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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
  2. A boil order, or boil water advisory, is a government

    issued public-health advisory to boil tap water before household use due to contamination of the water supply. Boil Order Photos: timesunion.com/news/article/Troy-issues-boil-water-advisory-12285126.php, wsp.com/en-CA/projects/village-of-middle-river-boil-water-advisory
  3. Water supply can become contaminated by: • Flooding • A

    break in water lines • Cross-contamination with sewage • Loss in water system pressure1 Contamination Photos: punctualplumberdallas.com/blog/what-causes-your-water-line-to-break, thestar.com/news/world/2010/08/09/millions_suffer_as_pakistan_flood_disaster_worsens.html, sofrep.com/news/the- pic-of-the-day-flooding-continues-to-cause-devastation-across-midwest, fox47news.com/part-of-downtown-detroit-under-boil-water-advisory-after-water-main-break
  4. Boil orders work in any situation where water quality could

    be compromised • Living in a disadvantaged or disaster-struck community • Camping or taking shelter Contamination Photos: samsylk.com/blog/jackson-miss-water-is-so-bad-they-have-to-shower-with-caution-video/, emergency-family-survival.com, who.int/southeastasia/news/detail/22-02-2018-working-for-clean- water-and-health-in-a-rohingya-refugee-camp Refugee camp Urban water system breakage Outdoor shelter
  5. Parasites – • Cryptosporidium, Giardia, Entamoeba, Taenia 2, 3 Bacteria

    – • Vibrio cholerae, Shigella, Campylobacter, Legionella 2 Viruses – • Hepatitis A, Norovirus, SARS-CoV-2 coronavirus 2,4, 5,6 Algae – • Algal blooms can produce harmful cyanotoxins 7 Contaminants Photos modified from: dreamstime.com, istock.com
  6. Parasites Photos modified from: marshallpumps.co.uk/giardia-water-parasite, “Col Sem Of Oocysts Of

    Cryptosporidium Parvum” by A.b. Dowsett/science Photo Library on fineartamerica.com, © David Ferguson on eurekaalert.org, thenepalidoctor.com/entamoeba-histolytica, masterroshsi.blogspot.com/2012/05/taenia-saginata-taenia-solium.html Taenia Cryptosporidium Entamoeba Giardia
  7. Causes cryptosporidiosis8 One of most common water-bourne parasites8 Contracted by

    swallowing as few as 10 oocysts8,9 Spread in faeces • 10,000,000–100,000,000 oocysts shed in a single bowel movement8 Cryptosporidia Photo: “SEM of the intestines showing Cryptosporidia” © Moredun Animal Health / Science Photo Library on sciencephoto.com Scanning electron micrograph of Cryptosporidia on intestinal epithelia, x700 magnification
  8. Trophozoite Cryptosporidia — Morphology Photos: Petry et al. 2009, Figure

    1.b., Aldeyarbi, & Karanis, 2016, Fig. 8.c. Oocyst 500 nm 1 μm Amylopectin granule – stores energy Micronemes – secrete proteins for cell invasion Nucleus – contains genetic material
  9. Ingested oocyst hatches in the gastrointestinal tract, releasing 4 sporozoites.

    Sporozoite = motile, elongated form that invades host cells10, 11 Cryptosporidia — Life Cycle Photo: "False-col Tem Of Cryptosporidia Sp." © London School Of Hygiene & Tropical Medicine, May 1, 2013, on fineartamerica.com oocyst sporozoites
  10. Photo: justbalancinghealth.com/health-problems/treatment-for-common-cause-of-diarrhea-more-promising Cryptosporidia — Life Cycle trophozoite Sporozoites invade intestinal

    epithelia, form vacuoles, mature into trophozoites10, 11, 12 Trophozoite = activated, feeding stage that enters and parasitizes cells
  11. Photo: "Intestinal Protozoan Parasites, Tem" © London School Of Hygiene

    & Tropical Medicine, May 13, 2013, on fineartamerica.com Cryptosporidia — Life Cycle meront merozoites Trophozoites mature, form meronts that produce 4-8 merozoites10, 11. Merozoite = life stage that undergoes asexual or sexual reproduction10, 11 Meronts containing merozoites
  12. Photo: Borowski et al., 2009, Figure 2.D. Cryptosporidia — Life

