UUnniivveerrssiittyy ooff MMaassssaacchhuusseettttss AAmmhheerrsstt SScchhoollaarrWWoorrkkss@@UUMMaassss AAmmhheerrsstt Masters Theses 1911 - February 2014 2009 WWaatteerrbboorrnnee DDiisseeaasseess:: LLiinnkkiinngg PPuubblliicc HHeeaalltthh AAnndd WWaatteerrsshheedd DDaattaa Debalina Das University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/theses Part of the Environmental Public Health Commons Das, Debalina, "Waterborne Diseases: Linking Public Health And Watershed Data" (2009). Masters Theses 1911 - February 2014. 235. Retrieved from https://scholarworks.umass.edu/theses/235 This thesis is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Masters Theses 1911 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. WATERBORNE DISEASES: LINKING PUBLIC HEALTH AND WATERSHED DATA A Thesis Presented By DEBALINA DAS Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE February 2009 Environmental Health Sciences WATERBORNE DISEASES: LINKING PUBLIC HEALTH AND WATERSHED DATA A Thesis Presented by DEBALINA DAS Approved as to style and content by: __________________________________________ Sarah Dorner, Chair __________________________________________ Christine A. Rogers, Member __________________________________________ Anthony P. DeCaprio, Member ________________________________________ Elaine Puleo, Graduate Program Director, Department of Public Health ACKNOWLEDGMENTS I would like to express my deep and sincere gratitude to my advisor, Dr. Sarah Dorner Ph.D., Assistant Professor, École Polytechnique de Montréal, Montréal, QC. Her understanding, encouraging and personal guidance have provided a good basis for the present thesis. I wish to express my warm and sincere thanks to Professor Anthony P. DeCaprio, Ph.D. Professor, Environmental Health Science, University of Massachusetts at Amherst. His valuable advice, ideas and concepts have had a remarkable influence on this thesis as well as my entire career in the field of Environmental research. I am grateful to my committee member Dr. Christine A. Rogers, Ph.D., Assistant Professor, Environmental Health Science, University of Massachusetts at Amherst for her detailed and constructive comments, and for her support throughout this work. I owe my most sincere gratitude to Dr. Carol Bigelow, Research Associate Professor, Biostatistics in Department of Public Health, University of Massachusetts at Amherst for her valuable advice. My warm thanks are due to Eva Goldwater of the Biostatistics Consulting Center and Elisa Campbell of the Office of Information Technologies. Their kind support and help have been of great value in this study. I warmly thank Charlene Galica, for her constant support and untiring help during my difficult moments and through out my academic carrier in Environmental Health science at UMass. ii i During this work I have collaborated with many colleagues for whom I have great regard, and I wish to extend my warmest thanks to all those who have helped me with my work in the Environmental Health Science, University of Massachusetts at Amherst. Finally I owe my loving thanks to my husband Mrinmoy De. Without his encouragement, understanding and technical support it would have been impossible for me to finish this work. The financial support of the University of Massachusetts at Amherst is gratefully acknowledged. Amherst, MA, February 2009 Debalina Das iv ABSTRACT WATERBORNE DISEASES: LINKING PUBLIC HEALTH AND WATERSHED DATA February 2009 DEBALINA DAS, MSc., VIDYASAGAR UNIVERSITY, INDIA M.S., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Dr. Sarah Dorner Microbial contaminants in water are a major public health concern. Pathogens have been identified as a primary threat to river water quality in the United States, potentially impacting drinking and irrigation water sources and recreational waters. Agricultural runoff, feedlot operations, wastewater effluents, swimming activities, domestic and wild animals are potential sources of microbial contamination. This thesis presents Massachusetts as a case study for linking public health data of waterborne gastrointestinal diseases with sources of drinking water, potential recreational exposures, as well as hydrologic, climatic, and land use data. Giardia sp. has been chosen as a model organism. Information of reported human Giardiasis cases has been synthesized. Using Geological Information system and statistical software (SPSS and SAS) relationships of confirmed Giardiasis have been compared with available climate and hydrologic data. In this thesis the research finding suggest that there is no visible difference in disease occurrence related with amount of precipitation or extreme rain event. However human giardiasis in Massachusetts has been found related with temperature thus shows a seasonal trend in disease occurrence. Seasonal water related human activity likely have played a role in disease occurrence. v TABLE OF CONTENTS Page ACKNOWLEDGMENTS.................................................................................................iii ABSTRACT.........................................................................................................................v LIST OF TABLES.............................................................................................................ix LIST OF FIGURES.............................................................................................................x CHAPTER 1. INTRODUCTION AND LITERATURE REVIEW...............................................1 1.1 Exposure to Pathogenic Microorganisms......................................................1 1.2 Water Quality Standards................................................................................3 1.2.1 TMDL ..............................................................................................5 1.2.2 Limitations of TMDL......................................................................6 1.2.3 Non Point Source Pollution (NPS):.................................................7 1.2.4 Quantitative Microbial Risk Assessment............................................7 1.3 Acceptable Risks...........................................................................................8 1.4 Measurement & requirements.......................................................................9 1.4.1 Indicator Organisms.........................................................................9 1.4.2 LT2 Rules.......................................................................................10 1.5 Factors Leading to Exposure.......................................................................11 1.6 Waterborne Pathogens