HISTORICAL PERSPECTIVE:

Municipal water treatment techniques developed 95 years ago used chlorine compounds to disinfect drinking water. This has dramatically reduced the incidence of waterborne diseases such as typhoid, cholera, and amoebic dysentery.

Third world countries still fight this pitched battle where human and animal wastes pollute water supplies and little or no mechanisms exist for proper disinfection. Rwanda is a recent example

Since the early 1900's, the rule of thumb "potability" standard has been the absence of coliform bacteria in a measured minimum volume of water.

A NEW INSIGHT:

However, as our understanding of microbial contaminants and their detection has improved, scientists have found that a wide range of microorganisms, including viruses, parasites/protozoa and bacteria, may persist in "potable" or so-called "safe" drinking water.

Pathogens including Legionella, Pseudomonas, Klebsiella, Acinetobacter, Aeromonas, Bacillus, Alcaligenes, Moraxella , Giardia, Cryptosporidium, and even pathogenic amoebae are appearing with regularity in "potable" water.

Recent research studies have identified a wide range of microbial problem areas including community drinking water supplies, delivered and store-bought bottled water, water coolers, water lines in dental offices, shower heads, air conditioning systems, ship holds, home plumbing systems and even under-sink reverse osmosis water treatment systems purchased, ironically, for the removal of water contaminants.

A MEDICAL TIME BOMB:

Complicating this entire issue are the millions of medically compromised individuals who may be experiencing immunudeficient conditions caused by recreational drugs, antibiotics, chronic fatigue syndrome(CFS), mononucleosis, HIV or other immune system problems.

The list of studies and reports by national and world-renowned researchers which illustrate the increased health risks realized by the immunodeficient individual when water-borne microbes such as those discussed here are encountered could cover this entire page.

An increasing number of these "super-bugs", including Giardia and Cryptosporidium, are impossible to eradicate with conventional water treatment procedures, and have caused hundreds of thousands of cases of water-borne illnesses in the US in recent years and more recently, the deaths of over 100 individuals in Milwaukee, most of whom were HIV positive, The recent NBC Dateline series on microbiological problems with drinking water brought this problem into focus for millions across the nation.

Legionella were formerly regarded as a hazard only when inhaled in aerosolized water(remember the original problem in Philadelphia years ago with the air-condition system in the hotel where dozens died), but there is considerable new evidence that aspiration from drinking water leads to many cases of Legionnaires' disease.

Even Mycobacterium Avium, a very common cause of terminal systemic infections in AIDS victims, has now been shown to be acquired from potable water.

SOURCES OF MICROBIAL CONTAMINATION:

The natural question is: where are these pathogens coming from? Part of the answer may lie in the findings of recent studies conducted in dental offices where a wide variety of pathogen microbes were found at extraordinary levels in dental unit water lines.

Recently, a well-known California dentist died from Legionella pneumophilia which was traced to the water coming from the dental instrument water lines in his office. A fatal case of endocarditis was recently traced to contamination of dental water lines encountered during a simple teeth cleaning operation.

In dental offices, researchers found that incoming tap water provides only part of the source organisms that lead to high bacterial contamination. An important part of the problem was shown to be the failure of anti-retraction(check) valves on dental hand pieces, thus permitting the "suck back" of patient blood, saliva and detritus into the dental water and air lines.

Cross contamination between consecutive dental patients therefore becomes possible, where pathogenic materials which grew and multiplied in the biofilm in the water delivery lines were then delivered into the mouth of the next and subsequent patients.

This raises the next question: Are defective or inadequate anti-siphon valves, water faucets and other home, school, office and industrial plumbing apparatus permitting infectious material from one infected family member(or even a neighbor) to be "sucked back" into the home plumbing lines--breeding there on the surfaces of water pipes in a cooperative biofilm environment--and then being released when water flowing past the microbe growths breaks a group free and carries it into the next glass of water?

A wide range of international studies have shown that this "biofilm", containing a wide range of microbial contaminants, resides on the inner surfaces of plastic water bottles that consumers increasingly have turned to because of their concerns about tap water safety. Water coolers in home and industrial environments have been found to contain a wide range of pathogens.

SO WHERE ARE THE BODIES?

One is prompted to ask:

"...if these microbiological problems are as serious as the open literature now indicates--where are all the clinical cases, or even perhaps the bodies?"

This is indeed a fair question.

The answer is really quite simple. The cases and bodies are there---scientists and clinicians just haven't been able to count them due to

• a lack of pursuit of the proper causal relationships between the manifestation and the source of the problem; and
• oversight of the source of problem itself.

Sometimes the hammer falls hard--as it did in Milwaukee--other times the incidents are smaller, go unreported or a cause/effect relationship goes unnoticed.

In other words, where is the last place you might consider contracting a disease caused by a water-borne pathogen? Your "safe" tap water? Bottled water? An office water cooler? A home use "water treatment" system? Your dentist's office?

Identifying these unlikely "sources" for potential disease will go far in developing causal relationships which will clearly illustrate where the "bodies" are--and what/who caused them to be there. Science is beginning to identify the sources--it is up to us to grasp this information and transform it into practical solutions for our families.

SOLUTIONS IN THE HOME:

Not trusting tap or bottled water, many have turned to a variety of home water treatment systems. Unfortunately, most of these popular systems aren't up to the task of dealing with these microbial problems.

Reverse osmosis systems have long been known to be incapable of dealing with bacterial problems. Indeed, recent Canadian studies have shown that they quickly become a massive breeding ground for pathogens which have been directly correlated with illnesses in most homes tested.

Carbon filtration, including those variations where silver compounds are used to allegedly deal with biological problems are clearly inadequate solutions---and, as noted over the years, carbon filters have their own propensity for developing heavy biological loadings.

Ozone treatment and ultraviolet irradiation can have very powerful disinfecting efficacy, however it is difficult to achieve this result close to the point of use, and this is the critical aspect of utility in dealing with the microbial contamination of water vessels and water lines used by consumers.

Steam distillation provides a secure approach to microbiological decontamination leading to production of safe, sterile drinking water and as implied on the NBC Dateline series, the boiling/steaming aspect of distillation may be the only practical and effective technique available to the homeowner.

We need to remember that the "carcasses" of bacteria contain toxic substances and pyrogens. So the physical removal of microbes, dead or alive, at the point of use through distillation techniques or contemporary micro filtration technology is likely to have an important role in addressing the problem in many circumstances, like the dental water lines, for example.

SUMMARY:

Clearly, there is a need for serious reexamination of the types of water testing and "purity" criteria used by municipal water systems, water bottlers and water treatment systems manufacturers. The older, coliform bacteria testing standards simply aren't suited for all purposes in the face of some of the recent findings reviewed here.

Conventional water treatment technologies are in step with decades old perception of biological impurities--but are out of step with the era of "super bugs"--complex microbiological entities which resist conventional treatment and which can only be eliminated by a very limited set of point of use technologies such as steam distillation or to a lesser extent, micro filtration.

Chlorine and ammonia are clearly inadequate in dealing with these new "super bugs"--and in some cases may increase the surviving organism's resistance to antibiotics.

New laboratory techniques and systems based on an assessment of total bacterial contamination and some evaluation of disease-causing potential are needed, and fortunately are being developed.

These methods, combined with techniques emerging from molecular biology will provide the basis for more judicious selection of suitable point-of-use prevention technologies, both in the U.S. and overseas. The end result will be to reduce the impact of waterborne pathogens on the public's health--and to rebuild the consumer's confidence in the purity of the water they drink.