Mystery of Cl2 resistant pathogens

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Alkalinity is one of the first considerations when it comes to the chemical quality of source water. Alkalinity is not a pollutant. It is a total measure of the substances in water that have "acid-neutralizing" ability. Don't confuse alkalinity with pH. pH measures the strength of an acid or base; alkalinity indicates a solution's power to react with acid and "buffer" its pH - that is, the power to keep its pH from changing. To illustrate, we will compare two samples of pure water and buffered water. Absolutely pure water has a pH of exactly 7.0. It contains no acids, no bases, and no (zero) alkalinity. The buffered water, with a pH of 6.0, can have high alkalinity. If you add a small amount of weak acid to both water samples, the pH of the pure water will change instantly (become more acid). But the buffered water's pH won't change easily because the Alka-Seltzer-like buffers absorb the acid and keep it from "expressing itself."

Although chlorine is the primary disinfectant of choice in water treatment practice, many waterborne pathogens are resistant to chlorine and are often found in finished water. These chlorine-resistant pathogens include viruses, parasites, and bacteria that can cause hepatitis, gastroenteritis, cryptosporidiosis, and Legionnaires' disease. In the past decade, some water treatment advancements have improved disinfection efficiency. Enhanced coagulation process and rapid sand filtration have been used to effectively remove a significant percentage of Cryptosporidium and Cyclospora. Post-treatment or on-site disinfection are also available to enhance the biological safety of drinking water.

For example, the Pittsburgh Water and Sewer Authority studied post-treatment options in an uncovered reservoir to remove Giardia cysts and Cryptosporidium oocysts. How does chlorine carry out its well-known role of making water safe? Upon adding chlorine to the water, two chemical species, known together as "free chlorine," are formed. These species, hypochlorous acid (HOCl, electrically neutral) and hypochlorite ion (OCl-, electrically negative), behave very differently. Hypochlorous acid is not only more reactive than the hypochlorite ion but is also a stronger disinfectant and oxidant. The ratio of hypochlorous acid to hypochlorite ion in water is determined by the pH. At low pH (higher acidity), hypochlorous acid dominates while at high pH hypochlorite ion dominates.

Thus, the speed and efficacy of chlorine disinfection against pathogens may be affected by the pH of the water being treated. Fortunately, bacteria and viruses are relatively easy targets of chlorination over a wide range of pH. However, treatment operators of surface water systems treating raw water contaminated by the parasitic protozoan Giardia may take advantage of the pH-hypochlorous acid relationship and adjust the pH to be effective against Giardia, which is much more resistant to chlorination than either viruses or bacteria.

Another reason for maintaining a predominance of hypochlorous acid during treatment has to do with the fact that pathogen surfaces carry a natural negative electrical charge. These surfaces are more readily penetrated by the uncharged, electrically neutral hypochlorous acid than the negatively charged hypochlorite ion. Moving through slime coatings, cell walls, and resistant shells of waterborne microorganisms, hypochlorous acid effectively destroys these pathogens. Water is made microbiologically safe as pathogens either die or are rendered incapable of reproducing. A typical bacterium has a negatively charged slime coating on its exterior cell wall, which is effectively penetrated by electrically neutral hypochlorous acid, favored by lower pHs.

Chlorine is added to drinking water to destroy pathogenic (disease-causing) organisms. It can be applied in several forms: elemental chlorine (chlorine gas), sodium hypochlorite solution (bleach), and dry calcium hypochlorite. When applied to water, each of these forms "free chlorine". One pound of elemental chlorine provides approximately as much free available chlorine as one gallon of sodium hypochlorite (12.5% solution) or approximately 1.5 pounds of calcium hypochlorite (65% strength). While any of these forms of chlorine can effectively disinfect drinking water, each has distinct advantages and limitations for particular applications. Almost all water systems that disinfect their water use some type of chlorine-based process, either alone or in combination with other disinfectants.

The Benefits of Chlorine.

