Water utilities are required to provide drinking water that is safe for their customers to drink. But what about other uses of municipal water? Is a water utility responsible for ensuring the safety of water that is introduced into the nose?
Over the past couple of days, news stories have been covering the death of a 4-year old boy in St. Bernard Parish, Louisiana, who contracted Primary Amoebic Meningoencephalitis (PAM) most likely by coming in contact with an amoeba called Naegleria fowleri. Officials from the Center for Disease Control and Prevention stated that it is likely he was exposed while playing on a Slip ‘N Slide in his backyard where tap water was used as part of the fun.
It is only possible to contract PAM by taking water contaminated with Naegleria fowleri directly into the nose. Once the microbes are in the nasal area they can migrate to the olfactory bulbs and move directly into the brain. The disease is almost 100 percent fatal but, thankfully, its occurrence is rare.
What caught my attention was the title of the news item on the NBC News website: “Deadly brain amoeba infects US tap water for the first time.” I knew that was not true. I was a consultant to a water utility in the Phoenix, Arizona, area in 2004 and 2005 that was peripherally involved in (and not responsible for) a tragic episode involving the amoeba in 2002.
On October 12 and 13, 2002, two 5-year old boys died of PAM within four hours of each other at two different Phoenix area hospitals. The boys and their families did not know each other. They had nothing in common—except their water supply from the Rose Valley Water Company. Both had been playing in different swimming pools filled with water from that small, private water utility. Also, in common was the fact that the water was not chlorinated…at all. Samples taken later from reservoirs and the distribution system of the water company were positive for Naegleria fowleri (the so-called “brain-eating amoeba”).
The investigation of this water utility uncovered some very disturbing information, but the most disturbing fact was that the water supply was not chlorinated. News reports of the recent case in St. Bernard Parish have stated that the water supply was poorly disinfected. Naegleria fowleri are known to infest and grow in warm water. Most of the deaths in the U.S., Australia and other countries resulted from people (mostly children) jumping into fresh water ponds or rivers in hot climates. But should children be cautioned against doing a cannonball in the local swimming pool that is filled with municipal water? The CDC thinks so. On the website explaining the problem with the amoeba is the statement: “Do not allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow up pools.”
Really? Let’s see if there is another possible solution to this problem since we are not going to keep water out of a kid’s nose. I know. PROPERLY DISINFECT THE TAP WATER AND KEEP IT DISINFECTED! Naegleria fowleri can be easily killed by chlorine, ozone, and UV light. A study at Arizona State University found that it was possible to find the amoeba in biofilms in distribution systems. Ok, that makes it a little more challenging, but an effective secondary disinfectant residual will kill any of the amoeba that escape from the biofilm into the bulk water phase. Control of biofilms by limiting nutrients and carbons sources that foster their growth is another good operational procedure.
So, does a water utility have to worry about a kid putting water up his nose? There is no question about it. They better be worried about this happening. A utility that operates in the U.S. Sunbelt that does not disinfect the water that it sends out to the public is risking another one of these heartbreaking tragedies.
Brown, A. et al. “Naegleria fowleri: Highly Fatal, But Rare.” presented to the 2012 Gatekeeper Regulatory Roundup Conference, Scottsdale, Arizona, April 3, 2012, http://www.epaz.org/userfiles/14-Naegleria%20Fowleri-%20A%20Brown-rev.pdf
CDC, “Naegleria fowleri and Public Drinking Water Systems,” http://www.cdc.gov/parasites/naegleria/public-water-systems.html Accessed September 17, 2013.
Fox, M. “Deadly Brain Amoeba Infects US Tap Water for the First Time.” NBC News, http://www.nbcnews.com/health/deadly-brain-amoeba-infects-first-us-drinking-water-system-8C11172643 Accessed September 17, 2013.
Wikipedia, “Naegleria fowleri.” https://en.wikipedia.org/wiki/Naegleria_fowleri, Accessed September 17, 2013.