This is a required core course for all Tufts Water Systems, Science and Society (WSSS) students but graduate students in other Tufts programs are welcome.
The Blue Death: Disease, Disaster and the Water We Drink. Harper Collins: New York 2007. Robert D. Morris. (Hereafter cited as Morris)
Hygiene Evaluation Procedures. Approaches and methods for Assessing Water- and Sanitation-Related Hygiene Practices. Almedom, Astier M., Blumenthal, Ursula, Manderson, Lenore. International Nutrition Foundation for Developing Countries. 1997.
The biological cycle of water and a brief distillation of human costs/risks/benefits as determined by quality and supply
Relevance to both domestic and international settings
Time and capital involved in procurement of water at the level of the household
Social and institutional factors influencing water and health
Connection between sanitation, potable water and other health indices: Case material from Stockholm, Chicago, Malaysia
Presentation of the basic vocabulary and concepts of the participating disciplines:
Bonn Recommendations for Action.
Gute, D.M. and Hanes, N.B. An applied approach to epidemiology and toxicology for engineers. U.S. Department of Health and Human Services. National Institute for Occupational Safety and Health. June, 1993. Units 1and 2.
Set of materials obtained from the World Health Organization Library. http://www.who.int/library
Environmental Water Flows. Social Impact. World Bank, 2003.
Equitable Child Health Interventions: The Impact of Improved Water and Sanitation. Bo Burström; Gloria Macassa; Lisa Öberg; Eva Bernhardt; Lars Smedman. American Journal of Public Health; Feb 2005; 95, 2.
Performance of the rural health improvement scheme in reducing the incidence of waterborne diseases in rural Sarawak, Malaysia. K.B. Liewa, M.Lepesteurb, Transactions of the Royal Society of Tropical Medicine and Hygiene (2006) 100, 949-955.
Public health investments and the infant mortality gap: Evidence from federal sanitation interventions on U.S. Indian reservations.Tara Watson. Journal of Public Economics 90 (2006) 1537-560.
3.2. Waterborne Disease
Who is at risk, what are the methods of transmission...
Overview of waterborne transmission
What makes infectious diseases epidemiology different from other fields of epidemiology?
Introduction of reproductive rate as a concept along with infectious dose; differences in clinical expression.
Surveillance for waterborne diseases: the good, the bad, and the ugly
Contrasting models of "simple" cycle infectious diseases (Crypto) versus complex, vector borne diseases such as Schistosomiasis
Introduction to water borne diseases including:
Polio and other Enteroviruses
Others such as Rotavirus
Zoonotic and human origins, Control strategies and engineering solutions
A model parasitic disease
Overlap of social and environmental factors
Role of mining and irrigation
Schisto as a "perfect infectious disease"
Role of human and animal sanitation
Sanitation methods to control
Need for molecular techniques for non-culturable pathogens
Morris Part I pp.1-108.
Bica, Ioana, Hamer, Davidson, Stadecker, Miguel J. Hepatic Schistosomiasis. Infections of the Liver. 14:583-604, 2000.
Danso-Appiah, A. Vlas, S.J. De, Bosompem, K.M. and Habbema, J.D.F. Determinants of health-seeking behaviour for schistosomiasis-related symptoms in the context of integrating schistosomiasis control within the regular health services in Ghana. Tropical Medicine and International Health. 9:784-794. 2004.
3. Sack, D.A, Sack, R.B., Balakrish, R. and Siddique, A.K. Cholera. Lancet. 363: 223-233. 2004.
4. Naumova EN, Christodouleas J, Hunter PR. Temporal and spatial variability in cryptosporidiosis recorded by the surveillance system in North West England in 1990 - 1999. Journal of Water and Health. (in press.)
5. Luby et al., Effect of handwashing on child health: a randomized controlled trial. Lancet 2005; 366:225-33.
6. Naumova, Egorov, Morris, & Griffiths. The Elderly and Waterborne Cryptosporidium Infection. Emerging Infectious Disease. Vol 9, No. 4. April 2003
7. Thapar and Sanderson. Diarrhoea in children: an interface between developing and developed countries. Lancet 2004; 363: 641-653.
8. Black, Morris, Bryce. Where and why are 10 million children dying every year? Lancet 2003; 361:2226-2234
3.3. Tools of Environmental Epidemiology
Surveillance and monitoring - classical and emerging techniques
Assessment and analysis
How do you make judgments about nature of the problem?