  • Potent Germicide-Chlorine disinfectants can reduce the level of many disease-causing microorganisms in drinking water to almost immeasurable levels.
  • Taste and Odor Control -Chlorine disinfectants reduce many disagreeable tastes and odors. Chlorine oxidizes many naturally occurring substances such as foul-smelling algae secretions, sulfides, and odors from decaying vegetation.
  • Biological Growth Control -Chlorine disinfectants eliminate slime bacteria, molds, and algae that commonly grow in water supply reservoirs, on the walls of water mains, and in storage tanks.
  • Chemical Control-Chlorine disinfectants destroy hydrogen sulfide (which has a rotten egg odor) and remove ammonia and other nitrogenous compounds that have unpleasant tastes and hinder disinfection. They also help to remove iron and manganese from raw water.

It is easy to take for granted the safety of modern municipal drinking water, but prior to widespread filtration and chlorination, contaminated drinking water presented a significant public health risk. The microscopic waterborne agents of cholera, typhoid fever, dysentery, and hepatitis A killed thousands of U.S. residents annually before disinfection methods were employed routinely, starting about a century ago. Although these pathogens are defeated regularly now by technologies such as chlorination, they should be thought of as ever-ready to "stage a come-back" given conditions of inadequate or no disinfection. Illnesses Associated with Waterborne Pathogens Worldwide, about 1.2 billion people lack access to safe drinking water, and twice that many lack adequate sanitation.

As a result, the World Health Organization estimates that 3.4 million people, mostly children, die every year from water-related diseases (WHO, 2002a). In the U.S., outbreaks are commonly associated with contaminated groundwater that has not been properly disinfected. In addition, contamination of the distribution system can occur with water main breaks or other emergency situations (CDC, 2002). Drinking water pathogens may be divided into three general categories: bacteria, viruses, and parasitic protozoa. Bacteria and viruses contaminate both surface and groundwater, whereas parasitic protozoa appear predominantly in surface water.

The purpose of disinfection is to kill or inactivate microorganisms so that they cannot reproduce and infect human hosts. Bacteria and viruses are well controlled by normal chlorination, in contrast to parasitic protozoa, which demand more sophisticated control measures. For that reason, parasitic protozoan infections may be more common than bacterial or viral infections in areas where some degree of disinfection is achieved. Bacteria Bacteria are microorganisms often composed of single cells shaped like rods, spheres, or spiral structures. Prior to widespread chlorination of drinking water, bacteria like Vibrio cholerae, Salmonella typhoid, and several species of Shigella routinely inflicted serious diseases such as cholera, typhoid fever, and bacillary dysentery, respectively.

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As recently as 2000, a drinking water outbreak of E. coli in Walkerton, Ontario sickened 2,300 residents and killed seven when operators failed to properly disinfect the municipal water supply. While developed nations have largely conquered water-borne bacterial pathogens through the use of chlorine and other disinfectants, the developing world still grapples with these public health enemies. Viruses are infectious agents that can reproduce only within living host cells. Shaped like rods, spheres, or filaments, viruses are so small that they pass through filters that retain bacteria. Enteric viruses, such as hepatitis A, Norwalk virus, and rotavirus are excreted in the feces of infected individuals and may contaminate water intended for drinking. Enteric viruses infect the gastrointestinal or respiratory tracts and are capable of causing a wide range of illnesses, including diarrhea, fever, hepatitis, paralysis, meningitis, and heart disease (American Water Works Association, 1999). Protozoan Parasites Protozoan parasites are single-celled microorganisms that feed on bacteria found in multicellular organisms, such as animals and humans.

Several species of protozoan parasites are transmitted through water in dormant, resistant forms, known as cysts and oocysts. According to the World Health Organization, Cryptosporidium parvum oocysts and Giardia lamblia cysts are introduced to waters all over the world by fecal pollution. The same durable form that permits them to persist in surface waters makes these microorganisms resistant to normal drinking water chlorination (WHO, 2002b). Water systems that filter raw water may successfully remove protozoan parasites.