    Cycle trophozoite merozoites Merozoites undergo asexual reproduction to form more trophozoites 10,11. Allows for rapid replication and establishment of infection10,11 1 μm
  13. Merozoites undergo sexual reproduction by forming microgamonts ( ), which

    produce microgametes, and macrogamonts ( )11. Photo: Koh et al., 2014, Figure 4.H. & I. Cryptosporidia — Life Cycle merozoites microgametes macrogamont microgamont Microgamont Macrogamont 5 μm 8 μm
  14. The microgamete fertilizes a macrogamont, forming a zygote11. Zygote matures

    into thin-walled oocyst (reinfects host) and a thick-walled oocyst (passed in faeces)11. Photo: healthtian.com/cryptosporidiosis Cryptosporidia — Life Cycle zygote thick wall thin wall Cysts on epithelia
  15. Cryptosporidiosis Symptoms begin in 2–10 days8 • Includes diarrhoea, stomach

    cramps, dehydration, fever8 • Can last 1–4 weeks8 Treatment: • Nitazoxanide for treatment of diarrhoea8 • Patients with healthy immune systems can recover without treatment8 • Care must be taken to stay hydrated Photo: pillintrip.com, clipground.com, alamy.com
  16. Clinical analysis of 3 stool samples collected on different days

    • Parasite is shed irregularly and can be difficult to detect8 Diagnosis Stool smear micrograph revealing Cryptosporidium parvum infection Photo: Public Health Image Library on wikidoc.org
  17. Giardia Photo: Modified from "Giardia lamblia protozoan, SEM" © Ami

    Images/Science Photo Library on sciencephoto.com SEM of G. duodenalis trophozoite Causes giardiasis 13 Spreads in faeces13 Persists in environment for several months13 Main species affecting humans is G. duodenalis a.k.a. G. lamblia or G. intestinalis 13
  18. Giardia — Morphology Photos: Modified from Melhorn, 2015, Figure 4.12

    Trophozoite Cyst B = base of flagella N = nucleus VD = ventral disk F = flagella CW = cyst wall
  19. Giardia — Life Cycle Cysts hatch in small intestine, each

    releasing two trophozoites 13 Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com cyst trophozoites
  20. Giardia — Life Cycle Photo: © Dr. Stan Erlandsen, USCDCP

    on pixnio.com cyst trophozoites binary fission encystation feeding D trophozoites Trophozoites undergo binary fission and replicate13
  21. Giardia — Life Cycle Trophozoites attach to intestinal epithelia by

    ventral disks , absorb nutrients from the intestinal lumen13,14 Photo: © Dr. Stan Erlandsen, USCDCP on pixnio.com feeding
  22. Giardia — Life Cycle Trophozoites move to colon, mature into

    cysts and shed in faeces13 Photo: microspedia.blogspot.com/2017/09/giardia-cyst-under-microscope.html encystation
  23. Symptoms begin in 1–2 weeks13 • Include greasy diarrhoea, cramps,

    nausea, and dehydration lasting 2–6 weeks13 • Impairs absorption of nutrients across intestine14,15 Treatment: • Nitroimidazole compounds, albendazole, or furazolidone13,15,16 • Rehydration therapy13 Giardiasis Photo: publicdomainfiles.com/show_file.php?id=13546270829533 SEM of Giardia causing damage to intestinal epithelia
  24. Clinical analysis of stool samples13 Diagnosis Photo: Dr. Bobbi Pritt

    & Emily Fernholz, Case #157, on pathologyoutlines.com/topic/smallbowelgiardiasis.html Micrograph of trichrome stained stool specimen showing G. duodenalis infection in small bowel
  25. Infects 50 million people worldwide, causing >100,000 deaths a year17

    • Common in tropical climates, developing countries, and institutions with poor sanitation17, 18 Causes amoebic dysentery18 • Only 10%–20% of people infected develop symptoms of illness18 Photo: Modified from “Entamoeba Histolytica Protozoa” © Sinclair Stammers, July 28, 2016 on fineartamerica.com Entamoeba histolytica Entamoeba histolytica, differential interference contrast micrograph
  26. Photos modified from: stepwards.com/?page_id=5948 and differencebetween.com/difference-between-wbc-and-amoeba, healio.com/news/infectious-disease/20140322/clemson-researcher-receives- nih-grant-to-study-entamoeba-histolytica E. histolytica

