Water Borne Diseases and Prevention

we have today a very important point to discuss waterborne diseases and this prevention and there are two very distinguished persons available with us professor Rita Colwell a very distinguished University professor at the University of Maryland and John Hopkins University and also professor Anwar from Maryland University welcome to our studio the channel I thank you cholera is that was their very predominant disease in Bangladesh and specifically during rainy season we had this disease and it has virtually wiped out villages after villages maybe thousands of patients especially young ones they come and also elderly they come with diarrheal diseases for the treatment I think there are incidences which indicates the resurgence of this particular problem in many areas of the world in Haiti in the Africa and some of the places in Middle East these things are happening not only cholera typhoid is also a major problem in Bangladesh and the children as well as elderly people are highly highly affected there are also incidences of hepatitis A and hepatitis E which is also a big problem so we'd like to hear from you how do you look at it and how we can prevent it and what are the things that we need to do and what are the latest scientific observations from your research well first I'd like to point out that cholera can remains a global disease more than a billion cases occur every year now with about 1.2 million deaths as you pointed out predominantly children in the elderly it hits 50 countries and what used to be restricted pretty much to India in Bangladesh it's really now understood to be a global disease so that's the first point yeah but I are you sure that it's cholera not necessarily other things like you take and there are equal I or there could be many other things rotavirus and things like that but why you said cholera there it's very good point because in fact some of the recent work that we're doing in analyzing the disease samples clinical specimens we're finding that it's between four and ten pathogens in a patient let's say in Calcutta coming into the cholera hospital which means that it's a really polymicrobial infection and much more than we had suspected so you're quite right I think that number of one to two billion cases it's diarrheal diseases yeah and they're waterborne so that's a very good point out of this let's say 2 billion you are talking about almost like 1 billion responsible at the disease is a real cholera the symptoms of cholera extreme diarrhea dehydrating diarrhea and vomiting and without replenishment of the fluid lost then death ensues now that's a good point because I would say that specifically if Vibrio cholera toxin genic form a given serotype occurs and can be detected then this would be called cholera but we're finding from the samples that we studied from victims in the Haitian cholera outbreak that 20% did not carry the real cholera one carried air monus or some other bacterium or virus that caused the diarrheal disease profits are onerous so what do you think that you are a scientist working in my and university so what do you think that how can you handle this particular situation well when you mentioned about cholera waterborne diseases and prevention and also mentioned typhoid or the other first prevention what safe drinking water for all waterborne diseases not only bacterial even parasitic disease that is how cholera was eradicated from the Western world Europe and the United States so it is there and it will be there the organisms are waterborne naturally occurring organisms our findings when dr. Corvis lab our team dr. goldstein has shown that these organisms are always there it's a matter of finding almost we can find anywhere this bacteria sometimes the concentration is so low it is hard to find unless you concentrate large volume of water and then we can find so bacteria is there now for prevention we have to find different methods it could be vaccine I mean first save drinking water then vaccine or any other preventable methods were at River so again we have to find a prevention method because we cannot eradicate this disease and why I said because it's important until about I would say 1970 or 1980 the assumption was that cholera was transmitted only person-to-person it was because it was very difficult to isolate it between epidemics what we found out was that the bacterium exists as part of the natural flora the natural microbiology of the environment it's in the aquatic system as a natural inhabitant associated with aquatic microscopic animals so it's impossible to eradicate as Allah pointed out because it's carrying out important natural functions cycling carbon some of fixing nitrogen and carrying out metabolism of substrates degrading it and recycling material so it's part of a natural system oh so this is a very very important finding that it's not going to be somebody is infected somewhere and then it originates I'm going to go and I'm going to go in different different places that's not the case so it's part of our nature and it could happen anytime and only you need the triggering factor to change that yeah okay there is another one issue let's say one thing that we are sure and agree with you that in in case of any all the waterborne diseases we if we specify cholera is a big problem in in Bangladesh and in addition to other diarrheal diseases it could happen from e.coli from from rotavirus from there are any other similar and such bacterias and then we also have typhoid yes which is is a big big issue because it's affecting