Emerging Pathogens

An emerging pathogen is one that gains attention because it is one of the following: a newly recognized disease-causing organism; a known organism that starts to cause disease; an organism whose transmission has increased. Cryptosporidium is an emerging parasitic protozoan pathogen because its transmission has increased dramatically over the past two decades. Evidence suggests it is newly spread in increasingly popular day-care centers and possibly in widely distributed water supplies, public pools, and institutions such as hospitals and extended-care facilities for the elderly. Recognized in humans largely since 1982 and the start of the AIDS epidemic, Cryptosporidium is able to cause potentially life-threatening disease in the growing number of immunocompromised patients.

Cryptosporidium was the cause of the largest reported drinking water outbreak in U.S. history, affecting over 400,000 people in Milwaukee in April 1993. More than 100 deaths are attributed to this outbreak. Cryptosporidium remains a major threat to the U.S. water supply (Ibid.). The EPA is developing new drinking water regulations to reduce Cryptosporidium and other resistant parasitic pathogens. Key provisions of the Long Term 2 Enhanced Surface Water Treatment Rule include source water monitoring for Cryptosporidium; inactivation by all unfiltered systems; and additional treatment for filtered systems based on source water Cryptosporidium concentrations. EPA will provide a range of treatment options to achieve the inactivation requirements.

Systems with high concentrations of Cryptosporidium in their source water may adopt alternative disinfection methods (e.g., ozone, UV, or chlorine dioxide). However, most water systems are expected to meet EPA requirements while continuing to use chlorination. Regardless of the primary disinfection method used, water systems must continue to maintain residual levels of chlorine-based disinfectants in their distribution systems.

Giardia Lambia

Giardia lamblia, discovered approximately 20 years ago, is another emerging waterborne pathogen. This parasitic microorganism can be transmitted to humans through drinking water that might otherwise be considered pristine. In the past, remote water sources that were not affected by human activity were thought to be pure, warranting minimal treatment. However, it is known now that all warm-blooded animals may carry Giardia and that beavers are prime vectors for its transmission to water supplies. There is a distinct pattern to the emergence of new pathogens.

First, there is a general recognition of the effects of the pathogen in highly susceptible populations such as children, cancer patients and the immuno-compromised. Next, practitioners begin to recognize the disease and its causative agent in their own patients, with varied accuracy. At this point, some may doubt the proposed agent is the causative agent, or insist that the disease is restricted to certain types of patients. Finally, a single or series of large outbreaks result in improved attention to preventive efforts. From the 1960s to the 1980s this sequence of events culminated in the recognition of Giardia lamblia as a cause of gastroenteritis (Lindquist, 1999).

Waterborne Disease Trends Detection and investigation of waterborne disease outbreaks is the primary responsibility of local, state, and territorial public health departments, with voluntary reporting to the CDC. The CDC and the U.S. Environmental Protection Agency (EPA) collaborate to track waterborne disease outbreaks of both microbial and chemical origins. Data on drinking water and recreational water outbreaks and contamination events have been collected and summarized since 1971. While useful, statistics derived from surveillance systems do not reflect the true incidence of waterborne disease outbreaks because many people who fall ill from such diseases do not consult medical professionals.

For those who do seek medical attention, attending physicians and laboratory and hospital personnel are required to report diagnosed cases of waterborne illness to state health departments. Further reporting of these illness cases by state health departments to the CDC is voluntary, and statistically more likely to occur for large outbreaks than small ones. Despite these limitations, surveillance data may be used to evaluate the relative degrees of risk associated with different types of source water and systems, problems in current technologies and operating conditions, and the adequacy of current regulations. (Craun, Nwachuku, Calderon, and Craun, 2002). From 1991 to 2000, there were 155 outbreaks and 431,846 cases of illness in public and individual water systems in the U.S. By far, the largest outbreak of this period occurred in 1993 with the emerging pathogen Cryptosporidium in Milwaukee.

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