Infect Yourself With Knowledge

Alison Bickerstaff is an environmental science major and Fairhaven student at Western Washington University. She has been previously published in the Huxley College magazine, The Planet.

On hot, sunny days in Whatcom County, you find it everywhere—in people’s mouths, on their skin, and in their cups. Whether for playing in or for quenching thirst, water is the common crux that satiates our needs and desires during the summer months.

But while we may be enjoying all that water has to offer, something in the water may be enjoying us even more. Pathogens, including bacteria, viruses, protozoa, and parasitic worms, can be present in contaminated waters and cause waterborne diseases.

Pathogens are found in the feces of infected persons, and most intestinal, or enteric, diseases are contracted through contact with feces or feces-contaminated water. (See page 9 for the table on “Waterborne Diseases” to learn more about the most common waterborne diseases, their sources, and the symptoms they can produce).

Since there is no pill you can take to avoid contracting waterborne diseases, the best thing you can do is to arm yourself with knowledge in order to prevent infection and the spread of outbreaks.

It is important to understand that while children, the elderly, and the immuno-compromised (cancer and chemotherapy patients, pregnant women, infants, dialysis patients, and people with AIDS, HIV, hepatitis, and liver or kidney problems) are the most at risk for contracting waterborne diseases, anyone can become ill from these pathogens, and some strains are quite strong.

This is why the Whatcom County Department of Health and Human Services (WC DHHS) tests water samples at designated, public beaches every six days during the summer months.

Whatcom County Environmental Health Director Don Vesper explained that although local governments are not required by law to test the water quality at local beaches, it is done anyway just as a precaution. For the last three years, the Whatcom County Department of Health and Human Services has tested for E-coli at Bloedel-Donovan swimming area in Lake Whatcom and has more recently begun testing at Lake Padden and Lake Sammish.

“What we’re looking for in our sampling program is to give us an idea of whether there may be fecal contamination present,” Vesper said. “If you find the generic E-coli in the water, then there may be other pathogens present to make people sick, not necessarily E-coli. You could have viruses present, and you’re more likely to become ill from a virus in the water than from E-coli.”

Although other health departments test for fecal coliform and use different standards, the Whatcom County Department of Health and Human Services uses Environmental Protection Agency-recommended standards that test for E-coli specifically.

“The difference is primarily the indicator organism. The EPA did epidemiological studies and felt like E-coli was a better indicator for the potential risk for people becoming ill as opposed to fecal coliform bacteria. We felt the EPA standards were more protective.”

So what are fecal coliform and E-coli, and why are these organisms considered a contaminant of concern? Fecal coliform are bacteria present in the intestinal tracts of humans and other animals. Their presence in water suggests recent contamination by sewage or animal feces. E-coli, a sub-group of fecal coliform, is considered an indication that potentially harmful, disease-causing agents (such as Giardia, Cryptosporidium, and other pathogens) may be present in water.

While most strains of E-coli are harmless, a strain known as 0157:H7 is known to produce a dangerous, disease-causing toxin. To a lesser extent, health professionals are beginning to suspect that other, more rare strains of E-coli are also capable of causing severe illness.

Hemolytic uremic syndrome, an uncommon yet potentially life-threatening complication of E-coli infection, causes red bloods cells to die and is the most common cause of acute kidney failure in children.

Although E-coli infection is most commonly labeled a food-borne disease and associated with undercooked ground beef, it should be realized that E-coli infection can result from contact with sewage or animal waste-contaminated waters.

Here are some tips from the Center for Disease Control and the Whatcom County Department of Health and Human Services that citizens should use to avoid contracting E-coli and other waterborne diseases:

•Don’t go swimming or share baths with others if you have diarrhea. People with diarrhea can spread germs and infect others.

•Avoid swallowing and getting lake or pool water in your mouth while swimming.

•Wash your hands thoroughly with hot, soapy water after changing diapers or using the toilet.

•Take children on frequent bathroom breaks.

•Change diapers in bathrooms and not near pools and lakes or picnic tables.