    — Morphology nucleus Cyst Trophozoite feeding vacuole – digests red blood cell meal chromatoid bar – condensed RNA pseudopod – used for motility 4 nuclei
  27. Cystic stage = infective form • Survives in environment for

    prolonged periods. Thick wall confers resistance to desiccation and chlorine treatment19 • Cyst is ingested, wall is lysed by intestinal trypsin19 • Excystation occurs in less acidic conditions of caecum or lower part of illium19 • 8 trophozoites released per cyst19 E. histolytica — Life Cycle
  28. Trophozoite stage = invasive form • Colonize the large intestine19

    • Adhere to colonic epithelial cells via surface lectins that bind surface of intestinal epithelium19,20 • Invade and penetrate intestinal mucosa, killing cells and causing inflammation20 E. histolytica — Life Cycle
  29. Trophozoite stage = invasive form • Can reach other areas

    of the body: liver, heart and brain, causing tissue necrosis and abscess formation20 • Matures into cyst • Cysts released in faeces E. histolytica — Life Cycle
  30. Symptoms begin within 2–4 weeks18 • Diarrhea, abdominal pain •

    Severe infection: mucosal inflammation, ulcers, bloody stools, and necrosis leading to lesions and perforation of gut20 • Can migrate to liver and form abscess Treatment: • Metronidazole, followed by a luminal amebicide, including paromomycin or diiodohydroxyquin20 Photos: "Metronidazole Antibiotic Pills" © Tek Image, 2013, on fineartamerica.com, stock.adobe.com, gnhindia.com Amoebic Dysentary
  31. Faecal microscopy20 PCR20 Serology: • Detection of antibodies at least

    a week into infection20 Colonoscopy followed by histologic examination20 Photos: modified from lstmed.ac.uk/intestinal-parasites/intestinal-parasites-entamoeba-histolytica, Yoon & Sumii, 2016, Figure 1.A. Diagnosis E. histolytica trophozoites in stool sample, wet mount Severe amoebic colitis in an HIV- infected patient (BMJ Case Reports, 2016)
  32. Tapeworm that infects humans, pigs, and cows21 Infectious eggs and

    body segments are passed in faeces within 2 months of infection21,22 Most tapeworms grow 2–7 m over 2–3 years, can reach up to 25 m21,22,23 2 different routes of infection: • 1.) Ingesting raw infected pork/beef, causing taeniasis21 • 2.) Ingesting contaminated water, causing cysticercosis21 Photos: Li & Guo, 2016, Figure B, © 2016 Massachusetts Medical Society Taenia 6.2 m long beef tapeworm removed from human patient. Arrow indicates head.
  33. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”)

    • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Photo: Flisser, 2013, Figure 1. Taenia
  34. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”)

    • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Taenia Photo: Flisser, 2013, Figure 1.
  35. 3 main species infect humans: 1.) T. asiatica (“Asian tapeworm”)

    • Encyst in viscera24 • Mild or no symptoms25 2.) T. saginata (“Beef tapeworm”) • Encyst in muscle24 • Mild or no symptoms25 3.) T. solium (“Pork tapeworm”) • Encyst in muscle and viscera21,24 • Causes cysticercosis21 Taenia Photo: Flisser, 2013, Figure 1.
  36. scolex = the head Attaches to intestinal wall with hooks24

    Photos: healthjade.com/wp-content/uploads/2019/02/Taenia-solium.jpg, "False-col Lm Of Scolex Of Adult Pork Tapeworm" © Science Photo Library on fineartamerica.com, Spina et al., 2005, Figure 2. T. Solium — Morphology rostellum = 2 rows of hooks four cup shaped suckers
  37. T. Solium — Morphology genital pore ovary gravid (pregnant) proglottids

    testes uterus longitudinal nerve mature proglottids Photos: healthjade.com/wp-content/uploads/2019/02/Taenia-solium.jpg, © Lance Wheeler, 2018 at Texas A&M College of Veterinary Medicine, Department of Veterinary Pathobiology Proglottids = segments containing and reproductive organs, mature and detach from posterior end24 • 1,000 proglottids/adult22 • 50,000 eggs/proglottid22
  38. Pigs (intermediate host) infected by ingesting water or vegetation contaminated

