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Water Borne Diseases

Worldwide, the lack of clean water for drinking, cooking and washing, and the lack of sanitary waste disposal are to blame for over 12 million deaths a year, say researchers.About 1.2 billion people are at risk because they lack access to safe fresh water. India too has its share of infectious epidemics and though mortality owing to these is decreasing, it is a significant part of the disease burden our society carries. Can something at the individual level be done about this? Dr V Ramasubramaniam, MD, MRCP talks of safeguards.

What is the impact of infectious diseases in India? Are they as rampant as thought to be? Do we have statistics?

But the disease burden is high, for obvious reasons like poor sanitation, lack of access to fresh water, poor hygiene etc, which are common in most developing countries.Dependable statistics are not available. For one thing, a good percentage of cases go unreported. Secondly, “infection” is not recognised till it becomes symptomatic. If you are speaking of Amoebiasis, I can wager that a very large percentage of the people in India, if tested will have amoeba in stools. But we have developed some resistance to it and it may not flare up each time there is infection.

What are the common water borne diseases in India?

The most common diseases are:

  • Typhoid
  • Polio
  • Hepatitis A & E
  • Leptospirosis
  • Diarrhoeal diseases
  • Epidemiologically, have we made any gains in the prevention and management of waterborne diseases?

    We have. We can observe a big drop in incidence (as can be observed from the case of Polio in India) with each of the following:

    1. Improved Sanitation
    2. Purified and piped water supply
    3. Vaccination.

    Recently the popularisation and easy availability of ORS have made an impact on diarrhoeal diseases. At least the death-due-to-dehydration count has dropped.

    Piped water supply is not available in much of rural India. In many metros water supply is in private hands, by default. In such a scenario, what can a citizen do to limit the infection?

    If you can afford bottled water, buy it. Boil water anyway. Even if water is not contaminated at the source, it can get contaminated while handling. Pots and ladles with handles are preferable.

    Are there other safeguards that patients can take to minimise infection?

    Practising personal hygiene is obviously very important. Taking a bath twice a day, proper hand washing after using the toilet and before a meal etc must be practised.

    Eat food that has been cooked fully and is still hot.

    Avoid raw vegetables and fruits that cannot be peeled, unless you are sure that they have been washed well in good water.

    If you have to eat raw fruit or vegetables from where you cannot have it cleaned, buy those you can peel and peel them yourself.

    Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street.

    Immunisation and Prevention

    For Typhoid:

    Typhoid can be prevented by vaccination. Protective efficacy is 70 to 90 percent. The vaccine is available either as injections or as an oral capsule. The course involves three capsules every other day or two injections one month apart. The protection lasts for at least three years. ( If you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination.) The vaccines are safe and have minimal complications.


    A person is considered to be fully immunized if he or she has received a primary series of at least three doses of inactivated poliovirus vaccine (IPV), live oral poliovirus (OPV), or four doses of any combination of IPV and OPV.

    Hepatitis A & E

    Hepatitis A

    Hepatitis A vaccine is the best protection.

    Short-term protection against hepatitis A is available from immune globulin. It can be given before and within 2 weeks after coming in contact with HAV.

    Hepatitis E:

    No Vaccine Available as yet.

    The best prevention of infection is to avoid potentially contaminated water and food, using measures recommended to prevent Hepatitis A and other enteric infections.


    No vaccines are available as yet.

    Good sanitation, rodent control, and protective measures like wearing boots and gloves can help to prevent exposure. Direct contact with potentially contaminated waters by swimming and wading should be avoided. Individuals, who are occupationally at risk, should cover all cuts and broken skin with waterproof plasters before and during work. Wearing protective clothing and washing hands (after handling animals and always before eating) are important in preventing exposure.

    Diarrhoeal diseases

    No vaccines are available.

    Proper food/water and personal hygiene (as stated above) can reduce the risk of Diarrhoeal Diseases.

    Oral Rehydration Solution which essentially consist of sugar and salt mixture, a tsp of which can be added to a glass of water, may have to be taken in adequate quantities to prevent dehydration.

    Viral infections are self limiting. Unless there is vomiting, blood or mucus in stools, greenish stools, diarrhoea of high frequency, antibiotics are not generally prescribed.

    Why do people who maintain a hygienic household and eat home food also succumb to infection?

    We cannot look at a home or workplace in isolation. How clean are the larger environs we live in? How clean are the people who work for us? Are they hygienic? Do the environments they live in have proper sanitation? What about other members of the family/household who live with us? There are contaminants on every surface. We come into contact with faecal/contaminant matter in ways we do not even realise. We might touch a surface that has been swabbed with contaminant water. We might scratch our own body parts and get contaminated.

    It is not uncommon to find that of the many people eat the same food or water, only a few succumb….

    Yes. That is true. For some a mild contamination can set off a flagrant infection. For others a high bacteria or viral count in the contaminating source may not produce alarming symptoms. Some people may be more resistant to infection than others. But most often we cannot determine exactly why. There are too many imponderables that make this so.

    Dr. V.Ramasubramaniam MBBS, MD, MRCP.

    Dr.V.Ramasubramaniam is an Assistant Professor of Medicine and heads the Division of Infectious Diseases at the Sri Ramachandra Medical College and Research Institute. He graduated from the Madras Medical College in 1988 and received his M.D. from the Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh in 1992. He obtained his MRCP (U.K.) in 1994 and subsequently secured Diplomas in Tropical Medicine and Hygiene and Genito-Urinary Medicine from London. His interests include infection control, rational antibiotic use, HIV and AIDS.

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