•Wash with soap and water before and after swimming, as well as before eating or drinking.

•Bring antibacterial wipes on picnic and park outings.

•Don’t feed the ducks or geese since more bird poop may mean a higher chance of getting swimmer’s itch, which is caused by a parasite.

•If you don’t have access to showering facilities, at least dry off with a towel to help prevent getting swimmer’s itch.

•Follow these tips and set a good example for young children to follow.

•Share these tips with friends and family.

Common symptoms of E-coli infection and other waterborne diseases include bloody or non-bloody diarrhea, abdominal cramps, fatigue, mid and lower back pain, dehydration, vomiting, nausea, malaise, and fever. People with some or all of these symptoms should see a doctor.

To determine if E-coli infection is the culprit, a stool sample analysis will be necessary, although many laboratories do not specifically test for 0157:H7, so this test may need to be requested specifically.

Whatcom County averages a dozen or more cases of E-coli infection each year, with cases peaking in the summer months. According to the Center for Disease Control, ten cases of Shiga toxin-producing E-coli (including 0157:H7) were reported in Whatcom County in August 2000. Eight people were hospitalized, and although the Northwest Washington Fair in Lynden was the suspected source of contamination, health officials were never able to definitively link the E-coli outbreak to the fair. Although some cases occur in clusters as in the August 2000 example, many cases are sporadic and sources of contamination are never determined.

After infection, however, symptoms generally appear within several days, although symptoms may not appear for as long as a dozen days. After symptoms resolve, infected persons may still be contagious for up to several weeks, and close monitoring of diet, fluid intake, and kidney function is recommended.

When the Whatcom County Department of Health and Human Services began testing water at Bloedel-Donovan swimming area late this June, E-coli counts were discovered to be high. The count slightly exceeded the EPA-recommended single sample standard of 235 cfu (colony forming units of E-coli)/100mL.

On Wednesday, July 10, 2002, Dick McKinley, Director of Bellingham Public Works, ordered the closure of Bloedel-Donovan swimming area due to high E-coli counts, counts that were nearly twice the EPA-recommended standard.

Although swimmers were out of the water and E-coli counts dropped for a few days, test results over the next weekend showed a sharp increase in the bacteria. The beach was closed until Friday, the 19th, by which time several consecutive days of testing revealed E-coli counts back in the acceptable range.

And although the drainage of a nearby duck pond was cited as a likely source of the E-coli contamination, Whatcom County Environmental Health Director Don Vesper was not convinced it was the only source.

“The pond was likely a contributing factor, but I wouldn’t say definitely,” Vesper said. “I can’t make that connection. There [are] a lot of possible sources.”

Other possible sources of bacterial contamination include geese, dogs, stirred up sediments in the lake, run-off, and sewage in the water.

Even though high E-coli counts were discovered at Bloedel-Donovan in July, genetic testing was not done to determine what species the contamination came from and the water was never tested specifically for the 0157:H7 strain.

“We test for generic E-coli as an indicator,” Vesper said. “We do not test for E-coli 0157 or E-coli 0157:H7. Very few laboratories are set up to test for these strains. In fact, only the state health laboratory is set-up to test for E-coli 0157:H7.”

It is not uncommon for E-coli counts to spike in the summer. Counts at Bloedel-Donovan have been in the hundreds before (even as much as 2,300 cfu/100mL), but this is the first time most people can recall the beach being closed to the public.

And although the E-coli concern appeared confined to only the Bloedel-Donovan beach, it should be pointed out that this is the only location on Lake Whatcom routinely tested in the summer by the Whatcom County Department of Health and Human Services.

Other swimming and recreational areas are not tested because they are not designated, public beaches. For example, Silver Beach, Sudden Valley beaches, Camp Firwood, Wildwood Resort, and other recreational areas along the shores of the lake are not routinely tested by Whatcom County Department of Health and Human Services. Moreover, immuno-compromised people are advised not to swim in Lake Whatcom anywhere.

