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Objectives

  • Emphasis is placed on participants understanding the biology of water and health.
  • Participants will demonstrate knowledge of the central role of water in
  • health, including adequate hydration.
  • Presentation of detailed coverage of selected prototypic or model diseases which include schistosomiasis, cryptosporidiosis, cholera, and others.
  • Participants will understand animal/human interactions and ecological
  • factors that affect human host susceptibility.
  • Participants will become familiar with widespread chemical agents and
  • their interactions with pathogens.
  • Participants will demonstrate a familiarity with the appropriate methods of
  • assessing the occurrence of water borne disease.
  • Participants will become knowledgeable about the principal methods of controlling the propogation of water-borne diseases.
  • Participants will become knowledgeable about the social and institutional factors influencing sanitation and water treatment decisions, and the subsequent impacts on a variety of health indices.

1. General

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.

2. Reading

2.1. Required

  • 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.

3. Topics

3.1. Overview

  • Content

  • Expectations

  • 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:

    • Clinical medicine

    • Environmental epidemiology

    • Environmental engineering

    • Ecology

    • Veterinary medicine

3.1.1. Readings

  • Bonn Recommendations for Action.
    http://www.water-2001.de/outcome/BonnRecommendations/Bonn_Recommendations.pdf

  • 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:

    • Hepatitis A

    • Polio and other Enteroviruses

    • Others such as Rotavirus

  • Cryptosporidium

    • Zoonotic and human origins, Control strategies and engineering solutions

  • Schistosomiasis

    • A model parasitic disease

  • Overlap of social and environmental factors

    • Role of mining and irrigation

    • Schisto as a "perfect infectious disease"

  • Cholera

    • History

    • Role of human and animal sanitation

    • Sanitation methods to control

    • Need for molecular techniques for non-culturable pathogens

3.2.1. Readings

Required:

  • Morris Part I pp.1-108.

Supplemental:

  • 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

  • Identifying outbreaks

  • Assessment and analysis

    • How do you make judgments about nature of the problem?

    • What sorts of assays are available?

    • Spatial analysis

    • Determining cause and effect

3.3.1. Readings

  • 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

  • Lead

  • Arsenic

  • Endocrine disrupters

  • Pesticides

  • Antibiotics

    • Woburn case

    • EPA priority pollutants

    • Emerging contaminants

    • Sources, environmental fate and transport

3.4.1. Readings

  • 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.

3.5.1. Readings

  • 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, history

    • Sanitation as a cultural construct

    • Case of schistosomiasis control in Puerto Rico

3.6.1. Field Trips

  1. 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.

  2. 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.

3.6.2. Readings

  • 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

3.7.1. Readings

  • 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

  • Criteria:

    • Low cost

    • Safe and effective

    • 'Trainable'

    • Use locally available materials

3.9.1. Readings

  • Design that Matters
    http://www.designthatmatters.org/

  • 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

3.10.1. Readings

  • 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

  1. 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*.

  2. Based on the term paper, a poster session summarizing results

  3. Midterm (take home)

  4. Homework exercises

  5. Class participation

    Term paper

    30%

    Poster

    20%

    Midterm

    20%

    Homework Exercises

    25%

    Number 1

    10%

    10%

    5%

    Number 2

    Number 3

    Class participation

    5%