Oral

The role of water in the causation of some U.S. illnesses and disease outbreaks needs to be better understood. The etiology of foodborne outbreaks is often linked to water. The use and consumption of contaminated water has caused a growing range and frequency of waterborne outbreaks. These outbreaks have a significant impact on public health in the U.S. and around the world. A significant portion of waterborne illnesses is most likely unreported or attributed to sources other than water. Findings of some studies suggest that 4%-12% of the estimated 211 million annual gastrointestinal illnesses in the U.S. may be attributed to water and 36% attributed to food. Detection and investigation of food and waterborne outbreaks have changed with the introduction of microbiological surveillance systems, such as PulseNet, allows the detection of outbreaks spread over the country and the world by matching genetic fingerprints of pathogens. This not only has enhanced our understanding of the interrelatedness and numbers of outbreaks that are occurring, but also emphasized the importance of understanding the interconnectedness of ecologies. To implement an effective prevention strategy, the environmental antecedents and contributing factors should be understood within an integrated systems perspective. A holistic investigation of food and waterborne outbreaks require that the dynamics of the interacting components be understood in the four dimensions (space and time). This is vital in devising a better informed prevention strategy because it emphasizes the understanding of the environmental contributing factors of these outbreaks within a system defined by the hydrological cycle. Local representations of the cycle can be used as the framework to better understand the health of the watershed, the dominant land use practices, types of water sources and potential sources of contamination, irrigation water, drinking water treatment and distribution systems, wastewater collection and treatment systems, and other uses of water. The Environmental Health Services Branch (EHSB) in the National Centers for Environmental Health (NCEH) at the CDC is working to answer surveillance, epidemiologic, behavioral and environmental health research questions and identify emerging public health issues. Through the use of the environmental health triads, systems theory, and the collaboration of state and national partners, CDC water teams have identified that almost half of all drinking water deficiencies were not under the jurisdiction of the water utility companies, and that nearly all waterborne disease outbreaks associated with contamination of source water, treatment facility, or distribution system occurred in systems using ground water. Much of them in houses that are served with both a private well and an onsite wastewater system. Thus surveillance data has led to the evaluation of current technologies and practices, identification of research priorities, as well as to emphasize the importance of a holistic view of the environmental conditions unique to each water system. Based on these findings and past experiences, EHSB and the EHS-Net Program have become increasingly important due to its role as a collaborative forum of environmental health specialists whose goals are to identify environmental antecedents to illness and disease outbreaks, translate findings into improved prevention efforts using a systems approach, offer training opportunities, and to strengthen collaboration among epidemiology, laboratory, and environmental public health service programs. The purpose of this session will be to introduce the disease ecology approach and the work that EHSB is currently conducting on water and food, and their related systems.

Session Objectives: 1. Describe the role of environmental health in the ecology of disease and how EHSB has utilized systems theory as a construct to understand the interaction between water systems and public health. 2. Identify the EHSB’s Environmental Health Services Network (EHS-Net) Program and describe how EHS-Net utilizes a collaborative forum comprised of environmental health specialists, epidemiologists and laboratorians to understand contributing factors and environmental antecedents in food and waterborne disease outbreaks. 3. Evaluate the role of environmental assessments in the investigation of food and waterborne disease outbreaks and identifying environmental factors related to these disease outbreaks.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)