    with eggs or gravid proglottids25 Oncospheres hatch from eggs in small intestine25,26 Photo: parasitewonders.blogspot.com/2015/08/answer-to-case-361.html T. solium — Life Cycle, Part 1 Oncosphere = infective 6-hooked embryo encased in keratin membrane27
  39. Oncospheres invade the intestinal wall and migrate to muscles via

    bloodstream25,26 Oncospheres develop into cysticerci, survive for several years in animal25 Cysticercus = larva encased in fluid-filled sac containing an invaginated scolex T. solium — Life Cycle, Part 1
  40. Humans (definitive host) ingest cysticerci in raw infected pork25 Cysticercus

    inverts body, attaches to the small intestine using scolex25 Evagination of scolex from cysticercus, releasing tapeworm Photo: © Lance Wheeler, 2018 at Texas A&M College of Veterinary Medicine, Department of Veterinary Pathobiology T. solium — Life Cycle, Part 1
  41. Matures into into an adult tapeworm in 2 months, survives

    in host for 2–3 years21,25 T. solium — Life Cycle, Part 1
  42. Grows longer, producing proglottids25 Proglottids mature, self- fertilize, produce eggs,

    and detach from posterior end25 Infectious eggs and proglottids shed in faeces25 T. solium — Life Cycle, Part 1
  43. Photos: Kim & Chung, 2017, Figure 2., dir.indiamart.com/impcat/niclosamide-drug.html, ryvispharma.com, drugs.com

    Taeniasis Taenia asiatica in intestine Intestinal infection with adult tapeworms21 • Symptoms are usually mild or non-existent25,27 • Include abdominal pain, loss of appetite, weight loss25 Treatment • Single doses of praziquantel (10 mg/kg) or niclosamide (1–2 g)21 • Albendazole at 400 mg for 3 consecutive days21
  44. Faecal microscopy: • Detection of eggs 2–3 months after infection

    is established25 • Taenia species can’t be identified by eggs alone 25 Observable expulsion of proglottids in faeces30 ELISA: • Detects genus-specific antigens in faeces30 • Not yet available outside the research setting25 Photos: cdc.gov/dpdx/taeniasis/index.html, wellnesslabinfo.blogspot.com/2015/04/parasite-in-our-body-tape-worms.html Diagnosis Taenia eggs in unstained wet mounts
  45. Infection in humans can occur without contact with swine by

    ingesting eggs or gravid proglottids in contaminated water31 Oncospheres hatch in intestine, migrate to multiple tissues and organs31 Mature into cysticerci over 60–70 days31 T. solium — Life Cycle, Part 2
  46. Tissue infection with T. solium larvae that migrate to muscle

    and organs (larva migrans)21 • Targets include muscles, skin, liver, heart, eyes, brain28,29,32 Symptoms depend on the location and load of infection, begin at variable times21,31 • Under skin: visible lumps31 • In muscle: usually do not cause symptoms31 • In nervous system (neurocysticercosis): severe headache, blindness, convulsions, epilepsy21,31 • Is major cause of adult onset seizures in most low-income countries21,31 Photos: Jakhere et al., 2011, Figures 1. & 3., ryvispharma.com Cysticercosis MRIs showing severe infection. Each white nodule is a cysticercus.
  47. • Corticosteroids (prednisolone, dexamethasone) to reduce inflammation28,31 Treatments: • Anticestodal

    drugs (albendazole, praziquantel)28,31 Cysticercosis Photos: ryvispharma.com, drugs.com, indiamart.com, myhealthyclick.com/wp-content/uploads/2020/07/dexamethason-for-coronavirus.jpg, Jakhere et al., 2011, Figures 1. & 3. • Antiepileptics (phenytoin, carbamazepine)28,31 • Surgery to remove cysts or to implant a shunt that redirects brain fluid28,31
  48. Microscopic analysis of tissue biopsy31 Serology: • Immunoblot assay to

    detect IgG antibody responses to cysticerci30,31 Brain scans: • Magnetic resonance imaging (MRI)31 • Non-contrast computed tomography (CT) scan31 Photos: cdc.gov/dpdx/cysticercosis/index.html Figures A and B, Carpio, 1998, Figure 1. Diagnosis CT scan showing many active cysts Section of human brain tissue with a cysticercus
  49. Vibrio cholerae Photos: “Cholera Bacteria” © Juergen Berger/Science Photo Library,

