Food and Waterborne

Diseases
Dr Vinod Kumar
Why Food and Waterborne
Diseases
Lack of Safe Drinking Water

Lack of Basic Hygiene & Sanitation

Poverty & Overcrowding

Lack of Awareness
Importance of Water
of the Earth is filled with water
Our body has 35 – 40 L of water
arcity of Drinking Wate
 Ever Thought of !!
How Much Water is
there on the Earth
Salt Water
§1.4 million Km3
§Comprises 97.5% of

Global Water

Fresh Water
( Remaining 2.5%)
§99% unavailable
§Remaining less than

1% is available for
drinking which comprises less than 0.009% of total.
§ 1/6 of the world
population
(1,100,000,000)
do not have
access to safe
drinking water
Acute Diarrheal Diseases

Viral Hepatitis

???
 Acute Diarrhoeal
Diseases
What is Diarrhoea?
• Passage of loose, liquid or watery
stools
• Usually when the frequency
increases beyond 3 times in a day
• Change in consistency is more
important than the frequency
Why Talk of Diarrhoeal
Diseases
Major problem in the developing countries

Approximately 1.5 billion episodes of diarrhoea occur

worldwide every year killing 1 -3 million people – almost 95 %
of whom are children below 5 years of age.

The occurrence of diarrhoea in a developing country like ours

is usually due to infection and is an indicator of poor hygiene
and sanitation standards.

Diarrhoeal diseases are not confined only to children but can

strike with vigor in adults too causing deaths & suffering.

An episode diarrhoeal illness leaves the patient weak, listless

& incapable of active working for at least a week.
How does Diarrhoea
Affect Us
Frequent loose stools causes loss of
body water and salts giving rise to
dehydration and derangement of
normal body functions.

If not controlled in time continued fluid

& electrolyte loss causes a drop in
blood pressure followed by effects on
other organs including kidneys & brain,
finally leading to shock, coma and
 How do we Get
Diarrhoea
Diarrhoea indicates poor hygiene
and sanitation.

Transmitted by contaminated food

and water.

The organisms from the faeces of

infected patients must gain access
to another person. This is easily
done when the disposal of excreta
CHOLERA
Vibrio Cholerae (Bacteria)
Clinical Features : The onset is abrupt 1-5 days after
infection. There is profuse, painless watery diarrhoea with
typical ‘rice water stools’. The patient may pass as much as
40 stools in a day and rapidly passes into the stage of
profound dehydration, shock and collapse. Sometimes the
volume of stools is so much that the patient passes into
shock in as less as 2 – 3 stools. Severe muscle cramps may
result from loss of salt & electrolytes and the patient
becomes restless & severely dehydrated. Abdominal pain &
blood in stools are NOT typical of cholera. Death occurs due
to severe dehydration & collapse.

Usually occurs in epidemic form affecting a large no of

persons in a community. One must suspect cholera in a
sudden explosive outbreak of diarrhoea in a community and
the water source must immediately be looked into.

Cholera has the notorious distinction of causing explosive

outbreaks and spreading on a global scale causing
pandemics (a global scale epidemic). There have been 7
Amoebic Dysentery
Entamoeba Histolytica (Protozoa)

Clinical Features:The onset is gradual after a

period of 1 – 3 weeks of infection. The features
are of frequent small volume loose stools with
cramping pain mainly of the lower abdomen. The
stools typically have blood and mucus. The pain is
relieved by passage of stools but returns shortly
with an urge to pass more motion. Fever may be
present. The infection may pass into the liver
causing liver abscesses.

Amoebiasis renders many people as healthy

carriers who effectively pass the cysts of amoeba
in their stools without being symptomatic.

 Mode of transmission : Contamination of food

Bacterial Dysentery
Various Bacteria mostly Shigella

Clinical features : The onset may be gradual or

acute depending on the virulence of the infecting
organism. Shigella is a bacteria associated with
the most dangerous form of bacterial dysentery
commonly known as bacillary dysentery.

The symptoms are similar to that of amoebic

dysentery but are comparatively more severe.

Bacillary Dysentery is known to cause serious

complications in some of the patients. These
include kidney failure, convulsions, joint
abnormalities, drop in blood cell counts and
disorders of small / large intestines.
Food Poisoning
Various Organisms or their Toxins

Food poisoning is a collective term for an acute

gastroenteritis caused by ingestion of food or
drink contaminated with either living bacteria or
their toxins. In addition even poisoning of food by
chemical or organic poisons leading to
gastroenteritis is included under this group.