Interestingly, the second-highest most common contaminant in the Lake Whatcom/Whatcom Creek watershed is caffeine. Since we all know geese and dogs do not line up for their morning lattés, animal-caused contamination can likely be ruled out in this case. Caffeine in the watershed, though, is likely a strong indicator that the water is contaminated with untreated sewage.

In fact, the Washington State Department of Ecology has listed fecal coliform as a contaminant of concern at Park Place drain, Cable Street drain, Austin Creek (Lake Whatcom watershed), Fever Creek, Lincoln Creek, and Cemetery Creek (Whatcom Creek watershed). This listing is based on a DOE study (The Lake Whatcom Watershed Cooperative Drinking Water Protection Project: Results of 1998 Water, Sediment, and Fish Tissue Sampling).

“Fecal coliform bacteria was (sic) the most common contaminant of concern, exceeding Washington State water quality standards at all sites tested where water was sampled,” said the report. “Water quality violations for fecal coliform have routinely been reported by the City of Bellingham and Western Washington University dating from as early as 1990. Fecal coliform bacteria levels for the present study ranged from 470 to 11,000 colonies/100 mL.”

So the notion that a fecal coliform or an E-coli concern in Lake Whatcom is limited to only one beach and one summer is certainly illusory.

For this reason, swimmers need to be aware that risks exist. And people who take drinking water directly from the lake should also be aware of possible water contamination.

“We have people who drink water directly from Lake Whatcom without it being treated,” Vesper said. “I think they are at an increased risk for gastrointestinal illness. If people are going to draw from the lake, we recommend that you filter the water to remove the protozoa that may be present, primarily crypto and giardia, and then disinfect it to kill the bacteria and viruses present.”

Giardia is a protozoan parasite that can cause giardiasis, an enteric disease that can cause long-term illness. The rate for this disease in Whatcom County is slightly higher than the state average. Another enteric disease called Cryptosporidiosis (caused by the protozoan parasite Crypto-sporidium) is actually the leading known source for waterborne outbreaks in the United States, followed by Giardia.

Most outbreaks of waterborne disease in the United States, however, are caused by unknown agents. Health professionals suspect that Norwalk viruses and Norwalk-like viruses cause many of these outbreaks, though. These viruses are likely caused by eating contaminated shellfish or by drinking water tainted with these shellfish. It is suspected that the contamination, which is caused by contact with feces from infected people, occurs during harvest or preparation.

Another difficulty healthcare professionals have in tracking and diagnosing cases of waterborne diseases is that doctors do not have to report cases of enteric disease to health departments. It is, therefore, difficult to connect the dots, establish that an outbreak has occurred, and, thus, prevent the spread of unnecessary and preventable suffering.

Whatcom County Environmental Health Director Don Vesper also recommended that people who have their own wells test them on an occasional basis to see if they have bacteria present.

“Probably the most important thing they can do is an annual or semi-annual test for coliform bacteria in their drinking water,” Vesper said.

Peg Wendling, the Bellingham Water Quality Technical Supervisor, explained that people who drink water provided by municipal treatment facilities, though, receive remarkably high quality water.

“We really take it for granted in this county that you can fill a cup with tap water and drink it and that you aren’t going to die,” Wendling said. “Unfortunately, 10,000 people a day in the world do not have the luxury of having water that’s not going to kill them.”

This is the approximate number of people a day who die from waterborne diseases.

This does not mean, however, that the water industry has turned a blind eye to the potential for waterborne diseases. They do happen.

“We’re most concerned at removing the enteric critters that inhabit the intestines,” Wendling said. “The things we worry most about as an industry are protozoan cysts.”

These cysts, such as Giardia and Cryptosporidium, are smaller than bacteria and more resistant to filtration and disinfection.

For this reason, Bellingham’s drinking water has been subject to increased contact time with chlorine since 1974 to help kill pathogens. The treatment facility also strives to optimize pre-treatment and perform routine testing of water along the distribution system.