    September 11, 2018, on fineartamerica.com, sickholiday.com/food-poisoning/campylobacter,ssickholiday.com/food-poisoning/ campylobacter, pixels.com/featured/legionella-pneumophila-tem-eye-of-science Bacteria Legionella Campylobacter Shigella
  50. Gram-negative, motile bacteria causing cholera • ≈ 1.3 to 4

    million people around the world infected each year, with 21,000 – 143,000 deaths33,34 Symptoms begin in 12 hours – 5 days34 • Severe watery diarrhoea that causes dehydration, lethal within hours if left untreated34 • Shed in faeces for 1-10 days after infection34 Treatment: oral or intravenous hydration33 • Doxycycline for severe illness33 Photo: “Vibrio cholerae” © M. Stephen Trent, University of Georgia, on eurekalert.org/multimedia/827668 Vibrio cholerae
  51. During the 1800’s, cholera spread across the world from its

    original reservoir in the Ganges delta, India, causing 6 pandemics and killing millions34. Partly due to prevalence of infection, cholera became one of the first pathogens understood to be transmitted in water35. Photos: alamy.com/stock-photo-pollution-cartoon-1866-ndeaths-dispensary-an-1866-cartoon-indicating-95462093.html, brewminate.com/the-blue-terror-british-troops-and-cholera-in-19th-century-india Vibrio cholerae Boil order from 1866, London
  52. Immobile, rod-shaped, Gram-negative bacteria that cause bacillary dysentery (shigellosis)36 •

    80–165 million cases and 600,000 deaths annually, world-wide37 Symptoms begin 1–2 days after infection and last 7 days36,37 • Watery, bloody, or mucoid diarrhea, fever, stomach cramps Can resolve within 5–7 days with supportive care alone37 • Immunocompromised patients can be treated with fluoroquinolone, azithromycin, or ceftriaxone37 Photos: atlas.sund.ku.dk/microatlas/veterinary/bacteria/Shigella_sonnei/shigellasonnei.jpg, gettyimages.com, vecteezy.com Shigella Gram stain of Shigella Shigella growing in culture
  53. Gram-negative, motile bacteria causing campylobacteriosis38 • The most common bacterial

    cause of human gastroenteritis39 • ≈ 1 in 10 people are infected globally each year39 Symptoms begin 2 – 5 days after infection and last about 1 week38 • Diarrhea, fever, and stomach cramps • Generally mild and resolves on its own, except in young children and the immunocompromised39 Photo: "Campylobacter Jejuni Bacteria" © Steve Gschmeissner, July 1, 2016, on fineartamerica.com Campylobacter
  54. Includes 60+ species of Gram-negative bacilli bacteria, all causing a

    form of pneumonia called legionellosis40,41,42 • Transmitted by inhaling aerosolized contaminated water41 Symptoms develop in 2–10 days, with variable severity:42 • Mild fever (also called Pontiac fever)41,42 • Acute lung infection (also called Legionnaires’ disease) with 10% mortality rate41,42,43 Global incidence of legionellosis is unknown42 Photos: James Gathany, 2005, on phil.cdc.gov (ID#: 7925), specialpathogenslab.com/wp-content/uploads/2020/05/legionnaires-disease.jpg Legionella X-ray of Legionella patient Legionella in culture under UV light
  55. Can spread via faecal-oral route and contaminated water2,4,5,44,45 • Hepatitis

    A • Causes mild to severe inflammation of the liver • Most of those infected recover44 • Norovirus • Causes 1 in 5 cases of acute gastroenteritis world-wide45 • No specific medicines available, symptoms resolve in 1–3 days45 • SARS-CoV-2 coronavirus (COVID-19) • Causes acute respiratory illness • Shown to spread through plumbing systems of residential buildings via water aerosols5,46 Photos: "Sars-cov-2, Covid-19 Virus, Sem" © Science Source, September 7, 2020, on fineartamerica.com, ucl.ac.uk/infection-immunity/sites/infection_immunity/files/styles/large_image/public/1791-norovirus-virions-electron- micrograph.jpg, phil.cdc.gov/PHIL_Images/8153/8153_lores.jpg Viruses
  56. Cyanobacteria = photosynthesizing bacteria informally called blue-green algae Produce a