of Concern..............................................................12 1.7 Climate and Waterborne Disease Outbreaks..............................................16 1.8 Land Use and Waterborne Disease Outbreaks.............................................19 1.9 Occurrence of Pathogens in Environmental Waters...................................20 1.9.1 Relationship of pathogen and indicators........................................20 1.10 Giardia as a model organism for waterborne diseases..............................21 1.10.1 Symptoms of Giardia....................................................................22 1.10.2 Sources of Giardia.........................................................................22 1.10.3 Exposure to Giardia through drinking water.................................23 1.10.4 Exposure to Giardia through food.................................................24 1.10.5 Exposure to Giardia through contaminated coastal recreation water..............................................................................24 vi 1.10.6 Cycle of transmission of Giardia...................................................25 1.10.6.1 In Humans....................................................................25 1.10.6.2 Cattle............................................................................26 1.10.6.3 Dogs and cats...............................................................26 1.10.6.4 Wildlife........................................................................27 1.10.7 Giardia Outbreaks.........................................................................27 1.10.7.1 Populations at risk........................................................28 1.10.7.2 Genotype specificity....................................................30 1.10.7.3 Hosts specificity/ Cross host transmission...................30 1.10.8 Environmental persistence.............................................................33 1.10.9 Social factors related to Giardia exposures...................................33 1.10.10 Giardia Detection Methods..........................................................34 1.10.10.1 Concentration and Separation from Environment........35 1.10.10.1.1 In Surface Water..........................................35 1.10.10.1.2 Sewage sludge..............................................36 1.10.10.1.3 Feces............................................................36 1.10.10.2 Identification..........................................................36 1.10.10.2.1 Immunofluorescence (IF) microscopy........36 1.10.10.2.2 Enzyme-linked immunosorbent assay (ELISA)........................................................37 1.10.10.2.3 Molecular identification techniques............37 1.10.11 Treatment...........................................................................37 2. GOALS AND OBJECTIVES................................................................................39 3. MATERIALS AND METHODS...........................................................................41 3.1 Study Areas..................................................................................................41 3.1.1 Blackstone River Watershed..........................................................41 3.1.2 Deerfield River Watershed............................................................41 3.1.3 Merrimack River Watershed..........................................................42 3.2 Land Use Data ……………………………………………………............42 3.3 Watershed populations.................................................................................46 vii 3.4 Precipitation and Streamflow Data..............................................................48 3.5 Public Health Data.......................................................................................49 3.6 Statistical Analysis...................................................................50 4. RESULTS AND DISCUSSION............................................................................52 4.1 Comparison of three watersheds (Urban Vs Rural).....................................52 4.1.1 Student t-test..................................................................................52 4.1.2 Chi square test of equality of proportion:......................................53 4.1.3 Influence of climatic conditions on giardiasis occurrence in the Merrimack River watershed.....................................................54 4.1.4 Regression model...........................................................................55 4.2 Extreme Events............................................................................................57 4.2.1 Extreme Rain days.........................................................................57 4.2.2 Control group / Non extreme rain days..........................................58 4.3 Figures and Tables........................................................................................61 5. CONCLUSIONS AND RECOMMENDATIONS................................................74 APPENDIX SUPPORTIVE MATERIAL: INDICATOR – PATHOGEN RELATIONSHIP..............77 BIBLIOGRAPHY..............................................................................................................81 viii LIST OF TABLES Table Page 1. Names of Different Waterborne Diseases and Their Symptoms.................13 2. Giardia Detected in Marine Mammals ........................................................23 3. Some Examples of Outbreaks of Waterborne and Foodborne Giardia........28 4. Recognized Species in the Genus Giardia....................................................30 5. Genetic Groupings and Host Range of Isolates within the Giardia duodenalis (Appelbee, Thompson, & Olson, 2005)...............................31 6. In Three Watersheds Agriculture and Water, Land Use Area Distribution (in acer) from Attribute Table of Arcmap..........................61 7. Cross Correlations of Monthly Precipitation and Monthly Giardia Cases in Merrimack Watershed..............................................................66 8. Cross Correlations between Daily Precipitation and Daily Reported Giardia Cases in Merrimack Watershed.................................................68 9. Cross Correlations of Monthly Temperature and Monthly Giardia Cases in Merrimack Watershed..............................................................69 10. Autocorrelations of Monthly Reported Giardia Cases in Merrimack Watersheds..............................................................................................71 11. Indicators and Pathogens Relation in Fresh Water......................................77 ix