many elderly people and it could be fatal at times and you could imagine that there is a tremendous amount of resistance coming up nowadays and you find out typhoid which is not sensitive to multiple antibiotics so this is a big problem for us the other issue which is a very dangerous issue which we are not looking at it at this moment is hepatitis E infection especially to pregnant mothers yes if that happens then it's a disaster so for to in order to prevent or protect our population from all these diseases cholera other so diarrheal diseases typhoid hepatitis A and hepatitis E so we have in order to give people protection from this there is no alternative but to give them safe drinking water absolutely so this is one criteria you can control if least 26 diseases yeah so you have to make sure while we are making safe drinking water available you have to parallely make sure that we have something so that these diseases do not exactly so we cannot ignore the possibility of bringing in a proper good in the vaccine but I while discussing with you we have a vaccine now at least there are two different vaccines and then also several other vaccines are being developed in several laboratories you like in rotavirus or in flu vaccines one single vaccine may not be good enough from the perineal so you have to look into the strains and then you have to identify how it is going to change and you have to come up with a new vaccine what is your opinion on this issue I look on in the cholera vaccine as a very powerful important tool to circle and contain cholera outbreak but not as a universal protection because to in vaccinate everybody is impossible and be very expensive and in addition if you were able to do that which I find very difficult because the best vaccine is probably 60 or 70% effective if you are able to provide safe water at least you are eliminating many of the diseases and there is something else that we're also beginning to understand and that is the assumption has been that a single agent causes the disease but as we analyze clinical samples stool samples from cholera patients we find that it's anywhere from four to ten other pathogens so so I think we have to use the same set or type or let's say different cell type of no Vibrio cholerae your talk well there'll be other pathogens like Salmonella Shigella rotavirus Giardia Cryptosporidium nature parasites so it's Milosh of pathogens you see as microbiologist for a hundred years we've operated on what are known to us as Koch's postulates Robert Koch a German microbiologist about 1890 showed that he could prove the germ theory of disease by isolating from an infected person an agent and then reinfect using animals and be able to prove and so we assume that it's rotavirus or cholera but we're now beginning because we have better tools with DNA sequencing in RNA sequencing to show that it's really a mixture of viruses and bacteria and parasites yes that's that's amazing yeah yeah now coming back to Professor Noir then what do you think about the water issue how can we look into this and make sure that more and more segments of our population they have access to safe water the idea of providing safe drinking water to everyone there are we should start thinking how local safe drinking water can be available there are different chemical of treatment methods clothes of circuit filtration method and all I would like to mention the method we developed a simple sorry filtration for Bangladesh context what we found a sari cloth cotton sari cloth used sari cloth which is not worn by people take a piece of it make four folds and filter water pond water that can remove 99% of the bacteria attached on to copy pores and other particles cholera is a dose-dependent so we don't need sterile water as long as we can bring down the number because we needed healthy volunteers we did in the United States in Maryland you need 1 million bacteria to show clinical symptom of cholera for nutritionally malnourished person maybe they require lesser fewer organisms but definitely one thousand or ten thousand bacteria is not going to cause cholera so if we filter can remove 99% of the bacteria most likely we will bring down below infectious dose so we did a field trial and 45,000 people in MATLAB about 10 12 years ago Jack and we found population that used the sorry filter had 48 percent reduction in cases compared to the group which carried out their normal method of practice of water use so clearly and it's a huge study 3-year study 45,000 people when it did not cost a penny to these family members because they used old sorry sorry sorry clot they were going to throw away just use it filter it a manifold it filtered water only thing you have to train these people how to really make sure that unfiltered water doesn't enter into so we found this and then there was question about it well is it sustainable are the people going to use it but we found went back to the same population after five years and we found people are still using it but not necessarily exactly the way sure they should use because there was no reinforcement so somebody was using 1/4 or two fold so this education is so important what we are thinking that if we can educate the whole population that they should use sari cloth and the way it that should be used I think it can have a significant impact then I want to add another one now that you have a good cholera vaccine and it is not protecting 100% right so our thinking we have been talking that if we combine sorry filtration and vaccinations I think the prevention level protection