    range of powerful poisons called cyanotoxins47 • Exposure can damage brain, internal organs, gastrointestinal tract, and skin47,48 • Symptoms range from headache, pneumonia, fever, vertigo, gastrointestinal distress, skin rashes, to hayfever, possibly linked to liver cancer47,48 Algal blooms Photos: ecokeith.blogspot.com/2013/10/cyanobacteria-in-pinto-lake.html, micropia.nl/nl/ontdek/nieuws/2016/3/25/bacterien-eerder-ontdekt-dan-gedacht
  57. Boiling water does not remove most chemicals49 • Requires specific

    filtration or treatment Common sources:50,51,52,53,54 • Agriculture – pesticides, fertilizer, burning forests • Industry – manufacturing, resource extraction, construction • Pharmacy – antidepressants, antiepileptic drugs, hormones54 • Air emissions – waste incineration, fuel combustion Chemical Contamination Photos: awsassets.panda.org/img/pesticides_39194_363774.jpg, ak9.picdn.net/shutterstock/videos/19986109/thumb/1.jpg, fashionista.com/2017/11/riverblue-documentary-fashion-pollution
  58. VOC = volatile organic compounds • Emitted as gas, enters

    water supply55 • Includes oil and petrolium products, paints, solvents, refrigerants55 POP = persistent organic pollutants • Do not degrade in environment, bioaccumulative, highly toxic51,53 • Includes DDT, polychlorinated biphenyls (PCBs), and dioxins51,53 Photos: vectairsystems.com/reduce-vocs-to-reduce-the-risk-in-homes, modified from lifegate.it/bandite_e_non_bandite Chemical Contamination
  59. Heavy metals: acutely toxic, bio accumulative with long-lasting health impacts56

    Photos: modified from familyhandyman.com/list/what-you-might-not-know-about-treated-lumber, theodoregray.com/P eriodicTable/Samples/080.14/s14s.JPG, thumbs.dreamstime.com/b/lead-chemical-element-periodic-table-science- symbol-lead-chemical-element-107765974.jpg • Highly carcinogenic • Skin lesions, pigmentation changes • Nervous system damage • Neurological damage • Severe physiological disruption • Widespread oxidative damage • Neurological damage • Behavioral disturbances • Cognitive impairment • Immune and endocrine disruption 56,57 56,57,58 56, 57 Chemical Contamination
  60. Plastics can leach harmful chemicals into water:59, 60 Bisphenol A

    (BPA): common ingredient in plastic water and food containers, especially plastics #3, #6, and #759,60 • Mimics estrogen and interferes with endocrine system, causing behavioral issues, reproductive and immune disorders, obesity, and cancer59,61 Photos: wdy.h-cdn.co/assets/16/05/1454430555-bottles.jpg, blog.longevitywarehouse.com/wp-content/uploads/2015/03/recycle.jpg Chemical Contamination
  61. Plastics can leach harmful chemicals into water:59, 60 Phthalates: softener

    for various plastics, found in PVC pipes, food containers, cosmetic additives, and industrial wastewater59,62,63,64 • Highly carcinogenic, linked to diabetes and autism spectrum disorders62,64 Photos: nbcnews.com/health/kids-health/chemical-phthalates-food-packaging-linked-lower-iq-kids-n265721, istock.com Chemical Contamination
  62. Plastics can leach harmful chemicals into water:59,60 Microplastics: particles of

    degraded plastic 5 mm diameter ≤ • Bioaccumulate and act as carriers for other pollutants65,66,67. Toxicity following ingestion requires further research67. Photos: nzherald.co.nz/world/microplastic-pollution-much-worse-than-feared, nist.gov/image/microplastic-pollution, news.yahoo.com/microplastic-polluting-rivers-seas-across-122447629.html Chemical Contamination
  63. Making water safe for consumption follows three basic steps: Water

    Decontamination Photos: sciencenotes.org/does-boiling-water-get-hotter, modified from dreamstime.com Filter out solids Disinfect water Use and store
  64. A chemical method to precipitate solids from cloudy water68 Flocculation

