What if I put it up my nose?

Put it up my nose Little Kid Jumping into a PoolBy Michael J. McGuire

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.

References

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.

UPDATE!!! July 28, 2015

DHH Confirms Naegleria Fowleri Ameba in Ascension Consolidated Utility District 1

Drinking water is safe to consume, but State urges public to take precautions

Baton Rouge, La. – Tuesday, the Louisiana Department of Health and Hospitals (DHH) confirmed the presence of the Naegleria fowleri ameba in the Ascension Consolidated Utility District 1 at the site 9295 Brou Road. The water system, which serves approximately 1,800 residents in a small community north of Donaldsonville in Ascension Parish, was tested by DHH as part of the State’s new public drinking water surveillance program. DHH notified the water system and local officials Tuesday afternoon. The Department asked the water system to conduct a 60-day chlorine burn to ensure that any remaining ameba in the system are eliminated. Parish officials today confirmed that the system would conduct the burn out of an abundance of caution.

The water system was not in compliance with the requirements for chloramine disinfectant levels set forth by the 2013 by emergency rule and additional requirements in 2014 by the Louisiana Legislature at the location where the sample tested positive for the ameba. Three other sites on the system tested negative for the ameba, but did meet the requirement for disinfectant.

Tap water in from the Ascension Consolidated Utility District 1 is safe for residents to drink, but the Department urges residents to avoid getting water in their noses. Naegleria fowleri is an ameba that occurs naturally in freshwater.

As Naegleria fowleri infections are extremely rare, testing for this ameba in public drinking water is still relatively new and evolving. Fewer than 10 deaths in the United States have been traced back to the ameba, with three occurring in Louisiana over the last several years.

DHH conducts sampling of public drinking water systems for Naegleria fowleri each summer when temperatures rise. So far, DHH has tested 12 other systems for the ameba. One positive result was identified on July 22 in St. Bernard Parish. St. Bernard Parish is currently conducting a chlorine burn throughout their water system to eliminate any remaining ameba.

Naegleria fowleri causes a disease called primary amebic meningoencephalitis (PAM), which is a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to bacterial meningitis.

DHH Safe Drinking Water Program staff sampled four sites along the Ascension Consolidated Utility District 1. One of the four sites tested positive for the ameba. One positive test was located at 9295 Brou Road. Chlorine levels at the site of the positive sample were below the 0.5 mg/l requirement.

The Department requested that the water system conduct a 60-day free chlorine burn in the water system. The chlorine burn will help reduce biofilm, or organic buildup, throughout the water system and will kill the ameba. The parish has agreed to conduct this precautionary measure.

Precautionary Measures for Families

According to the CDC, every resident can take simple steps to help reduce their risk of Naegleria fowleri infection. Individuals should focus on limiting the amount of water going up their nose. Preventative measures recommended by the CDC include the following:

  • 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.
  • DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools); walk or lower yourself in.
  • DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
  • DO run bath and shower taps and hoses for five minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level.
  • DO keep small hard plastic/blow-up pools clean by emptying, scrubbing and allowing them to dry after each use.
  • DO use only boiled and cooled, distilled or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
  • DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means:
    • Pools: free chlorine at 1 to 3 parts per million (ppm) and pH 7.2 to 7.8, and
    • Hot tubs/spas: free chlorine 2 to 4 parts per million (ppm) or free bromine 4 to 6 ppm and pH 7.2 to 7.8.
  • If you need to top off the water in your swimming pool with tap water, place the hose directly into the skimmer box and ensure that the filter is running. Do not top off the pool by placing the hose in the body of the pool.

Residents should continue these precautions until testing no longer confirms the presence of the ameba in the water system. Residents will be made aware when that occurs. For further information on preventative measures, please visit the CDC website here: http://www.cdc.gov/parasites/naegleria/prevention.html.

 

 

About safedrinkingwaterdotcom

McGuire is an environmental engineer and writer. He has worked in the drinking water community for over 40 yrs
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17 Responses to What if I put it up my nose?

  1. Anonymous says:

    Dear All,
    There might be a point of suspicion for Water Utility (Piped Water Supply Scheme), when its residual chlorine levels are low. Chlorine kills the amoeba. So let us begin flushing water lines with chlorine and the process should continue for weeks until residual chlorine levels reach recommended levels. It is important from the Public Health perspectives and to counteract with Naegleria fowleri.
    Last year also, there were 10 deaths in Karachi, Pakistan, from the attack of Naegleria fowleri – the Brain Eating Amoeba.
    Thanking you.
    Regards.
    Nripendra Kumar Sarma
    Guwahati, Assam, India

  2. Nripendra Kumar Sarma, Guwahati, Assam, India says:

    Dear All,
    The water is safe to drink, Centers for Disease Control and Prevention ( CDC ) officials said, although they cautioned against getting water in the nose to prevent infection from Naegleria fowleri – the Brain Eating Amoeba.

