Times article published in July of 2016, the World Health Organization (WHO) had "declared an international health emergency over the spread of the Zika virus." But what exactly is the virus? How does one "catch" it? How does one know they have it? Is the US at risk? And most importantly, how does one avoid it?

Let's start at the beginning, back in 1947 that is. It was during that year that the virus was discovered in a forest in Uganda known as the Zika Forest. According to the WHO, it was found in monkeys by a group that was trying to monitor yellow fever. It wasn't until 1952 that it was found in humans. Back then, according to the New York Times article, it was thought to be a common virus in the African and Asian regions of the world, and it seemed rather contained in those until around 2013. Around this time Brazil had begun to see a "mystery disease," and by 2015 the mystery had been solved: Zika had traveled across the ocean. Today, the virus has spread northward to the southern United States.

A photo (by Allison Cook) of the map found in the New York Times
article showing areas around the world infected with Zika. 
The mosquito that transmits the disease also is a carrier of yellow fever, dengue fever, and chikungunya, according to WebMD. All four viruses seem to be passed in a similar way: an infected person is bitten by the Aedes mosquito and then that same mosquito bites someone else, giving the new victim the disease. It has only been recently found that Zika can also be given to someone through the act of sex. While only female mosquitos will bite a person, and therefore are the main problem with the spread of the disease, both female and male humans can pass the disease along to their sex partners.

To be more specific, the virus is thought to be found in semen, blood, saliva, eye fluids and urine. The blood is key when dealing with mosquitos. Below is a photo of an illustration done by the New York Times to show how the virus gets from the infected person, into the mosquito and then into the new victim. Basically, it is through the mosquito's saliva that the virus travels to get from one person to the next.

A photo (by Allison Cook) of the illustration used by the New York Times
to show how the Zika virus is spread by mosquitos. 
Now that a person has the virus, how do they know? Well, according to both the New York Times and WebMD, only 20% (1/5) of victims show symptoms. WebMD reported that if a person were to develop symptoms that they could appear any time between 3 days to two weeks after an infected bite. These symptoms do not last long, only lingering from several days to a week, but it is crucial that the sickly person calls their doctor as soon as symptoms develop. New York Times reported that the best way for the virus to be detected is by a urine or blood sample within the first couple weeks of symptoms showing. 

What are the symptoms? According to the WHO, "symptoms are similar to other arbovirus infections," or viruses transmitted by arthropod vectors. These symptoms include fever, joint and muscle pain, rashes, red eyes, and headaches. 

The CDC reported on their website that the symptoms are usually mild enough that people do not get hospitalized, and therefore may not know they are infected. According to WebMD, there is a rare chance that victims can get a disease known as Guillain-Barre syndrome, which causes partial or complete paralysis of the legs for a usually temporary amount of time. While there have only been 13 cases of this link in the US, studies have shown an increasing link between the two diseases. 

The larger concern is the link between Zika and pregnancy. It is thought that the disease can cause fetal microcephaly. Microcephaly is when a baby is born with a smaller than usual head, which most of the time is not an issue to a developing child according to the New York Times. In the cases caused by Zika though, it is a more severe form of microcephaly which may stop the growing of the brain as well as make the brain smoother. There is also a chance that the nerves connecting the brain to the ears and eye could be damaged and the child may suffer from seizures, constantly. It is also noted that microcephaly can be caused by many other infections and may be a result from drug use or alcoholism.

A photo (by Allison Cook) of the CDC's illustration that links to their page
about the potential threats to a pregnant woman's unborn child(ren). 
Unfortunately, there is no cure for microcephaly, but there's hope for those who get Zika. According to the WHO, since the symptoms are very mild there is no specific treatment; just lots of rest, common medicines to treat any pains and drink lots of liquids. It should also be noted that there are no vaccines available at this time. 

Some would say though that the best cure for something is to prevent it from happening. The Who suggests avoiding mosquito bites by wearing clothing that covers your skin and that is lighter colored, wearing bug repellants, keeping physical barriers (such as doors and windows) closed, and sleeping under mosquito nets. It is also advised to practice safer sex or avoid having it at all in regions where the disease can be found or with people who may be infected. The New York Times also advised that women who could have been exposed should take these extra precautions for at least two months and men for at least six months.