level can go significantly higher I'd like to add this is exactly what he feels strongly about I would like to add that we need to look at the water clean water approach as a gradient in other words for the very very poor humble situation in the village the sorry filtration is very important and then those who are fortunate enough to live in the Western countries that are in a big city the distributed water supply works in between it's possible and I've been working with a safe water network which is a an organization based in New York that provides these kiosks that produce filtered water clean water it's also chlorinated but by the time you've done the filtration you only have to chlorinate a small amount so people don't taste it so we should have a range of treatment from the very poor who can use just Cerie cloth and it costs as an appointed out cost nothing to cities where you pay for the safe water and then something in between and then there are a variety of other techniques use of ceramic filters and so forth if we could figure out how to employ according to the need we could I think universalize here the important message is that educating people and transmitting the information across the board it's very important yes there are people who are just not being able to be communicated I mean they are isolated in some of the chars a very small and places where no drinking water is available faraway places so so they are not even going to the schools and these are the things that are our problem or to malaria so we have to connect to each and everybody yes we have to propagate this message that there is no frustration we can handle it but these are the ways we have to handle it yes so there is no alternative to safe drinking water we have to make sure but these are the ways by which we can achieve that like you say that we have options of ceramic filters or chlorinated water or kiosk which gives multiple of purification steps and then you get down drinking water and also where there is nothing we do not lose hope we can just fold four pieces of the clothes of a used sorry and then filter it and then we can have almost happened that not so dangerous I would add that term we designed their study specifically for Vibrio cholera the causative agent of cholera the when you fold the sari cloth four times we bond wide to the experiments we looked under the electron microscope and the pore size of the filter was about 20 micrometers now the plankton that carry the cholera bacteria are about 210 times bigger yeah so they're clogged but the parasites are bigger too yeah so we very likely reduced right Cryptosporidium and Giardia and perhaps even viruses that are attached to some of these other particulates and animals but we hadn't designed the study so we couldn't really publish any results to that effect because we didn't work on it but again the simple filtration may very well have been more effective than we had really anticipated the other issue I would like to touch on that let's say if you talk about this years the temperatures across the board across the world you would see that all of a sudden until December there was hardly any low temperature in North hemisphere and also in Bangladesh we have hardly seen the cold temperature that that we are used to and all of a sudden there were storm and record – temperatures and record amount of snowfalls ever in the history so do you connect with that with some kind of climate change and is there any other issue that we take note regarding waterborne diseases on this chain I think the evidence is very powerful that when you take into account predicted from the natural history that the slope is upward significantly upward so yes the storms are more frequent they tend to be more intense the temperature has gone up and the greenhouse gases have been measured so changes are taking place now I think what's really critical is to understand what these changes will do to us as a human community it is more than just more infectious disease it's more than just sea level rise and flooding its societal disruption it's a sociological it's a cultural devastating problem because take Bangladesh again it's essentially the the guinea pig of the situation because 20% from the lowest estimate of sea level rise 20% of the countries it is going to be under the sea water and that means migrants migration it means population pressures within the country and elsewhere so we can't put a blind eye to this for much longer yeah thank you professor for coming to China like at this studio no it was an honor for us to listen to you such a distinguished professor and you have been providing are giving doing the research and they're giving us the knowledge and how to solve this problem for so many years and we we are very very honored for your presence to us and also to Professor animal for being here with us and with your research findings and everything and we are really honored for your presence dear viewers you have heard from two very very distinguished scientists in the area of waterborne diseases especially diarrhea we heard from them that we have tremendous amount of potential and ways and means by which we can fight this out with the help of safe drinking water with inexpensive vaccines and many other things that we could do both in the city area also in remote village areas so that we have nothing to worry about it only thing that we have to do is to communicate with each other and give them the right message thank you so much for listening you

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