| Clinical Features |
A range of syndromes, including acute dehydrating diarrhea (cholera), prolonged febrile illness with abdominal symptoms (typhoid fever), acute bloody diarrhea (dysentery), and chronic diarrhea (Brainerd diarrhea). |
| Etiologic Agent |
Common agents include Vibrio cholerae, Campylobacter, Salmonella, Shigella, and the diarrheogenic Escherichia coli. |
| Incidence |
Each year, an estimated 4 billion episodes of diarrhea result in an estimated 2 million deaths, mostly among children. Waterborne bacterial infections may account for as many as half of these episodes and deaths. |
| Sequelae |
Many deaths among infants and young children are due to dehydration, malnutrition, or other complications of waterborne bacterial infections. |
| Transmission |
Contaminated surface water sources and large poorly functioning municipal water distribution systems contribute to transmission of waterborne bacterial diseases. Chlorination and safe water handling can eliminate the risk of waterborne bacterial diseases. |
| Risk Groups |
Over 2 billion persons living in poverty in the developing world are at high risk. Certain U.S. groups (residents of periurban "colonias" and remote rural areas with poor water treatment and delivery systems) are also at risk. |
| Surveillance |
Sporadic cases are under-reported. CDC surveillance may detect a small proportion of outbreaks in the United States; outbreaks abroad are often missed. |
| Trends |
Despite global efforts during the water and sanitation decade, improvements in water and sanitation infrastructure have barely kept pace with population increases and migrations in the developing world. |
| Challenges |
Centralized water treatment and distribution systems are expensive and take years to complete. To provide the under-served with potable water in the short term requires innovative practical solutions such as point-of-use disinfection and safe water storage vessels. |
| Opportunities |
Electrolytic generators that produce sodium hypochlorite from salt water are now affordable and available for use in the developing world. Villages that produce and use sodium hypochlorite and that store treated water in vessels to protect it from recontamination have had nearly 50% reductions in diarrheal disease incidence for pennies per family. This strategy has been successfully field tested in households in Bolivia, Zambia, Kenya, and Pakistan, in oral rehydration clinics in Guinea-Bissau, and among street vendors in Guatemala. |