The condition has three defining features : (a)

attack of many persons at the same time (b)
history of ingestion of a common food & (c)
similarity in signs & symptoms of those affected

 Presence of severe vomiting in addition to

Food Poisoning
Various Organisms or their Toxins

Food poisoning due to existing toxins of certain bacteria

leads to symptoms within six hours of eating contaminated
food, which include upper abdominal pain, nausea, vomiting
& diarrhoea. Such bacteria commonly contaminate milk and
milk products, fried rice and other preparations of Chinese
cuisine.

 Sometimes food poisoning results from some bacteria

which multiply and infect our gut. In such cases the onset is
delayed by 12 – 48 hours after consumption of contaminated
food and symptoms consist of diarrhoea associated with
abdominal cramps and pain. Fever may typically be present
but vomiting is infrequent. Such bacteria commonly
contaminate cooked food especially meat which has been
stored and repeatedly reheated before consumption.

 Some species of fishes and shellfishes contain powerful

toxins which are not destroyed even when well cooked. The
Traveller’s Diarrhoea
Escherichia coli

Travellers easily fall prey to diarrhoea on visit

to non native countries, especially in the tropics
when they consume food from places with
inadequate hygiene.

The severity varies from mild self limiting

diarrhoea to severe dehydration depending on the
causative organism.
Viral Diarrhoea
Rotavirus & Norwalk Viruses

Rotavirus causes the disease in young Children

while the latter causes diarrhoea in young adults

Profuse watery diarrhoea

Usually Self Limiting
Treatment of Acute
Diarrhoea
Most patients with acute diarrhoea can
be managed symptomatically with
fluid replacement therapy.

Antibiotics and diet modification also

have a secondary role in controlling
diarrhoea.
 ORS

ORS is the abbreviation for Oral

Rehydration Salts.
It is a balanced mixture of all essential
salts which can be dissolved in
drinking water easily to prepare an
ideal solution to replenish the salts &
water lost in diarrhoea (rehydration).

This method of rehydration is so

simple that even the most illiterate of
The presence of all essential salts in
the correct proportions helps to
normalize the salt loss in addition to
catering for water loss.

Miraculous impact in treating cases of

dehydration except in those most
severely affected

Now the use of ORS saves 1 – 1.5

million lives annually!!
 Is ORT Really
Effective
In a study by Mackenzie, et.al, 111
children were randomised to either
ORS (containing 50 mmol Na) given
over 6 hours or IV therapy given over
12 hours.

ORS failed in only 2 children (a failure

rate of 3.8%).

ORS was found to be as good as IV

rehydration when judged by
biochemical parameters and there
The second study by Sharifi compared 470 children
randomised to ORS or IV therapy.

Two different ORS were used in this study. Solution A

with a sodium content of 80mmol and osmolarity of 270
was given until signs of dehydration had disappeared
followed by solution B with 40 mmol sodium and an
osmolarity of 270 which was used for maintenance.

The aim of this study was to compare the two therapies

in severe dehydration but in fact the mean weight gain
in the study group at discharge was 8.9% and 7.2% in
the control group.
The results showed that nearly 99% of
children in the oral group were successfully
treated with ORS.

Duration of diarrhoea in hospital was found to

be significantly less in the oral group.

Oral rehydration should be the standard

treatment for children with mild moderate
dehydration secondary to gastroenteritis
 Viral Hepatitis

Infection of Liver caused by any of the

six viruses implicated.

Two of these are food/ water borne

while others are Blood Borne / Sexually
transmitted
Symptom Profile
Hepatitis A
Hepatitis A Virus (HAV)

 Commonly known as ‘Infective Hepatitis’

 Virus is passed in stools
 Spread by contaminated Food & water
 Usually the patients recover after a bout of
acute illness and jaundice. Serious
complications & death are very rare.
 Chronic carriers state is not seen.
 No risk of Liver cancer & chronic liver disease
 Proper hygiene & sanitation with safe drinking
water & food is the mainstay of prevention.
 Effective vaccine is now available but limited
by high cost.
Hepatitis E
Hepatitis E Virus (HEV)
Spreads by contaminated food and water.
 Cases increasing in various parts of India

and in countries having a hot climate.

First major epidemic in Delhi in 1995 – 96

(30,000 cases)
 Extremely dangerous in pregnancy.

 No vaccine available at present.

Proper hygiene & sanitation with safe

drinking water & food is the mainstay of

prevention.
 Control Strategy

Control of
Control of Vaccine
Transmissio
Reservoir n

Sanitary Limited
Not very
Disp of value
Effective Excreta
Handwashin No Vaccine
g Against HEV
Safe
Drinking
Water