GLOBAL HEALTH | Addressing the world’s health challenges
31 October 2008
Team Fights Waterborne Diseases in Developing Countries
U.S. health agency provides expertise in dealing with cholera outbreaks
Littleton, Colorado — An expert team from the U.S. Centers for Disease Control and Prevention (CDC) traveled to the small West African country of Guinea-Bissau in September to help control an outbreak of cholera, which so far has killed 200 and sickened 12,000.
The team is part of a larger CDC program that works in developing countries to control and prevent waterborne diseases such as cholera, typhoid fever and dysentery, which often are spread in contaminated drinking water.
CDC considers requests from any country to provide expert assistance when an outbreak of a disease with international importance occurs.
Prevention of waterborne disease also is addressed through the CDC Safe Water System (SWS) program, a water-quality intervention proven to reduce diarrheal disease by an average of 50 percent.
The SWS uses simple, effective and inexpensive technologies, such as adding a few drops of dilute bleach solution to drinking water stored in safe, covered containers. SWS programs have been implemented in more than 25 countries in Africa and Asia.
Waterborne pathogens often cause diarrheal disease, a serious international problem.
“Too often it is forgotten that 2 million children under age 5 die every year of diarrhea, most of them because of unsafe drinking water and poor sanitation,” Eric Mintz, leader of the CDC diarrheal diseases epidemiology team, told America.gov.
“A cholera outbreak gets international attention,” Rochelle Rainey, an environmental health technical adviser with the U.S. Agency for International Development (USAID), told America.gov. “Adults can sometimes die within hours of contracting the disease.” International attention can be lacking for the thousands of children who die every day from diarrhea, even though solutions are available to greatly reduce this tragedy, she said.
“Even nonfatal diarrheal disease is a critical concern, especially for children,” Rainey said. “Diarrhea and poor nutrition have lifelong effects for children, leading directly to decreased physical and cognitive development.”
Providing piped, treated drinking water for all people is a necessary but slow and expensive process, Mintz said. “CDC’s SWS program is a temporary measure to help children and adults survive until the day when they have access to piped, treated drinking water,” he said.
The SWS program and CDC outbreak response teams are funded by numerous U.S. sources, including two government agencies, the CDC and USAID.
Support comes from U.S. businesses and trade groups (such as Procter & Gamble, Arch Chemicals and the Chlorine Chemistry Council), charitable foundations (including the Bill & Melinda Gates Foundation), faith-based organizations (such as Gift of Water and the Southern Baptist Convention), and many universities (including Harvard University, Massachusetts Institute of Technology and Emory University).
International partners include governments in project countries, UNICEF, the World Health Organization, the Red Cross, CARE and Project Hope.
CDC’s SWS program is one component of USAID’s strategy to help increase access to safe drinking water and adequate sanitation worldwide, Rainey said.
“Safe drinking water is part of the first line of defense to break transmission of diarrheal disease, especially in acute outbreaks such as cholera," she added.
The SWS prevention program focuses on:
• Point-of-use treatment of contaminated water using a dilute bleach solution that is locally produced, marketed and purchased.
• Safe water storage to prevent recontamination.
• Hygiene-behavior changes, such as appropriate hand washing.
These behavior changes are a critical aspect needed to stop continued illnesses, Mintz said.
CDC INTERNATIONAL ASSISTANCE
Preventing diarrheal disease is difficult and complicated, Rainey said. The SWS program is effective when used correctly, but millions of people do not have access to the program (or other treatment) or do not follow the program correctly.
“Although cholera outbreaks still occur in countries where the SWS is available, we know they can be more quickly contained where household water-treatment products are widely available and where the accompanying behavior-change messages are already familiar to the population,” Mintz said.
Guinea-Bissau currently lacks a SWS program, and that country has had seven cholera epidemics in the past 12 years.
“We hope that the 2008 epidemic could be a stimulus to initiate a much-needed SWS program there,” Rob Quick, CDC medical epidemiologist, told America.gov.
In 2008, assistance provided by the CDC outbreak response team included recommendations that Guinea-Bissau implement simple household water chlorination, increase laboratory capabilities, improve municipal water disinfection and teach hygiene behaviors, Mintz said. Also, the CDC lab in Atlanta helped with diagnostic testing.
In Afghanistan, SWS program partners are responding to the 2008 cholera epidemic there by sending SWS water-treatment solution to affected areas, Quick said. Afghanistan authorities say more than 1,000 cases have been reported, including 17 deaths since September. Authorities attribute the outbreak to contaminated water supplies and poor sanitation.
In Kenya, the SWS project began in 2000, with initial results showing that the program reduced risks of diarrheal disease in rural communities by 56 percent. By 2007, CDC-partner Population Services International had sold about 1.2 million bottles of locally produced chlorine solution for household water treatment. But cholera remains a problem, with 12 to 14 small outbreaks so far in 2008, during which a local CDC-sponsored response team provided technical assistance for outbreak control.
More information about the Safe Water System is available at the program’s Web site.