What sorts of assays are available?
Determining cause and effect
David A. Savitz and Christine L. Moe. Water: Chlorinated Hydrocarbons and Infectious Agents. Topics in Environmental Epidemiology. Steenland, K. and Savitz, D. (Eds.) Oxford University Press: New York, 1997. pp.64-118.
3.4. Waterborne Chemical Agents
EPA priority pollutants
Sources, environmental fate and transport
Rogers, Catriona, Tomita, Avoy, et al. Hair Analysis Does Not Support Hypothesized Arsenic and Chromium Exposure to Drinking Water in Woburn. Environmental Health Perspectives. 105: 1997.
Aurelio et al. Sources and Distribution of Arsenic in the Aberjona Watershed, Eastern Massachusetts. Water, Air and Soil Pollution. 1995. 81:265-282.
Davis et al. Groundwater transport of arsenic and chromium at a historical tannery, Woburn, Massachusetts. Applied Geochemistry. 1994. Vol 9; 569-582. 1994.
Industri-Plex Superfund Site remediation plan. 2005 US EPA.
3.5. Outbreak Investigation Exercise
This will be a hands-on exercise dealing with analysis of a waterborne disease outbreak, using information on possible routes of transmission, incubation time and host behaviors to deduce cause and propose control strategies.
Part II Morris pp. 111-214.
Additional readings to be assigned
3.6. Water Treatment Technology and Operations
Modern evidence that waterborne diseases occur in the US despite water treatment
Exploration of conditions that allow for this
Sanitation, Primary Prevention and Control Strategies - Overview
History of water treatment
Techniques of control
Land use and related issues
Sanitation as a cultural construct
Case of schistosomiasis control in Puerto Rico
3.6.1. Field Trips
Cambridge Water Treatment Plant Tour or Deer Island Treatment Plant NOTE: These activities will either be held during regular class hours BUT at the Fresh pond Water Treatment Facility in Cambridge, Massachusetts or outside of class footprint at Deer Island, Winthrop, MA.
Participants will receive instruction and practice field sampling techniques while on the Mystic River in Medford, MA. These samples will be processed and analyzed and the results discussed. Logistics and transportation to be specified.
Halliday, Stephen. The Great Stink of London. Sir Joseph Bazelgette and the Cleansing of the Victorian Metropolis. London: Sutton. 2001. pp. 1-15.
Melosi, Martin. The Sanitary City: Urban Infrastructure in America from Colonial Times to the Present. Baltimore: Johns Hopkins Press. 2000. pp. 1-57.
3.7. Sanitation and Point of Use Treatment
Selections from: Almedom, Astier, Blumenthal, Ursuala, Manderson, Lenore. Hygiene Evaluation Procedures: Approaches and Methods for Assessing Water- and Sanitation-Related Hygiene Practices. International Nutrition Foundation for Developing Countries, London: 1997.
3.8. Tap Water vs. Bottled Water
Risk comparisons and life cycle analysis
Is it safe, and what about all that plastic?
Science, market forces, and consumer demand - is there a disconnect?
3.9. Reports from the Field and Around the World
Point of use treatment techniques
Appropriate for pathogens or chemical contaminants
Safe and effective
Use locally available materials
Design that Matters
R Dillingham and RL. Guerrant, Childhood stunting: measuring and stemming the staggering costs of inadequate water and sanitation. Lancet 363 (2004), p. 94.
3.10. Zoonoses, Eco-health, and Conservation Medicine
Animal to human disease transmission
Environmental overlap with animal health
Food webs and non human systems
Patz et al. Effects of environmental change on emerging parasitic diseases. International Journal for Parasitology. 2000; 30: 1395-1405.
Norris, Douglas E. Mosquito-borne disease as a consequence of land use change. Ecohealth. 2004 1: 19-24.
Daszak et al. Infectious disease and amphibian population declines. Diversity and Distributions. 2003. 9: 141-150.
3.11. Wrap-up: Major Themes Revisited
3.12. Poster Session/Presentations
4. Evaluation Criteria
Term paper: pick a health outcome related to water and pick one or two global geographic areas (nations or regions) where it is public health problem, or one or two contrasting interventions and discuss: nature of the problem, choice of solution, pros and cons (technical feasibility, operational, financial, political, social feasibility) and your own recommendations*.
Based on the term paper, a poster session summarizing results
Midterm (take home)