    Before + Coagulant + Flocculant negative charge neutral charge net of particles Agents added to water to encourage formation of solids (flocs) in a polymer “net”68. Solids can then be removed through filtration. Photos: inyopools.com/Blog/difference-pool-clarifier-flocculant, modified from dober.com/haloklear/resources/intern-view-how-flocculation-helps-filtration
  65. Filters can be used to remove solids, pathogens, and pollutants

    from water Depending on size of filter pores, can also be used for disinfection Filtration Photos: modified from crystalquest.com/pages/what-is-ultrafiltration, modified from epicwaterfilters.com, ajayplumbing.com/whole-house-inline-water-filtration-system Stand-alone pitcher with filter or installation directly into plumbing
  66. Ceramics can filter water through fine pores69 Silver coating on

    ceramic filter, pot, or tablet enhances disinfection69,70,71,72,73,74,75 • Silver ions released in water have antibacterial and antiviral capability, reduce infectivity of parasites70,69,70 • Variable effectiveness depending on clay composition, 60-70% reduction in diarrheal disease documented by users76 Limit for silver in drinking water = 100 g/L μ 70 • Silver in nanoparticle form (50 nm diameter) shows adverse health and environmental effects above 1 ppm73 Photos: modified from Bogler & Meierhofer, 2015, Figure 1., modified from McBean et al. 2018, Figure 1., gmanetwork.com/news/scitech/photo/49983/dost-s-homegrown-ceramic-water-filter/photo Filtration
  67. Slow sand filtration: • One of the oldest and most

    effective water decontamination methods77, 78, 79 • 99 99.9999% reduction of − oocysts77 • 99 99.99% reduction of bacteria − 77 • Up to 99.9% reduction of viruses77 • 99.9% reduction of nanoplastics80 Activated charcoal can remove cyanotoxins and < 99% of chemical contamination81,82 Photos: cdc.gov/safewater/sand-filtration.html, thewaternetwork.com/_/water-treatment/blog-Jl6/case-study-6-4-drinking-water-through-household-level-bio-sand-filtration-in-pakistan-un-scap-policy- manual-2015-2FIxkTSlat0vARTkXFqlvA, modified from cleanwatergear.com/wp-content/uploads/2020/04/diy-water-filter.jpg Dirty water Rocks Course sand Charcoal Fine sand Cloth Clean water Filtration
  68. Centers for Disease Control and Prevention: • Bring water to

    a full rolling boil for 1 minute (3 minutes at elevation > 6,500 feet)68 • Allow to cool, store in sterile, closed containers with a tight-fitting lid83 Disinfect - Heat Photos: shtfpreparedness.com/safe-drinking-water, voanews.com/a/south-african-firm-aims-to-supply-millions-with-solar-cookers/1495436, boil_on_electric_stove.istockphoto.com Heating by fire Heating by solar oven Heating by electric stove
  69. World Health Organization: • Bring water to a rolling boil

    and immediately allow to cool84 Disinfect - Heat World Health Organization. (2015). Boil Water. WHO Press. Retrieved September 23, 2022 from https://apps.who.int/iris/re st/bitstreams/693418/retrieve Organism Temperature (°C) Inactivation Time (seconds) Escherichia coli 72 0.4 Vibrio cholerae 70 120 Campylobacter spp. 62 15 Legionella spp. 80 18-42 Hepatitis A 80 5 Cryptosporidium parvum 72 5-15 Giardia 70 600
  70. Sunlight (ultraviolet radiation) kills microbes • UVA light (320–400 nm)

    absorbed by the cell, creates oxidative stress that damages lipids, proteins and DNA84 • UVB (290–320 nm) and UVC (220nm– 290nm) light directly damage DNA84 Disinfect - UV Photos: weuvcare.com/uv-education, modified from Huang & Zhou, 2020, Figure 1., wallpapermaiden.com/wallpaper/7167/sunshine-reflection-sea-horizon-waves-beach radiation cell base and sugar damage single-strand break double-strand break DNA
  71. Solar disinfection: • Leave contaminated water in a transparent container

    and expose to strong sunlight for 6–8 hours if sunny, 2 days if cloudy85 • Single-use plastics are not designed for this purpose– degrade in sunlight and release various toxins60,86,87,88 • Glass containers preferable to plastic • Recommended to change plastic bottles after 6 months85 Disinfect - UV Photos: eleanorfoundation.co.uk/our-work/solar-disinfection-and-hand-washing, i.pinimg.com/originals/3f/e3/04/3fe30479fe35c8e39657fa81f3f2e8fd.jpg
  72. UV Water Treatment System: • Mechanical unit installed into house

    plumbing that passes water through a UV chamber89 Disinfect - UV UV chamber Sediment filters Photos: ontariohvacandwater.com/uv-disinfection-systems, waterfilteruae.com/product/aqua-whole-house-three-stage-jumbo-water-filteration-with-uv
  73. • Main method of disinfection for most municipal water sources90

