Waterborne diseases continue to pose significant public health challenges globally, particularly in developing countries where water quality monitoring and infrastructure are often inadequate.
Water is essential for life but it can also be a medium for various pathogens that cause waterborne diseases.
Sean Mowbray in his article “ Pollution poses big risks to global clean water supplies, study shows ” expresses grave concern about water pollution globally.
Poor water quality can lead to waterborne diseases, impacting public health, and can degrade natural habitats, harming biodiversity.
Effective water management, therefore, must prioritize both ensuring sufficient water quantities and maintaining high water quality standards.
Waterborne diseases continue to pose significant public health challenges globally, particularly in developing countries where water quality monitoring and infrastructure are often inadequate. The recent tragic case of a 14-year-old boy in Kerala, who succumbed to amoebic meningoencephalitis, underscores the urgency of addressing water contamination issues.
Water is essential for life but it can also be a medium for various pathogens that cause waterborne diseases. According to the World Health Organisation (WHO) , contaminated water is a significant source of diseases like cholera, dysentery, typhoid and viral hepatitis. Cases of primary amoebic meningoencephalitis (PAM), caused by the brain-eating amoeba Naegleria fowleri, have once again highlighted the risks associated with inadequate water quality monitoring.
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Waterborne diseases are a significant public health issue, particularly in developing nations, where access to clean water and adequate sanitation is limited. The World Health Organisation estimates that around 2 billion people globally use drinking water sources contaminated with faeces, leading to diseases like cholera, typhoid and Hepatitis A and E, which cause almost or over 485,000 diarrheal deaths annually.
In India, these diseases are prevalent due to poor sanitation, inadequate water treatment facilities and rapid urbanisation that outpace infrastructure development. Contributing factors include (still largely prevalent) open defecation, inadequate sewage systems, improper waste disposal and climate change-induced flooding, contaminating water sources and increasing pathogen survival.
Improving sanitation through expanding access to toilets and promoting hygiene, enhancing water quality monitoring for early contamination detection and investing in advanced water treatment infrastructure are ways to combat waterborne diseases.
Public health education on safe water practices and strengthening policies and regulatory frameworks are crucial. Programs like the ‘ Swachh Bharat Mission ’ aim to eliminate open defecation and improve waste management. In contrast, initiatives like the ‘Safe Water Network’ create locally managed water enterprises to provide sustainable safe water. Collaborative efforts between government, NGOs, and the private sector are essential to ensure clean water and sanitation for all, ultimately reducing the burden of waterborne diseases.
Several recent cases of Naegleria fowleri, commonly known as the ‘brain-eating amoeba’, have gained attention following the tragic deaths of three children in Kerala.
Besides the 14-year-old boy, a five-year-old girl from Malappuram who died on May 21, and a 13-year-old girl from Kannur who died on June 25. This threat is not confined to India; an Israeli man also succumbed to the condition on July 7. Dr. Tushar Tayal, Lead Consultant at the Department of Internal Medicine at CK Birla Hospital in Gurugram, highlighted the necessity of understanding all aspects of this pathogen and ways to prevent it.
Brain-eating amoeba and suggestive preventive measures
Naegleria fowleri is a free-living microorganism that causes PAM, a severe and often fatal brain infection. It resides in warm freshwater environments such as lakes, rivers, and inadequately chlorinated swimming pools. The amoeba typically enters the human body through the nose during activities like swimming or diving in these waters.
Once inside, it travels to the brain, causing significant damage and laying thousands of eggs. Symptoms usually appear within a week of exposure and include intense headaches, fever, nausea and vomiting. As the infection progresses, affected individuals may experience seizures, mental changes, hallucinations, sensitivity to light, and eventual unconsciousness, often leading to death 10-15 days after symptoms onset.
Preventive measures are essential to reduce the risk of water entering the nasal passages. These include avoiding swimming in warm freshwater bodies, especially during high water temperatures, using nose clips or holding the nose shut while swimming or diving in warm freshwater, ensuring proper chlorination and maintenance of swimming pools and hot tubs, and using only distilled or sterilised water for nasal cleaning devices such as neti pots that can help clear the sinuses. However, they require sterilised water and proper use to avoid infections.
Diagnosis of primary amoebic meningoencephalitis (PAM) can be made by reviewing the patient’s clinical history, rapid onset of symptoms, and recent exposure to warm freshwater. Diagnostic methods include examining cerebrospinal fluid under a microscope, antigen tests, or PCR tests to detect Naegleria fowleri DNA, along with brain imaging techniques like CT or MRI scans to identify inflammation and brain changes.
Dr Tayal also emphasises the importance of early diagnosis and treatment due to the rapid progression and high fatality rate of PAM, stressing that awareness and preventive measures are crucial to safeguard against this deadly infection.
Sean Mowbray in his article “ Pollution poses big risks to global clean water supplies, study shows ” expresses grave concern about water pollution globally. Mowbray’s article, which was published in Mongabay , highlights the escalating global water crisis worsened by nitrogen pollution and other emerging contaminants.
A recent study in Nature Communications , further reveals that nitrogen pollution from agriculture and human waste could triple global water scarcity by 2050, affecting over 3,000 river basins.
The research, which examined over 10,000 river basins, found a dramatic increase in water scarcity when pollution factors were included. Benjamin Bodirsky from the ‘Potsdam Institute for Climate Impact Research’ in Germany emphasises the importance of clean water scarcity. They write that, “What we added to this [analysis] is clean water scarcity. We were looking at which rivers have sufficient water quality to support biodiversity and ecosystem functioning.”
The study’s findings underscore the severe public health implications of water pollution. Nitrogen pollution is known to cause toxic algae blooms, hypoxia, and fish kills, while contaminants like microplastics, heavy metals, and pharmaceuticals pose emerging threats.
Mengru Wang from ‘Wageningen University’, Netherlands, further exhorts, “You may have enough water, but if the quality is poor, then it cannot be safely used by humans or nature.” Wang underscores a critical aspect of water management: the importance of water quality alongside quantity.
Even with an ample water supply, if the water is contaminated, it poses significant risks to human health and ecosystems. Poor water quality can lead to waterborne diseases, impacting public health, and can degrade natural habitats, harming biodiversity. Effective water management, therefore, must prioritize both ensuring sufficient water quantities and maintaining high water quality standards. This dual focus is essential for sustainable development, ensuring safe drinking water for communities and preserving environmental integrity.
The convergence of pollution and climate change is further deteriorating water quality, with high temperatures exacerbating algal blooms and droughts increasing pollutant concentrations. Jan Semenza from Umeå University Sweden, warns of the “huge ramifications” for ecosystems and public health, stressing the necessity of clean water for both human and planetary health.
To combat these challenges, the researchers propose solutions such as improved fertilizer management, enhanced wastewater treatment, and a shift towards low-meat diets. However, even optimistic scenarios predicting significant positive changes still foresee clean water scarcity hotspots in regions like China, India, and Europe. The study calls for urgent action to address pollution and protect water systems. This is vital for healthy survival and mutual co-existence of nature, humans and wildlife.
