1. Private Water Supplies Dr Simon Padfield Consultant in Communicable Disease Control North Yorkshire and Humber Health Protection Unit

2. What does the health protection agency do? disease surveillance investigation of individual cases of illness outbreak management

3. What are the health issues in relation to water? infectious disease outbreaks lead other chemical/mineral contamination

4. Cryptosporidium: Cryptosporidium is a parasite that can cause symptoms of watery diarrhoea, abdominal pain, low grade fever, nausea and vomiting. Symptoms can range from mild to severe and usually last for up to 2 weeks, sometimes longer, with about one third of patients experiencing relapse. There is no specific treatment. Most people recover but in some patients with immune system conditions it can be severe and sometimes life threatening. All ages can be affected but more cases are reported among children, especially children under the age of five. Escherichia coli or ‘E.coli’ including ‘E.coli O157’: E. coli is a bacterium that lives in the intestines as part of the normal gut bacteria of both humans and animals. Some strains can produce a harmful toxin, sometimes these bacteria are referred to as ‘E.coli O157’ or VTEC O157. In people, VTEC O157 can cause a range of symptoms, from mild diarrhoea to severe abdominal pain and bloody diarrhoea. In a small proportion of patients (2-7%, and mainly children), it can cause haemolytic uraemic syndrome (HUS), which is a serious condition resulting in kidney failure. Cattle are thought to be the main reservoir of infection, but the bacterium has also been isolated in many other species including sheep, goats, pigs, horses, donkeys, farm dogs, llamas, alpacas and wild rabbits. Some common types of bacteria in unwholesome water Campylobacter: Campylobacter is the commonest reported bacterial cause of infectious intestinal disease in England and Wales. Symptoms include diarrhoea or bloody diarrhoea, vomiting, abdominal pain and fever. with an average duration of two to five days but prolonged illness and relapse can occur in adults. Poultry and cattle are the most common reservoirs of infection for the organism although puppies, kittens, other pets, rodents, sheep, pigs and birds may also be sources of infection in humans.

5. Outbreak linked to a private water supply, Lothersdale, North Yorkshire, 2008 60 cases of gastrointestinal illness 15 E.coli O157, 16 campylobacter, 2 both Haemolytic Uraemic Syndrome

6. Is your water always safe to drink? How the quality of untreated water from a private water supply can vary through the year 2010 2011

7. Who is at risk? you? (now or in the future?) what about immunity/tolerance? very young children and babies the elderly visitors people with specific underlying health conditions (immunodeficiency, cancer chemotherapy, high dose steroid treatment, HIV)