This may not be sufficient treatment, however, for those who are immuno-compromised. To help solve this problem, Bellingham Public Works can provide to immuno-compromised people free water that has been treated with reverse osmosis, which is a membrane filtration process that can remove pathogens that are .001 microns in diameter. This water is also treated with UV light and ozone. In 2001, over 3,600 gallons of this water was provided to immuno-compromised citizens.

Besides treatment and testing measures provided by local governments and actions we can take at a personal level to avoid infection with waterborne diseases, the media also has a role in preventing the spread of diseases.

Darin Watkins, a King 5 investigative reporter, said he feels that public safety issues should be at the top of any news coverage.

“It’s our first and foremost among our responsibilities for an operation using public airwaves,” Watkins said. “Often, knowledge can be the key link between treatment and apathy.”

Darin pointed out that E-coli, like other enteric diseases, is difficult to pinpoint. Although it often strikes in small numbers, it can lead to serious complications and even fatality. Education and prevention are the best tools we have to protect ourselves and our children from waterborne diseases.

It often takes quite a large number of people becoming ill until an outbreak is recognized. A good example of this is the recent outbreak of E-coli 0157:H7 infection that affected at least 31 girls at a cheerleading camp held at Eastern Washington University from July 11th through July 14th.

Washington State Department of Health investigators are still awaiting the return of surveys sent to the 130 girls who attended the camp. Hopefully the survey, which asks primarily what the girls ate and drank at the camp, will help connect the dots and point to the source of contamination.

To date, half of the fourteen Bellingham girls from the Squalicum High School dance team who attended the camp are ill. Four have confirmed cases of E-coli 0157:H7. And although recent newspaper articles have labeled the cases ‘food-borne’ or ‘food-poisoning,’ it should be realized that E-coli can also be contacted from water sources, even though water is a less common vehicle of transmission. Another factor that has not been ruled out is the possibility that one of the girls came to the camp already infected with the E-coli strain.

Marsha Goldoft, the Washington State Department of Health Medical Epidemiologist, is heading up the investigation into the E-coli outbreak. Tracking down the source of contamination involves much detective work and the investigation is still considered wide open.

“We don’t have a clear indication of what caused it,” Goldoft said. “And we’re trying to figure it out.”

Right now investigators are testing the water sources on campus, as well as the plastic containers that held the water and were provided to the girls during practices.

“The girls were told to drink three liters a day,” said Goldoft.

Tara Cummins, a member of the Squalicum High School dance team who was hospitalized for her E-coli infection, said her instincts told her the food was not the cause.

“I swear it was the water,” Cummins said. “My vote’s the water. The other girls think it’s the water too.”

Cummins’ teammate and roommate during the camp was Carrie Nelson, the first member of the girls to fall ill. That was on Saturday, July the 13th.

“But the day she got over it,” Cummins said, “I got it.”

On Sunday Cummins began feeling ill, and she came home to Bellingham to find both her mother and brother ill with the flu. By Tuesday, though, Cummins began feeling quite ill, and Friday morning she asked her mom to call the paramedics.

“I just knew it wasn’t the flu,” she said.

Test results confirmed the E-coli 0157:H7 infection. A few days later, Nelson was tested. And although she was already feeling better and she was never admitted to the hospital, the results were also positive for 0157:H7. Two other girls on the team were also diagnosed with E-coli infections, as were 23 girls from Spokane County (one of whom has been diagnosed with hemolytic uremic syndrome) and one girl from Montana who attended the camp.

It is important to realize that although symptoms may appear mild and short-lived, it is wise to get tested anyway and help prevent the spread of an outbreak.

Cummins offered words of advice to others who show symptoms or suspect they may have E-coli infections.

“I’m glad I got in and got tested and got out,” she said. “I know that if I didn’t go to the hospital that I wouldn’t be feeling better now.”

For more information on E-coli infection and other waterborne diseases or if you think you or others are infected, contact the Whatcom County Department of Health and Human Services at (360) 676-6720. Check out the Center for Disease Control website at http://www.cdc.gov and the Washington State Department of Health website at http://www.doh.wa.gov.