    • CDC defines safe level of chlorine up to 4 mg/L91 • Minimum 0.2 mg/L required for disinfection to work90 • WHO recommends dosing clear water at 2 mg/L and turbid water at 4 mg/L90 • Some studies show link between chlorinated water consumption and various cancers92,93,94,95,96,97,98,99,100,101,102,102,103 • Chlorine can be removed via filtration82 Disinfect - Chemicals Photos: modified from da Cruz Nizer et al., 2020, Figure 2. Chlorination forms hypochlorous acid in water, perforating cell membrane, damaging DNA, and disrupting cellular processes104,105
  74. Iodine can be used during emergencies or travel as a

    temporary method for up to 3 weeks106,107 • Not recommended for pregnant women or those with thyroid problems107 Effective against bacteria and viruses; does not kill cryptosporidia107 • Available as 2% tincture:107,108 • 5 drops per L clear water, 10 drops per L cloudy water • Let sit for 30 minutes before use • Available as tetraglycine hydroperiodide tablet:106,108 • One tablet in 1 L water, or by manufacturer's instructions106,108 1-2 mg/day considered safe for most people, maximum levels for long-term remain undetermined106 Photos: gettyimages.com, preparednessadvice.com/iodine-tablets-for-water-purification Forms elemental iodine (I2 ) and hypoiodous acid (HIO) in water, acts as strong oxidant to disrupt proteins, nucleic acids, and metabolic pathways106,109 & Disinfect - Chemicals
  75. To sanitize dishes during a boil order:68 • Wash and

    rinse the dishes as normal, using hot water. • In a separate basin, add 2 drops (0.1 mL) of unscented liquid bleach per liter warm water (1 teaspoon per gallon). • Must contain 5%–9% sodium hypochlorite83 • Soak the rinsed dishes in diluted bleach for at least one minute. • Let the dishes air dry completely, allowing chlorine to evaporate before next use. Disinfect Dishes - Bleach Add the concentrated bleach to the water Photo: fortheloveofclean.com/household-love/specialty-cleaning/how-to-sanitize-dishes
  76. Household Management Use decontaminated water for:68 Use contaminated water for:68*

    * Given chemical contaminants are not present Drinking Brushing teeth Washing food Ice Washing dishes Laundry Cooking Showering Dishwashers – final rinse temperature of >66°C (150°F) Photos: modified from shutterstock.com/vectors
  77. Store water in sanitized, food-grade storage containers with lids that

    can be closed securely68 Store at least 4–5 liters (1 gallon) of water per person per day68 Recommended to store 3 days worth for drinking and sanitation during emergencies68 Single-use plastics, such as PET water bottles, should not be re-used or stored long-term110,111 Storage Photos: img.diytrade.com/cdimg/1469588/21772279/0/1306833994,rotodynamics.com/wp-content/uploads/2020/08/ custom-water-tanks.jpg, i.ndtvimg.com/i/2017-06/clay-pot-natural-cooling_696x400_61497441665.jpg,indiamart.com/ proddetail/water-storage-clay-pot-8683683730.html,Shachee Gandhi on pinterest.com, cdc.gov/safewater/storage.html
  78. Most plastics contain chemical additives that can leach out112,113,114,115,116,117,118,119 •Includes

    more chemicals than currently considered in public health science and policies112 #1 Polyethylene terephthalate can leach toxic antimony when heated, degrades with time86,87,119 #2,3 High-density polyethylene and polyvinyl chloride can leach phthalates64,87,118 #6 Polystyrene can leach styrene, a suspected carcinogen, when heated87,120 #7 “Other” plastics likely to leach BPA, phthalates, and other toxins when heated87,118 • Higher risks associated with #3, #6, #7 plastics87 • Lower risks associated with #2, #4 (low-density polyethylene), #5 (polypropylene) plastics87,121 Most plastics used in food containers and water bottles can release estrogen-mimicing chemicals if used repeatedly over time112,119 A Note on Plastics
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