Waterborne diseases: Water can be dangerous

Waterborne diseases are those that are transmitted by drinking unhealthy water. Unfortunately, they are a major cause of morbidity and mortality, especially in children in our country. About 20 per cent of the communicable diseases in India are waterborne. Poor sanitation, improper storage of water and lack of proper waste disposal are the main causes of water contamination.

Following are some of the common waterborne diseases in our population.

Gastroenteritis [diarrhoea, dysentery]

This results from consumption of water contaminated by either viruses [Rota], bacteria [E.coli, salmonella, shigella, cholera] or protozoa [Amoebiasis, giardiasis]. The most common symptom is sudden onset of loose watery stools. It may be associated with vomiting, fever, crampy abdominal pain and blood in stools [dysentery]. Most often these infections are self-limited and last for a few days. Some infections may last for more than 3-4 weeks.

A common complication is dehydration, as indicated by increased thirst, lethargy, dark coloured and reduced quantity of urine. Children are more prone to dehydration than adults. Deaths due to diarrhoea are common in children below the age of five.

Treatment involves hydration, orally or through intravenous supplementation. Oral dehydration solution [ORS] available as a WHO[World Health Organisation] formula is the cornerstone of treatment in children. Short courses of antibiotics are required in few cases.

Viral Hepatitis [Jaundice]

Hepatitis A and E viruses are the most common cause of jaundice in our country. Viral Hepatitis starts with initial period of fever, nausea, vomiting for 3-4 days, followed by onset of jaundice. It usually lasts for 3-4 weeks. It resolves on its own and is, at times, complicated by liver failure. Pregnant women need to be more careful as chances of liver failure are more if hepatitis E develops during pregnancy. No specific medicines are required for treatment. Dietary restrictions are not necessary.

Common treatments with alternative medicines are of questionable benefit and may cause harm in some patients.

Typhoid fever [ Enteric fever]

Infection by certain bacteria [Salmonella typhi and paratyphi] causes this fever. It begins as high grade fever, loss of appetite and lethargy. Blood tests [Widal test, blood culture] are useful in the diagnosis of typhoid fever.

Treatment with antibiotics such as ciprofloxacin, ceftriaxone or azithromycin are an effective cure for typhoid fever.

Cholera

A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. Human behaviour related to personal hygiene and food preparation contributes greatly to the occurrence and severity of cholera.

WHO recommends improvements in water supply and sanitation as the most sustainable approach for protection against cholera. Safe and effective oral cholera vaccines are also available.

Prevention

Waterborne diseases are easily preventable.

• Consumption of water from unhygienic places should be avoided. Simple boiling of water kills most of theses germs and makes water safe for drinking.
• Vaccination: A vaccine is available for Hepatitis A and can be administered to children. Most adult Indians do not need a vaccine for Hepatis A because clinical jaundice or asymptomatic infection in their childhood makes them immune to the disease. Hepatitis E vaccine is not yet available in the market. Typhoid vaccine is available in oral or injectable form. Immunity through the typhoid vaccine is short and vaccination needs to be repeated every 3-4 years.