    Here are some tips from the CDC to help lower the risk of infection:
    • Avoid swimming in fresh water when the water temperature is high and the water level is low.
    • Hold your nose shut or use nose clips while swimming.
    • Avoid stirring up the sediment while wading in shallow, warm freshwater areas.
    • If you are irrigating, flushing or rinsing your sinuses (for example, by using a neti pot), use water that has been distilled or sterilized.

    Thanking All and waiting for the responses from Experts.
    Regards.
    Nripendra Kumar Sarma
    Guwahati, Assam, India

  3. Nripendra–Thank you for your comment. I just think that it is hard to control what children put up their noses. If there is a significant risk of Naegleria in a water supply, I believe it is incumbent upon the water utility to disinfect the water so that the amoeba is killed–no matter what the regulations state.

  4. Rodolfo Salas-Auvert says:

    Water disinfection and potabilty is a simple process but entails a comprehensive approach where removal of all microbial entities (including all pathogens and most saprophytic microorganisms) and foreign chemicals, where chlorine is insufficient /inadequate; and its a topic of public safety and human wellbeing; internal water distribution network quality is another issue to address or we must do like the Romans did where the water manager of the city was severely punished if responsible for the water supply interruption or bad quality; plus we have forgotten about the intrinsic energy of water.

  5. qewj says:

    So if I got water up my nose in a pool I was swimming in today (it was my friends) and the water had chlorine in it I should be fine?

  6. Isabella says:

    I don’t want to spend all my time being worried about this. Whenever I bathe or brush my teeth I get a few drops in my nose. I’m prone to anxiety over health related things so I apologize if this sounds ridiculous.

  7. A few drops of safe tap water up your nose is not the problem. Jumping into a pond of water with Naegleria growing in it is another that you should worry about.

  8. Anon says:

    What if I accidentally got one or two of drops of tap water into my nose and sneezed? Would I be in danger of dying? I know that a huge amount of water like in nasally irrigating with a neti pot can kill you, but what about a couple of tiny drops?

  9. Dear All,
    Is there any specific study, which deals on the sources, where such Naegleria fowleri – the Brain Eating Amoeba is likely to originate?
    Beacuse, the impacts are not being observed among the regular users of Swimming Pool ( whether controlled ( or well maintained ) or uncontrolled one ) or among the people taking bath in freshwater bodies like, ponds, lakes, rivers etc. [ if such attacks have still remained undetected, then it is different ]. Is it climate dependant or seasonal? In the year 2012, the deaths as detected in Karachi, Pakistan, from the attack of Naegleria fowleri – the Brain Eating Amoeba were reportedly during summer season only. However, after that no such attcks are reportedly noticed.

    Thanking All.
    Regards.
    Nripendra Kumar Sarma
    Nagaon, Assam, India

  10. A review article on Naegleria fowler will be published in the Journal American Water Works Association in October 2014. That will be your best source of information on occurrence and treatment.

  11. MJN SEIFER says:

    Am I potentially at risk of Naegleria Fowleri every time any amount of water goes up my nose? Water obviously goes on my nose while I take showers, it despite trying to breathe with my mouth and not my nose during said showers, so as to avoid sniffing the water, it’s not easy. They only seem to be drops, but would that be enough? I’m also really paranoid every time I get water anywhere near my nostrils for this reason, even if it’s a few drops.

    I know you said “A few drops of safe tap water” shouldn’t cause harm, in response to another commenter, but what if the water was infected? Would a few drops be enough to kill someone then?

    Also, I must add that I live in the UK, not the US.

    Sorry for the long comment, but I wanted to give a full question to make sure people understand because I really need to know how much I’m at risk.

  12. MJN–The most important fact is that Nf is not indigenous to the UK. It is too cold there. Second, the risk to you for a few drops of water is nil. Jumping into a pool, using a neti pot or a slip-n-slide forces large amounts of water up your nose and into contact with your olfactory bulb. Other than there limited exposures, you should not be concerned.

    MIke

    • MJN SEIFER says:

      Thank you for the information, Mike. I feel a lot more relaxed now, as like I said I was getting unbelievably paranoid about it. Thanks for putting my mind at rest, I deeply appreciate it.

  13. Pat says:

    Hi, do you know about the distribution and range of Naegleria fowleri in the world e.g. The countries/areas most at risk and ones which have no risk at all. Is Melbourne, Australia at risk of the amoeba, specifically in the water supply? I just want to know so I can watch out or calm down specifically if a tiny cupful of water accidentally enters my nose while I’m showering.

    Thanks.

  14. So, does a water utility have to worry about a kid putting water up his nose? … swaterp.wordpress.com

  15. Only if there is no chlorine residual in that water. For more info, check out this CDC website: http://www.cdc.gov/parasites/naegleria/public-water-systems-louisiana.html

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