In 1908, Jersey City, New Jersey became the first US city to regularly disinfect its water supply. Water disinfection encompasses various techniques aimed at eliminating microorganisms from drinking water. The most common methods of disinfection include the use of chlorine, chloramines, ultraviolet light and ozone water treatment.

Current Waterborne Disease Condition

Even though waterborne illnesses have significantly decreased in the US, they still persist. Nowadays, most waterborne diseases are not caused by insufficient disinfection at water treatment facilities, but by microorganisms that thrive and propagate within the plumbing of buildings and recreational water facilities like hot tubs and swimming pools. These microbes multiply within biofilms, which are bacterial colonies that adhere to surfaces within pipes, fixtures, and pools.

Furthermore, a significant number of illnesses nowadays result not from ingesting contaminated water directly but from inhaling small particles of tainted water. Legionella, a microbe that triggers Legionnaires’ disease, is a prime example of such pathogens.

It was only recently that national records for deaths caused by waterborne pathogens in the US became available. According to a 2017 report, 6,301 fatalities were linked to 13 different waterborne infections between 2003 and 2009. Meanwhile, a 2021 study analyzing US data from 2000 to 2015 estimated that approximately 118,000 individuals were hospitalized and 6,630 died due to waterborne diseases.

Legionnaires’ Disease is perhaps the most familiar of all waterborne illnesses. It was discovered after an outbreak of pneumonia occurred among American Legionnaires who attended a convention in Philadelphia. It was later determined that the cause of the outbreak was Legionella bacteria breeding in the cooling towers of the hotel’s air conditioning system, which then spread throughout the building. Legionnaires’ disease is a serious respiratory illness that presents with symptoms such as fever, cough, chest pains, and diarrhea. Additionally, Legionella bacteria can also cause Pontiac fever, which is a less severe, self-limiting flu-like illness.

Legionella bacteria are typically found in freshwater and seldom result in illness. However, when they multiply in plumbing systems, they can cause diseases. Individuals can contract Legionnaires’ disease when they inhale small droplets of water that contain the bacteria. In 2014 alone, an estimated 995 fatalities in the US were attributed to Legionnaires’ disease. For Legionella bacteria existed in cooling towers which are hard to reach, they can be efficiently eliminated by an ozone water treatment. And sometimes, when cooperated with UV light, there will be a better result.

Typhoid Fever and Cholera

Typhoid fever and cholera are the two diseases that account for the majority of worldwide deaths due to waterborne illnesses. However, they are uncommon in the US.

Typhoid fever is an infectious disease caused by the bacteria Salmonella typhi, which is often found in contaminated food or water. It is important to note that this is not the same bacterium that is responsible for Salmonella food poisoning (salmonellosis). In the 1900s, tens of thousands of typhoid fever cases were reported in the US each year. However, presently, there are fewer than 400 cases reported annually, with most of them occurring among individuals who travel abroad.

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Despite the availability of a vaccine, typhoid fever remains a global issue, with an estimated 11 million to 20 million cases and 128,000 to 161,000 deaths recorded each year. The majority of these cases are located in impoverished areas of South Asia and Sub-Saharan Africa.

Cholera is an infectious disease caused by the bacterium Vibrio cholera, which leads to acute and severe diarrhea. It has been known to humans for centuries, but it rapidly spread worldwide in the 19th century, and the first case was reported in the US in 1832. Between 1832 and 1875, there were four cholera pandemics that affected populations worldwide.

Although a fifth pandemic occurred from 1891 to 1896 and a sixth from 1899 to 1923, they did not impact North America and Western Europe due to significant improvements in water sanitation during that period.

According to the WHO, the seventh and current pandemic began in Indonesia in 1961 and has affected 120 countries, largely impoverished nations, with outbreaks often occurring after natural disasters such as earthquakes, droughts, and floods. Worldwide, there are an estimated 1.3 – 4.0 million cases of cholera and 21,000 – 143,000 deaths annually, highlighting the importance of clean drinking water and proper sanitation. And the cleaning solution, e.g. UV water treatment and ozone water treatment can address the problem and reduce its impact.

Cholera is very rare in the US today, with most cases occurring in individuals who have traveled internationally to areas where cholera is endemic or after consuming contaminated food. The number of cases in the US is estimated to be up to five annually.

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What We Can Do

Eliminating waterborne diseases is not an easy task, although the US has made significant progress in this area. To build on this progress, better data and innovative solutions are necessary.

EPA regulations effectively prevent contamination at water plants in public systems, but private well owners should test for microbial contamination. However, microbes may hide in plumbing and cooling systems, beyond the scope of traditional regulations. These areas need to be disinfected regularly with ozone water treatment to ensure a timely elimination of harmful microorganisms.

Accurate data is crucial for developing effective solutions, yet the extent of the waterborne disease problem remains unclear. The current data is fragmented and sourced from various channels. To address this, the CDC should collaborate with state and local public health agencies to establish a comprehensive national system for collecting waterborne disease data.

To address drinking water contamination issues beyond treatment plants, a combination of public-private partnerships is necessary. For instance, the CDC has recommended steps to reduce the spread of Legionella and other microbes in offices and hospitals. Similar programs should be expanded to hotels, recreational facilities, and other establishments that can inadvertently become sources of waterborne diseases. In terms of treatment methods, both traditional chlorination treatment, ozone water treatment and UV water treatment can be considered.