Risk of waterborne infection in BC

Issue: BCMJ, vol. 53, No. 8, October 2011, Pages 43\0 News
By: Perry Kendall, OBC, MBBS, MSc, FRCPC

BC physicians should be aware of the risk of waterborne infection in the province, particularly for immune-compromised individuals in communities with inadequately treated water supplies.

Cryptosporidium infection is of particular concern since it can cause severe disease in immune-compromised individuals and is not inactivated with chlorine. Conditions that in­crease the risk of severe Crypto­sporidium infection include:

• HIV infection with a CD4+ count of < 100 cells/mm3.
• Hematological malignancies (lymphoma or leukemia) under active treatment or in remission and off treatment for less than 1 year.
• Hematopoietic stem cell transplants.
• Primary immunodeficiencies that affect the number or function of CD4 cells, IFN-gamma and CD40 ligand such as severe combined immunodeficiency (SCID), selective IgA and Saccharomyces opsonin deficiencies, hyper-IgM syndrome and gamma-IFN deficiency

Individuals with the conditions listed above should consider the following additional drinking water treatments:

• Boiling. If the water supply is disinfected with chorine, simply bring water to a full boil. If the water supply is not disinfected with chlorine, filtered, or UV treated, boil for at least 1 minute (2 minutes at elevations >2000m).
• Filters. Filters used should be labeled as “Absolute” (1 micron or smaller), meeting ANSI/NSF International Standard #53. Jug-type filters and some built-in devices are not effective.
• Reverse osmosis.
• Ultraviolet treatment. Treatment must meet NSF Standard #55A.
• Bottled water. Check with company that water has been adequately treated.

Patients can be referred to HealthLink BC File #56, “Drinking Water and Those with Weakened Immune Systems” at www.healthlinkbc.ca/healthfiles/hfile56.stm. For more in­formation on the treatment of the local water system, contact your drinking water supplier or the drinking water officer in your health authority.
—Perry Kendall, MBBS
Provincial Health Officer

Perry Kendall, OBC, MBBS, MSc, FRCPC. Risk of waterborne infection in BC. BCMJ, Vol. 53, No. 8, October, 2011, Page(s) 43\0 - News.


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